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From Lockdown to Liberty

Puja Ahluwalia Ohlhaver and I have a piece in the Washington Post talking about a Federalist plan to move from lockdown to liberty. You won’t be surprised to learn that it involves testing, testing, testing. I know, you have testing fatigue. So do I. It’s important, however, to not give up on testing too early. We are really only 6-8 weeks into the US crisis and while everyone is frustrated at the slow pace I think we will start to see leaps in capacity soon as major labs come online.

The piece makes two points. First moving too quickly can kill grandma and the economy:

The dangers of reopening without disease control — or a coronavirus vaccine or therapeutic breakthrough — are illustrated by events at the Smithfield Foods meatpacking plant in Sioux Falls, S.D. Smithfield offered workers a bonus if they showed up every day in April. Normally, bonus pay would increase attendance. But in a pandemic, encouraging the sick to haul themselves into work can be disastrous. The plan backfired. Hundreds of Smithfield employees were infected, forcing the plant to shut down for more than three weeks. If we stay the current course, we risk repeating the same mistake across the whole economy.

Second, we need a Federalist approach to testing.

The only way to restore the economy is to earn the confidence of both vulnerable industries and vulnerable people through testing, contact tracing and isolation.

There is already a bipartisan plan to achieve this; we helped write it. The plan relies on frequent testing followed by tracing the contacts of people who test positive (and their contacts) until no new positive cases are found. It also encourages voluntary isolation, at home or in hotel rooms, to prevent further disease spread. Isolated patients would receive a federal stipend, like jurors, to discourage them from returning to workplaces too soon.

But our plan also recognizes that rural towns in Montana should not necessarily have to shut down the way New York City has. To pull off this balancing act, the country should be divided into red, yellow and green zones. The goal is to be a green zone, where fewer than one resident per 36,000 is infected. Here, large gatherings are allowed, and masks aren’t required for those who don’t interact with the elderly or other vulnerable populations. Green zones require a minimum of one test per day for every 10,000 people and a five-person contact tracing team for every 100,000 people. (These are the levels currently maintained in South Korea, which has suppressed covid-19.)

Most Americans — about 298 million — live in yellow zones, where disease prevalence is between .002 percent and 1 percent. But even in yellow zones, the economy could safely reopen with aggressive testing and tracing, coupled with safety measures including mandatory masks. In South Korea, during the peak of its outbreak, it took 25 tests to detect one positive case, and the case fatality rate was 1 percent. Following this model, yellow zones would require 2,500 tests for every daily death.

…A disease prevalence greater than 1 percent defines red zones. Today, 30 million Americans live in such hot spots — which include Detroit, New Jersey, New Orleans and New York City. In addition to the yellow-zone interventions, these places require stay-at-home orders.

One virtue of this plan is that conforms with the common sense of people where they live. People in New York have seen their friends die and understand that stricter rules make sense. People in Montana haven’t seen the crisis up close and so their common sense and our testing strategy require less stringent rules.

We do need testing even in low-prevalence areas, however, and we need to be able to mobilize a lot of testing and tracing quickly to cap flare ups.

One danger of the current situation is that many of the places which have not yet been hit hard by COVID-19 are also the places with the most natural danger as they have lots of elderly with comorbidities.

Read the whole thing.

Addendum: The plan is described in more detail in Pandemic Resilience: Getting it Done. A live map of the US and how different places are faring is here and the COVID vulnerability index is here.

What is the FDA Doing Now??!

My long-running skepticism about the safety and efficacy of the FDA is fast becoming conventional wisdom. Even normal people can’t believe what they are doing. This piece on the FDA in the New York Times reads like something I might have written for CATO.

An innovative coronavirus testing program in the Seattle area — promoted by the billionaire Bill Gates and local public health officials as a way of conducting wider surveillance on the invisible spread of the virus — has been ordered by the federal government to stop its work pending additional reviews.

…the program, a partnership between research groups and the Seattle and King County public health department that had been operating under authorization from the state, was notified this week that it now needs approval directly from the federal government. Officials with the Food and Drug Administration told the partnership to cease its testing and reporting until the agency grants further approval.

…the Seattle program …has wide backing, including from public health leaders, the Fred Hutchinson Cancer Research Center and Mr. Gates, whose foundation has been deeply involved in fighting the pandemic. The Centers for Disease Control and Prevention also provided an in-person technical adviser to the project.

Dr. Eric Topol, the director of the Scripps Research Translational Institute, who is not involved in the Seattle group, said it had “emerged as leading lights in this whole Covid-19 crisis.” He said it was “bizarre” that the F.D.A. would halt such a project.

By the way, Dr. Helen Chu, one of the leaders of the Seattle project, was one of the first Emergent Ventures prize winners for her work fighting the coronavirus (excellent pick, Tyler!). As you may recall, Chu started testing for coronavirus in an already running flu study without permission. Until she was shut down.

To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began.

By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval.

Federal and state officials said the flu study could not be repurposed because it did not have explicit permission from research subjects; the labs were also not certified for clinical work. While acknowledging the ethical questions, Dr. Chu and others argued there should be more flexibility in an emergency during which so many lives could be lost. On Monday night, state regulators told them to stop testing altogether.

The failure to tap into the flu study, detailed here for the first time, was just one in a series of missed chances by the federal government to ensure more widespread testing during the early days of the outbreak, when containment would have been easier. Instead, local officials across the country were left to work in the dark as the crisis grew undetected and exponentially.

History repeats itself, first as tragedy then as farce.

Addendum: I see now that Tyler covered this a bit earlier in the post below. I’ll leave this post up, however, as I have more details including Tyler’s connection.

Thursday assorted links

1. The dark side of Coase: a crypto tale.

2. The Covid-19 rave culture that is German.

3. Wisconsin Supreme Court rejects stay-at-home order (NYT).

4. How much of health care spending is discretionary?

5. What it is like to land in Hong Kong and try to enter (recommended, short photo essay).

6. New data from France.  And a Twitter thread on same.

7. What is the cost of reining in wild horses?

8. World 2.0: chess does indeed move to the internet, and Magnus Carlsen is calling the shots.

9. Is Virginia mixing up its test results and reporting the wrong numbers?

10. I find this kind of defense convincing for many research efforts, but not for actual real world problems with immediate decisions to be made: “I don’t know the 2 Swedish models in question but in general it is disingenuous to say the models that do not try to take into account changes in human behavior failed because people behaved in ways the models didn’t model. The models were upfront about the scenarios addressed.”

Why aren’t we talking about forcible quarantine more?

That is the topic of my latest Bloomberg column, here is one excerpt:

There has been surprisingly little debate in America about one strategy often cited as crucial for preventing and controlling the spread of Covid-19: coercive isolation and quarantine, even for mild cases. China, Singapore and South Korea separate people from their families if they test positive, typically sending them to dorms, makeshift hospitals or hotels. Vietnam and Hong Kong have gone further, sometimes isolating the close contacts of patients.

I am here to tell you that those practices are wrong, at least for the U.S. They are a form of detainment without due process, contrary to the spirit of the Constitution and, more important, to American notions of individual rights. Yes, those who test positive should have greater options for self-isolation than they currently do. But if a family wishes to stick together and care for each other, it is not the province of the government to tell them otherwise.

What I observe is people citing those other countries as successes, wishing to “score points,” but without either affirming or denying their willingness to engage in coercive quarantine.  Here is another bit:

Furthermore, all tests have false positives, not just medically but administratively (who else has experienced the government making mistakes on your tax returns?). Fortunately, current Covid-19 tests do not have a high rate of false positives. But even a 1% net false positive rate would mean — in a world where all Americans get tested — that more than 1 million innocent, non-sick Americans are forcibly detained and exposed to further Covid-19 risk.

And this:

Coercive containment was tried during one recent pandemic — in Castro’s Cuba, from 1986 to 1994, for those with HIV-AIDS. It is not generally a policy that is endorsed in polite society, and not because everyone is such an expert in Cuban public health data and epidemiological calculations. People oppose the policy because it was morally wrong.

And what about uncertainty? Is it really a safe bet that America’s quarantine policy would be executed successfully and save many lives? What if scientists are on the verge of discovering a cure or treatment that will lower the Covid-19 death rate significantly? Individual rights also protect society from the possibly disastrous consequences of its own ignorance.

Here are a few points that did not fit into the column:

1. I am not opposed to all small number, limited duration quarantine procedures, such as say holding Typhoid Mary out of socializing.  This same point also means that a society that starts coercive quarantine very early might be able to stamp out the virus by coercing relatively small numbers of people.  (It is not yet clear that the supposed successes have achieved this, by the way.)  That is very different from the “mass dragnet” to be directed against American society under current proposals.

2. I am familiar with the broad outlines of American quarantine law and past practice.  I don’t see that history as necessarily authorizing how a current proposal would have to operate, and on such a scale.  In any case, I am saying that such coercive quarantines would be wrong, not that they would be illegal.  I believe it is a genuinely open question how current courts would rule on these matters.

3. From my perch from a distance, it seems to me that Human Challenge Trials for vaccines are more controversial than is mass forced quarantine.  I could be wrong, and I would gladly pursue any leads on the current debate you might have for me.  Who are the philosophers or biomedical ethicists or legal scholars who have spoken out against such policies?

“Our regulatory state is failing us”

A number of commentators suggest that the real problem is President Trump, rich people overly concerned with tax cuts, a Republican Party with a deregulatory ideology, and so on.

Instead I have been repeating insistently that “our regulatory state is failing us.”  The FDA and CDC, for instance, have through their regulations made it harder for testing and also widespread mask supply to get off the ground.

I don’t see how you can blame (supposed) deregulatory fervor for the presence of too many regulations, as we have been observing in these instances.

I do think you can blame President Trump, along multiple dimensions, for a poor response to the pandemic, see my grades here.  (If there were a separate risk communication grade, Trump would get an F minus for that.)  Nonetheless a regulatory state cannot be said to work well if it requires such extraordinary attention from a sitting president.

It can be the case that both Trump and the permanent bureaucracy are at fault.  If something takes a long time to get done for reasons relating to preexisting rules, regulations, and laws, usually the current president is not directly at fault for that particular problem.  Was it only Trump’s fault, for instance, that the permits to build a mask factory can take months to acquire?  Or that the HHS did not respond to inquiries about gearing up mask production in Texas?  Or that a law had to be changed to allow industrial companies to sell quality masks to hospitals?  Or that so many a-legal or extra-legal activities (e.g., rich people arranging deliveries by plane, etc.) had to occur to sneak masks into this country?  That the trade barriers on masks persisted for so long? (And yes likely the Trump administration is at fault for de facto toughening restrictions on masks from China.)

It is fine to say “the buck stops here,” and to criticize Trump for not having erected processes to be more aware of these problems and to dissolve them more quickly.  I would agree with some of those criticisms, while noting the Trump administration also has tried to ease many of the regulations hampering adjustment.

This is more something on the horizon, but how do these apples make you feel?  Comforted?  The fault of plutocratic Republicans most of all?

And in both cases, vials and stoppers, a vaccine manufacturer cannot just switch to a slightly different product or another brand. They typically have to run manufacturing changes by FDA first, which could make quick supplier changes to curb shortages a difficult prospect.

The FDA can decide how flexible it will be about this type of change, says Sklamberg. The agency said in a December 2017 draft guidance that companies could note some changes in their annual reports rather than waiting for approval, but it has not finalized the policy.

The ability to switch products could be crucial as the entire world readies for a possible vaccine and vies to secure their supplies.

If you wish, consider a simple question.  When the CDC pooh-poohed masks early on, or botched their testing kit thereby delaying U.S. testing by weeks or maybe months, did the permanent staff of the CDC rise up and rebel and leak howling protests to the media, realizing that thousands of lives were at stake?  That is surely what would happen if say the current FDA announced it was going to approve thalidomide.

Those are still cases of our regulatory state failing us.

Germany R estimate of the day

Germany is being closely watched worldwide as the most successful large European country in curbing the spread of the virus, partly thanks to massive testing, which has prompted a partial reopening of the economy. Merkel has frequently said the reproduction rate of the new coronavirus must be held below 1 to prevent the health system from being overwhelmed.

But the Robert Koch Institute for public health said the rate hovered above this critical threshold for the third consecutive day with an estimated value of 1.07 on Monday, after 1.13 on Sunday.

That Germany does not have its R below one is, in a nutshell, why short-run measurements of coronavirus responses are not very reliable.  And why “we need to lock down until full testing is up and running” is not necessarily convincing.  Here is the full story.

Some reflections on GRE scores

The evidence indicates that GRE scores predict graduate school success, general intelligence, and also that SAT scores predict later success in science.  Here is further evidence, and here is yet further evidence.

You don’t have to think that “high GRE score fields” are better than “low GRE score fields.”  Many of my friends, for instance, think string theory is intellectually bankrupt, despite many of its proponents being very, very smart.  I don’t have an opinion on string theory per se, but my friends might be right, and in any case I would rather read books from cultural studies, a lower GRE score field.

If you wish to understand the relative strengths and pathologies of theoretical physics and cultural studies, you cannot do that without knowing that the former is a relatively high GRE score field (or the equivalent) and that the latter is a relatively low GRE score field (or the equivalent).

There are many top economists on Twitter, most of them Democrats, who would never ever utter a word about GRE scores in a blog post or on Twitter.  Yet when on an admissions committee, they will ruthlessly enforce the strictest standards for math GRE scores without hesitation.  Not only in top ten programs, but in top thirty programs and even further down the line in many cases.  It is very, very hard to get into a top or even second-tier economics program without an absolutely stellar math GRE score, and yes that is enforced by the same humans who won’t talk about the issue.

Just in case you didn’t know that.

Personally, I feel it has gone too far in that direction, and economics has overinvested in one very particular kind of intelligence (I would myself put greater stress on the old GRE subject test scores for economics, thus selecting for those with an initial interest in the economy rather than in mathematics).

When I did graduate admissions for George Mason University, I very consciously moved away from an emphasis on GRE scores, and for the better.  My first goal was simply to take in more students, and a more diverse group of students, and in fact many of the later top performers were originally “marginal” students by GRE standards.  Looking back, many of our top GRE-scoring students have not done better than the peers, though they have done fine.  For GMU these admission criteria are (in my view) more like the Rosen-Roback model than anything else, though I would readily grant Harvard and MIT are not in the same position.

If you are afraid to talk about GRE scores, you are afraid to talk about reality.

America’s reopening will depend on trust

That is the topic of my latest Bloomberg column, here is one bit:

The first wave of the Covid-19 pandemic brought serious economic damage for thinly capitalized face-to-face retailers, such as small family-owned restaurants. But many of those same institutions will lead the recovery — that is, if they have built up trust among their patrons. If they ask me to sit outside to eat my meal, I will trust that their kitchen procedures are “clean enough,” because I believe that the boss is watching [there I am referring to two of my favorite local places].

It is also worth asking whom I do not trust. When it comes to providing a fully clean and safe store, I do not trust most of the big-box retailers. I trust them just fine in ordinary times, but no single manager can oversee the entire cleaning and disinfectant operation. And can they monitor Covid-19 in the air? If they tell me that “all possible precautions have been taken,” I might believe their words, but I won’t believe that is enough.

And:

The NBA is wondering if it can resurrect its playoffs at a dedicated location with television coverage but no audience in the stands. So far the teams are hesitant, in part because they are afraid of public resentment if the league’s millionaire players have access to Covid-19 tests while the general public does not.

The reality is that if the NBA announced it was buying up a lot of tests, it would boost the supply of tests. That could provide testing with valuable positive publicity, with the NBA serving as a role model for what other businesses might do. Yet the NBA does not yet trust its fans to see things in such a positive light, and so reopening is delayed. There might be some danger to playoffs games without fans, but surely less than in, say, collegiate or professional football, where injuries and concussions are built into the very nature of the competition.

Which are the businesses that you really trust in matters pandemic?

Wednesday assorted links

Online Education is Better

The COVID-19 crisis is accelerating a long-term trend, the shift to online education. I’ve long argued that online education is superior to traditional models. In an excellent essay in the New York Times, Veronique Mintz, an eighth-grade NYC student agrees:

Talking out of turn. Destroying classroom materials. Disrespecting teachers. Blurting out answers during tests. Students pushing, kicking, hitting one another and even rolling on the ground. This is what happens in my school every single day.

You may think I’m joking, but I swear I’m not…during my three years of middle school, these sorts of disruptions occurred repeatedly in any given 42-minute class period.

That’s why I’m in favor of the distance learning the New York City school system instituted when the coronavirus pandemic hit.

…Distance learning gives me more control of my studies. I can focus more time on subjects that require greater effort and study. I don’t have to sit through a teacher fielding questions that have already been answered.

…This year I have struggled with math. The teacher rarely had the patience for questions as he spent at least a third of class time trying to maintain order. Often, when I scheduled time to meet with him before school, there would be a pileup at his door of students who also had questions. He couldn’t help us all in 20 minutes before first period. Other times he just wouldn’t show up….With distance learning, all of that wasted time is eliminated. I stop, start and even rewind the teacher’s recording when I need to and am able to understand the lesson on the day it’s taught.

Veronique’s online courses were put together in a rush. Imagine how much more she will learn when we invest millions in online classes and teach at scale. The online classes that Tyler and I teach, using Modern Principles and the Sapling/Achieve online course management system, took years to produce and feature high quality videos and sophisticated assessment tools including curve shifting (not just multiple-choice), empirical questions based on FRED, and adaptive practice–plus the videos are all subtitled in multiple languages, they can be sped up or slowed down, watched at different times of the day in different time zones and so forth. Moreover, technology is increasing the advantages of online education over time.

Communism still matters liberty still matters

Those who grew up in East Germany seem to have a harder time cottoning to the realities of capitalism:

We analyze the long-term effects of living under communism and its anticapitalist doctrine on households’ financial investment decisions and attitudes towards financial markets. Utilizing comprehensive German brokerage data and bank data, we show that, decades after Reunification, East Germans still invest significantly less in the stock market than West Germans. Consistent with communist friends-and-foes propaganda, East Germans are more likely to hold stocks of companies from communist countries (China, Russia, Vietnam) and of state-owned companies, and are unlikely to invest in American companies and the financial industry. Effects are stronger for individuals exposed to positive “emotional tagging,” e.g., those living in celebrated showcase cities. Effects reverse for individuals with negative experiences, e.g., environmental pollution, religious oppression, or lack of (Western) TV entertainment. Election years trigger further divergence of East and West Germans. We provide evidence of negative welfare consequences due to less diversified portfolios, higher-fee products, and lower risk-adjusted returns.

That is from a new NBER paper by Christine Laudenbach, Ulrike Malmendier, and Alexandra Niessen-Ruenzi.

But if you are looking for a contrary point of view, consider this new paper by Sascha O. Becker, Lukas Mergele, and Ludger Woessmann:

German separation in 1949 into a communist East and a capitalist West and their reunification in 1990 are commonly described as a natural experiment to study the enduring effects of communism. We show in three steps that the populations in East and West Germany were far from being randomly selected treatment and control groups. First, the later border is already visible in many socio-economic characteristics in pre-World War II data. Second, World War II and the subsequent occupying forces affected East and West differently. Third, a selective fifth of the population fled from East to West Germany before the building of the Wall in 1961. In light of our findings, we propose a more cautious interpretation of the extensive literature on the enduring effects of communist systems on economic outcomes, political preferences, cultural traits, and gender roles

That said, I still believe that communism really matters, and durably so, even if the longer history matters all the more so.  And now there is yet another paper on East Germany and political path dependence, by Luis R. Martinez, Jonas Jessen, and Guo Xu:

This paper studies costly political resistance in a non-democracy. When Nazi Germany surrendered in May 1945, 40% of the designated Soviet occupation zone was initially captured by the western Allied Expeditionary Force. This occupation was short-lived: Soviet forces took over after less than two months and installed an authoritarian regime in what became the German Democratic Republic (GDR). We exploit the idiosyncratic line of contact separating Allied and Soviet troops within the GDR to show that areas briefly under Allied occupation had higher incidence of protests during the only major episode of political unrest in the GDR before its demise in 1989 – the East German Uprising of 1953. These areas also exhibited lower regime support during the last free elections in 1946. We argue that even a “glimpse of freedom” can foster civilian opposition to dictatorship.

I take the core overall lesson to be that the eastern parts of Germany will experience significant problems for some time to come.

And speaking of communist persistence, why is it again that Eastern Europe is doing so well against Covid-19?  Belarus is an extreme case, with hardly any restrictions on activity, and about 14,000 cases and 89 deaths.  You might think that is a cover-up, but the region as a whole has been quite robust and thus it is unlikely to be a complete illusion.  And no, it doesn’t seem to be a BCG effect.

Does communism mean there is less of a culture of consumption and thus people find it easier to just stay at home voluntarily?  Or have all those weird, old paranoid communist pandemic ministries persisted and helped with the planning?  Or what?

Double credit on this one to both Kevin Lewis and Samir Varma, neither less excellent in his conjunction with the other.

Blood Money

NYTimes: Around the world, scientists are racing to develop and mass produce reliable antibody tests that public health experts say are a crucial element in ending the coronavirus lockdowns that are causing economic devastation. But that effort is being hamstrung, scientists say, by a shortage of the blood samples containing antibodies to Covid-19, the disease caused by the virus, that are needed to validate the tests.

Recognizing a rare opportunity, some companies are seeking to cash in on the shortages, soliciting blood donations and selling samples at rich markups in a practice that has been condemned by medical professionals as, at the very least, unethical.

“I’ve never seen these prices before,” said Dr. Joe Fitchett, the medical director of Mologic, one of the British test manufacturers that was offered the blood samples. “It’s money being made from people’s suffering.”

I am reminded of Walter Williams who asks his students whether it is wrong to profit from the misfortune of others:

But I caution them with some examples. An orthopedist profits from your misfortune of having broken your leg skiing. When there’s news of a pending ice storm, I doubt whether it saddens the hearts of those in the collision repair business. I also tell my students that I profit from their misfortune — their ignorance of economic theory.

A price is a signal wrapped up in an incentive so if you want a strong signal and a strong incentive you need to let prices rise. The prices in this case don’t even seem that high:

From March 31 to April 22, prices asked by Cantor BioConnect for its cheapest samples — always sold by the milliliter, the equivalent of less than a quarter of a teaspoon — rose more than 40 percent, to $500 from $350.

Bear in mind the costs of collecting the sample, including nurse time and PPE. Some samples which are especially rich in antibodies, do sell for prices that are well above cost which is not surprising as those samples are in high demand as they may offer a cure.

Do the firms willing and able to pay the highest prices necessarily have the best science? No, not necessarily, but on balance the decentralized allocation process offered by markets and civil society will likely be far more effective than centralized, political allocation. We also know from field experiments around the world that higher prices for blood increase supply, a key consideration.

As Hayek said the moral rules of the tribe which appear natural to us–like don’t profit from misery–cannot maintain a civilization so we struggle between what we think is right and what actually works to prevent misery.

There can be no doubt that our innate moral emotions and instincts were acquired in the hundreds of thousand years—probably half a million years—in which Homo sapiens lived in small hunting and gathering groups and developed a physiological constitution which governed his innate instincts. These instincts are still very strong in us. Yet civilization developed by our gradually learning cultural rules which were trans­mitted by teaching and which served largely to restrain and suppress some of those natural instincts.

Friday assorted links

USA non-existing facts of the day

Want to know how many tuberculosis cases there were in the U.S. last year? Ask the CDC. Want to know about health-care-associated infections? Ask the CDC. It knows.

But ask how many Covid-19 tests have been done, and the CDC’s doesn’t have an answer. Want a daily update on how many people are getting hospitalized for Covid-19? The CDC isn’t tracking it. Want to know if social distancing is making a difference? The CDC doesn’t know.

During this pandemic, when accurate, timely, nationwide information is the lifeblood of our response, the CDC has largely disappeared.

The performance of the world’s leading public health agency has been surprising, and by that I mean surprisingly disappointing. When the outbreak began, the CDC decided to forgo using the World Health Organization’s testing kit for Covid-19 and build its own. The test it shipped out to states was faulty, creating problems that stretched for weeks and slowed response as states waited for replacement tests.

Here is more from Ashish K. Jha.  As I’ve said before, our regulatory state has been failing us.

Early detection of superspreaders by mass group pool testing

Most of epidemiological models applied for COVID-19 do not consider heterogeneity in infectiousness and impact of superspreaders, despite the broad viral loading distributions amongst COVID-19 positive people (1-1 000 000 per mL). Also, mass group testing is not used regardless to existing shortage of tests. I propose new strategy for early detection of superspreaders with reasonable number of RT-PCR tests, which can dramatically mitigate development COVID-19 pandemic and even turn it endemic. Methods I used stochastic social-epidemiological SEIAR model, where S-suspected, E-exposed, I-infectious, A-admitted (confirmed COVID-19 positive, who are admitted to hospital or completely isolated), R-recovered. The model was applied to real COVID-19 dynamics in London, Moscow and New York City. Findings Viral loading data measured by RT-PCR were fitted by broad log-normal distribution, which governed high importance of superspreaders. The proposed full scale model of a metropolis shows that top 10% spreaders (100+ higher viral loading than median infector) transmit 45% of new cases. Rapid isolation of superspreaders leads to 4-8 fold mitigation of pandemic depending on applied quarantine strength and amount of currently infected people. High viral loading allows efficient group matrix pool testing of population focused on detection of the superspreaders requiring remarkably small amount of tests. Interpretation The model and new testing strategy may prevent thousand or millions COVID-19 deaths requiring just about 5000 daily RT-PCR test for big 12 million city such as Moscow.

Speculative, but I believe this is the future of our war against Covid-19.

The paper is by Maxim B. Gongalsky, via Alan Goldhammer.