Results for “Tests” 694 found
Hawaii Department of Health officials said today that the state’s tally of coronavirus cases has risen to 553, up 12 from Thursday.
Of all the confirmed cases in Hawaii since the start of the outbreak, 48 have required hospitalizations, with three new cases reported today, health officials said.
The state’s coronavirus death toll stands at nine, unchanged from Thursday. Six of the deaths were on Oahu, while three were in Maui.
The population of Hawaii is about 1.4 million. Three days ago, Hawaii was the lowest infection rate in the United States, but of course more and better data are needed. We’ll see, with the passage of time, if this remains a true heterogeneity. But do note this:
It is also noteworthy that Hawaii tests for coronavirus at a considerably higher rate than most states. According to data compiled by Vox, Hawaii continues to rank among the top 10 states for testing per capita, which suggests Hawaii’s infection rate may be more accurate than rates reported by some other states.
How do you feel about that statement? I take this as one psychometric test.
If your reaction is: “My goodness, these are tragic times but it is splendid and noble how we all can come together and sacrifice for a common endeavor!”…well…
…you have failed my test and I will suspect a wee bit of mood affiliation. Most likely it is bad news if the relative safety (for some) of the current moment comes from social distancing. Because at some point social distancing must end, or at least be significantly curtailed, and then a higher danger level may well reemerge.
Possibly you have inside information that a cure will be ready next week, but somehow I doubt it. You are happy because you like something about the process.
Alternatively, if you hear “social distancing is working so well!” and immediately feel a deep sense of foreboding, and begin to calculate whether good short-term results are correlated with better or worse long-term results. And then you calculate how how long the distancing can last for, due to governmental budget constraints, and then try to figure out what kinds of progress we might make in the meantime while the distancing lasts, and then start worrying about how reliant on social distancing we are becoming…
…But then you undertake a second-order calculation about how the greater danger spurred by the forthcoming decline in social distancing also might spur innovation…
And then you think “would it not be better if the current progress came from a more sustainable source, what might that be, how about faster than expected herd immunity amongst a relatively small group of heterogeneous super-spreaders, now what is the chance of that?”…
…and finish your analysis confused…
Then you are my kind of weirdo.
We are living in a time of psychometric tests.
There is a new paper by Ivan Korolev:
This paper studies the SEIRD epidemic model for COVID-19. First, I show that the model is poorly identified from the observed number of deaths and confirmed cases. There are many sets of parameters that are observationally equivalent in the short run but lead to markedly different long run forecasts. Second, I demonstrate using the data from Iceland that auxiliary information from random tests can be used to calibrate the initial parameters of the model and reduce the range of possible forecasts about the future number of deaths. Finally, I show that the basic reproduction number R0 can be identified from the data, conditional on the clinical parameters. I then estimate it for the US and several other countries, allowing for possible underreporting of the number of cases. The resulting estimates of R0 are heterogeneous across countries: they are 2-3 times higher for Western countries than for Asian countries. I demonstrate that if one fails to take underreporting into account and estimates R0 from the cases data, the resulting estimate of R0 will be biased downward and the model will fail to fit the observed data.
And here is a further paper on the IMHE model, by statisticians from CTDS, Northwestern University and the University of Texas, excerpt from the opener:
- In excess of 70% of US states had actual death rates falling outside the 95% prediction interval for that state, (see Figure 1)
- The ability of the model to make accurate predictions decreases with increasing amount of data. (figure 2)
Again, I am very happy to present counter evidence to these arguments. I readily admit this is outside my area of expertise, but I have read through the paper and it is not much more than a few pages of recording numbers and comparing them to the actual outcomes (you will note the model predicts New York fairly well, and thus the predictions are of a “train wreck” nature).
Let me just repeat the two central findings again:
- In excess of 70% of US states had actual death rates falling outside the 95% prediction interval for that state, (see Figure 1)
- The ability of the model to make accurate predictions decreases with increasing amount of data. (figure 2)
So now really is the time to be asking tough questions about epidemiology, and yes, epidemiologists. I would very gladly publish and “signal boost” the best positive response possible.
And just to be clear (again), I fully support current lockdown efforts (best choice until we have more data and also a better theory), I don’t want Fauci to be fired, and I don’t think economists are necessarily better forecasters. I do feel I am not getting straight answers.
Walmart, Amazon and other firms are developing safety protocols for the COVID workplace. Walmart, for example, will be doing temperature checks of its employees:
Walmart Blog: As the COVID-19 situation has evolved, we’ve decided to begin taking the temperatures of our associates as they report to work in stores, clubs and facilities, as well as asking them some basic health screening questions. We are in the process of sending infrared thermometers to all locations, which could take up to three weeks.
Any associate with a temperature of 100.0 degrees will be paid for reporting to work and asked to return home and seek medical treatment if necessary. The associate will not be able to return to work until they are fever-free for at least three days.
Many associates have already been taking their own temperatures at home, and we’re asking them to continue that practice as we start doing it on-site. And we’ll continue to ask associates to look out for other symptoms of the virus (coughing, feeling achy, difficulty breathing) and never come to work when they don’t feel well.
Our COVID-19 emergency leave policy allows associates to stay home if they have any COVID-19 related symptoms, concerns, illness or are quarantined – knowing that their jobs will be protected.
Amazon is even investing in their own testing labs.
Amazon Blog: A next step might be regular testing of all employees, including those showing no symptoms. Regular testing on a global scale across all industries would both help keep people safe and help get the economy back up and running. But, for this to work, we as a society would need vastly more testing capacity than is currently available. Unfortunately, today we live in a world of scarcity where COVID-19 testing is heavily rationed.
If every person, including people with no symptoms, could be tested regularly, it would make a huge difference in how we are all fighting this virus. Those who test positive could be quarantined and cared for, and everyone who tests negative could re-enter the economy with confidence.
Until we have an effective vaccine available in billions of doses, high-volume testing capacity would be of great help, but getting that done will take collective action by NGOs, companies, and governments.
For our part, we’ve begun the work of building incremental testing capacity. A team of Amazonians with a variety of skills – from research scientists and program managers to procurement specialists and software engineers – have moved from their normal day jobs onto a dedicated team to work on this initiative. We have begun assembling the equipment we need to build our first lab (photos below) and hope to start testing small numbers of our front line employees soon.
Actions and experiments like these will discover ways to work safely till we reach the vaccine era.
Hey people, what is up with this?
Via John V. And in the meantime, the virus has now affected 70% of New Jersey’s long-term care centers.
Shruti Rajagopalan and I have written a policy brief on pandemic policy in developing countries with specific recommendations for India. The Indian context requires a different approach. Even washing hands, for example, is not easily accomplished when hundreds of millions of people do not have access to piped water or soap. India needs to control the COVID-19 pandemic better than other nations because the consequences of losing control are more severe given India’s relatively low healthcare resources, limited state capacity, and large population of poor people, many of whom are already burdened with other health issues. We make 10 recommendations:
1: Any test kit approved in China, Japan, Singapore, South Korea, Taiwan, the United States, or Western Europe should be immediately approved in India.
2: The Indian government should announce a commitment to pay any private Indian lab running coronavirus tests at least the current cost of tests run at government labs.
3: All import tariffs and quotas on medical equipment related to the COVID-19 crisis should be immediately lifted and nullified.
4: Use mobile phones to survey, inform, and prescreen for symptoms. Direct any individual with symptoms and his or her family to a testing center, or direct mobile testing to them.
5: Keep mobile phone accounts alive even if the phone bills are not paid, and provide a subsidy for pay-as-you-go account holders who cannot afford to pay for mobile services.
6: Requisition government schools and buildings and rent private hotel rooms, repurposing them as quarantine facilities.
7: Rapidly scale up the production and distribution of masks and encourage everyone to wear masks.
8: Truck in water and soap for hand washing and use existing distribution networks to provide hand sanitizers.
9: Accept voter identification cards and AADHAAR cards for in-kind transfers at ration shops.
10: Announce a direct cash transfer of a minimum of 3000 rupees per month (equivalent to the poverty line of $1.25 a day or $38 a month) to be distributed through Jan Dhan accounts or mobile phone applications such as Paytm.
See the whole thing for more on the rationales.
Addendum: As we went to press we heard that India will lift tariffs on medical equipment. My co-author lobbied hard for this.
In a short-sighted blunder, India’s Supreme Court has ruled that private labs cannot charge for coronavirus tests:
NDTV: “The private hospitals including laboratories have an important role to play in containing the scale of pandemic by extending philanthropic services in the hour of national crisis…We thus are satisfied that the petitioner has made out a case…to issue necessary direction to accredited private labs to conduct free of cost COVID-19 test,” the court said.
Whether the private labs should be reimbursed by the government, will be decided later, Justices Ashok Bhushan and S Ravindra Bhat said in a hearing conducted via video conferencing.
The Supreme Court’s ruling will reduce the number of tests and dissuade firms from rushing to develop and field new drugs and devices to fight the coronavirus. A price is a signal wrapped up in an incentive. Instead of incentivizing investment, this order incentives firms to invest resources elsewhere.
Nor do private labs have a special obligation that mandates their conscription–an obligation to fund testing for all, falls on all.
The ruling is especially unfortunate because as Rajagopalan and Choutagunta document, India’s health care sector is predominantly private:
…India must rely primarily on the private sector and civil society to lead the response to COVID-19,…the role of the government should be financing and subsidizing testing and treatment for those who cannot afford to pay. India’s private healthcare system is better funded and better staffed than the government healthcare system, and it serves more people. It is estimated to be four times bigger in overall healthcare capacity, and it has 55 percent of the total hospital bed capacity, 90 percent of the doctors, and 80 percent of the ventilators.
The temptation to requisition private resources for state use in an emergency is ever present—but Indian policymakers must resist that temptation because it will compromise instead of increase capacity.
Benevolence is laudatory but even in a pandemic we should not rely on the benevolence of the butcher, brewer or baker for our dinner nor on the lab for our coronavirus tests. If we want results, never talk to suppliers of our own necessities, but only of their advantages.
China bent the curve, Italy bent the curve and I believe that the curve is bending in the United States. Suppression is working and the second part of the strategy of test, trace and isolate will start to come into play in a few weeks. The states are gearing up to test, trace and isolate and several large serological surveys are already underway which will gives us a much better idea of how widely the virus has spread. Ideally, we will move from test, trace and isolate to a situation where we can conduct millions of tests weekly which will take us into the vaccine time.
Before testing is fully operational, however, we will need to follow safety protocols. We can learn about what works from what essential workers are doing now. Green Circuits in CA, for example, redesigned the shift schedule:
His first move was to redesign the plant’s work schedule. The company, owned by the Dallas-based private equity firm Evolve Capital, always had the first and second shifts overlap for a half-hour. That allowed workers arriving in the afternoon to confer with colleagues as they handed off duties.
But O’Neil said they realized that would risk their whole workforce getting quarantined for 14 days, if someone got infected by the coronavirus and spent time at the factory as part of this larger group.
The solution was to create three separate teams of 40 workers each. The first shift now ends at 2 p.m., and then there’s an hour when the workspaces, tools, and breakrooms are sanitized. The third team does not work at all, but rather is held in reserve and available to jump in if an illness hampers one of the two other teams of workers.
Other safety protocols include:
- Shift work for white collar workers as well as for blue collar workers. Including spreading work over the weekends.
- Senior shopping hours.
- Temperature checks, perhaps via passive fever cameras at work and public transport.
- Mandatory masks for public transportation.
- Masks for workers.
- Sanitation breaks for mandatory hand washing.
- Quarantining at work for essential workers, as the MLB is thinking of doing despite not being essential.
- Reducing touch surfaces (even with simple things like propping up bathroom doors) and copper tape for hi-touch surfaces that cannot be eliminated.
It will take longer to reopen restaurants, clubs and sports stadiums but I believe that applying these protocols will allow many of us to work safely. We aren’t ready yet but now is the time to plan for our return.
There is a new paper by Benjamin Enke, Uri Gneezy, Brian Hall, David Martin, Vadim Nelidov, Theo Offerman, and Jeroen van de Ven:
Despite decades of research on heuristics and biases, empirical evidence on the effect of large incentives – as present in relevant economic decisions – on cognitive biases is scant. This paper tests the effect of incentives on four widely documented biases: base rate neglect, anchoring, failure of contingent thinking, and intuitive reasoning in the Cognitive Reflection Test. In preregistered laboratory experiments with 1,236 college students in Nairobi, we implement three incentive levels: no incentives, standard lab payments, and very high incentives that increase the stakes by a factor of 100 to more than a monthly income. We find that cognitive effort as measured by response times increases by 40% with very high stakes. Performance, on the other hand, improves very mildly or not at all as incentives increase, with the largest improvements due to a reduced reliance on intuitions. In none of the tasks are very high stakes sufficient to debias participants, or come even close to doing so. These results contrast with expert predictions that forecast larger performance improvements.
Via Kadeem Noray (EV winner, btw). This is perhaps related to behavior during and leading up to the lockdown…
Robin Hanson makes the strongest case for variolation, here is one excerpt:
So the scenario is this: Hero Hotels welcome sufficiently young and healthy volunteers. Friends and family can enter together, and remain together. A cohort enters together, and is briefly isolated individually for as long as it takes to verify that they’ve been infected with a very small dose of the virus. They can then interact freely with each other, those those that show symptoms are isolated more. They can’t leave until tests show they have recovered.
In a Hero Hotel, volunteers have a room, food, internet connection, and full medical care. Depending on available funding from government or philanthropic sources, volunteers might either pay to enter, get everything for free, or be paid a bonus to enter. Health plans of volunteers may even contribute to the expense.
1. Qualified medical personnel are remarkably scarce right now. I do not see how it is possible to oversee the variolation of more than a small number of individuals. Furthermore, it is possible that many medical personnel would refuse to oversee the practice. The net result would be only a small impact on herd immunity. If you doubt this, just consider how bad a job we Americans have done scaling up testing and making masks.
The real question right now is what can you do that is scalable? This isn’t it.
I recall Robin writing on Twitter that variolation would economize on the number of medical personnel. I think it would take many months for that effect to kick in, or possibly many years.
2. Where will we put all of the Covid-positive, contagious individuals we create? What network will we use to monitor their behavior? We have nothing close to the test and trace systems of Singapore and South Korea.
In essence, we would have to send them home to infect their families (the Lombardy solution) or lock them up in provisional camps. Who feeds and takes care of them in those camps, and what prevents those individuals from becoming infected? What is the penalty for trying to leave such a camp? Is our current penal system, or for that matter our current military — both longstanding institutions with plenty of experienced personnel — doing an even OK job of overseeing Covid-positive individuals in their midst? I think not.
Under the coercive approach, what is the exact legal basis for this detention? That a 19-year-old signed a detention contract? Is that supposed to be binding on the will in the Rousseauian sense? Where are the governmental structures to oversee and coordinate all of this? Should we be trusting the CDC to do it? Will any private institutions do it without complete governmental cover? I don’t think so.
If all this is all voluntary, the version that Robin himself seems to favor, what percentage of individuals will simply leave in the middle of their treatment? Robin talks of “Hero Hotels,” but which actual hotels will accept the implied liability? There is no magic valve out there to relieve the pressure on actual health care systems. Note that the purely voluntary version of Robin’s plan can be done right now, but does it seem so popular? Is anyone demanding it, any company wishing it could do it for its workforce?
3. The NBA has an amazing amount of money, on-staff doctors, the ability to afford tests, and so on. And with hundreds of millions or billions of dollars at stake they still won’t restart a crowdless, TV-only season. They could indeed run a “Heroes Hotel” for players who got infected from training and play, and yet they won’t. “Stadium and locker room as Heroes Hotel” is failing the market test. Similarly, colleges and universities have a lot at stake, but they are not rushing to volunteer their dorms for this purpose, even if it might boost their tuition revenue if it went as planned (which is not my prediction, to be clear).
The proposal requires institutions to implement it, yet it doesn’t seem suited for any actual institution we have today.
4. Does small/marginal amounts of variolation do much good compared to simply a weaker lockdown enforcement for activities that involve the young disproportionately? Just tell the local police not to crack down on those soccer games out in the park (NB: I am not recommending this, rather it is the more practical version of what Robin is recommending; both in my view are bad ideas.) Robin’s idea has the “Heroes Hotel” attached, but that is a deus ex machina that simply assumes a “free space” (both a literal free space and a legally free space) is available for experimentation, which it is not.
5. Society can only absorb a small number of very blunt messages from its leaders. You can’t have the President saying “this is terrible and you all must hide” and “we’re going to expose our young” and expect any kind of coherent response. People are already confused enough from mixed messages from leaders such as presidents and governors.
6. There is still a chance that Covid-19 causes or induces permanent damage, perhaps to the heart and perhaps in the young as well. That does not militate in favor of increasing the number of exposures now, especially since partial protective measures (e.g., antivirals, antibodies) might arise before a vaccine does. This residual risk, even if fairly small, also makes the liability issues harder to solve.
7. The actual future of the idea is that as lockdown drags on, many individuals deliberately will become less careful, hoping to get their infections over with. A few may even infect themselves on purpose, one hopes with a proper understanding of dosage. One can expect this practice will be more popular with the (non-obese) young. The question is then how to take care of those people and how to treat them. That debate will devolve rather rapidly into current discussions of testing, test and trace, self-isolation, antivirals, triage, and so on. And then it will be seen that variolation is not so much of a distinct alternative as right now it seems to be.
8. The main benefit of variolation proposals is to raise issues about the rates at which people get infected, and the sequencing of who is and indeed should be more likely to get infected first. Those questions deserve much more consideration than they are receiving, and in that sense I am very happy to see variolation being brought (not much risk of it happening as an explicit proposal). That said, I don’t think Heroes Hotel, and accelerating the rate of deliberate, publicly-intended infection, is the way to a better solution.
Soon I’ll write more on what I think we should be doing, but I would not put explicit variolation above the path of the status quo.
I wrote earlier that “recovered individuals have a kind of superpower and would be highly desirable workers.” Antibody tests will soon be able to identify these workers and that will help to reopen the economy because not only can these workers go back to work relatively safely they can also work relatively safely with those who are not immune, thus a kind of multiplier-effect for the workplace. Hence, Italy and the UK are talking about “Immunity Passes” that would allow (we hope) immune workers to go back to work.
One factor, however, which hasn’t been taken into account is that the demand to go back to work may be so strong that some people will want to become deliberately infected. If not done carefully, however, these people will be a threat to others, especially in their asymptomatic phase. Thus, if we use Immunity Passes they will need to be combined with variolation, infecting people with small doses of the virus to create immunity under controlled conditions, as suggested by Robin Hanson.
Hat tip for discussion: Rafael Yglesias.
From internet comments I’ve seen some confusion on the suppress then “test, trace, isolate” strategy. The “flattening the curve” metaphor suggested that lockdown was all about spreading infections over time to keep the medical system operational. But more importantly, the purpose of lockdown is to reduce the infection rate, R, below 1. A virus needs hosts. Take away the hosts and it fades away. We can take away hosts by making people immune, either with a vaccine or through surviving exposure. We can also take away hosts by hiding–that’s what lockdown is for. If enough people hide, then the virus burns out and fades away.
Of course, hiding leaves us vulnerable to multiple rounds of infection. That’s where the second part of the strategy, test, trace and isolate comes into play. When the infection is running wild, as it is now, we don’t have enough tests to keep up with the virus. But after suppression we can put test, trace and isolate into effect very quickly as outbreaks flare up but before the virus runs out of control again. Increasing our test capacity dramatically makes this strategy even more viable. Thus, as V.V. Chari and Christopher Phelan write in a good op-ed:
…A wise use of the breathing room provided by mass quarantines would be to put in place the infrastructure to allow us to mimic the policies of countries such as South Korea, Taiwan, Singapore and Hong Kong. These countries have thus far controlled the pandemic at much lower economic cost…[using] aggressive but targeted quarantine policies. They quarantine people displaying symptoms, aggressively trace the people they have contacted, test their contacts, and then quarantine those who have the virus (and sometimes those who have just had contact with those who test positive), regardless of whether they are symptomatic or not.
It is a test, trace and isolate policy. These countries have not generally engaged in mass quarantines or shut down factories, shopping malls or restaurants.
After suppression, we can combine “test, trace and isolate” with mask wearing and other safety protocols and move towards reopening the economy.
7. I could link to Matt Levine every day, but do read this one on liquidity transformation.
8. How is the cloud holding up? A good post.
12. The true story of the toilet paper shortage: it’s not about hoarding, rather a shift of demand away from the commercial sector into the household sector (you are doing more “business” at home these days).
14. Fan, Jamison, and Larry Summers 2016 paper on the economics of a pandemic. I wrote at the end of the blog post: “In other words, in expected value terms an influenza pandemic is a big problem indeed. But since, unlike global warming, it does not fit conveniently into the usual social status battles which define our politics, it receives far less attention.”
Do we have evidence that hospitalization of COVID19 patients is actually saving significant numbers of lives?
I’ve now seen multiple studies suggesting that up to 80 or 90 percent of patients who end up on ventilators ultimately die. At this point, I guess there’s no way to know if the other 10 percent would have lived without the ventilators. From what I can tell, most other hospitalized patients are getting supplemental oxygen, IV fluids and antibiotics. I have not seen any evidence on the effectiveness of these treatments. Many of those patients live, but we don’t know whether they would have recovered without hospitalization. It would obviously be impossible to do a RCT on that at the moment.
Answering the question about the efficacy of hospitalization would seem to be critical, though, since, as best I can tell, the main justification for shutting down society now is to prevent our health care system from being overwhelmed – especially the supply of ventilators. If our hospitals are overwhelmed, not only COVID19 patients, but others with treatable injuries/diseases might die. But if hospitalization is not actually saving COVID19 patients in large numbers, then all the costly social interventions we are implementing now are mostly just delaying the spread of infection. Still, I recognize that it’s possible that this delay could save lives in one of two ways (or maybe there are more I’m not thinking of?).
1. We use the time to get better at testing. Then, when we lift the social distancing measures in a month or two, we have the ability to quickly test and isolate infected individuals and their close contacts. Maybe we also have anti-body tests so we can avoid quarantining immune individuals. This keeps the rate of spread relatively low until we have better treatments or a vaccine for those who haven’t been infected yet. It’s possible that “at-risk” groups will have to stay isolated during this time until we get effective treatments/vaccine. I haven’t seen any estimates of how effective this kind of strategy might be – i.e., over a course of 18 months (the time to develop/deploy a vaccine) how many infections would this prevent?
2. We could keep the social distancing policies in place until we get a vaccine/treatment. But if estimates of 18+ months to a vaccine are correct, I suspect the economic costs will be too high to bear to wait it out this way. So this is probably not in the cards.
If the number of lives we can save with #1 is relatively low (I have no idea what the number is), and if #2 is off the table, then we are really just delaying most deaths, at great social cost. It might be better to prevent our hospitals from being overwhelmed by doing better triage for admission – especially to ICU beds and ventilators (what percent of people over age 75 survive after going on a ventilator?), and working on getting people other treatments (oxygen, etc.) at home. At a minimum, it seems like the intense energy and resources focused on ventilators now might be misplaced.
For what it is worth, I’m not a skeptic of the current social distancing policies. I’m pretty sure I’d be doing all this and more if I were in charge. But I’d also be looking for evidence that what we are doing is the best course of action, given the massive costs.
That is an email from a very smart person. To that tally we also must add the negative that hospitals often become a vector for the further spread of the virus.
So what does the best evidence say here?
5. Why was it so hard to raise the coronavirus alarm? (the yappers are one reason, btw — are you one of them?)
6. Under these calculations, an average coronavirus death in China means 11 years lost, 16 years lost in the United States.
8. Are the new testing kits going to be sent to the American South, which has fewer measured cases? Where should they be sent? A good piece.
10. Overnight, Magnus Carlsen just revolutionized the future organization of chess play. This will become the new normal.
11. Social distancing tips from a hermit. “Keep track of something” is a good one.