Archive for the ‘COVID-19’ Category.

A Framework for Thinking About Lockdowns and Why They Are Counter-Productive

Warning:  I am not a trained expert on infectious diseases, just a well-informed person with scientific training and a bias towards skepticism.   If you are a scientific Catholic (meaning your science can only come from officially-designated authorities) rather than a scientific Protestant (which allows you to take responsibility for your own understanding of the universe) then you might as well skip to the next article.

Hypothesis 1:  It is impossible for a large population in a modern society to hide from the disease.  It might be possible to delay or slow the onset of the disease in the larger group, but until some sort of herd immunity exists, reservoirs of the disease will still remain and spark new infections.   For God sakes we still have whooping cough outbreaks in this country.  Look at COVID disease curve shapes for states and counties -- Some locked down early, some late, some hard, some not at all.  Some required masks and some didn't.  But all the curves look the same shape.

Corollary 1:  All lockdowns do is delay the onset of the disease, not avoid it, and thus add severe economic dislocation, increased poverty, domestic violence, alcoholism, suicide and any number of other negative lockdown effects to the inevitable toll of the disease.  If we are doing anything at all to affect the course of the disease, we are stretching out the misery.

Hypothesis 2:  Individuals can, with some decent probability of success, hide from the disease.  There are those who see a conflict between hypotheses 1 and 2, so let me address that.  There is a very old joke about two men who are camping and are awakened by a very large, angry, hungry bear.  One man starts putting on his tennis shoes.  The other says to him, "you can't outrun that bear" and the first man responds, "I don't have to outrun the bear, I just have to outrun you."  In this story, no matter how much running or hiding is done, its likely unavoidable that 50% of the men will get chomped, but individual action can influence who that 50% is.

Corollary 2:  While we cannot do much about ultimate COVID case counts, because the disease is so selective in who it tends to kill we CAN do a lot to limit the death toll.  We should be protecting seniors and other vulnerable people.  Everyone nods their heads to this.  But logically we should also be encouraging everyone else to get the disease and get us to herd immunity.  I don't want to overstretch the bear analogy, but imagine now that one of the two men were wearing a Kevlar suit.  That person needs to face the bear while the other runs -- the experience may not be pleasant for him, but he will probably survive and thus the total bear death toll will be reduced 100%.

A while back when I was active on Twitter, I wrote that instead of closing colleges, we should have opened them for 8 weeks this summer with no teachers and administrators -- Just leave them alone with a few truckloads of alcohol and condoms.  Soon an entire generation would be immune.  The death rate from COVID in healthy 20-year-olds is microscopic (it appears to be lower than the flu, which killed my 25-year-old nephew btw).  Instead we sent them all home from infection hotspots of NY and Boston to potentially infect grandma.

The best way to test a series of hypotheses that are crafted from historic data is to see if they continue to make sense going forward.  So I bring you this recent story on COVID and Hawaii:

After initially defying fears that its proximity to Japan and popularity with tourists might lead to a massive outbreak, Hawaii is finally facing its very own COVID-19 reckoning.

The state is now struggling with a genuine surge in the month of August after remaining at or near the bottom of the US league tables for the first four months of the pandemic.

For a small state with just 1.4 million residents, Hawaii has a total of 7,260 confirmed cases, 5,549 of which were confirmed within the last month, according to Johns Hopkins data. The state has gone from last or near last to No. 19 in terms of new cases reported daily over the past few weeks.

From mid-March to mid-June, the state saw an average of just 7.9 new cases reported per day. Last week, that average number climbed to 219.

This is terrible news for a state that, at the end of July, had the highest unemployment rate in the US (more than 13%) due to its reliance on tourism.

For me, given my hypotheses about virus responses, this is the least surprising story ever.  But apparently the "experts" are scratching their heads

One infectious disease specialist says the surge is surprising given Hawaii's geography, and the plunge in tourism-related traffic.

"As a public health professional, I expect this to look like New Zealand," he said, referring to the Pacific island nation that isolated itself and had few Covid-19 cases.

Postscript:  I am not a fan of "check your privilege" retorts, but if one accepts that framework for a moment, one might notice just how privileged the exhortation to "Lock down, work from home, and stay in touch with friends over Zoom" really is.  Listen to the folks rooting for lockdowns and you will find that the vast majority

  • have professional jobs that can be done from home
  • continue to get paid even when they don't work at all (e.g. teachers and politicians)
  • have a lot of savings

A large number also tend to ignore the rules they foist on everyone else.

Update:  Relevent to my sort of tongue in cheek college suggestion above

Good News on COVID No One Will Likely Report

  • Arizona ICU beds in use for COVID patients fell to 16%, the lowest number of beds in use for COVID since April 10.
  • COVID patients, even at the nationally ballyhooed Arizona peak, never reached 60% of ICU beds.   Total ICU capacity utilization never exceeded 91%  (note that these likely overstate the numbers, as a shooting victim who tests positive for COVID can be listed as a COVID patient).

Source

There is something weird about the COVID test and/or test process we are using in AZ.  We are still testing a lot of people every day and the test positive rate for the state is still high, like 5-8% each day.  But the number of new cases is falling rapidly to levels we last saw in May, and the number of hospitalizations have fallen into early April levels.  So what gives?

One anecdotal data point is an employee of ours who tested positive without symptoms (he has other medical issues that brought him into the hospital).  Weeks and weeks later he continues to test positive on followup tests and continues to be entirely asymptomatic.   My hypothesis is that we are retesting the hell out of people and using a test that is overly sensitive and does not really indicate disease activity.

One other note on this same fellow -- he and we are in somewhat of a bind on his employment.  We are working under contract to a division of the Federal government and they require that employees test negative before they return to work.  Many corporations have the same internal policy.  So what do folks in this situation do?  They are likely perfectly safe to everyone but can't get a negative test.  Do they ever get to work again?

AZ Finally Comes Up With A Better Way to Show COVID-Related Hospital Capacity

Now that the COVID wave in Arizona is receding, the ADHS Data Dashboard finally has come up with a better way to show COVID-related hospital bed use.  Had this been in use at the peak, I think the general panic about overwhelmed hospitals might have been reduced.  I would consider this serious but not disastrous, with some squeezing out of less urgent or delay-able procedures but still with substantial non-COVID capacity remaining.

 

Postscript:  I have an acquaintance, a man in his late 70's, who passed away this week.  He had a long history of heart issues and had something go wrong again.  The ICU in his area of California was apparently full -- could have been COVID, could have been the fires in the area, but he had to be flown to another.  He passed away at the new location, and I don't know if the ICU shuffle was the cause or a contributor but it certainly did not help.  So I am not arguing ICU loads are not important -- this is why we all were mostly OK with "flatten the curve" (but not necessarily with "hide for months or years until the disease completely goes away").  But the situation has been grossly exaggerated to scare people and that makes me angry.

Well, So Much for Medical Privacy

I got this in my email today from the state of New Mexico:

Dear Employer,

As of Wednesday, August 5, 2020, the New Mexico Environment Department (NMED) filed an emergency rule that requires employers to report positive COVID-19 cases to NMED within four hours of being notified of the case. The employer must notify NMED by email at:

Email: NMENV-OSHA@state.nm.us

This kind of thing actually makes it harder for us to keep our workplace safe.  We depend on our employees completing a daily health self-assessment each day and the only way we could coax a number of them into being honest on this survey was to promise them that a) we would take care of them financially through any quarantine and b) their self-assessment would remain confidential.  But now it can't remain confidential in NM.  This is going to make it much harder for us to get honest information from our employees on potential infection, as they are all worried about  -- as they put it -- getting into some government system.  Arguing that this fear is irrational (and I am not sure it is entirely in a world where mayors are turning off power and water to homes they don't obey them) is beside the point, as it is a fear they have and will prevent an honest discussion with some.

Wait, You Mean That the Economic Damage From COVID Lockdowns DOES Matter?

As I mentioned last week on twitter, I have retreated from that platform for a variety of reasons and will focus again on long-form blogging of the style this site has been pursuing for 16 years.

For the last several months, I have been a lockdown skeptic, at least for the healthy population under 55 or 60 years old.  I will confess my early tendency toward skepticism was driven as much by the behavior of lockdown hawks as any data or knowledge on my part.  Whenever I hear appeals to authority, use of non-transparent computer model results as facts, politicization of scientific positions, and restrictions on dissent in any scientific issue, I immediately get skeptical of the orthodox position.  As I have watched things unfold, I am increasingly convinced that this virus is (like most new viruses in history) going to run its course until large sections of the population have gained immunity.  Lockdowns, while they may have salutary effects in preventing hospitals from being overwhelmed, just seem to be delaying the inevitable -- when we come out of hiding, reservoirs of the disease are still there and infections mount again.  "Flatten the curve" made sense to me, but that seems as far in the past of political rationals as does the Tiger King mania.

But to some extent my opinion on lockdowns does not matter.  The one thing I AM sure of is that, whether lockdowns are effective or not, it is perfectly reasonable to balance the costs of such interventions against their benefits.  But I remember clearly when this commitment to making thoughtful tradeoffs marked one as practically Hitler.  Many of our intelligentsia, particularly on the Left, argued that it was immoral even to consider effects on the economy of COVID interventions.  I always thought this was ironic, because the worst economic effects were sure to hit lower income folks first -- they had jobs you had to, you know, show up for and they had less savings to weather the storm.   Paraphrasing one of my commenters, "Stay at home, work remotely by computer, and keep up with your family on Zoom" has to be one of the most white privilege government orders ever.  But nevertheless there was the Left self-righteously advising exactly this, with pundit after pundit who had portable jobs writing on a computer criticizing any hair dresser who wanted to actually be able to ply their trade as well.

So I was floored when I saw these charts on Kevin Drum's site as part of a criticism of the Republican reluctance to extend rich unemployment benefits:

You know what my reaction to these charts is?  No sh*t, Sherlock.  Many of us warned of EXACTLY this when the lockdowns began.  And folks on the Left treated our warning as not just irrelevant but evil. They would say, "How can you be so callous as to suggest jobs are more important that lives?"

But wait, now the economic impact of the lockdowns IS a problem?  I refuse to defend the Republican morons in Congress or the White House, but I can say that many of them warned of exactly this problem with the lockdowns while the Democrats were full steam ahead on economic shutdown.  I could accept Drum's post as self-criticism of the sort like "Wow, I really underestimated this when I was advocating for lockdowns" but now, he uses this as a platform to blame other people for the problem.

Libertarians have often highlighted how the government tends to create problems by their actions and then gains more power by saying that it needs to fix the problem its own actions created.   I can't imagine we will ever have a better example of this effect -- here is Drum advocating that the government simply must send more money to help people who were willing, even eager, to work but were not allowed to do so by the government.  COVID has been a socialist dream, converting payment for productive work to payment for breathing.

And let's discuss the exact program he is advocating.  He wants an extension of the Federal unemployment supplement of $600 a week which takes most state benefits to $1000 to $1200 a week.    Realize that is $50,000 to $60,000 a year we are paying people to not work (one only qualifies for these benefits if one does not work -- take a job and they are gone).  Look at the former income levels in his chart -- who is going back to work with this kind of government payment?  We are training people that they should be paid this much for not working and encouraging them not to seek actual employment -- this is a terrible message (and one reason a UBI makes far more sense if we are going to transfer this much money).   I think this is contributing somewhat to the position of the teachers' unions.  The public game now is to get paid and not work.

We have 13+% unemployment and our company has to struggle to hire anyone in these conditions.   I posted this on twitter as a comment on a Paul Krugman post, and his followers dutifully lined up to tell me that it was because I did not pay a fair wage.  People are making $25-$30 an hour on unemployment.  I thought $15 was our idea of "fair" -- are we really going to set $30 as our minimum wage?  Will anyone be employed?

Postscript:  I have one other rant related to employment and COVID.   Every blue check mark and Hollywood star bends over backwards on every occasion to thank health care workers during the pandemic.  Good, I agree, health care work is particularly fraught right now.  But you know who else worked through the pandemic?  I will give you a hint:  I bet you never had problems filling your car with gas, that you always had gas and electricity at home, and that (with a few brief exceptions) you always had plenty of food choices.  There are a lot of folks out there who showed a lot of commitment during COVID on whom we rely, and a lot of them are in industries (oil, manufacturing, farming) the elite of the Left tends to look down its nose at as backwards and inferior.

Postscript #2:  I am well aware that Drum has had significant medical issues that make him likely particularly vulnerable to this virus.  I am thrilled that he has a career he can pursue without endangering himself via public contact.  Our family made certain choices we might not have to protect my 85 year old mother in law.  But I am exhausted with people applying their own personal preferences and risk trade-offs to others who may be in very different situations.

Another Climate-COVID Computer Modelling Similarity

In this post, I wrote about parallels between climate and COVID alarm and related issues of computer modelling.  I realized I left out at least one parallel.

In the world of climate, computer model results are often used as the counterfactual case.  Let me give you an example.  The world has warmed over the last 100 years at the same time atmospheric CO2 concentration has increased.  Obviously, to truly judge the effect of CO2 on temperatures, we would like to know what the temperatures would have been over the last 100 years without rising CO2 concentrations.  But we don't have thermometers that read "with" and "without" CO2.

I remember I got caught up in this years ago when I published an analysis that showed that estimates of temperature sensitivity to CO2 concentrations used in projections going forward greatly over-predicted the amount of warming we have seen already.  In other words, there had not been enough warming historically to justify such high sensitivity numbers.  In response, I was told that alarmists considered the base case without CO2 increases to be a cooling world, because that is what some models showed.  Compared to this cooling counterfactual, they argued that the warming from CO2 historically had been much higher.

By the way, this argument always gets to be very circular.  When you really dig into the assumptions of the counter-factual models, they are based on assumptions that temperature sensitivity to CO2 is high.  Thus models predicated on high sensitivity are used to justify the assumption of high sensitivity.

I thought of all this today when I saw this post on COVID models and interventions from Kevin Drum.  I read Drum because, though I don't love his politics, he is more likely than most team-politics writers from either the Coke or Pepsi party to do a reasonable job of data analysis and interpretation.  But I have to fault him for this post, which I think is just terrible.  You can click through to see the chart but here is the text:

At the end of March, the highest estimate for [NY State] hospitalizations was 136,000+. Today the peak is estimated at about 30,000. That’s a difference of 5x. Did the modelers screw up?

Not really. Remember the Imperial College projections for the United States? They estimated about 2 million deaths if nothing was done; 1 million deaths if some countermeasures were taken; and 200,000 deaths if stringent countermeasures were taken. That’s a range of 10x. If you figure that we’ve taken fairly stringent countermeasures but not the maximum possible, then a reduction of 5x is about what you’d expect. Alternatively, if you ignore the Columbia University projection as an outlier, the IHME estimate has only gone down by about 2x. That’s what you’d expect if we took countermeasures that were just a little more stringent than their model assumed.

At the end of March it was still not clear how stringent and how effective the coronavirus countermeasures would be. In the event, it looks like they worked pretty well, cutting cases by at least 2x and possibly more. This is why the model estimates have gone down: because we followed expert advice and locked ourselves down. Just as we hoped.

Treating the early model estimates as if they are accurate representations of the "no intervention" counter-factual is just absurd.   It is particularly absurd in this case as he actually quotes a model -- the early Imperial College model -- that is demonstrably grossly flawed.  He is positing that we are in the Imperial College  middle intervention case, which estimated a million deaths in the US and is likely to be off by more than an order of magnitude.  Given this clear model/estimate miss, why in the world does he treat early Columbia and McKinsey models as accurate representations of the counter-factual?  Isn't it at least as likely that these models were just as flawed as the Imperial College models (and for many of the same reasons)?

The way he uses the IHME model results is also  flawed.  He acts like the reductions in the IHME estimates are due to countermeasures, but IHME has always assumed full counter-measures so it is impossible to use the numbers the way he wants to use them.

Parallels Between COVID-19 Alarm and Global Warming Alarm

So I finally had a day or two of downtime from trying to keep my business afloat (it's weird reading all the internet memes of people at home bored when I have never been busier).  I wondered why I was initially, and remain, skeptical of apocalyptic COVID-19 projections.

I have been skeptical about extreme global warming and climate change forecasts, but those were informed by my knowledge of physics and dynamic systems (e.g. feedback mechanics).  I have been immensely skeptical of Elon Musk, but again that skepticism has been informed by domain knowledge (e.g. engineering in the case of the hyperloop and business strategy in the case of SolarCity and Tesla).  But I have no domain knowledge that is at all relevant to disease transfer and pathology.  So why was I immediately skeptical when, for example, the governor of Texas was told by "experts" that a million persons would die in Texas if a lock-down order was not issued?

I think the reason for my skepticism was pattern recognition -- I saw a lot of elements in COVID-19 modelling and responses that appeared really similar to what I thought were the most questionable aspects of climate science.  For example:

  • We seem to have a sorting process of "experts" that selects for only the most extreme.  We start any such question, such as forecasting disease death rates or global temperature increases, with a wide range of opinion among people with domain knowledge.  When presented with a range of possible outcomes, the media's incentives generally push it to present the most extreme.  So if five folks say 100,000 might die and one person says a million, the media will feature the latter person as their "expert" and tell the public "up to a million expected to die."  After this new "expert" is repetitively featured in the media, that person becomes the go-to expert for politicians, as politicians want to be seen by the public to be using "experts" the public recognizes as "experts."
  • Computer models are converted from tools to project out the implications of a certain set of starting hypotheses and assumptions into "facts" in and of themselves.   They are treated as having a reality, and a certainty, that actually exceeds that of their inputs (a scientific absurdity but a media reality I have observed so many times I gave it the name "data-washing").  Never are the key assumptions that drive the model's behavior ever disclosed along with the model results.  Rather than go on forever on this topic, I will refer you to my earlier article.
  • Defenders of alarmist projections cloak themselves in a mantle of being pro-science.  Their discussions of the topic tend to by science-y without being scientific.  They tend to understand one aspect of the science -- exponential growth in viruses or tipping points in systems dominated by positive feedback.  But they don't really understand it -- for example, what is interesting about exponential growth is not the math of its growth, but what stops the growth from being infinite.  Why doesn't a bacteria culture grow to the mass of the Earth, or nuclear fission continue until all the fuel is used up?  We are going to have a lot of problem with this after COVID-19.  People will want to attribute the end of the exponential growth to lock-downs and distancing, but it's hard to really make this analysis without understanding at what point -- and there is a point -- the virus's growth would have turned down anyway.
  • Alarmists who claim to be anti-science have a tendency to insist on "solutions" that have absolutely no basis in science, or even ones that science has proven to be utterly bankrupt.  Ethanol and wind power likely do little to reduce CO2 emissions and may make them worse, yet we spend billions on them as taxpayers.  And don't get me started on plastic bag and straw bans.   I am willing to cut COVID-19 responses a little more slack because we don't have the time to do elaborate studies.  But just don't tell me lockdown orders are science -- they are guesses as to the correct response.  I live in Phoenix where it was sunny and 80F this weekend.  We are on lockdown in our houses.  I could argue that ordering everyone out into the natural disinfectant of heat and sunlight for 2 hours a day is as effective a response as forcing families into their houses (initial data, though it is sketchy, of limited transfer of the virus in summertime Australia is interesting -- only a small portion of cases are from community transferBy comparison less than a half percent of US cases from travel).
  • In both cases, advocates of the precautionary principle seem to rule the day.  I would argue that in practice, the precautionary principle means that any steps that might conceivably limit something bad should be pursued irregardless of cost.  You see a form of this all over social media, which folks arguing that it is wrong to balance deaths against money, and any life spared is worth the cost.  But this is absurd two at least two reasons
    • First, unemployment and economic recession have real, proven effects on mortality.  Shut down the economy to reduce CO2 or virus spread, and people will die
    • Second, if we really followed this principle for everything we would be back in the stone age.  Take the flu.  15,000-20,000 people will die of the flu every year in the US -- my healthy 25-year-old nephew died of the flu.  Are we going to shut down the economy next year in flu season?  It would reduce flu deaths.  Or take the 37,000 people killed each year in the US in motor vehicle accidents.  With the lockdowns, that figure is certainly reduced right now.  Should we just shut down the economy forever, it sure would reduce car fatalities?
  • And of course there is the political polarization of what should be scientific opinion.  The Nevada and Michigan governors initially banned chloroquine treatment strategies for no good reason other than the fact that Trump publicly highlighted them as promising.

Update:  Prediction from climate applied to COVID-19:  No one will go back and call out widely-used models for failing to accurately model the disease or attempt to learn from their mistakes.  If it is ever mentioned that these models grossly over-estimated deaths, it will be forgiven as being exaggeration in a good cause.  (Somewhat related, Bryan Caplan on Social Desirability Bias)

Please Honor Social Distancing Rules, Even if You Are Skeptical of the Risk

I write this because I have been publicly skeptical of some of the COVID-19 responses.  But be that as it may, the decision has been made to go all-in on social distancing.  I am fully participating, whatever my personal beliefs are about risk.  Our family is staying isolated and wearing masks and gloves when we need to go into a store -- not because we are scared but because we are participating.  These sorts of things are much easier to do when everyone else is doing them, and more effective as well.

In places like Phoenix that is lightly hit by the virus and in rural areas where my company operates that have been hit not at all (e.g. zero cases in the county), a lot of folks are not playing along.  It would be heartbreaking to crash the economy and double the government debt only to have this thing still drag out because folks couldn't put neighborhood barbecues on hold for a few weeks (yes, I have seen several).

Update from a long-time reader:

The claimed purpose of quarantine is to create a gap in a long line of transmission. While it can be quite effective, the quarantine time does not really start until EVERYONE stops moving around. As long as even a few still move between isolated groups, those groups are not actually isolated at all. This means that failure to self quarantine lengthens the required quarantine period of all who actually comply. I would like this to be over, the sooner the better.