tag:blogger.com,1999:blog-582368152716771238.post3862142898906329448..comments2024-03-28T09:32:23.535-05:00Comments on The Grumpy Economist: Ready to reopen? John H. Cochranehttp://www.blogger.com/profile/04842601651429471525noreply@blogger.comBlogger31125tag:blogger.com,1999:blog-582368152716771238.post-46177752100209593992020-04-19T20:15:26.426-05:002020-04-19T20:15:26.426-05:00Totally agree. There are two monsters that are de...Totally agree. There are two monsters that are destroying us. Monster #1 is the Virus. Monster #2 is Quarantine & shutdown. People are losing jobs, savings, homes, health insurance plus having life saving surgeries postponed. We need to attack BOTH monsters. <br />Jonathanhttps://www.blogger.com/profile/05456288125512662470noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-41419923435237950852020-04-19T14:45:50.175-05:002020-04-19T14:45:50.175-05:00Part II:
Even a 4:1 ration of undetected to detec...Part II:<br /><br />Even a 4:1 ration of undetected to detected (as a limited Chinese sample study indicated some weeks back) drives the true mortality rates below 1%, and 20X to 50X or more really makes the true mortality rates much more like those of say, annual influenza infestations, ~0.15% range, where annual mortality ranges 30k-70k/yr; e.g. 2017-2018 was particularly bad, perhaps as many as 80k. <br /><br />This really makes me think we should start going after the idea of how fat and how long are the tails as John Cochran talked about a few weeks back. That it, once we know overall mortality rates are close to flu, the concerns are really those at risk of the severe cases, the elderly, the chronic diseased sub-populations (asthma, Diabetes II, CHF, COPID, obesity etc.)<br /><br />The next most important numbers then become disease sub category outcomes, i.e., "how many infections transition to moderate or severe disease", how many moderate cases transition to ICU, and then % to intubation care, how many intubated cases actually survive (pretty low number on the last one currently). Can we change the rates of these outcome categories of "the tail" with increasing, improving therapeutics? <br /><br />For example, anti-virals such as remdesivir are much more likely much sooner than full vaccines to be able to change the therapeutic statistics of "immune system pulmonary cascade response to local virus presence", i.e., transition point to moderate and severe and life threatening disease. <br /><br />While 2-4% population disease penetration rates really aren't yet getting to significant levels of herd immunity, there's another value for the previously infected. Now we can identify & use large populations of local "previously infected" folks who have had the disease with high counts of IgG antibodies, i.e., enabling recovered patient plasma therapeutics for hospitalized patients which might really start to impact "outcomes" rates on the tail as well.<br /><br />Focusing on the tails and going after them allows us to add more safety error margin to opening up strategies and tactics without risking or creating a new "super bloom" of disease, or risk overwhelming local health care resources.<br /><br />Besides these tactics to go after the most significant negative outcomes rates of the infected, obviously we still need to transition to effective but less severe forms of social distancing and transmission mitigation. I.e,., shaking hands is out, masks are sort of ubiquitous, & all similar related extensions, but we do open up again and get to 90-95% no longer "shuttered at home" sooner and with less risk, from current 90% shuttered at home rates, and yes it will all be different, maybe sooner than currently is thought by many.<br /><br />Also throw in full contact tracing, very large escalation and significant sub-population sample or full antibody testing, etc. And yes, finally, use the mobile GPS apps automated contact tracing to ID possible contacts for folks (like South Korea and others continue to do already for many weeks). <br /><br />In true libertarian sense, it may make perfect sense to give up privacy concerns short term to conquer COVID transmissions, then later scale back as we get closer to normal again. Even in the short term, there are already well know ways to anonymize large data sets, e.g. for HIPAA and other concerns (my start up does this), ahead of when we start to scale back.<br /><br />Appreciate this whole discussion and line of discourse the last several weeks, i.e., it is not economy vs life or death, black or white, but rather, how will we open this up again (which has finally gotten a lot of traction the last couple of weeks).<br /><br />Cheers<br />Mike Rodgershttps://www.blogger.com/profile/10284181056479977017noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-59240242298498485932020-04-19T14:44:21.066-05:002020-04-19T14:44:21.066-05:00Part I: I think we're finally still starting ...Part I: I think we're finally still starting to see what a geologist, or ex semiconductor reliability guy like me would call preliminary "faulty" data, i.e., the 1st real data on critical "missing" COVID-19 parameters that the models have used to date (being a little blunt here) "wild guesses" for in the models, i.e., what are the real population infection (disease penetration), mortality, and transmission rates. <br /><br />Stanford's Dr. Bendavid's preliminary results this week on Silicon Valley infection rates via off the shelf commercial anti-body tests indicated local infection rates (in our one of the oldest US COVID clusters) might be as high as 2-4% of overall population, or 60-80,000 more than have locally (Santa Clara County) tested positive (just under 2000). <br /><br />Yesterday's WSJ OpEd by local PhD molecular biophysicist fund manager Aaron Bogan https://www.wsj.com/articles/new-data-suggest-the-coronavirus-isnt-as-deadly-as-we-thought-11587155298?mod=opinion_lead_pos5 referenced Dr. Bendavid's preliminary data plus similar numbers from studies across Europe from Italy, Germany, Denmark, Iceland showing "true" infection rates 10-30X the "tested" infection rate. Even with huge error bars (alpha, beta, false risks on the Premier Biotech test used by Dr. Bendavid, or selection bias in those that wanted to take it, e.g., folks that think they had it might preferentially select to volunteer initially), these results are phenomenal in filling in the huge unknowns we've had all along on rate of true rates of "asymptomatics", true mortality rates, etc. that we've had no "evidenced" based clinical results for earlier.<br /><br />Even a 4:1 ration of undetected to detected (as a limited Chinese sample study indicated some weeks back) drives the true mortality rates below 1%, and 20X to 50X or more really makes the true mortality rates much more like those of say, annual influenza infestations,, ~0.15% range, where annual mortality ranges 30k-70k/yr; e.g. 2017-2018 was particularly bad, perhaps as many as 80k. <br />Mike Rodgershttps://www.blogger.com/profile/10284181056479977017noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-25874103702662917882020-04-18T20:05:43.615-05:002020-04-18T20:05:43.615-05:00The wonderful Dr Michael Osterholm of the U of Min...The wonderful Dr Michael Osterholm of the U of Minnesota reminds us that there will be new waves of the virus in future months. We are not going to do another lockdown when we are still counting up the unemployed from this lockdown.<br /><br />Americans are used to spending infinite amounts of money to prevent anyone from dying. In normal times, this leads to $400,000 health insurance claims from a long ICU stay, a transplant, or a specialty drug. Analysts like me are troubled by these claims, but if we question them in public we are vilified as heartless Darwinists.<br /><br />The argument is going to get tougher in the near future. We will have to face the fact that saving every save-able life might cost us our job, not just a little higher insurance premium.<br /><br />Americans are used to feel that every death is an outrage. Our national skin might have to get a little thicker.Bob Hertzhttps://www.blogger.com/profile/08889826739646491269noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-30556488898146370032020-04-18T17:59:23.119-05:002020-04-18T17:59:23.119-05:00Bob,
You are correct on point 1. except that the l...Bob,<br />You are correct on point 1. except that the lockdowns are only needed locally where there is a risk to the ability of hospitals to care effectively for the sick. With regard to your point 2, although restaurants and bars may have been affected anyway what about all of the other business which could have gone on relatively normally including: all other retail, medical, office work, banking, etc.etc.etc. Davidhttps://www.blogger.com/profile/17832201304019008227noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-25054367053809556512020-04-18T17:54:30.897-05:002020-04-18T17:54:30.897-05:00Dear Anonymous,
If you actually follow the science...Dear Anonymous,<br />If you actually follow the science of epidemics, epidemiology, you will find that what the government has done is not a reasonable short term approach. To make a long story short, the lock down should only be applied locally where there is a very great risk of hospital over crowding. The lock down does not in fact save lives for the most part except in that situation. Given that it does not save lives, it has no benefit whatsoever except with regard to the hospitals. For no benefit at all, millions are out of work and trillions of dollars have been wasted.Davidhttps://www.blogger.com/profile/17832201304019008227noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-16373753015785890032020-04-18T17:46:55.668-05:002020-04-18T17:46:55.668-05:00DWAnderson, It is so great to see that at least o...DWAnderson, It is so great to see that at least one person has the knowledge and ability to express it with regard to the current situation. If only you were advising the President and also editing the MSM so that the news would be as intelligent. This comment is not sarcasm.Davidhttps://www.blogger.com/profile/17832201304019008227noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-2562346276185541532020-04-18T17:41:54.890-05:002020-04-18T17:41:54.890-05:00The article states, "The whole point has been...The article states, "The whole point has been to bend the curve so that the vast majority don't get it." That's not quite correct. The curve is bent so that the hospitals don't face a melt down situation. There is good news from the Stanford study in Santa Clara which finds that the viral incidence is up to 80 times greater than has been assumed. This means, if you do the calculation, that the novel coronavirus is not more deadly than the flu - it only works faster resulting in hospital melt down in highly interactive places like NYC.<br />For most of the US the moral is that getting back to normal ASAP is the right thing to do.Davidhttps://www.blogger.com/profile/17832201304019008227noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-28726664104925513402020-04-18T11:48:10.393-05:002020-04-18T11:48:10.393-05:00I think the talking head's endless, misinforme...I think the talking head's endless, misinformed and politicized coverage has confused the public at large. People simply don't understand that mitigation's goal is to slow the spread, not avoid the spread. The goal of mitigation was to avoid overwhelming hospitals due to a rapid spread, however most of the population will need to get infected and develop immunity in order to get past this pandemic. The only way to really avoid everyone from eventually "catching" this thing is vaccination, but that's unlikely to happen anytime soon. Forget all these notions about some vast, capable bureaucracy that will keep us from getting sick. Trying to stop this virus is like stopping the wind. We need to unwind mitigation in tranches, and people will simply get sick in as orderly a fashion as possible, hoping not to outstrip the healthcare system's ability to care for them. We can get through this, but not around it. Anonymoushttps://www.blogger.com/profile/12045129708772296744noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-90506034806966028532020-04-18T09:00:31.289-05:002020-04-18T09:00:31.289-05:00https://ritholtz.com/2020/04/malaria-detecting-dog...https://ritholtz.com/2020/04/malaria-detecting-dogs-coronavirus/<br /><br />Interesting ideaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-45102267106321148542020-04-18T06:45:15.416-05:002020-04-18T06:45:15.416-05:00There are two problems with the current approach. ...There are two problems with the current approach. The first is the logical fallacy that a positive test for the virus means the patient is positive for the virus, the patient is carrying live virus or infective virus and any symptoms are due to the virus. The virus is tested for by PCR. PCR detects live virus, dead virus and viral fragments. Patients may shed non-infective virus for days after clearing the live virus.. This problem is known in all areas of infectious disease when the pathogen is established by PCR, Therefore a positive test by PCR devoid of the clinical context is useless information. (Distinguishing live from dead virus is possible but requires extensive high level laboratory evaluation that is not readily available).<br /><br />We run into a similar problem with any laboratory testing, including alcohol breathalyzers. The validity of a positive test (a true positive) must be put into the context of a positive test (devoid of the disease; a false positive). <br /><br />As an example:<br />Assume a test with a 5% false positive rate. What does that mean to the individual. If the prevalence of the disease is 1/1000 then a 5% false positive rate means that there are 50 patients identified with the disease who do not have it. <br /><br />This fact is used by lawyers to have the results of a breathalyzer excluded if the arresting officer cannot show good reason why he/she believes the patient had been drinking. The first question asked by a police officer: Have you been drinking?<br /><br />The second problem is an ethical/moral issues:<br />If we begin from these premises:<br />All lives are precious.<br />All lives are equal.<br />Then any action to preserve life A must be balanced against the likelihood of eliminating life B. Otherwise, we are valuing A more than B.<br />Negate OPMhttps://www.blogger.com/profile/04113058583009674222noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-82706949072759797552020-04-17T23:34:35.061-05:002020-04-17T23:34:35.061-05:00"We, properly, have big laws against all of t..."We, properly, have big laws against all of this!"<br /><br />The USA having to remain closed-for-business while the rest of the world gets to enjoy life (basically) will force a lot of people to reevaluate that judgment. Anonymoushttps://www.blogger.com/profile/06387538972480064296noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-8946691776492603362020-04-17T12:10:37.323-05:002020-04-17T12:10:37.323-05:00DNewman: I'm not anyone special, but in my opi...DNewman: I'm not anyone special, but in my opinion, an actual treatment is almost as good as a vaccine. As long as it, too, is widely available. You go out, you come in contact with your neighbor who is positive. The gods of random numbers stack up against you and you get sick (you've infected 2-3 others in the meantime). But you can take the drugs, isolate for a couple of weeks, and recover, as opposed to "go to the ICU and die". Seems like a VERY different equation, to me. Of course, we still have to deal with the exponentially increasing exposure (the 2-3 you infected, which turns into 4-9 they infected, and then 8-27 etc.) But if only 20% need drugs, it might be doable.Anonymoushttps://www.blogger.com/profile/06710244868121166520noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-40276219446731717202020-04-17T11:30:35.171-05:002020-04-17T11:30:35.171-05:00I keep coming back to Romer’s simulations. As I un...I keep coming back to Romer’s simulations. As I understand it, his exercise assumed frequent random testing (7% of the population per day), isolation of those who tested positive but no contact tracing. He ran a horserace between that policy and one of random isolation. (What he calls random isolation is, I think, more or less what we’re doing now.) He showed that for the random isolation policy to achieve the same path of infection we would need to isolate about 50% of the population. This was an uncalibrated simulation and so we can’t trust the precise results but it does suggest two things, both encouraging.<br /><br />1) Isolation without contact tracing can still work. Big if true since isolation is easier to enforce and less intrusive than isolation with contact tracing.<br />2) Romer showed that in simulations with a very high false negative rate you could still get R0 below 1. The key is lots of tests, not accurate tests. That’s great because it suggests that even badly enforced isolation can still help. Under Romer’s simulations a false negative is equivalent to a non-compliant true positive (in both cases someone is walking around spreading the virus.)<br />mike davishttps://www.blogger.com/profile/10989810128194836571noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-7913518251357555892020-04-17T11:21:49.214-05:002020-04-17T11:21:49.214-05:00I agree as well. The goal at this point should be ...I agree as well. The goal at this point should be to delay what infections we can at relatively low cost. That means eliminating most govt controls and letting people make their own judgments about how to do that. The delay gives us a shot a getting lucky that we find therapies or vaccines that work, but that is not assured.<br /><br />I think this approach will dictated by some new knowledge we have gained over the past month: <br /><br />(1) Lockdowns (at least in the West) don't appear that effective. At best they push R down slightly below 1 and come at great cost. That is the experience of Europe. The great cost is evident in the drastic decline in US employment and the growing political pressure to lift them.<br /><br />(2) Distancing doesn't require lockdowns. Data pre-lockdown in most areas show that people were already doing significant distancing at the expense of things like conventions and restaurant reservations. This made the marginal effect of lockdowns small, and means that lifting them won't restore normal levels of economic activity.<br /><br />(3) SARS CoV2 is significantly more infectious than we thought. This makes attempts to stamp out the virus likely to fail even when done well (see Singapore). Even were one successful, you would have to isolate your country from the rest of the world (as China is now trying to do) which imposes significant costs itself.<br /><br />(4) SARS CoV2 is significantly less deadly than we thought-- especially to healthy young people. The IFR is probably between 0.3% and 0.6% overall and much lower for the healthy young. This means it makes sense for many to run the risk of infection and build toward herd immunity. It also means it makes more sense to concentrate efforts on protecting the vulnerable (even if that is a lot of people).<br /><br />(5) The dynamics of building toward herd immunity mean that as more people recover from infection and become immune, R falls because there a fewer people to infect. As the number of recovered people increases, the safer it is for the vulnerable. This is a reason to flatten the curve of infection (ideally with people that recover) rather than to bend it down.<br /><br />I think things will be better the sooner that government imposed lockdowns end. As in other cases where you eliminate harsh regulation, people will adapt in innovative ways to these new circumstances in ways that make their lives better.<br /><br />BUT, I think that absent finding a great vaccine or great therapies, the facts outlined above mean that you probably have 100,000-500,000 Americans dying and significant losses to the welfare of the living as they adapt to a distanced world. <br /><br />I wouldn't end lockdowns because I think that will make things great and return to normal. I would end lcokdowns because they make a bad situation worse.<br /><br />DWAndersonhttps://www.blogger.com/profile/11912588081258797990noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-80188416356919340612020-04-17T10:40:25.776-05:002020-04-17T10:40:25.776-05:00Indeed - Days before the announced lockdown in Ill...Indeed - Days before the announced lockdown in Illinois, restaurants were empty on a Friday evening, just out of fear. That's may change somewhat, but not entirely. Mikehttps://www.blogger.com/profile/03133364913963606581noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-70224034093750572822020-04-17T10:34:36.353-05:002020-04-17T10:34:36.353-05:00You make a valid point - a "post-epidemic&quo...You make a valid point - a "post-epidemic" scenario that prevents a major resurgence of CV-19 active cases, will require a level of self-constrained human/social behavior that Americans are certainly not well known to exercise.Mikehttps://www.blogger.com/profile/03133364913963606581noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-90373971145052376092020-04-17T10:00:06.918-05:002020-04-17T10:00:06.918-05:00Isn't it somehow possible to get people to rea... Isn't it somehow possible to get people to realize that quarantining 2% of the population is less abusive of human rights than quarantining 80%? It's simply crazy how people accept our current massive lockdown, but object to the age-old idea of quarantining just sick people and those exposed to them. Eric Rasmusenhttps://www.blogger.com/profile/01609599580545475695noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-88821000366601615132020-04-17T09:37:51.263-05:002020-04-17T09:37:51.263-05:00People are good at knowing what is best for them. ...People are good at knowing what is best for them. They aren't nearly as good at acting in the best interest of the community. There is an enormous positive externality to staying home right now, and it isn't folded into the price of doing so.<br /><br />So you for it by regulation, and subsidize it with massive government spending. It is a reasonable short-term approach.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-56669237268663068662020-04-17T08:16:41.260-05:002020-04-17T08:16:41.260-05:00People have fought against pubic health actions to...People have fought against pubic health actions to protect against infectious disease since John Snow took away the handle of the Broad street pump in London in 1854 to stop a Cholera epidemic. People didn't like it or understand then and they are almost as stupid or ignorant today. That is why we still have local public health laws today to compel them to do so. Many of the comments here are testament to that. Yes sometimes there are reason we needs laws and a nanny state approach - to get people to wear seat belts and helmet laws and people still reject them despite clear logic and effectiveness. Is it perfect? No, but to some extend they are necessary. Lives are at stake and sometimes we have to weigh the importance of the outcomes. Sometimes we must wait to figure it out with better information. Luckily we can vote to change our politicians and laws - but that comes later. Hopefully we will have the wisdom to decide later what mistakes were made and correct them. Until then we must work to figure it all out and that takes time and the right people rather than a rush to judgement. Sorry, just the facts.ezkappdohttps://www.blogger.com/profile/07423286659537202070noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-19080559205376193772020-04-17T07:23:50.422-05:002020-04-17T07:23:50.422-05:00I am surprised to find myself defending the lockd...I am surprised to find myself defending the lockdowns, but here goes:<br /><br />1. The lockdowns were intended as much to preserve the hospital system as to save lives. We were looking at the Italian hospital collapse as what was coming for us.<br /><br />2. Unemployment was going to be a problem with or without a legal lockdown. The restaurant, bar, hotel and casino industry employ over 15 million persons, and contraction was well under way by the time that lockdowns were imposed. Bob Hertzhttps://www.blogger.com/profile/08889826739646491269noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-33343835671747858922020-04-17T05:34:18.748-05:002020-04-17T05:34:18.748-05:00Totally agree.Totally agree.Cokerhttps://www.blogger.com/profile/02631288439451432057noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-36675948635423689902020-04-16T23:22:02.799-05:002020-04-16T23:22:02.799-05:00How about we trust people to do the right thing?
...How about we trust people to do the right thing? <br />People are usually pretty good at knowing what's best for them - vulnerable people will keep isolating no matter what the government says, and there's no point in keeping inside people with much lower risk.<br />The authorities increased hospital capacity and equipment availability; maybe they should also 'ask' companies to let employees work from home for as long as they need to be comfortable. Other than that, further government action most likely won't affect the long-term health outcomes, and most certainly will damage the economic and social ones.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-13176314713114185072020-04-16T22:36:51.439-05:002020-04-16T22:36:51.439-05:00so the notary trusted you enough to sign their nam...so the notary trusted you enough to sign their name to prove honesty, but not enough to cash your check? ironic.<br />Chrhttps://www.blogger.com/profile/03228429551243765996noreply@blogger.comtag:blogger.com,1999:blog-582368152716771238.post-91474716994371701992020-04-16T22:15:46.086-05:002020-04-16T22:15:46.086-05:00Again, why not seriously consider risk-based appro...Again, why not seriously consider risk-based approaches for achieving herd immunity? Vaccines and herd immunity are the same biologically. So if you are really skeptical about herd immunity, then this never ends.Anonymoushttps://www.blogger.com/profile/14905367607633792713noreply@blogger.com