[I wrote and scheduled this post before I found out that the White House has released its plan for Opening up America Again. I could pick apart the plan, but instead I will just stick with what I already wrote, which stands up pretty well.]
What is going to happen when governors give the go-ahead to “re-open the economy”? Continue reading
The definition is that region Y has many more deaths per million than region X. Examples include:
Continue reading
1. On the issue of enclosure vs. outdoors, a reader alerted me to an article from 2009, by Richard A. Hobday and Jown W. Cason about the Spanish Flu outbreak, which seems to support my idea of treating patients in the parking lot. Here is the abstract, with my emphasis provided.
The H1N1 “Spanish flu” outbreak of 1918–1919 was the most devastating pandemic on record, killing between 50 million and 100 million people. Should the next influenza pandemic prove equally virulent, there could be more than 300 million deaths globally. The conventional view is that little could have been done to prevent the H1N1 virus from spreading or to treat those infected; however, there is evidence to the contrary. Records from an “open-air” hospital in Boston, Massachusetts, suggest that some patients and staff were spared the worst of the outbreak. A combination of fresh air, sunlight, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff. We argue that temporary hospitals should be a priority in emergency planning. Equally, other measures adopted during the 1918 pandemic merit more attention than they currently receive.
2. D.F. Linton made some charts that smooth the 3DDRR.
3. Sweden, which is relying primarily on private decisions for social distancing, as of this morning was at 132 deaths per million, more than all but 7 other European countries. I was forwarded information that points to immigrant populations in Sweden having a disproportionately large share of infections relative to their share of Sweden’s population.
4. Health economist Jeffrey E. Harris writes,
New York City’s multitentacled subway system was a major disseminator – if not the principal transmission vehicle – of coronavirus infection during the initial takeoff of the massive epidemic that became evident throughout the city during March 2020. The near shutoff of subway ridership in Manhattan – down by over 90 percent at the end of March – correlates strongly with the substantial increase in the doubling time of new cases in this borough. Maps of subway station turnstile entries, superimposed upon zip code-level maps of reported coronavirus incidence, are strongly consistent with subway-facilitated disease propagation. Local train lines appear to have a higher propensity to transmit infection than express lines.
From my timeline: March 4. New York Health Commissioner Oxiris Barbot: There’s no indication that being in a car, being in the subways with someone who’s potentially sick is a risk factor.
5. Speaking of New York, today is the day that about 4000 deaths showed up that had not been previously reported. As of yesterday, New York was showing only 11,586 and the number of “new death” reported to day was 606. But today the total for the state is 16,251
6. Olivier Blanchard and Jean Pisani-Ferry write,
The extraordinary operations that are under way in most countries in response to the COVID-19 shock have raised fears that large-scale monetisation will result in a major inflation episode. This column argues that so far, there is no evidence that central banks have given up, or are preparing to give up, on their price stability mandate. While there are obviously some reasons to worry, central banks are doing the right thing and the authors see no reason to panic.
Take anything Blanchard says, put a minus sign in front of it, and you have my view.
7. Pat Bayer looks at death rates in Italy and sees flat declines post-peak. Pointer from Tyler Cowen. I think I am seeing the same thing in the ex-NY data in the U.S., and I am not happy about it.
8. I listened to a bit of the Sweden update that Tyler linked to, around minutes 12 through 16. It seems that there was a lot of voluntary social distancing, including an enormous reduction in the use of mass transit. Also, many of the deaths were in nursing homes. So perhaps we are not learning as much from the “Sweden experiment” as one might hope.
Cato’s David Boaz had a good idea. He put together a timeline that shows how the private sector started to act on the virus before the government did. I would like to expand the timeline, particularly to contrast the CDC, the FDA, WHO and officials in New York with the private sector actions. I welcome suggestions. Continue reading
to the extent pandemic policy is driven by biomed academics, don’t expect it to be very flexible or abstractly reasoned. And my personal observation is that, of the people I’ve seen who have had insightful things to say recently about this pandemic, most are relatively flexible and abstract polymaths and generalists, not lost-in-the-weeds biomed experts.
Read the whole post. He offers many interesting hypotheses, including an explanation for why you have to fire many of the generals who rose through the ranks during peacetime.
From the March 4 and April 8 Fed H.1 data, we learn that the Fed held $2,502 billion and $3,634 billion Treasury securities on those dates, an increase of $1,132 billion. From the Treasury debt to the minute page, we learn that debt held by the public (including the Fed) rose from $17,469 billionaires to $18,231 billion — a (huge) rise of $762 billion. $9 trillion at an annual rate. The Fed bought all the Treasury debt, printing new money to do it, and then some. On net, the government financed the entire $762 billion by printing new money and printed up another $370 billion to buy back that much existing treasury debt.
Later, he writes,
Inflation comes basically if the US hits a debt crisis.
I would say that we only get hyper-inflation if there is a debt crisis. But I believe that we can get at least a 1970s-style inflation without a debt crisis. We are keeping people home and getting them laid off, which means that they are not producing anything of value. Yet we are giving them funds as if they were still producing, which they will then spend on stuff that other people produced. Regardless of what games the Fed plays with interest on reserves, we have more money chasing fewer goods, and that means inflation.
As it stands now, inflation is being repressed by a form of price controls, in the form of laws and social norms against “price gouging.” If it weren’t for those laws and norms, prices would be soaring for the things that people want to hoard (masks, toilet paper), many grocery products, and stuff that we used to get easily from China.
In the midst of the COVID-19 pandemic that has already prompted Congress to hike spending by $2.2 trillion (with more likely on the way), and with revenue collections likely to drop in a big way as a result of the coronavirus-induced economic shutdown, the federal government is facing the prospect of a budget deficit of nearly $4 trillion this year.
4. Concerning age and obesity as risk predictors, Christopher M. Petrilli and others write,
In the decision tree for [hospital] admission, the most important features were age >65 and obesity. . .Age and comorbidities are powerful predictors of hospitalization; however, admission oxygen impairment and markers of inflammation are most strongly associated with critical illness.
The most recent NYC data show only 133 deaths out of 6589 were among people who were deemed as having no underlying conditions. The footnote in the table lists only medical conditions such as cancer or heart disease, but it does not include obesity. Also, the table includes 1422 deceased individuals who are not classified as either having or not having underlying conditions but instead are deemed “underlying conditions unknown.”
Thanks to commenters for pointers.
5. The WSJ reports,
CVS—where Mr. Lackey heads up talent acquisition—is now taking on the most ambitious hiring drive in its history. To recruit the 50,000 staffers it needs to meet a coronavirus-fueled surge in business, it is partnering with Gap Inc., Hilton Worldwide Holdings Inc. . .Delta Air Lines Inc. . . . and dozens of other companies to employ their laid-off workers. More than 900,000 people have applied for CVS jobs in just the last few weeks, including roles stocking warehouses and stores, answering phones at call centers or stepping in for CVS staff who end up sick or quarantined.
As the government and many pundits try to figure out how to make the economy revert to what it used to be, the market tries to find patterns of sustainable specialization and trade.
6. Meanwhile, Olivier Coibion, Yuriy Gorodnichenko, and Michael Weber write,
the employment-to-population ratio has declined sharply. Using the adjusted metrics described above, we find that the employment ratio fell from 60% of the population down to 52.2%, a nearly eight percentage point decline. . . this decline in employment is enormous by historical standards and is larger than the entire decline in the employment-to-population ratio experienced during the Great Recession. Given that the US civilian non-institutional population is approximately 260 million, this drop in the employment-to-population ratio is equivalent to 20 million people losing their jobs. This drop is even larger than the 16.5 million new unemployment claims over this time period.
Any model of optimal policy should be “what should we do now, knowing the lockdown can’t last very long?” rather than “what is the optimal length of lockdown?”
But we are still flying blind. I am hopeful that asymptomatic spreaders are unlikely to kill people, other than those who are very old or very obese, but this is just a conjecture. As far as I know, we still don’t know the prevalence of the doorknob effect, or the importance of viral load. We have no idea whether there are 1 million people in this country with immunity, or 20 million. We don’t know about the effectiveness of masks and scarves.
We need to replace the peacetime public health leadership, which only knows how to scold and cower, with some actual scientists determined to answer these urgent questions.
8. Maybe we do know something about the effect of enclosed spaces. Hua Qian and others write,
Home outbreaks were the dominant category (254 of 318 outbreaks; 79.9%), followed by transport (108; 34.0%; note that many outbreaks involved more than one venue category). Most home outbreaks involved three to five cases. We identified only a single outbreak in an outdoor environment, which involved two cases. Conclusions: All identified outbreaks of three or more cases occurred in an indoor environment
Pointer from Tyler Cowen. Also from Tyler and possibly related: Travis P. Bagett and others write,
testing of an adult homeless shelter population in Boston shortly after the identification of a COVID-19 case cluster yielded an alarming 36% positivity rate. The vast majority of newly identified cases had no symptoms and no fever on a single point-in-time assessment
9. From the Hollywood Reporter,
California Gov. Gavin Newsom on Tuesday announced a broad six-point plan to reopen the state’s economy and relax strict Safer at Home guidelines.
The six points sound more like conditions that must be achieved before relaxing restrictions. For example,
the ability to monitor and protect communities through testing, tracking positive cases, properly isolate and support individuals who are positive and/or exposed to COVID-19.
A few weeks ago, the focus was on avoiding hospitals becoming overwhelmed. But that is only one of the Newsom’s conditions. Somewhere along the way, we went beyond the goal of reducing infection risk as a means to preserve scarce medical resources. The goal now seems to be reducing infection risk as an end in itself. Once we accept that as a vital government objective, the default becomes indefinite infringement on liberty.
As you know, I am not a fan of models, such as the one that Tyler Cowen points to. I prefer an Ed Leamer “patterns and stories” approach.
One pattern, which Tyler agrees is significant, is that the virus is producing fatalities very unevenly across regions. For example, New York has 552 deaths per million, and Texas has 11. If you believe models, then you probably believe that Texas will catch up at some point. But I can imagine a story in which that does not happen.
Here are what I think are the causal factors for the differences.
1. Living conditions of the elderly. Consider Spain, which appears to have the highest per capita death rate of any major country (although Belgium might catch up). Wikipedia says,
Many nursing homes in Spain are understaffed because they are for-profit businesses and elderly Spaniards cannot necessarily afford sufficient care. In some nursing homes, elderly victims were found abandoned in their beds by Spanish soldiers mounting emergency response. Defense minister Margarita Robles said that anyone guilty of neglect will be prosecuted. By 23 March, a fifth of nursing homes in the Madrid area had reported cases of the virus. More than 65% of fatalities have occurred in those 80 or older, compared to 50% in Italy and only 15% in China. By 3 April, at least 3,500 Spaniards had died in nursing homes and another 6,500 contracted infections there. Thousands of elder care workers are also infected.
2. Concentrated poverty. Actually, it is not dire poverty. It is working conditions and living conditions that make it hard to socially distance.
Low income neighbourhoods in Barcelona have seven times the rate of infection of more affluent neighbourhoods. Part of the reason is that essential workers, who have kept going to work despite the epidemic, are likely to work in low-skill jobs such as supermarkets or elder care. Also, many care workers are immigrants, who lack access to unemployment benefits and live in some of the lowest category housing. Homeless people are also at risk and the charities that help them were forced to cease operations because of the disease.
3. Enclosed spaces where one might come into contact with someone with a high viral load.
I think that enclosure matters. I think some scientific papers suggest this, although I don’t have any links right now.
Actually, someone just sent me a link to Wendell Cox on exposure density which says
Exposure density, and thus infection, is likely to be less, all else equal, if common halls, elevators, crowded places and transportation facilities are avoided.
Cox says that exposure density is the likely explanation for why deaths have been much higher in New York City than elsewhere.
I am trying to come up with an explanation for why the virus has not killed thousands of homeless people in LA and SF. I think that the most plausible reason is that they live outdoors, and so do not inhale the large viral loads that you can inhale in a confined space. That is just a guess.
Note that if enclosure matters, then maybe health care workers would be safer treating patients in the parking lot than inside the hospital building.
So here are some hypotheses.
a) We will find that New York has some nursing homes that are run appallingly badly, and these will account for a significant share of the deaths there. Going forward, spikes in deaths in other locations will be tied to nursing homes that fail to maintain proper hygiene and to keep sick workers away.
b) The elderly and the very obese are vulnerable to fatal infection even from asymptomatic or mildly symptomatic spreaders. But the rest of us will have low infection fatality rates unless exposed to a highly symptomatic individual in a confined space.
c) Someone who is very symptomatic and gets into a crowded space, such as a bar or subway, can kill many people.
If these hypotheses are correct, then I believe that we can avoid a repeat of the New York fiasco with carefully targeted public health interventions and not require general lockdowns.
Keep in mind that I am not an expert and I have an aversion to lockdowns, so there are some obvious biases at work.
Socialism should therefore be called “coercionism.”
. . .another good name for the system that the non-conservatives and the non-socialists among us favor would be “adultism.”
2. I am still cranky, for the same reasons as before. We still do not have results of random-sample testing to have an idea of how many people have the virus in various regions. We still do not know how viral load affects outcomes. We still do not know whether people get it from touching surfaces and then touching their faces, or whether they have to breathe near an infected person. We still are not conducting any scientific experiments. Instead, we are contemplating mass “experiments” with changing regimes for social distancing, arguing over putting at risk either more economic activity or more human lives. Worse yet, we really won’t learn anything from these “experiments.”
We still talk about political leaders “re-opening the economy,” as if the economy is theirs to re-open and individual choices will not be affected by the virus. People still expect that any and every household and business can be saved from the consequences of the virus, because government has the know-how and skill to undertake this. People still conceive of government as an infinite storehouse of riches that is disconnected from any need to obtain the wealth that it purports to distribute.
what has been increasingly whitewashed in the story of California and Washington’s success in battling the coronavirus1 is the role tech companies played: the first work-from-home orders started around March 1st, and within a week nearly all tech companies had closed their doors; local governments followed another week later.
So, the approximate order of events was: private sector response, then local government response in the west, then response in the east and by the Federal government. But as Thompson points out, the east coast media have missed this aspect of the story.
4. Ali Hortaçsu, Jiarui Liu, and Timothy Schwieg attempt to do some epidemoiology.
we find that 4% to 14% of cases were reported across the U.S. up to March 16
The paper describes their methods. As of March 16, according to this site there were 4300 reported cases. But if the authors are correct, there were between 3000 and 100,000 actual cases.
I suspect that the ratio of unreported cases to reported cases has gone down since then, but I have no idea by how much. We now have almost 600K reported cases, and if we have between 6 and 25 times as many unreported cases, then that would mean between 3.6 million and 15 million people have had the virus.
Economists are probably building better models than epidemiologists. But random-sample testing would be much better.
[Note: askblog had an existence prior to the virus crisis. I still schedule occasional posts like this one.]
The impact of COVID-19 on Gender Equality. A commenter gives this link.
A new NBER working paper.
1. Tyler Cowen continues to question the caliber of the practitioners of epidemiology. I would add that
–John Ioannidis in his classic work around 2005-2007 debunking published papers was particularly hard on epidemiological research.
–Robin Hanson was quickly able to point out the problem with treating R0 as a fixed parameter.
–I am frustrated that epidemiology is determined to rely on observational data rather than experiments
–I am frustrated at the eagerness to embrace computer models regardless of the faulty data and parametrizations.
Having said all that, I am also dismayed that laymen put such pressure on epidemiologists to make forecasts. Imagine if it was your job when you see a leaf falling from a tree 40 feet overhead to place your foot on the exact spot where you “forecast” that the leaf will land. As I pointed out when Dr. Fauci forecast between 100K and 240K deaths for the U.S. that this would require the number of deaths to double no fewer than 5 times and no more than 6 times. And this was when the 3DDRR was 2.0, which meant there was no way that such a narrow forecasting range was defensible.
2. A reader recommends that I re-link to a classic essay, lenders and spenders. It clarifies the problem with deficit spending.
3. Do you know about the phenomenon at the shore known as an undertow? On rare occasions at a section of a beach, a strong current will carry people out to sea. If this happens to you, the guidance I have read says that you need to swim parallel to the shore until you no longer encounter the current. Then you can make it back to land.
Think of the economic losses from the virus as an undertow. But instead of swimming, everyone is looking at a boat, the USS Government, where sailors from Congress and the Fed are busily tying ropes, with life preservers on one end and the railing of the boat on the other. The people in the water are each waving their arms and screaming “I need a life preserver. Throw one to me.” They are so frantic that the sailors think that the only way to keep order is to keep tossing more and more life preservers.
But there is a problem. The USS Government has a big hole in the bottom, called the deficit. It is likely to sink. And at that point a school of sharks, called inflation, will arrive on the scene.
We would have been better off swimming. There are some people who really could not swim to safety, and the better swimmers should try to pitch in to help them. But we should not be attributing so much capability to the USS Government.