1. My proposal for credit lines is looking better, because the existing approaches are starting out fouled up in red tape and confusion. See the WSJ on mortgage relief. See The American Banker on paycheck protection loans (pointer from Tyler Cowen).
2. Last night, it seemed as though the Administration was considering a masks and scarves approach. But this morning. . .crickets. I guess the opposition is still strong. [UPDATE: this evening, a recommendation to wear face covering when we go out, e.g. to grocery stores.]
3. There are stories that Asian countries that have had success with their initial approaches, including masks, are now worried that they need more social distancing, because virus spread is starting to accelerate. Pointer from a reader.
4. Maybe we are practicing Hansonian medicine* in treating the virus. Tyler Cowen passes along a disturbing letter.
The letter passes along the claim that of patients put on ventilators, 80 percent or more never recover. My guess is that doctors know the characteristics of patients with an extremely low probability of recovery. Putting such patients on ventilators and caring for those patients puts health care workers at risk. At the margin, we may be costing lives.
The letter points out that if other hospital treatments are not working well, then the whole issue of keeping the hospital system from becoming overwhelmed is moot. I suspect that we get some trial-and-error learning value from hospital treatment. Maybe that trial-and-error learning value can produce a triage approach that uses hospital resources effectively. One way to achieve the goal of getting medical resources above “the curve” is to get better at figuring out who doesn’t need treatment and who cannot be treated successfully, so that resources only are used on treatment-worthy patients.
*For those of you new to this blog, Hansonian medicine refers to a meta-analysis by Robin Hanson that finds that when two populations with different intensity of use of medical care are compared, average outcomes do not differ. Hanson’s interpretation (which I am not totally on board with) is that in a population the cases where medical intervention causes harm cancel out the cases where medical intervention helps.
(4) Any idea who wrote that email to Tyler?
Ive been wondering the same thing all week, was nice to see it so well articulated.
Regarding Hansonian medicine, one of the reasons for higher health care costs in the US is defensive medicine, aka, “cover your ass” medicine. This because the US is a litigious society.
As regards ventilators, this video by a doctor in New York was eye-opening:
https://vimeo.com/402537849
Regarding 2, today CDC is recommending but not requiring cloth face coverings for general public: https://www.breitbart.com/politics/2020/04/03/donald-trump-announces-cdc-recommendation-for-americans-to-wear-cloth-masks-in-public/
” My guess is that doctors know the characteristics of patients with an extremely low probability of recovery”
Don’t really care what they think anymore than I care my plumbers opinion once we have established what he will be paid to do. They are paid (by me) to perform a service,l for me, they can do it regardless their opinion or get out the business.
Hanson picked an early study which turns out to be an outlier in terms of ventilator survival rate.
Here’s another early study, small n of 24. http://www.nejm.org/doi/full/10.1056/NEJMoa2004500
18 went on mechanical ventilation. 9 lived, 9 died, so 50/50 chance of survival.
That’s pretty good!
Age groups: and how many lived vs died:
Under 60: 3 vs 1
60-70: 5 vs 2
70-80: 0 vs 5
Over 80: 1 vs 1
So, for the under 70 crowd, 8 out of 11 lived, that’s nearly 3 out of 4, which is excellent – almost the opposite of the rate Hanson cited.
For the over 70 crowd on the other hand, only one octogenarian tough guy lived.
That only 14%, but it’s probably less on average, since I think the survivor was a special case, maybe in the top 5% of otherwise similar cases. He was one of only 3 of the 24 patients to have no comorbid conditions, and the only one over 70. His BMI of 23.5 was in the lowest 3 again, and the only one with under BMI 34 with no comorbidities. And he was admitted to the hospital only 2 days after developing symptoms, while the average was over a week.
So, the lesson seems to be “Under 70, absolutely ventilate, even for people with other problems, since the change of survival is very high. Over 70, on the other hand, unless conditions are really perfect, they probably aren’t going to make it. If you have to triage because of scarce machines, the order of precedence should likely be set by age.”