The question in assessing universal tax rebates is, what about the vast majority of families who are still working, and whose incomes have not declined or whose pension or Social Security benefits have not been affected by Covid-19? For this group, the pandemic has reduced the ability to spend more than the ability to earn.
In other words, we should not be applying conventional macroeconomics right now. Conventional macro sees as all working the same GDP factory, which is producing below capacity because of insufficient demand. Conventional macro says that it does not matter how the government directs spending, because any spending will inject more “aggregate demand.”
Even a conventional macroeconomist like Larry Summers is able to see that this model does not fit the current situation. I happen to think that conventional macroeconomics needs a much broader reassessment.
2. We continue to argue about asymptomatic spreading.
The secondary attack rate for symptomatic index cases was 18.0% (95% CI 14.2%-22.1%), and the rate of asymptomatic and presymptomatic index cases was 0.7% (95% CI 0%-4.9%), “although there were few studies in the latter group.” The asymptomatic/presymptomatic secondary attack rate is not statistically different from zero
Just run a test, for crying out loud.
3. Megan McArdle writes (WaPo),
Looking back over the past nine months, it’s as if the public health community deliberately decided to alienate large groups of Americans, usually in the name of saving someone else.
The World Health Organization told us travel bans don’t work, apparently because they harm tourist economies; then we were told masks don’t work, apparently because experts worried that hoarding them would leave health-care workers without personal protective equipment; the public health community fell suddenly silent about the dangers of large gatherings during the George Floyd protests; a presentation to a government advisory committee actually described thousands of potential additional deaths as “minimal” compared with pursuing racial and economic equity; Anthony S. Fauci admitted he’d been lowballing his estimates of the point at which we’ll reach herd immunity.
The Orwellian public health community notwithstanding, my nominee for villain of the crisis is the FDA, for two reasons.
First, the FDA placed a very high priority on accuracy in deciding whether to approve tests for the virus. For some purposes, such as estimating the prevalence of the virus, accuracy is a good thing. But for controlling the spread of the virus, an accurate test that takes a week to provide results is worthless. The FDA should have prioritized “faster and cheaper” over “reliable.”
Second, the FDA did not use human challenge trials (give one group the vaccine and one group the placebo, and then expose them to the virus). Instead it gave one group the vaccine and one group the placebo, and then waiting until enough people naturally were exposed to the virus to show efficacy. We could have been starting to take the vaccine in June, but instead we had to wait until now.
4. Mr. Biden got into the virus forecasting business a few days ago, saying that the U.S. will have 400,000 deaths by the time he is sworn in as President. According to this site, we had 329,000 as of December 29. To get to 400,000 by inauguration day, we would need to average about 3000 deaths per day. On a 7-day average basis, the highest that it has been is 2680 on December 22. It has been edging down over the past week. But if you are trying to forecast the closest round number, then 400,000 is right.
He rightly criticized the slow process of distributing the vaccine. If it were rationed by price rather than by government authorities, my guess is that there would not be such a large supply of vaccine sitting around waiting for someone to administer it.
5. Miles Kimball joins those of us criticizing peacetime bureaucrats.
Highly accurate tests whose results take many days to arrive are next to useless. But the US government was very slow to approve tests of lower accuracy that could have made a big difference because they gave results within minutes.
Pointer from Alex Tabarrok. He says that the problem is perfectionism. I think it’s blame-avoidance.
If you do something and harm results (e.g., somebody gets a wrong test result), then you can be blamed. If you do nothing (i.e., don’t allow fast but less-accurate tests), then the harm that results is God’s Will. It’s the trolley problem.
I second the FDA being the worst actor in the pandemic. Note that either option, vaccines in June or $5 instant at home testing, would have been enough to stop the pandemic in its tracks. Or at a minimum end lockdowns (vaccine would prevent overloaded hospitals if even just a decent fraction of the elderly take it; if every school child is taking a test every morning and getting results immediately, why do we need to shut down schools)?
BTW, the FDA ended 2020 trying to fine one of my local distiller thousands of dollars for the crime of switching to producing (safe, effective) hand sanitizer in March. Only intervention by Trumps HHS got it overturned after outcry.
Word on the vaccine is exactly what you would expect. The elderly are taking it up at high rates and young healthy healthcare workers have relatively high non-compliance rates. It’s almost like people that are vulnerable to the virus want it and people that aren’t don’t want to take the risk. Just let us buy the damn thing.
“It’s the trolley problem.”
At least the trolley problem assumes that minimizing death is a moral goal everyone shares. Rather than minimizing personal discomfort regardless of the death toll.
This is the pandemic that never had to happen. Period. If there was no government response it would have been over by the summer.
+1
I consider the virus to be opposite, in economic effect, to technology. Compared to the pre-covid era, many businesses have the choice between producing a less valuable product (because it comes with a chance of contracting the disease), producing a safe product at a greater cost (empty seats in theaters, masks, extra cleaning), or some combination (producing a product with reduced risk at a somewhat increased cost).
“I think it’s blame-avoidance…If you do nothing (i.e., don’t allow fast but less-accurate tests), then the harm that results is God’s Will”
Actually, the FDA and public health officials don’t even need to resort to blaming God’s Will. Every death or infection that has resulted from delays or refusal to approve tests and vaccines has been blamed on the American public. Didn’t approve a rapid test that could have been used to screen people at Thanksgiving? No matter, people should have just avoided Thanksgiving dinners. Vaccine didn’t get released in time for Christmas? Well, if Americans would just cancel Christmas, then there would be no problem. Slow vaccine roll out? Not really a problem if everyone would just lockdown for a few extra months. Public health officials feel no urgency to release vaccines and tests because their mindset is that lockdowns are no big deal and that every infection is the fault of Americans that refuse to stay home until public officials give the green light to come out. Associating a low cost to lockdowns is equivalent to putting a low value on vaccines and tests.
I find COVID shaming particularly nonsensical because the only way to not get COVID is to completely shut down ones life. If you have any kind of life at all you have at least some risk of getting COVID, even if you WEAR A MASK!
Avoiding COVID at all costs isn’t a mark of virtue as a sign of already being dead inside.
One suspects that people who already didn’t have people to visit at the holidays or otherwise couldn’t even get along with their own family are just happy as hell the rest of us can’t get instant tests to protect our loved ones. We should all be miserable as they are.
Wellness shaming is, if anything, even less constructive than COVID shaming and just as repulsive.
The FDA and the CDC won’t learn the proper lessons from the pandemic because it’s not in their interests to admit that they messed up.
For much the same reason, our government (Congress, Freddie Mac, Fannie Mae, HUD, etc.) didn’t learn the right lessons from the housing boom and bust.
I know this will sound weird, and one is not supposed to use the excuses, “just following orders”, “just doing my job, doing what I was told, it’s the system and hey man, I just work here”, and but my double-contrarian take is that it’s not really the bureaucrat’s ‘fault’ in terms of the way we normally assign culpability.
A lot of people are complaining about individuals making terrible decisions defying logic and common sense with terrible consequences for hundreds of millions of people. And that’s true, no denying it.
But these complainers are only half right. They are not going the extra step of post-mortem and figuring out why these people and these institutions are so incredibly bad, and what it would take to really fix the problem. I mean, yes, there are plenty of TDS people who will just say “Trump” and feel satisfied with that as an answer, but that is not just wrong but probably the opposite of right. The influence of Trump’s idiosyncratic character, flaws and all, probably was a net positive in terms of accelerating all this as much as any normal politician could have.
Which raises a meta-level question of why so little meta-analysis on this level? I think the ugly answer is that people suspect the answer is something that is so socially undesirable and gloomy that their brains stick a toe in the water of these ideas, discover they are socially toxic for the individual thinking them, and then simply refuse to let them go there and open up that whole can of worms, similar to Orwell’s ‘crimestop’.
That is, if you blame “the system” that produces and incentivizes them, and not the “peacetime bureaucrats” themselves, then you see that you cannot solve the problem by replacing bad, dumb, senseless, deluded people with smart, righteous ones with better, truer ideas and who can apply common sense.
So, I don’t blame the bureaucrats, who are kind of helpless and stuck and “just doing their jobs” as we are stuck in a situation of “zero free energy” as explained in Yudkowsky’s “Inadequate Equilibria”. I blame our system, which is completely insane, unsalvageable, and irredeemable in anything like its present form, not fixable by reforms or tinkering or elections, and that this should be an obvious and uncontroversial conclusion from this whole experience for all clear-thinking people.
The trouble is that can of worms. You start saying we need to throw the rotten egg we have out and get a fresh one, and there is no way to achieve any kind of consensus for peaceful resolution of the question of what that should look like and how to get there from here. So we’ll probably keep sleepwalking one day into a crisis so big we won’t bounce back from it.
My second-best proposal is that, if anything is genuinely an “emergency”, the military should take 100% control of the government response to it, and be granted the full authorities of martial law in order to end the emergency as soon as possible. As bad as DoD is, it is still far and away the only USG institution ready, willing, and able to deal with a crisis in an effective manner. Sad but true.
“I blame our system, which is completely insane, unsalvageable, and irredeemable…”
The country became “ungovernable” when the government stopped trying to do the things it could do – maintain stability, “peace, easy taxes, and a tolerable administration of justice” – and began trying to do what it could not – manage the nation’s economy and ensure equality of outcome.
Why would we expect anything other than dysfunction when we take decisions out of the hands of individuals who understand local conditions, can quickly respond to feedback, and who will pay a price if they choose poorly and place them in the hands of central planners who have limited knowledge, imperfect feedback mechanisms, and who pay no price for being wrong?
On the one hand you could say that nearly all the western nations ended up with the same response, so how different could the individuals involved have done.
On the other hand, lots of countries and states didn’t close elementary schools, so that is obviously a huge thing specifically wrong with many of our leaders. And some countries/states have approved vaccines faster, or gone with one dose first, or prioritized the old rather than social justice nonsense. So there is a range of decisions even in the first world western context that are really impactful and subject to the actual decision making powers and range of the parties with decision making power.
Arnold,
Re: Crucial opportunities that were missed because of the FDA’s psychology of blame avoidance in real-world trolley-problems.
Well-designed, early human challenge trials can integrate multiple research lines; for example, vaccine efficacy (your point no. 3) and controlled experiments about asymptomatic transmission (your point no. 2).
See the WHO document, Key criteria for the ethical acceptability of COVID-19 human challenge studies (6 May 2020):
“Challenge studies could thus be associated with substantial public health benefit in so far as they (a) accelerate vaccine development, (b) increase the likelihood that the most effective (candidate) vaccines will ultimately become available), (c) validate tests of immunity, and (d) improve knowledge regarding SARS-CoV-2 infection and transmission. [… .] SARS-CoV-2 challenge studies could add value to other types of vaccine research by enabling (a) accurate assessment of asymptomatic infection, (b) more rapid and standardized testing of multiple vaccine candidates, and (c) testing vaccines in contexts where there is little continuing transmission (for example, due to public health measures or during inter-epidemic periods).” (pp. 1 & 3)
Link: https://apps.who.int/iris/bitstream/handle/10665/331976/WHO-2019-nCoV-Ethics_criteria-2020.1-eng.pdf
A more comprehensive WHO document, Human Challenge Trials for Vaccine Development: regulatory considerations (Expert Committee on Biological Standardization, Geneva CH, 17-21 October 2016) explains that in-patient challenge trials can be designed specifically to integrate also study of transmission:
“It may be necessary to ensure housing of controls and vaccinees together if an objective of the human challenge trial is to identify potential for transmissibility. In such a situation, only the vaccinees or unvaccinated participants might be challenged, and the controls, who were not challenged, would be monitored for evidence of acquiring the challenge organism through contact with the challenged vaccinees. In this way, transmissibility of the challenge organism may be determined. In order to achieve the study objective of identifying transmissibility, it would be necessary to conduct the study in-house even if the challenge organism was attenuated and the wild-type organism was present in the locality.” (pp. 7-8)
Link: https://www.who.int/biologicals/expert_committee/Human_challenge_Trials_IK_final.pdf
BTW, design features that reduce risks for participants in human challenge trials also reduce the scope of the empirical findings. For example, in order to reduce risk, SARS-CoV-2 challenge trials might accept only healthy young adults, and might use an attenuated viral strain or dose for infection. Thus the findings would not be dispositive for other demographic groups (such as the elderly, who are at high risk) or for transmission in the wild. However, there are countervailing mechanisms. WHO’s document of 6 May 2020 notes:
“The (scientific and social) value and ethical acceptability of vaccine research is not contingent on (early) demonstration of efficacy in high-risk groups, in part because vaccination of (large numbers of) low-risk individuals provides indirect protection to high-risk individuals (compare rubella vaccination of whole populations so as to protect unborn children).” (footnote 12, at p. 7)
Thus human challenge studies of SARS-CoV-2 can be part of a broader “focussed protection” strategy, if the studies involve the least vulnerable (healthy young adults), and if the least vulnerable in the wild then get vaccinated at high rates. Notice, however, that a young healthy person’s low-risk status cuts two ways. It reduces (a) individual risk in a challenge trial and (b) individual need to take the vaccine in the wild.
Re: “it’s as if the public health community deliberately decided to alienate large groups of Americans” (Megan McArdle).
The sequence of misleading communications by public-health experts might just as well be interpreted the other way around: It’s as if the public health community deliberately decided to pander to large groups of Americans.
“If it were rationed by price rather than by government authorities, my guess is that there would not be such a large supply of vaccine sitting around waiting for someone to administer it.“
Just to play devil’s advocate, with over 230 hospitals around country, the federal government could easily take over vaccinations. Call out the military health care providers both active and reserve and have them vaccinate around the clock boot-camp style. Back in boot camp, I got something like 15 vaccinations in 30 seconds. Of course both sleeves on my t-shirt were shredded and my arms were bleeding afterwards, and it was about a two hour wait in line, but nevertheless the job got done. The VHA has according to press accounts been MIA as has the DHA. Why can’t they get off their dead butts?
“Just run a test, for crying out loud.”
Have you even considered for a few minutes what such a test would entail? Since you want to measure contagion over the full asymptomatic course of the disease, that means monitoring a huge set of subjects, waiting for some subset to get asymptomatic COVID, then recording all of their contacts and monitoring them to find out if they have gotten COVID from the primary subject. You’d want at least hundreds if not thousands of asymptomatic cases, so you’d be monitoring tens of thousands of subjects with frequent tests, contact tracing and all the rest. OMFG.
The FDA?
No one in the public health sector has been covered with glory. I think the CDC seriously screwed up with their initial test roll out and the FDA played along. Most of the useful testing was being done by radiologists and university and institution laboratories. It didn’t help that the boss insisted that COVID-19 wasn’t a problem and definitely not a problem that could be dealt with by improving testing or expediting PPE production or just about doing anything. If you’ve ever had to work on a project that one’s boss doesn’t want to get done, you’d have some sympathy for these guys.