Category Archives: virus crisis

Speaking of Institutional Irrationality

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Ben Weingarten writes,

If Afghanistan should have taught us anything, it is this: When confronting an enemy, we need a clear set of goals, a reasonable plan to achieve those goals as efficiently as possible and an ironclad exit strategy.

He argues that the virus response failed to do this.

Go back to the quoted passage and for “When confronting an enemy” substitute “When our organization undertakes an initiative…” That might make for a pretty good definition of institutional rationality. It leaves out the possibility of rationally setting out to undertake an activity permanently. But in fact it is hardly ever viable to do the exact same thing in the exact same way long term.

The virus, public health, and science

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In an interview, epidemiology professor Vinay Prasad says,

Another great failure is that we didn’t learn a lot. We did so many different interventions, but we didn’t actually study many of them. For example, there are still questions about how much to wear masks, and under what circumstances. We don’t know much more about that than when the pandemic began.

If I had been in charge, this would have been different. You will recall that I clamored for rigorous testing very early on. He also says,

Zoom allowed a lot of upper-middle-class white-collar people the ability to work and make money and not lose their jobs, and to exclude themselves from society. That fundamentally changed the pandemic. If you went back 15 years ago, and you didn’t have Zoom, you would be facing unprecedented layoffs of wealthy, upper-middle-class people. I think a lot of businesses would have had staggered schedules and improved ventilation. Schools would have pushed to reopen. Amazon Prime and Zoom and all these things in our lives allowed a certain class of people to be spared the pains of COVID-19, taking them out of the game, and making them silent on many of the issues that affected other communities.

Why health officials were slow to understand COVID transmission

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Zeynep Tufekci writes (NYT),

If the importance of aerosol transmission had been accepted early, we would have been told from the beginning that it was much safer outdoors, where these small particles disperse more easily, as long as you avoid close, prolonged contact with others. We would have tried to make sure indoor spaces were well ventilated, with air filtered as necessary. Instead of blanket rules on gatherings, we would have targeted conditions that can produce superspreading events: people in poorly ventilated indoor spaces, especially if engaged over time in activities that increase aerosol production, like shouting and singing. We would have started using masks more quickly, and we would have paid more attention to their fit, too. And we would have been less obsessed with cleaning surfaces.

If you were reading me back in the early days of the pandemic, you will see that I noticed, without understanding the science, that outdoors was especially safe. I was also a big skeptic of what I called “doorknob effects,” the idea that you could get the virus by touching a surface that someone else had touched.

The point is not that I know virology better than the virologists. I don’t. But I believe in drawing inference from evidence. My biggest complaint with the public health establishment, which I voiced emphatically and often, is that they would not conduct experiments to test hypotheses in a situation where there was considerable uncertainty.

In the early days of the pandemic, we were not following science. We were following bureaucrats, who put way too much emphasis on “computer models,” which anyone with a strong scientific mind could see were garbage. They refused to use evidence-based reasoning, and they never considered conducting experiments.

The problem was much deeper than just the one issue that Tufekci describes.

Against vaccine passports

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Mask mandates make more sense to me than vaccine passports.

I would make the case for a mask mandate in a pandemic with no vaccine available. Suppose you and I enter the same store. As I understand it, my mask offers little protection to me. But your mask offers significant protection to me.

With a vaccine, the relative values are reversed. If you and I visit the same store, my vaccination shot gives me lots of protection, while your vaccination shot is much less meaningful to me.

In terms of immediate contact with other people, there is a public-goods argument for a mask mandate in a pandemic without a vaccine. But in terms of immediate contact with other people, vaccines are much more of a private good.

The public-goods argument for vaccines has to do with “crushing the virus” in general, not with making individuals safer to be around. You can argue that if not everyone is vaccinated, the virus will have more hosts and more opportunities to mutate.

I am willing to buy this public-goods argument for giving people an incentive to get vaccinated. But the penalty for not getting a vaccine should not be house arrest. Metaphorically, I would say we should give people a “vaccine discount” at the movies rather than banning unvaccinated people from going to the movies altogether.

Maybe the subsidy for getting a vaccine should be quite high. Maybe the “no-vaccine” tax should be quite high. But depriving someone of their freedom of movement because they refuse to get a COVID vaccine is wrong. I strongly oppose vaccine passports.

COVID models still don’t work

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David Wallace-Wells writes,

Looking back, you could find a few lonely voices suggesting winter would be calmer than autumn. But the CDC aggregates and showcases 26 pedigreed models predicting the near-term course of the disease. On January 18, only two of the 26 showed the dramatic case decline the country experienced by February 1 as being within what’s called the 95 percent confidence interval. In other words, 24 of the 26 models said what ended up happening over just the next two weeks was, more or less, statistically impossible. The other two gave it, at best, a sliver of a chance.

Pointer from Tyler Cowen.

The article correctly points out that the only clear differences in outcomes are between Asia and the West. I still wonder whether the two faced the same virus.

Virus update

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1. In a podcast with Russ Roberts, John Cochrane says,

We can talk about medicines and vaccines–those maybe could go wrong–but a test cannot hurt you unless you take this extraordinarily paternalistic view that you might do something bad with the information that you get with the test, which is in fact the kind of view that they take.

He is questioning the way that the FDA is conservative about approving tests.

To this day, I cannot understand the failure to do regular random-sample testing. I really want to send our public health officials walking across a live minefield wearing blindfolds, so that they can get a sense of how they are providing us with information that would be helpful.

2. A well-known COVID tracker is shutting down. They say that the CDC is now a better data source. The 7-day moving average daily death rate is the number I watch. I really would like to see it take another dive like it did the week after Valentine’s Day.

3. Israeli health officials are effusively praising the vaccine. But the overall numbers for cases and deaths in Israel are not plunging. Maybe in another couple of weeks?

Herd immunity by April?

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Marty Makary writes,

Testing has been capturing only from 10% to 25% of infections, depending on when during the pandemic someone got the virus. Applying a time-weighted case capture average of 1 in 6.5 to the cumulative 28 million confirmed cases would mean about 55% of Americans have natural immunity.

Unfortunately, he does not spell out his calculations enough for me to check. But it is likely that he is badly mistaken. Yes, back in March and April, we were not doing very many tests, and a large share of infections went undetected. I doubt that this has been true in recent weeks. I bet that the number of undetected cases in the last two months is less than double the total number of detected cases over that period. If so, then his claim that we will have herd immunity by April is probably unsound.

Number One Pick, who I think is a more credible observer, wrote,

Prediction: 75% chance that there will be a new wave peaking in March or April, with a peak at least half again as high as the preceding trough.
[EDIT: some people link new studies saying the B117 strain is less virulent than previously believed, and the US has been getting much better at vaccination since I checked, probably my prediction above is too high and we should worry less about this]

So it is hard to say what his current prediction is. I am guessing that he would put a low probability on herd immunity by April.

UPDATE: The 7-day average death rate has really plummeted over the past week. So maybe I should be more optimistic.

Virus update

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1. Ynetnews said,

Researchers at Tel Aviv’s Ichilov Hospital on Thursday announced it has seen positive results in preliminary trials for a cure for COVID-19.

Meanwhile, Joseph A. Ladapo wrote,

while scientists argue that widespread vaccination will prevent variants from taking hold, lessons from the past year should make it abundantly clear that our ability to stop the spread of variants is extraordinarily limited.

So there is still a low-probability scenario in which We will quietly give up on a vaccine. But keep in mind that neither the Ynetnews piece nor Lapado’s op-ed should be treated as reliable.

2. I am pretty close to declaring Mr. Biden a failure as a virus-war President. To succeed, he needs to fight the bureaucracy much harder.

–declare the vaccine distribution system a failure, and put a military person in charge.

–take the vaccine approval process out of the hands of the FDA. In addition to FDA input, get input from a scientific advisory panel, consisting of folks like Michael Kremer, Scott Alexander, Bret Weinstein, and Balaji Srinivasan.

–create a treatment-protocol study group to evaluate current knowledge, disseminate best practices on an ongoing basis, and see that trials are conducted as rapidly and reliably as possible.

3. Our county’s vaccine appointment systems are ridiculous. Pointer from Tyler Cowen. But my wife got her first shot Friday, and I got mine Monday.

–Even though some occupations under age 65 are eligible, I don’t see how anyone with a job could possibly get an appointment. Trying to navigate/game the appointment systems is a full-time job, involving checking multiple web sites, learning what time is best to check a particular web site, hitting the “refresh” on your computer continually, and so on.
–Because it takes so much social capital to work the system (local list-servs are buzzing with tips on how to get an appointment), I was not surprised when a white person told me of getting an appointment at a grocery store in a mostly-black neighborhood and finding that all the other people with appointments were white. So on top of everything else, it exemplifies systemic racism.
–If a private firm operated like this, no one would put up with it.

4. You can’t die now–it’s the Super Bowl! Total COVID deaths for February 7-8 were under 3000, the lowest two-day total this year. Doctors do have a lot of discretion to keep someone alive for a day or two longer if that is more convenient for the family. I’m expecting a bounceback today.

V-Day?

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Today we have had our appointments for the first dose. But because the vaccine location is in a different county from where we live, that county decided to cancel us.

Actually, it sounds like we would have had a DMV-like experience. I’m not feeling sad.

Note that the average daily death rate in the U.S. is about 5 times it was this summer. If the vaccine is 90 percent effective, that means that my risk after vaccination is 1/10 of what it was without vaccination. Combining the two, that means that after the second dose and the vaccine has taken hold, I will have half the risk that I had this summer. That does not make me excited about getting out and circulating, even with the vaccine.

I will feel better if after a couple of months there are signs that the vaccine is reducing the incidence of the virus in the whole population. In a sense, getting the vaccine early is like getting onto a tour bus early. The bus isn’t going anywhere until more people are on board.

By the way, I think that Alex Tabarrok’s idea of giving first doses to more people and second doses to fewer people is unlikely to work in a free society. From society’s perspective, it may work more quickly to eradicate the virus. But from an individual perspective, I would rather wait to get two doses than get one dose and have to live with uncertainty about what happens next.

Speaking of the virus, the asymptomatic spreader fight never ends. Daniel P. Oran and Eric J. Topol write,

Today, the best evidence suggests that about half of Covid-19 cases are caused by infected people who do not have symptoms when they pass on the virus. These symptom-free spreaders are roughly divided between those who later develop symptoms, known as pre-symptomatic individuals, and those who never develop symptoms.

On the politics of the virus, Christopher J. Snowdon writes,

I suppose my position is boringly centrist. If you want a more invigorating take, you might be drawn to the Zero COVID strategy supported by “Independent” SAGE or the plan laid out in the the Great Barrington Declaration to shield the vulnerable and achieve herd immunity the old-fashioned way. Both of these options carry significant downsides and have now been made redundant by the vaccines, but whilst these ideas might have been flawed or unrealistic, they were not crazy. The former had worked in New Zealand and the latter had been the preferred policy of the chief medical officer until the hasty U-turn of March 2020. These were ideas that reasonable people could debate without being considered cranks.

But now, in the final months of this nightmare, the conversation among many of the noisiest lockdown sceptics has become decidedly cranky.

He speaks as a libertarian, policing his own side. Policing your own side is very honorable, in my view. It is the best way to fight polarization.

But libertarians can be more correct than others give them credit for. See Jacob Grier, who points out the many way government failures in the pandemic. Pointer from Tyler Cowen.

This reminds me that my main problem with “state-capacity libertarianism” is that the phrase itself assumes away, or at least downplays, the main reason I have for leaning libertarian. That is, there are structural reasons for state performance to be worse than you would expect and for market performance to be better than most people would expect.