1. Commenter John Alcorn watched the entire Swedish health minister video. John points out that the Swedish experiment definitely differs from ours in that they kept schools open. Some more of John’s take-aways.

School closures would de facto pull 20% of medical personnel away from hospitals because parents (including medical personnel) would have to stay home with children.

Sweden is halfway thru major wave of pandemic. Now seeing slowdown of contagion in Stockholm. One third of populace “has been involved” (exposed?). Summer probably will diminish contagion. But this virus, unlike SARS and MERS, won’t go away. Key will be to achieve original goal of shield or isolating the vulnerable (esp. those in elder care) much more effectively.

Skeptical of face masks (except in hospitals and nursing homes) because they tempt people who are symptomatic to go out with a mask instead of properly staying at home.

conditional on infection, death risk isn’t much greater than the flu if the individual receives timely care.

So they are approaching it as just a rapid-spreading flu that you want to keep out of nursing homes. Maybe Swedes are healthier then we are. Physically–less obese? Or mentally–less easily frightened?

And what does the health minister make of the disparity in incidence between their immigrant population and natives?

2. While trying to understand how New York’s delayed reporting of 4000 deaths is affecting things, I came across the NY health department page. I had to go to my browser settings and shrink the type to be able to see it all, but it has some interesting information. The co-morbidities that matter the most seem to me to be generally associated with obesity. I wonder if this puts me in a low-risk category, in spite of my age. It depends a lot on the Unknown Denominator, which is how many people are infected. The higher that number, and the lower the number of deaths of people my age with my BMI, the better off I am.

Poking around the site further, I found data on deaths among nursing home residents in NY state. Does anybody know how to prevent outbreaks in nursing homes? What do the Asian countries do about it?

3. German virologist Hendrick Streeck claims to have debunked the doorknob effect.

“There is no significant risk of catching the disease when you go shopping. Severe outbreaks of the infection were always a result of people being closer together over a longer period of time, for example the après- ski parties in Ischgl, Austria.” He could also not find any evidence of ‘living’ viruses on surfaces. “When we took samples from door handles, phones or toilets it has not been possible to cultivate the virus in the laboratory on the basis of these swabs….”

“To actually ‘get’ the virus it would be necessary that someone coughs into their hand, immediately touches a door knob and then straight after that another person grasps the handle and goes on to touches their face.” Streeck therefore believes that there is little chance of transmission through contact with so-called contaminated surfaces.

He bases his view on the result of a “case cluster study.” I gather that the idea is to try to determine how the people with the virus in a particular region contracted the virus. If there are no doorknob cases in a sample of one thousand people, then you are inclined to downplay doorknob effects.

4. What will be the long-term economic effects of the virus crisis? I am going to try to put my thoughts together this weekend. Meanwhile, Joel Kotkin writes,

Growing corporate concentration in the technology sector, both in the United States and Europe, will enhance the power of these companies to dominate commerce and information flows. As we stare at our screens, we are evermore subject to manipulation by a handful of “platforms” that increasingly control the means of communication. Zoom, whose daily traffic has boomed 535% over the past month, has been caught sharing data from its users with its clients widely, and without approval. Not surprisingly these platforms are most widely deployed in tech centers like the Bay Area, Seattle, and Salt Lake City as opposed to areas like Las Vegas , Tucson, or Miami where more jobs require close physical proximity.

The modern-day clerisy consisting of academics, media, scientists, nonprofit activists, and other members of the country’s credentialed bureaucracy also stand to benefit from the pandemic.

Off hand, I don’t agree with the second paragraph. I think that there is now an “essential/non-essential” divide, and a lot of the clerisy fall on the wrong side of it. But I am still pondering.

5. The story about the findings of lots of asymptomatic carriers at a Boston homeless shelter is being framed as scary news about the way the virus gets transmitted. Personally, I would have headlined the story “Homeless people show the way in developing herd immunity.”

6. Eran Bendavid and many co-authors write

These prevalence estimates represent a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases.

Wow. Pointer from Tyler Cowen.

If you believe that this is true, and that it holds for the country as a whole, the implications are staggering. As of today in the United States, we are at about 700,000 confirmed cases. Multiply that by a number between 50 and 85. That would make the infection fatality rate 1 in a thousand, as opposed to the expert estimate of between 10 and 20 in a thousand. It also would say that voluntary social distancing and government-imposed lockdowns came too late to stop the spread of the virus, for better or worse (probably for worse–if the death rate is so low, we should have just let it keep spreading). It would make it seem probable that the virus was in the U.S. much sooner than we now believe.

That is too much revisionism for me to adopt, based on just the one study. But I am encouraged by an apparent trend toward more studies and more pushback against relying on computer simulations.

[UPDATE: Balaji S. Srinivasan pours some cold water on the study.]

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.

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.