26 June 2020

Heather Cox Richardson and my plan to devise an "Oregon Plan" for America

If you liked Heather Cox Richardson's piece I sent around, she has a Facebook page in which she delivers folksy but scholarly and  fascinating American history lectures via live stream and also makes cogent and succinct (as well as historically informed) comments on current affairs. I can't say I listen every week, but she is interesting and engaging and makes you realize that understanding the history of how we got to this ridiculous predicament is helpful in thinking about how the hell we navigate ourselves out of it. 

Apropos, I'm thinking of writing a long open letter to "President-elect-to-be" Biden, and Schumer and Pelosi, laying out an "Oregon Plan" for a step by step approach to repairing our republic and our society. If I actually do it, I'll share it first and maybe hone it a bit, incorporating any changes and good ideas suggested by others. I don't kid myself that I, a mere retiree in a remote West Coast state with no political connections and no financial heft, have any chance at actually being influential, but sometimes ideas are "in the air," and when individuals make the effort to actually express them,it contributes to the overall process of their becoming real potential policy. 

23 June 2020

Please indulge a little rant about the COVID response


It was bad enough, as in searing blue-fire anger, when the Trump Death Cult and their administration did nothing during the long lockdown... a time which the American people sacrificed precisely so that their government could organize a real, and effective response to the Pandemic. The experts were unanimous and perfectly clear what needed to be done. We needed to stage a massive mobilization, comparable to a major World War of the 20th century, to develop tens and tens of millions of tests, administer them broadly and widely, hire an almost literal army of contact tracers, train, organize, and deploy them; and organize and deploy a massive system of isolation and quarantine of people testing positive. We knew this; epidemiologists explained all this to the government officials with the power to make it happen. And to a great extent other countries have done this, and as a result have come close to containing the virus; are able to manage outbreaks. We are not. We are on the verge of the whole thing commencing another out of control geometric increase. Here it is nearly 90 days out, and not only has our government not done what was needed, they are bragging about doing nothing, denying the truth of the pandemic, feeding their foolish followers lies and propaganda, and cutting back even on what minimal efforts were made. This is not negligence. It is not even recklessness. This is criminality, and we must not tolerate it further. We have marched for racial justice, for an end to police violence. Now it is time to demand that this do-nothing, malevolent government step the fuck aside and let others take the lead and serve the American people in their time of need. Demand that Trump resign now. We should be prepared to take to the streets to demand action. It is not enough to just vote him out of office. We need to organize and demand that there be a real response to this threat to our peoples' health, their livelihood, and the very economy these idiots claim to be trying to protect!

21 June 2020

Heather Cox Richardson : good summation of the State of Trumpworld at this very moment


This is a rather good post lifted from the Facebook page of the political historian Heather Cox Richardson. Good summation of the current state of Trumpworld. My impression is that CNN and MSNBC are floundering a little over the weekend to put together a coherent narrative. (I don't usually even watch either of them on weekends, but I get the impression the ongoing meltdown of the Trump campaign and presidency is sort of coming to a head right now). Even the Post and Times seem a little unfocused. This piece is tight and informative. 

June 20, 2020 (Saturday)
Yesterday's standoff between Attorney General William Barr and the interim U.S. Attorney for the Southern District of New York Geoffrey Berman, whom Barr was trying to fire, was only one of today's significant stories.
Last night, Barr announced Berman was "stepping down." Berman retorted he was doing nothing of the sort and that Barr had no authority to fire him. This morning, Berman showed up for work. Then Barr wrote Berman a letter saying he was "surprised and disappointed by the press statement you released last night…. Because you have declared that you have no intention of resigning, I have asked the President to remove you as of today, and he has done so." Barr gave no reason for the firing.
Because Berman was an interim U.S. Attorney, appointed by the court rather than confirmed by the Senate, it was not clear if Trump had the authority to fire him (although it was clear Barr did not). But that point became moot quickly, when Trump told reporters: "That's his department, not my department…. I'm not involved." The president's disavowal of Barr's declaration means Barr, the Attorney General, has lied in writing twice in the past two days.
And Berman had gained his point. Barr's letter said he would not replace Berman with an outside candidate—which was highly irregular—but would follow normal procedure and permit Berman's deputy, Audrey Strauss, to become acting U.S. Attorney in his place. With this win for the Southern District of New York's U.S. Attorney's office, Berman said he would leave his post. A former SDNY prosecutor said: "After all this what did they gain by getting rid of Berman? Nothing."
Berman's office has been handling a number of cases involving Trump and his allies, including one involving Trump's lawyer Rudy Giuliani and political operatives Lev Parnas and Igor Fruman, who are charged with funneling Russian money to Republican candidates for office. The three have also been involved in the attempt to smear Joe Biden's son Hunter Biden by digging up witnesses in Ukraine who are willing to testify against the Bidens, although after repeated investigations there is no evidence either Biden committed any wrongdoing.
It may be these cases, or others, that the Trump administration is eager to quash. My guess is that we have not heard the end of its attempt to stifle the SDNY, but there is yet another roadblock in their way. Senator Lindsey Graham (R-SC), chair of the Senate Judiciary Committee and usually a staunch Trump supporter, said he had not been consulted on the proposed replacement for Berman. He added that he would follow Senate tradition, and permit the Senators from New York, where the office is based, to veto the nomination if they wished. Nominee Jay Clayton has never been a prosecutor, and New York's Senators Charles Schumer and Kirsten Gillibrand, Democrats both, will almost certainly not accept his candidacy.
There was another loss for the administration today. A federal judge decided against Trump's attempt to stop the release of former National Security Advisor John Bolton's memoir of his days in the Trump administration. U.S. District Court Judge Royce Lamberth said it would be impossible to stop the distribution of the book, which has already begun to circulate.
The judge also blasted Bolton for moving ahead with publication without an official government sign-off on the book certifying that it did not reveal classified information. He warned that Bolton might face prosecution if he has exposed national security secrets in the book. Bolton's lawyer welcomed the decision and said "we respectfully take issue… with the Court's preliminary conclusion at this early stage of the case that Ambassador Bolton did not comply fully with his contractual prepublication obligation to the Government…. The full story of these events has yet to be told—but it will be."
The other big story today was, of course, Trump's rally in Tulsa, Oklahoma, designed to jumpstart his campaign and reunite him with the crowds that energize him. His campaign manager, Brad Parscale, along with the president himself, has spent days crowing that almost a million tickets had been reserved, and the campaign had built an outside stage for overflow crowds.
But far fewer than the 19,000 people Tulsa's BOK Center could hold showed up: the local fire marshal said the number was just under 6,200. Young TikTok users and fans of Korean pop music (so-called "K-Pop stans"), along with Instagram and Snapchat users, had quietly ordered tickets to prank the campaign. The technological savvy of their generation has turned political: they knew that the Trump campaign harvests information from ticket reservations, bombarding applicants with texts and requests for donations. So they set up fake accounts and phone numbers to order the tickets, then deleted the fake accounts. They also deleted their social media posts organizing the plan to keep it from the attention of the Trump campaign.
The poor turnout after such hype was deeply embarrassing for the campaign. Trump's people took down the outside stage and Trump blamed "protesters" who had kept supporters out of the venue for the small size of the rally, but there were few reports of any interactions between Trump supporters and protesters and no one was turned away.
The rally itself did not deliver the punch Trump's people had hoped. The speech was disjointed as the president rambled from one topic to another, rehashing old topics that no longer charged up the crowd, many of whom were caught on camera yawning or checking their phones. It was clear that The Lincoln Project's needling of his difficulty raising a glass to his mouth and walking down a ramp at last week's West Point graduation has gotten under Trump's skin: he spent more than ten minutes pushing back on those stories—the ramp was "like an ice skating rink," he claimed-- which, of course, only reinforced them.
Much more damning, when discussing coronavirus, he told the audience falsely that the recent spikes in infections are because there has been more testing: "When you do more testing to that extent, you are going to find more people, you will find more cases. I said to my people, 'Slow the testing down, please.'"
This is an astonishing admission. More than 120,000 Americans have died of Covid-19 so far, and while in some states hard hit early on numbers of cases are declining, cases are right now spiking in a number of other states in far higher numbers than increased testing would show. Experts agree that the administration's odd reluctance to test for coronavirus cost American lives. Within hours of his statement, it was being used in a political ad against the president.
Far from energizing Trump's 2020 campaign, the rally made Trump look like a washed-up performer who has lost his audience and become a punchline for the new kids in town. According to White House reporter Andrew Feinberg, a Trump campaign staffer told him that Biden "should have to report our costs to the [Federal Election Commission] as a contribution to his campaign."

09 June 2020

HARM REDUCTION


I can't cite chapter and verse scientifically. But (for a change) let me try to keep this brief.
1. Unlike (paradigmatically) New Zealand, and slighly less so other countries including some in Europe, the US has simply FAILED to do what is necessary to prevent the virus from roaring back when "social distancing" etc. is loosened. We can't get the time back and it's very clear we are NOT going to do the massive test, contact trace, isolate regimen that was the only option to actually suppress the virus.
2. The lockdown regime, stay home stay safe, is not sustainable. People just won't do it, so they have to be given an alternative. It's very much like "just say no" in past campaigns against teen pregnancy or drug use. Abstinence alone is not a viable option.
3. We may, just may, have gotten lucky. There may be a bit of a summer reprieve underway, at least in places where there was a lockdown in place long enough to bring the numbers way down. There are parts of the US where this is NOT happening, and short term peaks are still in the offing.
4. So what to do? If you live in an area (Oregon, even New York now, Washington, California), where the virus is somewhat controlled, given what we now know about how the virus spreads, this seems to be the best advice:
Always wear a mask when you go out in public places where you will be within 10 feet of other people.
Carry and use hand sanitizer and wash hands frequently and thoroughly, especially when outside the house.
Avoid public places where you aren't six feet apart, unless absolutely necessary, and when it is, wear a mask and don't linger in such places. Restaurants MAY be reasonably safe, if they are spread out enough and you are in a group that's only "household."
Avoid activities that involve yelling, singing, strenuous physical activity, etc. with others. This is tough, but it's really necessary. (Playing music with others is a big problem. Possibly outdoors or with maximal separation. But choral groups are screwed. There's just no way to do that safely now. )
Obviously, avoid big crowds. Malls, movie theaters, concerts... these things are best avoided for now. Sad, but I see no way around this.
A good thing. It is reasonable in harm reduction mode (that's what this is) to make pacts with a FEW friends and relatives to form extended "double" groups, but not too many. What this means is you agree to certain standards you will all follow with regard to social distancing, masks, etc., but then you will admit each other into your virtual household so you can socialize with them, with reasonable hygienic precautions, as if they were part of your own household. We all need some social contact. This is fraught. It's like high school. Are you in my "in" group, or not? But it's really the only safe way to have intimate social contact with people outside your household.
Another good thing. Apart from strenuous physical activity, outdoor recreation, maintaining physical distancing, is pretty safe. Go for walks, hikes, even swims, boating, etc. Just dont' party too close. Backyard gatherings (masks and hand sanitizer preferred) are safe if physical distance is maintained. Meet friends for dog walks, etc.
Minimize physical contact (except with actual family members). Don't hug. Don't shake hands.
This sucks. Some day there will be an effective treatment or vaccine and we can set all this aside. But as I see it, something like this modified harm reduction protocol is NECESSARY. If we want to avoid another 100,000 deaths (or more), especially in Fall, when there is nothing really in place other than peoples' behavior to prevent a recurrence of rapid spreading, we have no choice but to pretty radically change our lifestyle semi-permanently.
Thoughts? (Other than that, as usual, I didn't manage to keep it brief).

20 May 2020

Interesting Book; John Danaher: Automation and Utopia




What does the book do?
This book provides a novel and optimistic
case for the automated future. It doesn't shy
away from the recent criticisms and
challenges to technology, but it does make
the case for an intellectually respectable form
of techno-optimism.
In the process, the book undermines some
cherished beliefs in the value of work, the
fallacy of utopian thinking and the importance
of 'reality' in the well-lived life.
Who is the book for?
Anyone who cares about the impact of AI and
robotics on the future of work and human life
more generally. Anyone who wants to be
optimistic, but realistic, about the future.
Anyone who is willing to question their
current commitments and beliefs. Anyone
interested in the philosophy of technology.
What's different about it?
This book provides a rigorous and detailed
assessment of the post-work future, and
moves beyond the superficial hype one finds
in other books on this topic. It aims to
disorient the reader and open their minds to
new possibilities, using stories and concrete
examples to illustrate its key arguments.

What are the key arguments?
Automation and Utopia defends a number of
controversial and novel claims. It does so in a
way that fully engages with critical and
contrary views.
• A defence of the claim that humans are
obsolescing and that we are moving
beyond the 'anthropocene' to the
'robocene'.
• A robust, up to date, defence of the claim
that widespread technological
unemployment is possible.
• An extended argument for the claim that
work is bad and that you really should hate
your job, even if you enjoy it right now,
including a discussion of income inequality,
and the perils of platform work.
• A defence of the claim that automating
technologies pose five major threats to
human flourishing:
• They block human achievement
• They make the world more opaque and
usher in a new era of techno-
superstition.
• They distract and monopolise our
attention.
• They manipulate us, dominate us and
undermine our autonomy
• They turn us into moral patients (i.e.
passive recipients of well-being, not
active agents of change)
• A defence of the claim that humanity should
organize itself around largescale utopian
projects.
• A detailed and extended defence of the
claim that we should become cyborgs (i.e.
fuse ourselves with machines and become
more machinelike)
• An equally extensive discussion of the
limitations of the 'cyborg' ideal.
• A detailed and extended defence of the
claim that we should 'retreat from reality'
and prefer to live in virtual worlds.
• A defence of the claim that much of what
we currently think of as 'reality' is in fact
'virtual' and that what we currently call
'virtual' is in fact 'real'.

John Danaher is a Senior
Lecturer in Law at NUI
Galway, Ireland, and the
coeditor of Robot Sex:
Social and Ethical
Implications. He has
published over fifty papers
on topics including the
risks of advanced AI, the
ethics of social robotics,
meaning of life and the
future of work, and the ethics of human
enhancement, His work has appeared in
The Guardian, The Irish Times, The Sunday
Times, Aeon, and The Philosophers'
Magazine. He is the author of the popular
blog Philosophical Disquisitions.

What are the key arguments?
Automation and Utopia defends a number of
controversial and novel claims. It does so in a
way that fully engages with critical and
contrary views.
. A defence of the claim that humans are
obsolescing and that we are moving
beyond the 'anthropocene' to the
'robocene'.
. A robust, up to date, defence of the claim
that widespread technological
unemployment is possible.
. An extended argument for the claim that
work is bad and that you really should hate
your job, even if you enjoy it right now,
including a discussion of income inequality,
and the perils of platform work.
. A defence of the claim that automating
technologies pose five major threats to
human flourishing:

. They block human achievement
. They make the world more opaque and
usher in a new era of techno-
superstition.
- They distract and monopolise our
attention.
. They manipulate us, dominate us and
undermine our autonomy
. They turn us into moral patients (i.e.
passive recipients of well-being, not
active agents of change)

. A defence of the claim that humanity should
organize itself around largescale utopian
projects.
A detailed and extended defence of the
claim that we should become cyborgs (i.e.
fuse ourselves with machines and become
more machinelike)
. An equally extensive discussion of the
limitations of the 'cyborg' ideal.
. A detailed and extended defence of the
claim that we should 'retreat from reality'
and prefer to live in virtual worlds.
. A defence of the claim that much of what
we currently think of as 'reality' is in fact
'virtual' and that what we currently call
'virtual' is in fact 'real'.

What does the book do?
This book provides a novel and optimistic
case for the automated future. It doesn't shy
away from the recent criticisms and
challenges to technology, but it does make
the case for an intellectually respectable form
of techno-optimism.
In the process, the book undermines some
cherished beliefs in the value of work, the
fallacy of utopian thinking and the importance
of 'reality' in the well-lived life.

Who is the book for?
Anyone who cares about the impact of Al and
robotics on the future of work and human life
more generally. Anyone who wants to be
optimistic, but realistic, about the future.
Anyone who is willing to question their
current commitments and beliefs. Anyone
interested in the philosophy of technology.

What's different about it?
This book provides a rigorous and detailed
assessment of the post-work future, and
moves beyond the superficial hype one finds
in other books on this topic. It aims to
disorient the reader and open their minds to
new possibilities, using stories and concrete
examples to illustrate its key arguments.

John Danaher is a Senior
Lecturer in Law at NUl
Galway, Ireland, and the
coeditor of Robot Sex:
Social and Ethical
Implications. He has
published over fifty papers
on topics including the
risks of advanced Al, the
ethics of social robotics,
meaning of life and the
future of work, and the ethics of human
enhancement, His work has appeared in
The Guardian, The Irish Times, The Sunday
Times, Aeon, and The Philosophers'
Magazine. He is the author of the popular
blog Philosophical Disquisitions.
 

From the LA Times on "socially distant" socializing

I'm not necessarily endorsing all the conclusions of this piece, but pass it on for information. My personal take is that when you have the new case rate down in the less-than-3 a day area, as Oregon now does, a little relaxation of the isolation regimes is justifiable on a "quantification of risk" basis. Sensible distancing, selectivity, small groups, outdoors, hygiene, etc., but not total isolation from everyone. There are, after all, mental health factors to be considered too. 

 

08 May 2020

Blame enough

• Trump did not conjure up this pandemic in the Oval Office. But he IS to blame. He wasted months doing nothing despite all kinds of intelligence warnings, and even since we began sheltering in place, IN ORDER to give the government time to devise and execute a strategy to actually suppress this virus, he and his government have done, effectively, NOTHING. Our economy COULD be on the road to recovery, had they mobilized a smart response. But no, they care nothing for the people, only for themselves, and they lack imagination. Completely. They lack courage and determination. Completely. They have fucked this thing up. Completely. And they, and he, refuse to accept any responsibility. Completely. But guess what, DON? WE BLAME YOU. And we are going to throw you out on your ass.

21 April 2020

George Packer: We are living in a Failed State (Atlantic)

George Packer in the current Atlantic. Here.

"The crisis demanded a response that was swift, rational, and collective. The United States reacted instead like Pakistan or Belarus—like a country with shoddy infrastructure and a dysfunctional government whose leaders were too corrupt or stupid to head off mass suffering."

I would change "or" to "and," as there is no doubt on either score. 

--
••  

20 April 2020

Pulse oximeter

See this. Might want to consider investing $50 or so in a pulse oximeter. Available in drugstores or on Amazon. 

 

--
•• 
 

Strategic Stockpile of Oil Now

With oil below $5/bbl,* there is no way that fracking can be profitable. I am of a pragmatic frame of mind, despite my idealistic/social democratic politics, if you choose to believe those are not pragmatic (they actually are, but never mind). The US should restock its oil reserves by buying oil, not for release to the market for use, but for greatly ramped up underground storage. And NOT for future use as fuel. We must, simply must, when this pandemic is over, switch to a major crisis-mode conversion of our industrial and transportation economies, and eventually every aspect of our economy, to renewable energy sources. One of the consequences of that will be that oil exploration and development, which is inherently more expensive than in the past, will become completely unprofitable. Oil companies that have failed to diversify sufficiently will fail. But more to the point, oil production will virtually cease, sometime before 2050. And that's mostly a good thing. But oil is not only a fuel, and in the future will not be a fuel at all. But it WILL be a strategic, critical MATERIAL. For plastics, pharmaceuticals, advanced chemistry. A steady, small compared to today but hardly negligible, supply of oil into the medium-long-term future will be crucial. And here is our opportunity to ensure that supply for generations at the lowest price that will likely EVER be seen for oil again.  

-*Had to correct the above ½ hour after writing it, because oil dropped from below $10/bbl to below FIVE dollars! 

 
 

18 April 2020

Lessons to Learn

There are two very broad takeaways that it seems to me we as a society must learn from this pandemic. In addition to a whole host of other things that I hope it motivates us to reform. But here are the two that it seems to me we need to be talking about NOW, including in the context of this year's presidential and Congressional elections.

1. We have spent trillions and vast human effort and lives countering the HUMAN threat. Defense and counterterrorism. Some of this, such as aircraft carriers and far more ballistic missiles than could ever be used in any imaginable survivable conflict, are obsolescent and of dubious worth. But we balk at spending a few hundred million dollars at really being prepared for microbial attacks. Read the article on Tony Fauci in the New Yorker. We could probably develop a universal flu vaccine, that would work against any flu virus. It would cost more than we've ever spent on a vaccine. But, seriously? Consider what really matters to people. There is promising research that could even lead to a molecular understanding of viruses that might lead to almost Star Trek like responsiveness. A viral platform vaccine that you just tag in the specific genome and you have an effective vaccine within days, with the basic safety already pretested. And on the diplomatic front, we could do far more to make sure that pathogens are not free to pass from animals to humans. The Chinese should face sanctions, for example, if they don't eliminate wet markets once and for all. To sum it up, FAR MORE effort on public health security is the takeaway.

2. The need for universal health care and systematic and universal preparedness to deal with threats to human health. If there is nothing we learn from this pandemic else from this, let it be that the time has come to recognize robust, high standard health care as a right of all citizens and a global goal for all of humanity.

I will have more bloviation on "learning lessons from this" later (fair warning, but anyone not of a mind to think about these things won't read this far anyway LOL).

--  

16 April 2020

looney toon

Before any of our time. (1930)


--
••          Дэвид Студхальтер 
Vote like the future depends on it. 
Because it does. 
Vote Blue 2020. 

14 April 2020

Helping out in Wisconsin

My vote here in Oregon isn't going to have any effect on the presidential election, so I sent a contribution to Wisdems.org to help them make sure every Wisconsin Democrat has an absentee ballot and knows how to vote in November. Instead.  

--
••          
Vote like the future depends on it. 
Because it does. 
Vote Blue 2020. 

Response to an objection to the point that even imperfect testing/tracing/isolation is likely our optimal strategy

I looked at the Romer argument and find an important flaw/omission in it and your argument: a certain percentage of those false negatives will go out into the community with impunity due to their clean diagnosis, and be in contact with exponentially more people each day thereafter.  As far as I see from your link, Romer's model is mired in math and doesn't account for the reality of human behaviour.  A very serious flaw.

Please link me to a place where he does address this, and I will review his argument and my opinion, as we all should be willing to do in the face of reasoned argument. 

I got the above comment as a response to my posting or Paul Romer's (https://paulromer.net/ ) analysis purporting to show that even imperfect massive scale testing, contact tracing, and isolation of positives is a better course of action than alternatives. Below is my attempt at a response. 

First, I make no claim to be a statistical economist, demographer or epidemiologist, although all of us are delving into these areas more than ever before because they've suddenly become important to the continuity of our everyday lives. I did a quick look and couldn't find exactly what was asked for, which if I understand it, is a piece by Romer in which he specifically addresses what is described as a flaw or omission in his argument. Folks might want to look at this (1), which gives some more detail to the thought process behind the somewhat more general argument that testing, even less than perfect testing, combined with contact tracing and quarantine of positives, can achieve the same or better results than more general (but necessarily, because of the same "human behavior" cited, less rigorous) "social distancing," and, indeed, when applied to the majority of the population, is much more effective. 

I have to say dismissing an argument because it is "mired in math" is not particularly constructive. Economics, finance, demographics, and epidemiology (as well as climate science and other areas where direct measurement and analysis is effectively impossible and modeling is the only option)... all depend on mathematical modeling of aggregate human behavior. It's almost a truism that on an individual level human behavior is chaotic and unpredictable, but on a population level it can often be quite accurately described using statistical models and data

But the more fundamental objection, if I understand it correctly, is one that needs to be addressed or at least clarified. We're all in this together, as has become the watchword of this time, so we do need to work on a common understanding of the problem and how best to deal with it. I think part of the immediate problem is that we're starting in the middle, by asserting a response to an earlier objection to the basic argument for massive scale testing/tracing/isolation. And then the response is a response to the response. Let's try starting at the beginning, and I think I see where what is being objected objecting to drops out as something that actually is included in the original argument. If anyone still doesn't think so, I'm happy to try to understand better what they're objecting to and work towards a better understanding of the whole problem. 

The original premise is that it is not good enough to accept the status quo of generalized "social distancing," which is largely the result of inadequate built capacity for scaling up testing for this thing. We just didn't anticipate this need, and prepare for it, and we have been caught flat footed. The advocacy is for major mobilization of public resources to quickly create new and greatly upscaled testing capacity so that a large percentage of the population can be tested (both serum antibody tests, to find people exposed and either recovered or otherwise no longer positive and possibly immune; and for active viral infection). This would be enormously expensive and require "command economy" action on the part of government, which the Federal government under Trump is clearly unwilling to do. Included in the regime would be massively upscaled capacity to do contact tracing and provide for effective quarantine of people who are positive and incubating the virus or mildly ill. (The seriously ill, of course, have to be treated in hospitals). 

The rationale for doing this has been explained in a number of places, which I've cited to on Facebook several times. See this (2) for a relatively mainstream version of this idea. Even Joe Biden just yesterday set forth a version of it; Tony Fauci has talked about it; indeed it's become a consensus view, which has, to some extent, already been effectively put in place in other countries. Most notably Iceland, which, with only 300,000 people, can accomplish this more easily, but can still serve as a test of concept. By having much more information about who is infected, and who is potentially exposed but immune (serum testing), and doing the usual epidemiologic response of contact tracing and isolation, it should be possible, from the inexorable math of herd immunity, to drive the presence of the virus in the community to very low levels. Subsequent outbreaks could then be dealt with using tried and true response techniques (which were blown through in the case of this virus early on). It should be emphasized that this kind of process is envisioned for AFTER the current social distancing regime has already succeeded in bringing down the rate of new infections to very low levels. But we need to prepare for that next phase NOW, because a great deal of work and development will be needed for it to work. And time is being wasted and we are NOT doing this. 

The core argument is that this kind of approach is likely the only way to achieve a sufficient reduction in the risk of infection at some time before effective antivirals and/or vaccines become available for anything like a return to normal social and economic activity. Probably not including large crowds or close contact such as lines in amusement parks, but people will, the thought goes, be able for the most part to go to work, and with some sensible physical distancing, go to restaurants, shop, meet with friends, etc. The current regime will likely lead to a short term reduction to low levels of new cases, but the belief is that if the physical distancing is then relaxed, in the absence of a strict testing/contact tracing/isolation regime, it is the nature of epidemics that it will likely break out again, and there will be little public health infrastructure in place to prevent it from spreading almost as fast and wide as it did the first time. But WITH adequate massive scale testing/tracing/isolation, outbreaks can be quickly quelled and the epidemic can be brought to some kind of control, even before there is effective treatment or a vaccine. The modeling in these scenarios shows that the overall cumulative infection numbers, deaths, and economic impact, will all be lower, and that, even taking the huge costs and effort involved in mobilizing this kind of response, which greatly exceeds the ability of current laboratory and manufacturing facilities to scale up and would therefore require major public health infrastructure mobilization, the medium term cost both in terms of public health outcomes and economic impact would be more than worth it. Unfortunately, this understanding has not penetrated the minds of the people in charge of Federal policy to date. 

So far so good, but then there is the objection that Romer was addressing, which is that what if the scaled up testing is unreliable to some degree? The short analysis I linked to was his attempt to show, through statistical analysis, that even with some (not huge, but some) degree of inaccuracy in the testing, the course of action (testing/tracing/isolation) is STILL the best available option, because all the other options result in WORSE outcomes, again, both in terms of public health and in terms of economic impact overall. Of course, there are limits. If the testing is so inaccurate that the average rate of spread R0 ("R-naught") is not brought below 1, which is the threshold for herd immunity, then it will not work. In case this isn't clear, if on average each infected person infects 3 people, which is about what this virus is without any measures to prevent spread, then it quickly envelopes the entire population and spreads uncontrollably until a large percentage of the entire world population is infected. Epidemics in those cases only die down when natural immunity of recovered people reaches a certain level, and the R0 drops below one. Once the rate of infection drops to less than one additional person for each newly infected person, whether through public health intervention or just through natural immunity, the epidemic will quite rapidly disappear. This is not intuitively obvious to everyone, but it is mathematically demonstrable and backed up by historical experience of literally hundreds of past epidemics. (Sorry if this is all pretty basic, but I'm trying to be as comprehensive as I can in case anyone reading this is unfamiliar with this concept). 

We could achieve this R0<1 by social distancing alone, with no or insufficient information from testing, but there is every reason to believe that if we tried to ease up on this social distancing without effective treatments or vaccines, the epidemic would break out again and we'd have not much better ability to control it than we did in the first place. And grossly incorrect testing obviously would have the same result, since as is noted, the people who test false negative will then be the same as untested positives without the testing regime. But testing which is above a certain threshold of accuracy will achieve the desired effect, just not quite as efficiently as a "perfect test." Obviously, perfect testing is better, better accuracy is better than worse accuracy, but what is possible and optimal will fall somewhere short of perfection. This is also true of vaccination and treatment options: no treatment or vaccine is 100% effective, nor do they reach 100% of the population, but by getting most of the way there, you can get the R0 under one and the epidemic will fairly rapidly disappear. In some cases, even without anywhere near 100% penetration, pathogens actually become extinct, but not usually in cases where there are nonhuman hosts, which is unfortunately the case with this virus, in all probability. 

So, to the point. Let me restate it verbatim: "a certain percentage of those false negatives will go out into the community with impunity due to their clean diagnosis, and be in contact with exponentially more people each day thereafter." I believe that the reason this is not a serious flaw in the argument is that it just isn't true; the keys being "certain percentage" and "exponentially." If, say, there is a 15% false negative rate, those people will encounter a population which is not "virgin," but is, to whatever extent of penetration, already itself subject to testing and isolation of positives. So, in other words, the false negatives are a drag on the process of limiting the overall rate of infection, but they do not, beyond a certain threshold, completely derail that process. They do NOT spread infection exponentially, because the people they infect are themselves getting tested, and if positive, being isolated or treated. The testing does not occur all at once and one time only, but is a regime, in place over time, and continuing until the disease is completely controlled, either because of natural decline or due to treatment or vaccines. Just as herd immunity does not require 100% penetration to be effective, neither does the accuracy of the testing have to be 100% to achieve the reduction of the spreading rate R0 to less than one. R0, in other words, doesn't have to be 0, it just has to be less than one, for the epidemic to begin to disappear. And it does disappear. If one person infects two people, and they each infect two (=4), it isn't long before you have millions infected. But by the same token, if ten people infect 7, who infect 3.5, who infect 1.75, etc., it is surprisingly rapid for the epidemic to simply wink out (because people eventually recover or die, so the number of active infections begins to decline, slowly, then rapidly). We are nowhere near that point yet, but it is possible, and this kind of regime appears to be the fastest, most reliable, and most cost effective way to achieve this goal, short of treatments and vaccines. It would be VERY costly, but the alternatives, versions of what we're doing now or doing nothing, would be far MORE costly. 

I hope this makes sense. The factor of reinfection by false negatives actually IS included in the kind of analysis Prof. Romer was referring to, but that is not perhaps as clear as it could be. 


13 April 2020

Bad tests worse than no tests? No, actually, probably not.


• In response to a comment that inaccurate testing could be worse than no testing, I came up with the following as a response.

Well, yes, to some extent, but as Paul Romer has argued (https://paulromer.net/), this is not a black and white issue. Even tests with some degree of systematic inaccuracy, while potentially pretty bad for an individual affected, can be almost as useful as non-existent "perfect" testing in getting the critical infection rate factor R0 ("R-naught") down to ~1 or below. Think of it this way. Unchecked, an infected person will infect about 2.5 others (R0 ~ 2.5). If even somewhat flawed (say 90% accurate) testing, with follow up contact tracing and isolation of positives and close contacts of positives, were aggressively pursued, it should be possible to get the real R0 down to something like 0.7, meaning each person on average infects less than one person; 10 infections lead to 7 new infections. That process leads to complete eradication of the epidemic, fairly quickly, even though that may seem counterintuitive. So, in other words, yes, of course, they need to strive for the most accurate testing possible, but even a moderately flawed testing regime could be effective in eliminating the virus from the population. Whereas our current inadequate, in fact nearly nonexistent, regime CERTAINLY will not. As things are now the ONLY things that will end the epidemic are 1) it burns through the population, killing 2 million or possibly many more people, and disappears on its own in a year or two; 2) we develop effective antivirals or vaccines, and maintain social isolation... again for a year or two. We could have some unsatisfactory in between, which would be less bad but still really bad and would still last well over a year, or we can mobilize and do the necessary millions of tests, contact tracing, and isolation, and actually suppress this thing in a few months. Seems to me there is no real basis to argue for any other course of action

12 April 2020

New post by Jakub Józef Orliński

 It's not so often, anymore, that music brings tears to my eyes on first hearing. But this did. Just posted April 10. 


Jakub Józef Orliński - Countertenor
 
A.Vivaldi „Eja Mater" - Jakub Józef Orliński & Aleksander Dębicz

11 April 2020

Life in the time of Corona Virus: Even less than perfect testing can be effective, but ONLY if massively deployed... and we are not doing that

Please read this to help understand why a full-on wartimelike mobilization to develop and deploy MILLIONS of tests and follow up contact tracing and isolation of positives is the ONLY WAY we will be able to return to a semblance of normality short of a vaccine or effective antiviral treatment. It's all about getting R0 under 1, so that the virus can be contained if it breaks out. This really only takes place AFTER we get this initial wave under control, but if we're not ready to go at that point with testing on a massive scale, the epidemic will just come roaring back. (And early indications are that, like other coronaviruses, this one is NOT seasonal, and can return even in Summer).

Sadly, our Federal government is simply not doing what needs to be done to control this epidemic. They failed to take any useful action in January (even the so called travel ban with China was entirely ineffective). They wasted February. They wasted March, doing virtually nothing other than cooperating with states that imposed stay at home orders and actually interfering with the efficient control of supplies of critical medical equipment, making the situation worse not better. Now they seem to be wasting April, talking about totally infeasible early ending of social isolation procedures, which if implemented will only cause the epidemic to roar back.

Massive testing, contact tracing, and isolation of positives is the ONLY way to suppress the epidemic enough to allow any return to relatively normal activity.


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••          
Vote like the future depends on it. 
Because it does. 

10 April 2020

Wa Po: National Coronavirus Plan emerging... no thanks to Trump

Focusing on the positive: this emerging plan has all the essentials necessary to actually get control of this thing: massive testing enterprise; contact tracing of positives; isolation of positives.
«  [A] collection of governors, former government officials, disease specialists and nonprofits are pursuing a strategy that relies on the three pillars of disease control: ramp up testing to identify people who are infected. Find everyone they interact with by deploying contact tracing on a scale America has never attempted before. And focus restrictions more narrowly on the infected and their contacts so the rest of society doesn't have to stay in permanent lockdown. »

Focusing on the negative: it shows up in stark relief the utter and complete incompetence and lack of leadership on the part of Trump and the Trump administration.

Big surprise.


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••          
Vote like the future depends on it. 
Because it does. 
Vote Blue 2020. 

08 April 2020

Daily Testing Rant.

This piece underscores the need for a truly massive enterprise to not only get the number of new cases and deaths down to as low as possible using physical isolation, but to test nearly everyone (both serum and swab to find active cases, asymptomatic carriers, and those who have antibodies and may be immune), and to quarantine and contact trace everyone who tests positive or had close contact with someone who tests positive. This is the ONLY WAY we can get control of this thing short of effective antivirals or vaccines. Which WE CANNOT AFFORD TO WAIT FOR.

We must demand full mobilization to get this done with the fierce urgency that it warrants.

•••

07 April 2020

Testing / Contact Tracing / Quarantine of Positives... the ONLY WAY (again)

Rajiv Shah (MD), the head of the Rockefeller Foundation, was excellent on Chris Hayes today, explaining EXACTLY what I've been saying. "We need a huge massive enterprise to expand testing around the world"... the only "pathway out" of our current economic and public health predicament. Testing both serum and diagnostic, contact tracing, and isolation of people testing positive is the ONLY way to actually succeed in suppressing the epidemic short of effective antivirals and/or vaccines. The sooner people understand this and start DEMANDING that our government mobilize whatever resources are necessary to get this done, the sooner life can return to some semblance of normal. The fact that it is also the only way to minimize more death and suffering should be reason enough.   

TEST, CONTACT TRACE, QUARANTINE EVERYONE TESTING POSITIVE.

TEST, CONTACT TRACE, QUARANTINE EVERYONE TESTING POSITIVE. RINSE. REPEAT.

Iceland only has a third of a million people, so it's easier for them, but this is what EVERY country, including ours, needs to do if there is going to be ANY chance of returning to relatively normal economic and social conditions before the development of reliable antiviral treatments and/or vaccines. (Which could be more than a year from now).


••• 尚大文
My daily rant on the subject of testing.

06 April 2020

testing as an absolute imperative

I feel I have to say this EVERY day until something happens. The key to getting through this to anything like a normal state, with a normal economy, is TESTING TESTING TESTING. Test everyone insofar as possible. Develop and deploy both swab (current infection) and serum (presence of antibody) tests designed to give instant results and cost very little. Deploy, deploy, deploy. Equivalent to wartime necessity. I see NO SIGN the idiots in charge of our country get this. But if we want to return to anything like a normal economy before effective antirvirals or vaccines are available (up to 18 months and no guarantee), this is the ONLY way. Testing, contact tracing, isolation of positives. There is no other way.

The vital importance of testing

I don't know why it's so difficult for people to understand the importance of cheap, nearly universal, and reliable testing, both diagnostic and serology (antibody testing to determine if the person has been exposed and either recovered or remained asymptomatic. Even this article doesn't really lay it out clearly. Which is as follows. We will NOT be able to "return to normal" until we are easily and reliably able to determine who is and who is not infectious. Even after a "die down" following a peak, as modeled by IHME {here} ... without testing and immediate quarantine of people who test positive, we will have repeated waves of infection, at least until an effective antiviral treatment or vaccine becomes available, which could easily be more than a year from now. Estimates are that up to 97% of the population will REMAIN susceptible to the virus after the initial peaks and die downs the model anticipates. This strongly suggests that repeated outbreaks, more strain on medical facilities, and more deaths, can be expected. Testing and contact tracing, such as was done effectively in S. Korea and even to a great extent in Japan, could ameliorate these developments, and the antibody tests could provide us with a pool of people who have some or even robust immunity. Such people could help greatly in future handling of outbreaks. This is not opinion. It is fact based analysis.

Yet our miserable excuse for a Federal disaster response has STILL not successfully ramped up testing.

We should call on wealthy philanthropists, like the Waltons, Bill Gates, Warren Buffett, the remaining Koch brother; the Sackler gang (responsible for the Oxycontin epidemic), to step in and fill the breach. Fund and coordinate a massive research and development project to make tens of millions of tests available ASAP.

It is their PATRIOTIC duty.


05 April 2020

IHME model projections


While this information indicates that WITH continued physical distancing, which means closure of nonessential businesses and schools, etc. for several more MONTHS, many parts of the country, including the West Coast, will avoid serious overtaxing of the medical care system. But for there to be any kind of return to normal life, it is clear, we will ABSOLUTELY HAVE TO start testing nearly everyone, and isolate people who are positive. Otherwise, we can fully expect the epidemic to come roaring back in successive waves. At some point, we hope, there will be effective antiviral treatments and/or vaccines, but until then, massive testing and isolation of positives is the only possible way to stave off complete disaster.

 
 

Where the hell is mobilization? Airlifts?

 We have the world's largest military. With tremendous logistical capability, including the ability to construct giant field hospitals anywhere and even staff them. Why in HELL aren't they airlifting critical patients to wherever there is room for them, and constructing giant temporary hospitals to which patients who can't be cared for in peak outbreak areas can be airlifted on short notice? Why? One word: Trump. This narcissistic sociopath hasn't done a damn thing. And Americans of all walks of life are dying. If the American people reelect this monster the only possible explanation can be mass hysteria on a historically unprecedented scale, because ANYONE with half a brain can see this is the most malignantly incompetent handling of a major crisis in American history.

03 April 2020

What then must we do, RIGHT NOW, goddamnit

Look up Rachel Maddow's opening segment today on MSNBC. She got it 100% right, including "it's too late, but we can't just do nothing. Yesterday would've been better than today, but today is better than tomorrow." 

Wartime Strategic Materials

Our federal government is failing miserably at handling the emergency. There are so many aspects to this that one could literally go on and on about it page after page. But here's one aspect of it I haven't seen discussed. I'm surprised, frankly, something like this idea hasn't already been done.

PPE, medical equipment, certain staples and basic supplies even including things like paper towels and toilet paper, should be declared by Congress to be pandemic emergency strategic commodities. Supply lines and prices should be regulated on a wartime schedule. Fair markup to compensate manufacturers, distributors and retailers at a standard rate. All profiteering treated as a serious felony, with fines minimum $10,000 up to 1000x the retail price of the product being trafficked.

We need to start thinking of this as a war. Because it is. And in wartime, trafficking in strategic materials is very close to treason.