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.

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.

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.   



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.