Jack

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Faeroe Islands is the first place with over 100 cases to completely eradicate Covid-19.

Iceland had over 1800 cases, and is still a few weeks away from being Covid-19 free.

There are 237 Airbus A380s in the fleets of the world’s airlines. The biggest passenger jets ever, which can carry more people than any plane, have been a staple of long-haul travel since the late 2000s. But not anymore.

Now they are all grounded, rendered useless by the precipitous drop in travel demand this year due to the coronavirus crisis. The sight of huge double-deckers parked in the desert, dwarfing smaller planes and just as unable to fly profitably, is a perfect visual summation of the airline industry’s current troubles.

An Australian photographer captured poignant sunset images of Singapore Airlines A380s awaiting better days in Alice Springs, and posted them on Facebook.

The world’s A380s are all parked for storage — except five, all belonging to China Southern Airlines, the largest airline in Asia.

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According to flight-tracking sites, China Southern is still sending A380s to Europe, North America and Australia, on regularly scheduled flights. Since China is barring foreigners from entering the country and leisure travel worldwide has essentially stopped, those A380s may be filled with cargo more than passengers. After all, using passenger jets as freighters is one way that airlines try to make money these days, as revenue has dried up.

That’s a somewhat ironic development, since China Southern is not — unlike, say, Emirates — a happy A380 customer, and even before the crisis was finding it hard to turn a profit on its A380 flights. “The A380’s large size makes it challenging to profitably fill,” an aviation analyst told the South China Morning Post in 2015.  “At Emirates you have different economics since you have A380s feeding A380s for transfer traffic – that brings scale.”

In fact, when we sent our reviews intern to fly a China Southern A380 from Guangzhou to Los Angeles last year, he had the first-class cabin almost entirely to himself.

That Los Angeles route is one of the few where China Southern is using the double-decker giant. It also appears sporadically on flights from the airline’s Guangzhou home base to Amsterdam, Vancouver, Sydney and London. That’s a bizarre choice of destinations; China Southern has smaller long-haul aircraft that could cover these routes losing less money than a likely empty A380. Even if used as a cargo carrier, the A380 — built to maximize space for passengers, not freight — can haul less stuff in its cargo holds than a smaller Boeing 777.

But it does have a vast passenger cabin — the biggest around. That could come in handy when carrying boxes that do not need to go in the holds and can simply be fastened to seats, which is often the case with boxes containing masks and other protective equipment shipped from China.

A map from flight-tracking site Flightradar24 showed that on Friday morning, two China Southern flights were the only A380s airborne in the entire world. One was over Russia on the way home from Amsterdam; the other over the Philippines, headed to Australia.

 

The A380, for all its wonders like onboard showers and bars, has not been a commercial success, and Airbus has decided to stop making it this year. There will be no more sold to airlines, and certainly not in China, where the big three carriers — Air China, China Eastern and China Southern itself — all went from making a profit to losing lots of money due to the traffic slump. China was never a big market for the A380, despite Airbus’ efforts to sell there. China Southern was the only customer to bite, and even then it bought just five.

And yet, today a country where the flagship product of Europe’s aircraft industry never made a splash is the only one where it is still flying. It’s another bizarre, unforeseen consequence of the pandemic that has turned so much of the world on its head.

Featured image: A China Southern A380 lands at LAX in April 2016. Photo by Alberto Riva / The Points Guy 

Today many Americans who have never needed help to feed their families are turning to charity as they struggle with the fallout from the coronavirus pandemic.

To better understand this crisis, I contacted a dozen different hunger-relief organizations that are scrambling to meet the sudden increase in demand. The level of need and vulnerability that their staffers described was alarming. These organizations’ resourcefulness under current circumstances is impressive. If nothing changes, though, they’ll run out of food and money. Government officials could help tremendously by making it easier for people to qualify for food stamps, even beyond recent emergency reforms, but public-assistance programs are often designed to limit enrollment rather than to guarantee nutrition to everyone thrown out of work during a global pandemic.

[Read: Who will run the soup kitchens?]

In San Diego County, the fifth most populous in the country, the nonprofit Feeding San Diego reports that demand at its 300 distribution sites is up at least 40 to 50 percent. “People who four weeks ago were living middle-class lives now find themselves in debt, without cash, unable to pay for their most essential needs,” Vince Hall, the group’s CEO, told me. The organization’s online “food finder” tool experienced such a big surge in traffic that its web-hosting provider levied a bandwidth penalty.

Meeting San Diego’s rise in demand has required adaptability. Normally, “rescued” food—items that would otherwise be thrown out as their sell-by date approaches—accounts for 97 percent of Feeding San Diego’s distributions. Until the pandemic, the group was receiving unpurchased food from 204 Starbucks locations every night of the year. Most of those stores are now closed. The organization normally gets excess food from 260 grocery stores too, but consumers have been stocking up enough lately that many shelves are picked clean.

In the first weeks of this crisis, the lack of food from these sources was offset by restaurants, hotels, and catering firms that donated their inventories as the shutdown began. But that was a onetime windfall—and some of it was food packaged in industrial sizes that work well in large commercial kitchens but poorly for parceling out to families. To compensate for the dearth of rescued food, Feeding San Diego is now purchasing wholesale in the same system where grocery stores themselves are accelerating orders. Food banks are also having to pay premium prices. The day we spoke, Hall authorized a $97,000 purchase of chicken and pork.

Facing Hunger Foodbank in West Virginia used to serve about 129,000 people on a typical day. Its executive director, Cynthia D. Kirkhart, witnessed the same sharp rise in demand after her state issued its stay-at-home order. Then the retail donations that the food bank receives from partners such as Walmart and Kroger shrank by roughly 90 percent, and delivery times for purchased food grew from a week to eight or 10 weeks. “Between March 30 and April 8, I placed orders in excess of $487,000 for food, and some of it won’t be arriving until late June, but at least I’ll have a regular influx coming in,” she told me. “My total budget for this year was about $500,000. My reworked budget is going to look more like $1.2 million to $1.5 million, and that’s with an optimistic outlook for what happens with this pandemic and how long we are in recovery.”

Kirkhart could swing that purchase because of reserves built up through frugality and fundraising. Big Sandy Superstore, a furniture retailer, has urged its customers to donate $50 to Facing Hunger to feed a family for a week. On Easter, the Dutch Miller Auto Group sponsored three church services on a local TV station and ran ads during breaks urging food-bank donations. “In an hour, there were 53 new donors,” she said. When food is donated directly, the logistics of sorting and distributing it are not simple, and Kirkhart’s group encourages people to give money when possible. The food bank can give out 7.5 meals per dollar, she said. “I can make $50 become magical with economies of scale.”

In Ventura County, California, the organization Food Share had been distributing 1 million pounds of food each month before the pandemic. That figure is now doubling. The Air National Guard is helping it to pack up boxes for drive-through pickup events. Its supply took a hit when the availability of food to rescue fell significantly. But California’s unusually large local agriculture industry makes securing fresh produce easier than in most American communities. “The abundance of surplus produce we’re seeing across the country is particularly concentrated in Ventura County, because we produce enough to feed a global market,” Food Share stated in a release. “We are distributing fresh produce with each pop-up distribution but at this time we do not have the resources or facilities to receive and distribute everything that is offered to us.”

[Read: Why the coronavirus is so confusing]

Alaska faces different circumstances. Headquartered in Anchorage, the Food Bank of Alaska is dealing with about 75 percent more demand than usual—in a state whose spread-out geography makes collection and distribution a particular challenge. Most food must be imported from elsewhere. And once that feat is accomplished, getting that food out to far-flung rural communities and into the hands of the needy involves a complex distribution channel. “Recently a prominent air carrier, RavnAir, declared bankruptcy and ceased operations. So there’s concern from smaller communities about how they’re going to get goods,” Cara Durr, the organization’s director of public engagement, told me. “Other airlines have stepped up to fill some gaps, but there’s not a lot of wiggle room in these systems.”

Getting food to needy children is harder than before with public schools shut down. The Food Bank of Alaska typically runs a summer program for kids too, but many of the organizations that help it pass food out haven’t yet signed on this year due to uncertainty about running a distribution site in a pandemic.

What would make feeding needy Alaskans easier?

When the federal government began giving out unemployment benefits of $600 a week beyond what states normally offer, many families got a necessary lifeline, but also found themselves exceeding the income eligibility requirements for the Supplemental Nutrition Assistance Program, the federal program formerly—and still colloquially—known as food stamps. Those people will need to reapply for SNAP when the unemployment benefits run out, Durr said.

Alaska is one of the states that doesn’t yet allow residents to sign up for SNAP online. Applications require a paper signature, despite the significant difficulties involved in travel to and from most rural communities. A recent waiver will allow the Food Bank of Alaska to use telephonic signatures once a system for them is set up. But administrative burden would be reduced if people kicked off of SNAP because of a brief spike in income didn’t need to reapply just weeks later.

[Photos: The volunteers]

The diverging circumstances in different regions underscore the importance of local knowledge in meeting the challenges ahead. But food-bank staffers in every area agreed that getting nutrition to people who need it is complicated by regulations meant to prevent people from abusing SNAP—some of them added as recently as last year. The Families First Coronavirus Response Act gave states permission to modify some needlessly onerous eligibility restrictions and procedures, but not all states have taken full advantage of that new flexibility, and hunger-relief advocates have called for additional reforms, such as expanding the ability to order food online.

More generous food-stamp benefits would help too. “We must provide more food assistance as more families struggle financially and our food banks strain to help,” the Representative Mike Doyle, a Democrat from Pennsylvania, wrote on Twitter, acknowledging that the strain on food banks will be reduced once families can meet more of their food needs using EBT cards to make purchases online and at supermarkets.

Especially in the months ahead, when social distancing will prevent many from returning to work and even mild unrest could prove hugely damaging to the country, the United States would be better off focusing on getting food to people who need it rather than keeping it from those who don’t.

“This is a moment of incredible anxiety and fear in our communities, and the health crisis is the primary fear everyone has. But the economic crisis is equally terrifying to people, and they are despondent over the lack of a path forward,” Hall, of Feeding San Diego, told me. “They don’t understand how long we are going to be in this environment and what it’s going to look like to get out of it.

“But when you put a box of food in somebody’s hands—let me revise that, because we use drive-through lanes now. When you put a box of food in somebody’s car, and you look through the windshield and give them a wave, sometimes they’re smiling and sometimes they’re crying, but for many, it is the one hopeful, optimistic, compassionate thing that will happen to them that entire day. And food is the most visceral human need. Without adequate nutrition, we can’t expect people to address any other challenge.”

Lev Fedoseyev\TASS via Getty Images

• Russia reported a record number of new coronavirus cases for the fourth consecutive day Sunday, as the virus rapidly spreads in the country, which is fast becoming one of the global epicenters of COVID-19.
• There were 10,633 new cases of COVID-19 confirmed on Sunday, Russian President Vladimir Putin said, some 1,000 more than were reported on Saturday, according to Worldometers data.
• A total of 134,687 people have now contracted the coronavirus in Russia, making it the seventh most-infected country on the planet.
• While in the early stages of the virus Russia was relatively unscathed, the number of cases is now increasing rapidly.
• "The peak is not behind us, we are about to face a new and grueling phase of the pandemic," President Vladimir Putin warned, according to CNN.
• Visit Business Insider's homepage for more stories.

Russia reported a record number of new coronavirus cases for the fourth consecutive day Sunday, as the virus rapidly spreads in the country, which is fast becoming one of the global epicenters of COVID-19.

There were 10,633 new cases of COVID-19 confirmed on Sunday, Russian President Vladimir Putin said, some 1,000 more than were reported on Saturday, according to Worldometers data.See the rest of the story at Business Insider

NOW WATCH: Inside London during COVID-19 lockdown

See Also:

• A nursing home in New York was forced to order a refrigerator truck to store corpses after reporting 98 coronavirus deaths in 'horrifying' outbreak
• A West Virginia worker told us what it was like living at his factory for 28 days to help make PPE, and says he would 'absolutely' do another 'lock-in' to help
• Donald Trump has once again changed his coronavirus deaths prediction to 'hopefully' under 100,000

Mark Kolbe/Getty Images

• Coober Pedy is a small town in the Outback of Southern Australia. 
• Originally an opal mining town, many of Coober Pedy's residents live underground to escape the region's immense heat.
• Homes, dive bars, a church, and more can be found buried underground in what the locals call "dugouts."
• Visit Business Insider's homepage for more stories.

In the middle of the Australian Outback, there's a town where chimneys rise from the sand and big red signs warn people of "unmarked holes."

Welcome to Coober Pedy, the town that lives underground.

What began in 1916 as perhaps the largest opal mining operation in the world has since expanded into a subterranean community that is safely out of reach from the region's 120-degree summers.

Entire bedrooms, bookstores, churches, and bars are installed in the carved underground walls of Coober Pedy — and after 100 years of living in these "dugouts," the folks who call it home have no plans of stopping.

Here's a look inside the underground mining town of Coober Pedy.

Coober Pedy is located in South Australia, over 1,000 miles from Canberra, the country's capital city.

The town is referred to as the "opal capital of the world." Coober Pedy is an Aboriginal word that roughly translates to "white man in a hole."

The town's summer months can reach 120 degrees Fahrenheit.

Shutterstock

Even in the shade, it's common to feel temperatures of 100-plus. Much to the dismay of locals and visitors, there's little rainfall to provide relief from the harsh sun.

Due to the dry climate, water can be scarce sometimes.

Mark Kolbe/Getty Images

According to ABC News, Coober Pedy sources its water from the Great Artesian Basin located about 15 miles away from the town.

See the rest of the story at Business Insider

See Also:

• Here's what life looks like right now in Singapore, where an outbreak in migrant worker dormitories has led to new lockdown measures
• The best hotels in Santa Fe
• The best hotels in Boston

SEE ALSO: After buying an entire abandoned ghost town in California, a man is stuck out there due to a snowstorm and the coronavirus

The Good: Do aggressive monetary stimulus to keep 2021 NGDP expectations on track. This involves level targeting combined with a “whatever it takes” approach to asset purchases. Buy only safe assets unless there are not enough safe assets to hit your target.

The Bad: Buy risky assets with newly created money in order to help the credit markets. Do enough to keep the credit markets flowing, but not enough to maintain adequate NGDP in 2021.

The Ugly: Bail out failing firms with fiscal policy. Let NGDP expectations collapse.

It looks like we’ve avoided the ugliest outcome, so give thanks for that:

Less than two months ago Boeing Co. went to Washington, hat in hand, asking for a $60 billion bailout for itself and its suppliers. The company, which had spent heavily on stock buybacks and was still reeling from the 737 Max disaster, was an unlikely candidate for government support.

Yet by urging the Federal Reserve to take unprecedented steps to bolster credit markets, the Trump administration ended up helping the plane maker more than any government handout could.

The Fed’s decision to use its near limitless balance sheet to purchase corporate bonds improved liquidity so much that it was a game changer for the company, according to people with knowledge of the matter who asked not to be identified because they weren’t authorized to speak publicly.

Notice how you do not need to directly bail out the corporate sector in order to save most big companies.  For that same reason, a massive Fed purchase of T-bonds (and Treasury-backed MBSs) would have (indirectly) helped to provide liquidity in the corporate bond market.  The key is maintaining expectations of adequate growth in NGDP.  As long as NGDP expectations are on track and lenders know that nominal national income in 2021 will be sufficient to repay nominal debts, then the credit will flow.

Conventional monetary stimulus is the best option.  Fed purchases of risky assets is second best.  Fiscal stimulus is the worst.

(6 COMMENTS)

I was shocked to learn that the US had no plan to deal with a pandemic, and had not even done basic things like stockpile enough surgical masks or an adequate supply of testing equipment (or at least the ability to produce the testing equipment rapidly.)

Some people say this is “Monday morning quarterbacking”. It’s easy to throw stones after an event that “no one could have foreseen”.

OK, then today I’d like to do some Sunday morning quarterbacking. I’d like to ask you guys whether we are prepared for other black swans. Let’s start with a collapse of the electrical system due to solar flares or electromagnetic pulse attacks.

This 2019 article caught my eye:

In testimony before a Congressional Committee, it has been asserted that a prolonged collapse of this nation’s electrical grid—through starvation, disease, and societal collapse—could result in the death of up to 90% of the American population.

Well that caught my attention. It sounds worse than being cooped up for a few months watching lots of Netflix films.

HV transformers are the weak link in the system, and the Federal Energy Regulatory Commission (FERC) has identified 30 of these as being critical. The simultaneous loss of just 9, in various combinations, could cripple the network and lead to a cascading failure, resulting in a “coast-to coast blackout”.

If the HV transformers are irreparably damaged it is problematic whether they can be replaced. The great majority of these units are custom built. The lead time between order and delivery for a domestically manufactured HV transformer is between 12 and 24 months, and this is under benign, low demand conditions.

OK, I think I understand what needs to be done—stockpile some of these transformers that cannot be quickly replaced.

Ordered today, delivery of a unit from overseas (responsible for 85% of current American purchasing) would take nearly 3 years. The factory price for an HV transformer can be in excess of $10 million—too expensive to maintain an inventory solely as spares for emergency replacement.

Yes, $300 million dollars for a stockpile of 30 HV transformers is far too expensive to prevent 90% of the public dying and the rest reduced to cannibalism.  Too much for a government that spends trillions of dollars with about as much care as a drunken sailor spending his wages in a red light district.  Instead, let’s buy another F-22 jet fighter.

And people wonder why I’m so cynical.

Obviously I’m no expert here, and I expect commenters will tell me why I’m wrong.  Perhaps the very same commenters who told me that I was foolish to think that surgical masks would provide any protection.

BTW, this isn’t one of those once in 60 million year events like dinosaur-killing asteroids; a huge solar flare hit Earth in 1859.

Update:  I forget to mention that I’m far more worried about accidental nuclear war, bioterrorism and AI run amok than I am about solar flares.

There have been many instances during this coronavirus pandemic where I’ve found myself questioning, “Is this real life?”

The whole situation feels so surreal. If you would’ve told me that I’d be stuck at home and not able to travel for the foreseeable future, I would’ve thought you were kidding.

Well folks, here we are — nearly two months into being stuck at home. With the world at a halt, we’ve witnessed a lot of interesting things. Adding to that list is Anchorage Airport (ANC) becoming the “busiest airport in the world” as of Saturday, April 25.

On a typical day, busy hubs like Atlanta (ATL), Los Angeles (LAX), Dubai (DXB) and Beijing (PEK) hold some of the top spots, whereas Anchorage (ANC) is usually toward the end of the list. However, coronavirus has changed that completely.

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To put it into perspective, on Saturday, April 25, Anchorage (ANC) had 948 airport arrivals and departures, whereas London (LHR) had just 682 arrivals and departures, according to FlightRadar data.

So how did Anchorage (ANC) become the world’s busiest airport in the midst of coronavirus? Cargo operations, something the Alaskan airport is no stranger to. In fact, Anchorage usually tops the charts as the fifth busiest cargo airport in the world and second busiest cargo airport in the U.S. thanks to Alaska’s equidistant location between Asia and North America.

Related: What will US airline maps look like after coronavirus?

So while we’ve seen significant decreases in passenger flights overall with airlines being forced to slash routes — and in some cases, reconfigure routes all together — cargo flights haven’t been impacted quite as dramatically. Hence, why we’ve seen many commercial carriers start to carry cargo.

So here’s to the world’s new busiest airport!

Featured photo by chaolik/Getty Images.

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The post Whether or not we are living in a simulation, *they* are living in a simulation appeared first on Marginal REVOLUTION.

I.

Actually, no. You should not do this. Most of you were probably already not doing this, and I support your decision. But if you want a 2000 word essay on some reasons to consider this, and then some other reasons why those reasons are wrong, keep reading.

Gout is a disease caused by high levels of uric acid in the blood. Everyone has some uric acid in their blood, but when you get too much, it can form little crystals that get deposited around your body and cause various problems, most commonly joint pain. Some uric acid comes from chemicals found in certain foods (especially meat), so the first step for a gout patient is to change their diet. If that doesn’t work, they can take various chemicals that affect uric acid metabolism or prevent inflammation.

Gout is traditionally associated with kings, probably because they used to be the only people who ate enough meat to be affected. Veal, venison, duck, and beer are among the highest-risk foods; that list sounds a lot like a medieval king’s dinner menu. But as kings faded from view, gout started affecting a new class of movers and shakers. King George III had gout, but so did many of his American enemies, including Franklin, Jefferson, and Hancock (beginning a long line of gout-stricken US politicians, most recently Bernie Sanders). Lists of other famous historical gout sufferers are contradictory and sometimes based on flimsy evidence, but frequently mentioned names include Alexander the Great, Charlemagne, Leonardo da Vinci, Martin Luther, John Milton, Isaac Newton, Ludwig von Beethoven, Karl Marx, Charles Dickens, and Mark Twain.

Question: isn’t this just a list of every famous person ever? It sure seems that way, and even today gout seems to disproportionately strike the rich and powerful. In 1963, Dunn, Brooks, and Mausner published Social Class Gradient Of Serum Uric Acid Levels In Males, showing that in many different domains, the highest-ranking and most successful men had the highest uric acid (and so, presumably, the most gout). Executives have higher uric acid than blue-collar workers. College graduates have higher levels than dropouts. Good students have higher levels than bad students. Top professors have higher levels than mediocre professors. DB&M admitted rich people probably still eat more meat than poor people, but didn’t think this explained the magnitude or universality of the effect. They proposed a different theory: maybe uric acid makes you more successful.

Before we mock them, let’s take more of a look at why they might think that, and at the people who have tried to flesh out their theory over the years.

Most animals don’t have uric acid in their blood. They use an enzyme called uricase to metabolize it into a harmless chemical called allantoin. About ten million years ago, the common ancestor of apes and humans got a mutation that broke uricase, causing uric acid levels to rise. The mutation spread very quickly, suggesting that evolution really wanted primates to have lots of uric acid for some reason. Since discovering this, scientists have been trying to figure out exactly what that reason was, with most people thinking it’s probably an antioxidant or neuroprotectant or something else helpful if you’re trying to evolve giant brains. Other researchers note that in lower animals, uric acid is a “come out of hibernation” sign which seems to induce energetic foraging and goal-directed behavior more generally.

Some of these people note the similarity between uric acid and caffeine:

If uric acid had caffeine-like effects, then high levels of uric acid in the blood would be like being on a constant caffeine drip. The exact numbers don’t really work out, but you can fix this by assuming uric acid is an order of magnitude or so weaker than straight caffeine. Add this fudge factor, and Benjamin Franklin was on exactly one espresso all the time.

But you can’t actually be hyperproductive by being on one espresso all the time, can you? Don’t you eventually gain tolerance to caffeine and lose any benefits?

Although uric acid is structurally similar to caffeine, it’s even more similar to a chemical called theacrine. In fact, theacrine is just 1,3,7,9-tetramethyl-uric acid:

Theacrine (not the same as theanine, be careful with this one!) is a caffeine-like substance found in an unusual Chinese variety of tea plant. It’s recently gained fame in the nootropic community for not producing tolerance the same way regular caffeine does – see eg Theacrine: Caffeine-Like Alkaloid Without Tolerance Build-Up. This makes the theory work even better: Franklin (and other gout sufferers) were constantly on one espresso worth of magic no-tolerance caffeine. Seems plausible!

II.

This theory is hilarious, but is it true?

I was able to find eleven studies comparing achievement and uric acid levels. I’ve put them into a table below.

Nine out of eleven are positive. But I find it hard to be confident in any of them. Modern studies can be pretty bad, but studies from the 1960s ask you to take even more things on trust, while inspiring a lot less of it. Many of these studies were unable to find the outcomes that the others found, but discovered new outcomes of their own. Many failed to report basic pieces of information. The largest experiments usually found the least impressive results. Overall this looks a lot like you would expect from something forty years before anyone realized there was a replication crisis.

I also notice that the most positive studies compare business executives to people in other walks of life, and the least positive studies compare good students with bad students. Business executives get a lot of chances to differ from the general population – maybe they still eat more meat and richer food? Maybe they’re stressed and stress affects uric acid levels?

What about the list of very famous people with gout? I agree it’s a lot of people, but what’s the base rate? Kings were born to their position, so we have no reason to think they were especially high achievers (someone in their family might have been, but that gene could have gotten pretty diluted). Since so many kings got gout, this suggests rich old people in the past had gout pretty often regardless of achievement. Also, this was before people invented good medical diagnosis, so probably arthritis, injuries, and any other form of joint pain got rounded off to gout too. What percent of rich old people in the past had some kind of joint pain? I’m prepared to guess “a lot”.

The biochemists report equally confusing results around the uric acid / caffeine connection. Caffeine mostly works by antagonizing adenosine, a chemical involved in sleepiness. According to Hunter et al, Effects of uric acid and caffeine on A1 adenosine receptor binding in developing rat brain, uric acid does not affect adenosine, and so probably does not have a caffeine-like mechanism of action. On the other hand, caffeine probably has a small additional effect on catecholamine (eg dopamine, norepinephrine) release, and a different paper finds that uric acid does share this mechanism. So it doesn’t have caffeine’s main effect, but it does seem to have some kind of mild stimulant properties.

Given this level of uncertainty around every step in the hypothesis, I would describe any link between uric acid and achievement as kind of a stretch at this point. I feel bad about this, because it’s an elegant theory with mostly positive studies in support, but I’m just not feeling like it’s met its burden of proof.

III.

But some recent research is trying to bring this field back from the dead. At least this is what I get from Ortiz et al, Purinergic System Dysfunction In Mood Disorders, which synthesizes some more modern evidence that “uric acid and purines (such as adenosine) regulate mood, sleep, activity, appetite, cognition, memory, convulsive threshold, social interaction, drive, and impulsivity”. It argues that we know there are neurorecptors for adenosine (another similar-looking molecule) and ATP (adenosine triphosphate, the body’s main form of chemical energy). These seem to be involved in depression and mania, in the predicted direction (manic people have too much ATP, depressed people have too little, and treatments for both conditions seem to normalize ATP levels). These results seem to be daring someone to make up a theory where mania is just too much chemical energy floating around, but if Ortiz et al are doing that, it’s sandwiched in between so many dense paragraphs on receptor binding that I can’t make it out.

More interesting for us, uric acid is related to all these chemicals and also seems to be involved in mania. See eg de Berardis et al, Evaluation of plasma antioxidant levels during different phases of illness in adult patients with bipolar disorder, which finds that uric acid is elevated in manic patients, and the more manic, the higher the uric acid levels. And Machado-Vieria claims to have gotten pretty good results treating bipolar mania with allopurinol, a gout medication that decreases uric acid – and the more the allopurinol decreased uric acid, the better the results. There’s also a little evidence that depressed people have lower uric acid than normal. None of this is a large effect – there are still a lot of depressed people with higher-than-normal uric acid and a lot of manic people with lower – but it’s around the same size as all the other infuriatingly suggestive effects we find in psychiatry that never lead to overarching theories or go anywhere useful.

Future studies should try to replicate the link between uric acid and mania, and come up with a better understanding of why it might be true – maybe since uric acid is a decay product of ATP, the body interprets it as a sign that energy is plentiful? They should try to explain away anomalies – if gout is maniogenic, how come so many people with gout are depressed? Is it just because having a painful illness is inherently depressing? And then it should investigate how mania bleeds into normal personality. Is someone with slightly higher uric acid a tiny bit hypomanic all the time?

If they can fill in all those steps, I’ll be willing to take a fresh look at the old papers linking gout and achievement. Until then, you should probably hold off on eating megadoses of venison to become the next Ben Franklin.

Knowing how hard it has been to manage my dad's illness, even with all my advantages, I keep thinking about the people who are helping sicker relatives with fewer resources.

1. Don’t rely on others:

“I don’t think any country has a perfect record,” Bill Gates said in a recent interview. “Taiwan comes close.” . . . Taiwan seems to have followed the model recommended by disaster expert Vaughan: It doesn’t expect infallibility from its leaders. Instead, Taiwan makes sure that its health institutions are hyper-vigilant about epidemic risks. After the SARS epidemic of 2003, Taiwan set up an interlocking set of agencies geared toward the early detection of pandemics and bioterrorism. If a threat is detected, containment plans and supply stockpiles are ready. That process starts at the bottom, not the top.

Vaughan and other researchers note that complacency is usually fed by groupthink. At a time when China and the World Health Organization were downplaying the coronavirus threat, it was easy for world leaders to believe that everything was under control. Meanwhile, China has used its influence to keep Taiwan out of the WHO and other international organizations, and Samson Ellis, the Taipei bureau chief for Bloomberg News, believes that Taiwan’s isolation from WHO paradoxically helped the country by forcing it to rely on its own judgment on health issues.

“Taiwan knows it’s on its own,” he says.

In January, while other countries were trusting the WHO’s bland assurances, Taiwan was already turning away cruise ships and performing health checks at airports. Taking early action against COVID-19 meant defying a consensus shared by much of the world. The country’s public-health institutions were designed to be sensitive to even faint signs of trouble and to guard against optimistic biases.

Read the whole things (by James Meigs.)  Taiwan is rapidly becoming one of my very favorite countr . . . er . . . places.

They also make outstanding films.

2.  Bill Gates has been great, but here he’s a bit too soft on China:

He is impatient too about attacks on China for its lack of openness about Covid-19 and particularly its reluctance to allow non-Chinese experts to investigate the origins of the coronavirus outbreak in the city of Wuhan. “Sure, they should be open, but what is it that people are saying they’re not being open about? Every country has a lot you can criticise,” he said.

“Most people, whenever something new comes along, they take their classic criticisms of that country and just repeat them. But here we should get concrete. I don’t see any deep insights that are missing in terms of the origin of the disease that somebody is holding something back.”

I have a more centrist position on China—harshly critical of their government’s initial cover-up, which imposed great hardship on the Chinese people, and (like Bill Gates) dismissive of Westerners who want to blame our current policy failures on China.

3.  Fortunately, while the US government tries to launch a cold war against China, private sector actors are trying to work with Chinese scientists in a constructive fashion:

US scientists are working with China to investigate the origin of coronavirus, despite criticism from the Trump administration that Beijing is failing to co-operate with outsiders to stem the disease.

Ian Lipkin, director of the Center for Infection and Immunity at the Mailman School of Public Health at Columbia University, said he was working with a team of Chinese researchers to determine whether coronavirus emerged in other parts of China before it was first discovered in Wuhan in December. The effort relies on help from the Chinese Centers for Disease Control and Prevention.

4.  This is great news:

After Brigham and Women’s Hospital in Boston began requiring that nearly everyone in the hospital wear masks, new coronavirus infections diagnosed in its staffers dropped by half — or more.

Brigham and Women’s epidemiologist Dr. Michael Klompas said the hospital mandated masks for all health care staffers on March 25, and extended the requirement to patients as well on April 6.

But they should have started on March 1st.

5.  We have lots of testing capability that is not being used due to regulatory barriers:

As the United States struggles to test people for COVID-19, academic laboratories that are ready and able to run diagnostics are not operating at full capacity.

A Nature investigation of several university labs certified to test for the virus finds that they have been held up by regulatory, logistic and administrative obstacles, and stymied by the fragmented US health-care system. Even as testing backlogs mounted for hospitals in California, for example, clinics were turning away offers of testing from certified academic labs because they didn’t use compatible health-record software, or didn’t have existing contracts with the hospital. Researchers warn that if such hurdles remain, labs trying to join the effort to fight coronavirus might end up spinning their wheels.

This is insane.  We need deregulation and we need more price gouging.

6.  It’s possible that the virus escaped from a lab, but it’s about a million times more likely that it infected a random person in Southeast Asia:

Next, he says, consider the data he’s collected on people near bat caves getting exposed to viruses: “We went out and surveyed a population in Yunnan, China — we’d been to bat caves and found viruses that we thought could be high risk. So we sample people nearby, and 3 percent had antibodies to those viruses,” he says. “So between the last two and three years, those people were exposed to bat coronaviruses. If you extrapolate that population across the whole of Southeast Asia, it’s 1 million to 7 million people a year getting infected by bat viruses.”

Compare that, he says, to what we know about the labs: “If you look at the labs in Southeast Asia that have any coronaviruses in culture, there are probably two or three and they’re in high security. The Wuhan Institute of Virology does have a small number of bat coronaviruses in culture. But they’re not [the new coronavirus], SARS-CoV-2. There are probably half a dozen people that do work in those labs. So let’s compare 1 million to 7 million people a year to half a dozen people; it’s just not logical.”

In addition, a cover-up is very unlikely:

Carroll, the former director of USAID’s emerging threats division who also spent years working with emerging infectious disease scientists in China, agrees that there’s no evidence the Chinese researchers were working with a novel pathogen. His reasoning? He would have heard about it.

“The reason I’m not putting a lot of weight on [the lab-escape theory] is there was no chatter prior to the emergence of this virus to a discovery that would have ended up bringing the virus into a lab,” he says. “And if nothing else, the scientific community tends to be very gossipy. If there is a novel, potentially dangerous virus which has been identified, circulating in nature, and it’s brought into a laboratory, there is chatter about that. And when you look back retrospectively, there’s no chatter whatsoever about the discovery of a new virus.”

And if these viruses infect millions of people each year, then why is it so important if that person happens to work in a lab?

7.  I usually agree with Ramesh Ponnuru, but here I think he’s being a bit too kind to the US:

America Isn’t Actually Doing So Badly Against Coronavirus

I agree with Ponnuru that it’s silly to focus on Trump, as if another president would have made a big difference.  And I agree that it was almost inevitable that our response would be messy and full of mistakes (as James Meigs pointed out in the article I linked to on top).

But let’s not mince words; we (including myself) have done very poorly.  We have 4% of the world’s population and 27% (and rising) of fatalities.  Even accounting for errors in the data, we are doing much worse than average.  Yes, some countries have done even worse, but that just means they’ve also done poorly.

Many countries have done far better than the US.  If we do far worse than South Korea, Australia, Vietnam, Taiwan, Japan, Germany and Austria, I don’t get much consolation from the fact that we are doing better than Italy, Spain, France and the UK.  We are supposed to be a global leader in technology and state capacity.

I also think this is a bit too optimistic:

The Federal Reserve cut interest rates and expanded lending facilities, moving, like Congress, faster than it had during the financial crisis of a dozen years ago.

Yes, they’ve done some very good things, and this crisis is more severe than 2008.  But the bottom line is that we are currently making the same mistakes as in 2008, failing to adopt level targeting and allowing price level/NGDP expectations for 2022 to fall sharply.  Level targeting isn’t an extreme idea; people both inside and outside the Fed know it’s the right thing to do right now.  It’s just institutional inertia holding them back.

(I.e., if we already had level targeting there is zero chance the Fed would switch back to growth rate targeting right now.  That’s what I mean by “inertia”.)

8.  On the lighter side, I just LOVE Japan:

Hokkaido has now had to re-impose the restrictions, though Japan’s version of a Covid-19 “lockdown” is a rather softer than those imposed elsewhere.

Most people are still going to work. Schools may be closed, but shops and even bars remain open.

Bars open, schools closed.  I recall on my 2018 visit to Japan that you could buy booze from a vending machine:

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The post Spit Works appeared first on Marginal REVOLUTION.

Harrison Brown of the National Academy of Sciences published a chart in the September 1970 issue of Scientific American projecting that humanity would run out of copper shortly after 2000; lead, zinc, tin, gold, and silver would be gone before 1990. Brown claimed that his estimates took into account the possibilities that "new reserves will be discovered by exploration or created by innovation." The February 2, 1970, issue of Time quoted the ecologist Kenneth Watt: "By the year 2000, if present trends continue, we will be using up crude oil at such a rate…that there won't be any more crude oil."

I report these dire prognostications from five decades ago in my column Earth Day Turns 50.

Today economist Gale L. Pooley and Human Progress website proprietor Marian L. Tupy show how badly mistaken these prophecies of imminent resource depletion have turned in their updated Simon Abundance Index calculations. The index is named after University of Maryland economist Julian Simon, who won his famous bet on resource trends in 1990 against perennial doomsayer Stanford University biologist Paul Ehrlich.

In October 1980, Ehrlich and Simon drew up a futures contract obligating Simon to sell Ehrlich the same quantities that could be purchased for $1,000 of five metals (copper, chromium, nickel, tin, and tungsten) 10 years later at 1980 prices. If the combined prices rose above $1,000, Simon would pay the difference. If they fell below $1,000, Ehrlich would pay Simon the difference. In October 1990, Ehrlich mailed Simon a check for $576.07. There was no note in the letter. The price of the basket of metals chosen by Ehrlich and his cohorts had fallen by more than 50 percent.

Tupy and Pooley calculate the index using "time price" as a way to measure resource abundance. "The time price denotes the amount of time that a person has to work in order to earn enough money to buy something. To calculate the time price, the nominal money price is divided by nominal hourly income," they explain.

Using this measure, they report:

The average time price of 50 commodities fell by 74.2 percent. That means that for the same length of time that a person needed to work to earn enough money to buy one unit in our basket of 50 commodities in 1980, he or she could buy 3.87 units in 2019. In other words, the average person saw his or her level of abundance rise by 287.4 percent. That amounts to a compound annual growth rate of 3.63 percent and implies a doubling of abundance every 19.45 year.

The index has a base year of 1980 and a base value of 100. In 2019, the Index reached a level of 670.9. That is to say that the Earth as a whole was 570.9 percent more abundant in 2019 than it was in 1980.

How is this possible? Tupy and Pooley explain:

Simon's revolutionary insights with regard to the mutually beneficial interaction between population growth and availability of natural resources, which our research confirms, may be counterintuitive, but they are real. The world's resources are finite in the same way that the number of piano keys is finite. The instrument has only 88 notes, but those can be played in an infinite variety of ways. The same applies to our planet. The Earth's atoms may be fixed, but the possible combinations of those atoms are infinite. What matters, then, is not the physical limits of our planet, but human freedom to experiment and reimagine the use of resources that we have.

Happy Earth Day, everybody!

I.

Amish people spend only a fifth as much as you do on health care, and their health is fine. What can we learn from them?

A reminder: the Amish are a German religious sect who immigrated to colonial America. Most of them live apart from ordinary Americans (who they call “the English”) in rural communities in Pennsylvania and Ohio. They’re famous for their low-tech way of life, generally avoiding anything invented after the 1700s. But this isn’t absolute; they are willing to accept technology they see as a net positive. Modern medicine is in this category. When the Amish get seriously ill, they will go to modern doctors and accept modern treatments.

The Muslims claim Mohammed was the last of the prophets, and that after his death God stopped advising earthly religions. But sometimes modern faiths will make a decision so inspired that it could only have come from divine revelation. This is how I feel about the Amish belief that health insurance companies are evil, and that good Christians must have no traffic with them.

And Deists believe that God is like a watchmaker, an artisan who built the world but does not act upon it. But by some miracle, the US government played along and granted the Amish exemptions from all the usual health care laws. They don’t have to pay Medicare taxes or social security. They aren’t included in the Obamacare mandate. They can share health care costs the way they want, ignoring any regulations to the contrary. They are genuinely on their own.

They’ve ended up with a simple system based on church aid. Everyone pays tithes to their congregation (though they don’t call it that). The churches meet in houses and have volunteer leaders, so expenses minimal. Most of the money goes to “alms” which the bishop distributes to members in need. This replaces the social safety net, including health insurance. Most Amish go their entire life without needing anything else.

About a third of Amish are part of a more formal insurance-like institution called Amish Hospital Aid. Individuals and families pay a fixed fee to the organization, which is not-for-profit and run by an unpaid board of all-male elders. If they need hospital care, AHA will pay for it. How does this interact with the church-based system? Rohrer and Dundes, my source for most of this post, say that it’s mostly better-off Amish who use AHA. Their wealth is tied up in their farmland, so it’s not like they can use it to pay hospital bills. But they would feel guilty asking their church to give them alms meant for the poor. AHA helps protect their dignity and keep church funds for those who need them most.

How well does this system work?

The Amish outperform the English on every measured health outcome. 65% of Amish rate their health as excellent or very good, compared to 58% of English. Diabetes rates are 2% vs. 8%, heart attack rates are 1% vs. 6%, high blood pressure is 11% vs. 31%. Amish people go to the hospital about a quarter as often as English people, and this difference is consistent across various categories of illness (the big exception is pregnancy-related issues – most Amish women have five to ten children). This is noticeable enough that lots of health magazines have articles on The Health Secrets of the Amish and Amish Secrets That Will Add Years To Your Life. As far as I can tell, most of the secret is spending your whole life outside doing strenuous agricultural labor, plus being at a tech level two centuries too early for fast food.

But Amish people also die earlier. Lots of old studies say the opposite – for example, this one finds Amish people live longer than matched Framingham Heart Study participants. But things have changed since Framingham. The Amish have had a life expectancy in the low 70s since colonial times, when the rest of us were dying at 40 or 50. Since then, Amish life expectancy has stayed the same, and English life expectancy has improved to the high 70s. The most recent Amish estimates I have still say low seventies, so I think we are beating them now.

If they’re healthier, why is their life expectancy lower? Possibly they are less interested in prolonging life than we are. R&D write:

Amish people are more willing to stop interventions earlier and resist invasive therapies than the general population because, while they long for healing, they also have a profound respect for God’s will. This means taking modest steps toward healing sick bodies, giving preference to natural remedies, setting common-sense limits, and believing that in the end their bodies are in God’s hands.

The Amish health care system has an easier job than ours does. It has to take care of people who are generally healthy and less interested in extreme end-of-life care. It also supports a younger population – because Amish families have five to ten children, the demographics are weighted to younger people. All of these make its job a little bit simpler, and we should keep that in mind for the following sections.

How much do the Amish pay for health care? This is easy to answer for Amish Hospital Aid, much harder for the church system.

Amish Hospital Aid charges $125 monthly per individual or $250 monthly per family (remember, Amish families can easily be ten people). Average US health insurance costs $411 monthly per individual (Obamacare policies) or $558 monthly per individual (employer sponsored plan; employers pay most of this). I’m not going to bother comparing family plans because the definition of “family” matters a lot here. On the surface, it looks like the English spend about 4x as much as the Amish do.

But US plans include many more services than AHA, which covers catastrophic hospital admissions only. The government bans most Americans from buying plans like this; they believe it’s not enough to count as real coverage. The cheapest legal US health plan varies by age and location, but when I take my real age and pretend that I live near Amish country, the government offers me a $219/month policy on Obamacare. This is only a little higher than what the Amish get, and probably includes more services. So here it seems like the Amish don’t have much of an efficiency advantage. They just make a different tradeoff. It’s probably the right tradeoff for them, given their healthier lifestyle.

But remember, only a third of Amish use AHA. The rest use a church-based system? How does that come out?

It’s hard to tell. Nobody agrees on how much Amish tithe their churches, maybe because different Amish churches have different practices. R&D suggest families tithe 10% of income, this article on church-based insurances says a flat $100/month fee, and this “Ask The Amish” column says that churches have twice-yearly occasions where they ask for donations in secret and nobody is obligated to give any particular amount (“often husbands and wives won’t even know how much the other is giving.”) So it’s a mess, and even knowing the exact per-Amish donation wouldn’t help, because church alms cover not just health insurance but the entire social safety net; the amount that goes to health care probably varies by congregation and circumstance.

A few people try to estimate Amish health spending directly. This ABC story says $5 million total for all 30,000 Amish in Lancaster County, but they give no source, and it’s absurdly low. This QZ story quotes Amish health elder Marvin Wengerd as saying $20 – $30 million total for Lancaster County, which would suggest health spending of between $600-$1000 per person. This sounds potentially in keeping with some of the other estimates. A $100 per month tithe would be $1200 per year – if half of that goes to non-health social services, that implies $600 for health. The average Amish family earns about $50K (the same as the average English family, somehow!) so a 10% tithe would be $5000 per year, but since the average Amish family size is seven children, that comes out to about $600 per person again. So several estimates seem to agree on between $600 and $1000 per person.

One possible issue with this number: does Wengerd know how much Amish spend out of pocket? Or does his number just represent the amount that the official communal Amish health system spends? I’m not sure, but taking his words literally it’s total Amish spending, so I am going to assume it’s the intended meaning. And since the Amish rarely see doctors for minor things, probably their communal spending is a big chunk of their total.

[Update: an SSC reader is able to contact his brother, a Mennonite deacon, for better numbers. He says that their church spends an average of $2000 per person (including out of pocket).]

How does this compare to the US as a whole? The National Center For Health Statistics says that the average American spends $11,000 on health care. This suggests that the average American spends between five and ten times more on health care than the average Amish person.

How do the Amish keep costs so low? R&D (plus a few other sources) identify some key strategies.

First, the Amish community bargains collectively with providers to keep prices low. This isn’t unusual – your insurance company does the same – but it nets them better prices than you would get if you tried to pay out of pocket at your local hospital. This article gives some examples of Amish getting sticker prices discounted from between 50% to 66% with this tactic alone; Medicare gets about the same.

Second, the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professionals to thwart insurance companies’ attempts to cheat their way out of paying. If you are an honorable Amish person and the hospital knows you will pay your bill on time with zero fuss, they can waive all this.

But can this really be the reason Amish healthcare is cheaper? When insurance companies negotiate with providers, patients are on the side of the insurances; when insurance companies get good deals (eg a deal of zero dollars because the insurance has scammed the hospital), the patient’s care is cheaper, and the insurance company can pass some of those savings down as lower prices. If occasionally scamming providers meant insurance companies had to pay more money total, then they would stop doing it. My impression is that the real losers here are uninsured patients; absent any pressure to do otherwise, hospitals will charge them the sticker price, which includes the dealing-with-insurance-scams fee. The Amish successfully pressure them to waive that fee, which gets them better prices than the average uninsured patient, but still doesn’t land them ahead of insured people.

Third, Amish don’t go to the doctor for little things. They either use folk medicine or chiropractors. Some of the folk medicine probably works. The chiropractors probably don’t, but they play a helpful role reassuring people and giving them the appropriate obvious advice while telling the really serious cases to seek outside care. With this help, Amish people mostly avoid primary care doctors. Holmes County health statistics find that only 16% of Amish have seen a doctor in the past year, compared to 54% of English.

Fourth, the Amish never sue doctors. Doctors around Amish country know this, and give them the medically indicated level of care instead of practicing “defensive medicine”. If Amish people ask their doctors to be financially considerate – for example, let them leave the hospital a little early – their doctors will usually say yes, whereas your doctor would say no because you could sue them if anything went wrong. In some cases, Amish elders formally promise that no member of their congregation will ever launch a malpractice lawsuit.

Fifth, the Amish don’t make a profit. Church aid is dispensed by ministers and bishops. Even Amish Hospital Aid is run by a volunteer board. None of these people draw a salary or take a cut. I don’t want to overemphasize this one – people constantly obsess over insurance company profits and attribute all health care pathologies to them, whereas in fact they’re a low single-digit percent of costs (did you know Kaiser Permanente is a nonprofit? Hard to tell, isn’t it?) But every little bit adds up, and this is one bit.

Sixth, the Amish don’t have administrative expenses. Since the minister knows and trusts everyone in his congregation, the “approval process” is just telling your minister what the problem is, and the minister agreeing that’s a problem and giving you money to solve it. This sidesteps a lot of horrible algorithms and review boards and appeal boards and lawyers. I don’t want to overemphasize this one either – insurance companies are legally required to keep administrative expenses low, and most of them succeed. But again, it all adds up.

Seventh, the Amish feel pressure to avoid taking risks with their health. If you live in a tiny community with the people who are your health insurance support system, you’re going to feel awkward smoking or drinking too much. Realistically this probably blends into a general insistence on godly living, but the health insurance aspect doesn’t hurt. And I’m talking like this is just informal pressure, but occasionally it can get very real. R&D discuss the case of some Amish teens who get injured riding a snowmobile – forbidden technology. Their church decided this was not the sort of problem that godly people would have gotten themselves into, and refused to help – their families were on the hook for the whole bill.

Eighth, for the same reason, Amish try not to overspend on health care. I realize this sounds insulting – other Americans aren’t trying? I think this is harsh but true. Lots of Americans get an insurance plan from their employer, and then consume health services in a price-insensitive way, knowing very well that their insurance will pay for it. Sometimes they will briefly be limited by deductibles or out-of-pocket charges, but after these are used up, they’ll go crazy. You wouldn’t believe how many patients I see who say things like “I’ve covered my deductible for the year, so you might as well give me the most expensive thing you’ve got”, or “I’m actually feeling fine, but let’s have another appointment next week because I like talking to you and my out-of-pocket charges are low.”

But it’s not just avoiding the obvious failure modes. Careful price-shopping can look very different from regular medical consumption. Several of the articles I read talked about Amish families traveling from Pennsylvania to Tijuana for medical treatment. One writer describes Tijuana clinics sending salespeople up to Amish Country to advertise their latest prices and services. For people who rarely leave their hometown and avoid modern technology, a train trip to Mexico must be a scary experience. But prices in Mexico are cheap enough to make it worthwhile.

Meanwhile, back in the modern world, I’ve written before about how a pharma company took clonidine, a workhorse older drug that costs $4.84 a month, transformed it into Lucemyra, a basically identical drug that costs $1,974.78 a month, then created a rebate plan so that patients wouldn’t have to pay any extra out-of-pocket. Then they told patients to ask their doctors for Lucemyra because it was newer and cooler. Patients sometimes went along with this, being indifferent between spending $4 of someone else’s money or $2000 of someone else’s money. Everything in the US health system is like this, and the Amish avoid all of it. They have a normal free market in medical care where people pay for a product with their own money (or their community’s money) and have incentives to check how much it costs before they buy it. I do want to over-emphasize this one, and honestly I am surprised Amish health care costs are only ten times cheaper than ours are.

I don’t know how important each of these factors is, or how they compare to more structural factors like younger populations, healthier lifestyles, and less end-of-life care. But taken together, they make it possible for the Amish to get health care without undue financial burden or government support.

II.

Why look into the Amish health system?

I’m fascinated by how many of today’s biggest economic problems just mysteriously failed to exist in the past. Our grandparents easily paid for college with summer jobs, raised three or four kids on a single income, and bought houses in their 20s or 30s and never worried about rent or eviction again. And yes, they got medical care without health insurance, and avoided the kind of medical bankruptcies we see too frequently today. How did this work so well? Are there ways to make it work today? The Amish are an extreme example of people who try to make traditional systems work in the modern world, which makes them a natural laboratory for this kind of question.

The Amish system seems to work well for the Amish. It’s hard to say this with confidence because of all the uncertainties. The Amish skew much younger than the “English”, and live much healthier lifestyles. Although a few vague estimates suggest health care spending far below the English average, they could be missing lots of under-the-table transactions. And again, I don’t want to ignore the fact that the Amish do live a little bit shorter lives. You could tell a story where all of these add up to explain 100% of the difference, and the Amish aren’t any more efficient in their spending at all. I don’t think this is right. I think the apparent 5x advantage, or something like it, is real. But right now this is just a guess, not a hard number.

What if it is? It’s hard to figure out exactly what it would take to apply the same principles to English society. Only about a quarter of Americans attend church regularly, so church-based aid is out. In theory, health insurance companies ought to fill the same niche, with maybe a 10% cost increase for profits and overhead. Instead we have a 1000% cost increase. Why?

Above, I said that the most important factor is that the Amish comparison shop. Everyone needs to use other people’s money to afford expensive procedures. But for the Amish, those other people are their fellow church members and they feel an obligation to spend it wisely. For the English, the “other people” are faceless insurance companies, and we treat people who don’t extract as much money as possible from them as insufficiently savvy. But there’s no easy way to solve this in an atomized system. If you don’t have a set of thirty close friends you can turn to for financial help, then the only institutions with enough coordination power to make risk pooling work are companies and the government. And they have no way of keeping you honest except the with byzantine rules about “prior authorizations” and “preferred alternatives” we’ve become all too familiar with.

(and as bad as these are, there’s something to be said for a faceless but impartial bureaucracy, compared to having all your neighbors judging your lifestyle all the time.)

This is a neat story, but I have two concerns about it.

First, when I think in terms of individual people I know who have had trouble paying for health care, it’s hard for me to imagine the Amish system working very well for them. Many have chronic diseases. Some have mysterious pain that they couldn’t identify for years before finally getting diagnosed with something obscure. Amish Hospital Aid’s catastrophic policy would be useless for this, and I feel like your fellow church members would get tired of you pretty quickly. I’m not sure how the Amish cope with this kind of thing, and maybe their system relies on a very low rate of mental illness and chronic disease. A lot of the original “hygiene hypothesis” work was done on the Amish, their autoimmune disease rates are amazing, and when you take out the stresses of modern life maybe a lot of the ailments the American system was set up to deal with just stop being problems. I guess my point is that the numbers seem to work out, and the Amish apparently remain alive, but when I imagine trying to apply the Amish system to real people, even assuming those real people have cooperative churches and all the other elements I’ve talked about, I can’t imagine it doing anything other than crashing and burning.

Second, I don’t think this is actually how our grandparents did things. I asked my literal grandmother, a 95 year old former nurse, how health care worked in her day. She said it just wasn’t a problem. Hospitals were supported by wealthy philanthropists and religious organizations. Poor people got treated for free. Middle class people paid as much as they could afford, which was often the whole bill, because bills were cheap. Rich people paid extra for fancy hospital suites and helped subsidize everyone else. Although most people went to church or synagogue, there wasn’t the same kind of Amish-style risk pooling.

This makes me think that the Amish method, even though it works, isn’t the method that worked for past generations. It’s an innovation intended to cover for health care prices being higher than anything that traditional societies had to deal with.

Why did health care prices start rising? I’ve wondered about this a lot before – see here, here, and here. Looking into this issue, I noticed glimpses of a different possibility. The increase started around the same time that health insurance began to spread. In one sense, this is unsurprising – of course health insurance would become a thing around the time care became unaffordable. But I’ve never seen someone really try to tease out causality here. Might the two trends have been mutually self-reinforcing? The price of care rises due to some original shock. Someone invents health insurance, which seems like a good idea. But this creates a series of perverse incentives, which other actors figure out how to exploit (eg the Lucemyra example above). Insurance-based-health-care becomes less efficient, but hospitals can’t or don’t internalize this to the insured patients – they just raise the price for everyone, insurance or no. That makes even more people need health insurance, and the cycle repeats as prices grow higher and higher and insurance becomes more and more necessary. This syncs well with some explanations I’ve heard of rising college prices, where once the government made easy loans and subsidies available to everyone, prices rose until they consumed all the resources available.

I have no idea if this is true or not. If it is, the Amish succeed partly by successfully forcing providers to internalize the costs of insurance to insurance patients. Sometimes they do this by literally asking hospitals for better prices because they are not insured (eg the “honest customer” example above). Other times they flee the country entirely to reach a medical system that doesn’t deal with insured patients (eg Tijuana). This seems to work well for them. But their reliance on church alms and Amish Hospital Aid suggests that their care is still more expensive and burdensome for them than past generations’ care was for them. They’ve just learned ways to manage the expense successfully.

In my view, we will learn a lot about Covid-19 over the next 4 weeks from the data coming from various island countries. Many of these countries are now pretty isolated from the rest of the world, and will provide a useful test for certain key questions.

1. Greenland had 11 cases, and now has zero. It was the first island to exterminate the virus.

2. Faeroe Islands had 185 cases. There are only 11 active cases today, and no new infections since April 6. No deaths, and no one is in serious or critical condition. They will likely eliminate the disease within a few weeks.

3. Iceland has had 1771 cases and gets about 10 new ones each day, with the number steadily declining.  They will probably no longer be getting new cases after a few more weeks, and then in another 6 weeks or so will be virus free.  They’ve had 9 deaths.  Iceland is important because unlike Greenland and Faeroe Islands it’s a statistically significant sample.  Within a month or so we’ll have a good idea as to how many Icelanders will eventually die of the disease (I’d guess about 15), and this will begin to pin down the actual fatality rate.  Testing is extremely comprehensive in Iceland, and hence the data is more accurate than elsewhere.

4.  New Zealand has had 1431 cases and gets about 10 new ones a day, with the number steadily declining.  In other words, very much like Iceland.  As in Iceland, active cases are also falling very fast.  They’ve had 12 deaths, a modestly higher rate than Iceland.  This makes sense given that they’ve tested less comprehensively than Iceland, and thus missed a few more cases.  The NZ government intends to drive the case total to zero, at which time normal life can resume.

You see a similar pattern in other islands.  Taiwan had a spike of new cases today from a ship in their navy, but otherwise has almost stopped community transmission. Hawaii has bent the curve more than other American states.  I’d also like to point to some quasi-islands:

1.  Australia looks a lot like New Zealand and nothing at all like Canada (which it closely resembled during the early weeks of the crisis.)  Its active caseload is falling fast, as is community transmission.  The mortality rate so far is a bit over 1%.  That will rise modestly, but of course they missed some cases.

2.  South Korea’s hard border with the North makes it a quasi-island.  Active cases are falling very fast, with rapidly declining community transmission.  The reported mortality rate is over 2%, but of course they missed some cases.

3.  Hong Kong has only 4 deaths in 1026 cases, and only 8 are in serious or critical condition.  Community transmission has almost stopped and active caseloads are falling fast.  Macao had only 45 cases, no deaths, and community transmission has stopped.

Overall, the various island and quasi-island data suggests a far lower mortality rate than what one sees in Europe, or even the US and China.  The obvious explanation is that these islands are missing fewer cases, as demographics alone can’t explain the 13% reported mortality rates you see in some European countries.  Singapore’s particularly interesting, with only 11 deaths out of 6588 cases.  I attribute that to pretty complete testing and the fact that many cases are recent, so some of the infected will eventually die.

Of course recall the previous post.  Everything here could turn on a dime, as infections surge again in some of these countries.  I did not expect the recent surge in Singapore.  But we’ll know much more in about 4 weeks.

PS.  I’ve generally discounted the possibility of “herd immunity” building up to any significant extent.  Not enough cases where I live in Orange County.  But I’m going to change my view on New York.  They look likely to end up with at least 30,000 deaths.  That suggests that at least 3 million New Yorkers will be infected in this wave of the epidemic.  That’s 15% of New York State’s population.  (And the ratio would be even higher in the NYC metro area.)  Furthermore, the infected would skew heavily toward socially active people that interact a lot with others, including the so-called super-spreaders.  The non-infected 85% will have a lower than average R0.  That’s certainly not complete herd immunity, but given the skew toward the socially active, the 15% figure understates the true amount of herd immunity.  The next wave in NYC (next winter?) will be milder, especially if people continue to be cautious, wear masks, etc.

Maybe it’s wishful thinking on my part, but I believe we can ride out the rest of this pandemic (until a vaccine) without any more government-mandated lockdowns after this one is lifted in May.  But people will still be very cautious, and hence I expect a weak economy for quite some time.

PPS.  This picture of Faeroe Islands looks like an optimal optical illusion.  Unfortunately, I’ll never get there:

Above is a picture of my mother as a young woman. I would like to tell you about her.

My mother was born on July 18, 1927, the second child of Nicholas and Catherine Sawchak.

Nicholas and Catherine were immigrants from Ukraine. They came to the United States as teenagers, arriving separately, neither with more than a fourth-grade education. Catherine was from a farming area in western Ukraine. She left because her family wanted her to marry an older man rather than her younger boyfriend, who had been conscripted into the army. Her first job here was as a maid. Nicholas was from Kiev, where he had been trained to be a furrier. In the United States, he worked as a potter, making sinks and toilettes. When Nicholas and Catherine came to the United States, they thought they might return home to Ukraine eventually. But World War I and the Russian Revolution intervened, causing a change of plans. Catherine’s boyfriend died in the war. Nicholas and Catherine met each other, married, and settled in a small row house in Trenton, New Jersey, where they lived the rest of their lives.

Catherine and Nicholas had two children, my uncle Walter and my mother Dorothy. When my mother was born, her parents chose to name her “Dorothy Theresa Sawchak.” But because Catherine spoke with a heavy accent, the clerk preparing the birth certificate did not understand her. So officially, my mother’s middle name was “Tessie” rather than “Theresa.” She never bothered to change it.

Nicholas and Catherine were hardworking and frugal. They saved enough to send Walter to college and medical school. He served as a physician in the army during the Korean war. Once I asked him if he worked at a MASH unit, like in the TV show. He said no, he worked closer to the front. He patched up the wounded soldiers the best he could and then sent them to a MASH unit to recover and receive more treatment. After the war, he became a pathologist in a Trenton-area hospital. He married and had two daughters, my cousins.

My mother attended Trenton High School (the same high school, I learned years later, attended by the economist Robert Solow at about the same time). She danced ballet. She water-skied on the Delaware River. She loved to read and go to the movies.

In part because of limited resources and in part because of the gender bias of the time, my mother was not given the chance to go to college. Years later, her parents would say that not giving her that opportunity was one of their great regrets. Instead, my mother learned to be a hairdresser. She was also pressured to marry the son of some family friends.

The marriage did not work. With my mother pregnant, her new husband started “running around,” my mother’s euphemism for infidelity. They divorced, and she kicked him out of her life. But the marriage did leave her with one blessing—my sister Peg.

My mother continued life as a single mother. Some years later, she met my father, also named Nicholas, through social functions run by local Ukrainian churches. They both loved to dance. He wanted to marry her, but having been burned once, she was reluctant at first. Only when she realized that he had become her best friend did she finally accept.

In 1958, nine months after I was born, Mom, Dad, Peg, and I left Trenton for a newly built split-level house in Cranford, New Jersey. My father was working for Western Electric, an arm of AT&T, first as a draftsman and then as an electrical engineer. He worked there until his retirement. One of his specialties was battery design. When I was growing up, I thought it sounded incredibly boring. Now I realize how important it is.

My mother then stopped working as a hairdresser to become a full-time mom. But she kept all the hairdresser equipment from her shop—chair, mirrors, scissors, razors, and so on—in our basement. She would cut the hair of her friends on a part-time basis. When I was a small boy, she cut my hair as well.

I attended the Brookside School, the public grade school which was a short walk from our house. When I was in the second or third grade, my mother was called in to see the teacher. The class had been given some standardized aptitude test. “Greg did well,” the teacher said. “We were very surprised.”

At that moment, my mother decided the school was not working out for me. I was talkative and inquisitive at home but shy and lackluster at school. I needed a change.

She started looking around for the best school she could find for me. She decided it was The Pingry School, an independent day school about a dozen miles from our house. She had me apply, and I was accepted.

The question then became, how to pay for it? Pingry was expensive, and we did not have a lot of extra money. My mother decided that she needed to return to work.

She started looking for a job, and an extraordinary opportunity presented itself. Union County, where we lived, was opening a public vocational school, and they were looking for teachers. She applied to be the cosmetology teacher and was hired.

There was, however, a glitch. The teachers, even though teaching trades like hairdressing, needed teacher certification. That required a certain number of college courses, and my mother had not taken any. So she got a temporary reprieve from the requirement. While teaching at the vocational school during the day, she started taking college courses at night to earn her certification, all while raising two children.

My mother taught at the vocational school until her retirement. During that time, she also co-authored a couple of books, called Beauty Culture I and II, which were teacher’s guides. From the summary of the first volume: “The syllabus is divided into six sections and includes the following areas of instruction: shop, school, and the cosmetologist; sterilization practices in the beauty salon; scalp and hair applications and shampooing; hair styling; manicuring; and hairpressing and iron curling.” I suppose one might view this project as a harbinger of my career as a textbook author.

When my parents both retired, they were still the best of friends. They traveled together, exploring the world in ways that were impossible when they were younger and poorer. During my third year as an economics professor, I was visiting the LSE for about a month. I encouraged my parents to come over to London for a week or so. They had a grand time. I believe it was the first time they had ever visited Europe. When I was growing up, vacations were usually at the Jersey shore.

My father died a few years later. My mother spent the next three decades living alone. She was then living full-time at the Jersey shore in Brant Beach on Long Beach Island. The house was close to the ocean and large enough to encourage her growing family to come for extended visits. Two children, five grandchildren, four great-grandchildren. The more, the merrier. Nothing made her happier than being surrounded by family.

My mother loved to cook, especially the Ukrainian dishes she learned in her childhood. Holubtsi (stuffed cabbage) was a specialty. Another was kapusta (cabbage) soup. One time, the local newspaper offered to publish her kapusta soup recipe. They did so, but with an error. Every seasoning that was supposed to be measured in teaspoons was printed as tablespoons. The paper later ran a correction but probably to no avail. I am not sure if anyone ever tried the misprinted recipe and, if so, to what end.

During her free time in her later years, my mother read extensively, played FreeCell on her computer, and watched TV. A few years ago, when she was about 90 years old, I was visiting her, and I happened to mention the show “Breaking Bad.” She had not heard of it. She suggested we watch the first episode. And then another. And another. After I left, she binge-watched all five seasons.

As she aged, living alone became harder. When she had trouble going up and down the stairs, an elevator was added to her house. But slowly her balance faltered, and she fell several times. She started having small strokes, and then a more significant one. She moved into a nursing home. Whenever I visited, I brought her new books to read. Her love of reading never diminished.

This is, I am afraid, where the story ends. Last week, Dorothy Theresa Sawchak Mankiw tested positive for Covid-19. Yesterday, she died. I will miss her.

There’s an old saying in Hollywood; “Nobody knows anything”. That is, no one can predict which films will do well and which films will bomb at the box office—at least back in the days when we had “box offices”.

I’d like to argue that nobody knows anything about the coronavirus epidemic.  Of course that’s an exaggeration; we know a bunch of things.  But it’s striking how little we do know, given how much scrutiny the problem has received.  I recently saw a video of doctors from all over the country saying that they had no idea if the medical treatment they were giving Covid-19 patients in intensive care was doing more good than harm.  

About 6 weeks ago, the virus was seemingly under tight control in Singapore, and completely out of control in South Korea.  Even worse, Korea’s in the temperate zone most prone to high infection rates, and Singapore’s a hot humid place right on the equator.  Even worse, Singapore has far more “state capacity” than South Korea.  Even worse, Korea never shut down its economy.  So raise your hand if 6 weeks ago you predicted that the two places would go in completely opposite directions.  I’d guess that among the 7.8 billion humans on Earth, exactly zero predicted Korea would quickly control its epidemic and Singapore’s would spiral out of control.  And even after it happened, no one knows why.

Cafes bustled with customers, parks teemed with sunbathers, and the first Apple store to reopen outside China had lines snaking out the door as many South Koreans — almost all wearing masks — emerged from months of self-isolation.

The scene in Seoul on a picture-perfect Saturday contrasted sharply with other nations where major cities look like ghost towns as governments lock down huge swaths of the population or impose strict restrictions on social gatherings.

Initially one of the hardest-hit with the second-highest number of cases globally, South Korea has managed to curb the spread without taking measures that were too severe. It didn’t require businesses to close or restrict travel.

Despite government pleas to remain indoors with a warning of a flare-up, many Koreans ventured out Saturday, saying they believe the worst of the pandemic is over.

And since no one knows anything, I have no idea whether this will still be true in another 6 weeks, or if it will reverse again, with Singapore under control and Korea out of control.  No one knows.

PS.  I will say that mask wearing was far more widespread in Korea than in Singapore.   

For months, Singapore’s leaders urged citizens to wear masks only when ill, especially after locals panicked and rushed to stores to grab bundles of the essentials as the coronavirus spread. Now, they’ve shifted tack.

In a live address to the nation Friday afternoon, Prime Minister Lee Hsien Loong said his government will stop discouraging the general public from wearing face masks in public.

And this:

Taiwan’s Ministry of Foreign Affairs (MOFA) confirmed on Wednesday (April 7) that Singapore is among the New Southbound Policy (NSP) nations that it will be donating over 1 million medical masks to.

I.

Vox asks What Went Wrong With The Media’s Coronavirus Coverage? They conclude that the media needs to be better at “not just saying what we do know, but what we don’t know”. This raises some important questions. Like: how much ink and paper is there in the world? Are we sure it’s enough? But also: how do you become better at saying what you don’t know?

In case you’ve been hiding under a rock recently (honestly, valid) the media not only failed to adequately warn its readers about the epidemic, but actively mocked and condescended to anyone who did sound a warning. Real Clear Politics has a list of highlights. The Vox tweet saying “Is this going to be a deadly pandemic? No.” Washington Post telling us in February “Why we should be wary of an aggressive government reponse to coronavirus (it might “scapegoat marginalized populations”). The Daily Beast complaining that “coronavirus, with zero American fatalities, is dominating headlines, while the flu is the real threat”. The New York Times, weighing in with articles like “The pandemic panic” and “Who says it’s not safe to travel to China”. The constant attempts to attribute “alarmism” over the virus to anti-Chinese racism. Etc, etc, etc.

One way people have summed this up is that the media (and the experts they relied on) did a terrible job predicting what would happen. I think this lets them off too easy.

Prediction is very hard. Nate Silver is maybe the best political predicter alive, and he estimated a 29% chance of Trump winning just before Trump won. UPenn professor Philip Tetlock has spent decades identifying “superforecasters” and coming up with complicated algorithms for aggregating their predictions, developing a prediction infrastructure that beats top CIA analysts, but they estimated a 23% chance Britain would choose Brexit just before it happened. This isn’t intended to criticize Silver or Tetlock. I believe they’re operating at close to optimum – the best anyone could possibly do with the information that they had. But the world is full of noise, and tiny chance events can have outsized effects, and there are only so many polls you can scrutinize, and even geniuses can only do so well.

Predicting the coronavirus was equally hard, and the best institutions we had missed it. On February 20th, Tetlock’s superforecasters predicted only a 3% chance that there would be 200,000+ coronavirus cases a month later (there were). The stock market is a giant coordinated attempt to predict the economy, and it reached an all-time high on February 12, suggesting that analysts expected the economy to do great over the following few months. On February 20th it fell in a way that suggested a mild inconvenience to the economy, but it didn’t really start plummeting until mid-March – the same time the media finally got a clue. These aren’t empty suits on cable TV with no skin in the game. These are the best predictive institutions we have, and they got it wrong. I conclude that predicting the scale of coronavirus in mid-February – the time when we could have done something about it – was really hard.

I don’t like this conclusion. But I have to ask myself – if it was so easy, why didn’t I do it? It’s easy to look back and say “yeah, I always secretly knew it would be pretty bad”. I did a few things right – I started prepping half-heartedly in mid-February, I recommended my readers prep in early March, I never criticized others for being alarmist. Overall I give myself a solid B-. But if it was so easy, why didn’t I post “Hey everyone, I officially predict the coronavirus will be a nightmarish worldwide pandemic” two months ago? It wouldn’t have helped anything, but I would have had bragging rights forever. For that matter, why didn’t you post this – on Facebook, on Twitter, on the comments here? You could have gone down in legend, alongside Travis W. Fisher, for making a single tweet. Since you didn’t do that (aside from the handful of you who did – we love you, Balaji) I conclude that predicting it was hard, even for smart and well-intentioned people like yourselves.

Does that mean we can’t put everyone’s heads on spikes outside the Capitol Building as a warning for future generations? I would be very disappointed if it meant that. I think we can still put heads on spikes. We just have to do it for more subtle, better-thought-out reasons.

II.

I used to run user surveys for a forum on probabilistic reasoning…

(I promise this will become relevant soon)

A surprising number of these people had signed up for cryonics – the thing where they freeze your brain after you die, in case the future invents a way to resurrect frozen brains. Lots of people mocked us for this – “if you’re so good at probabilistic reasoning, how can you believe something so implausible?” I was curious about this myself, so I put some questions on one of the surveys.

The results were pretty strange. Frequent users of the forum (many of whom had pre-paid for brain freezing) said they estimated there was a 12% chance the process would work and they’d get resurrected. A control group with no interest in cryonics estimated a 15% chance. The people who were doing it were no more optimistic than the people who weren’t. What gives?

I think they were actually good at probabilistic reasoning. The control group said “15%? That’s less than 50%, which means cryonics probably won’t work, which means I shouldn’t sign up for it.” The frequent user group said “A 12% chance of eternal life for the cost of a freezer? Sounds like a good deal!”

There are a lot of potential objections and complications – for one thing, maybe both those numbers are much too high. You can read more here and here. But overall I learned something really important from this.

Making decisions is about more than just having certain beliefs. It’s also about how you act on them.

III.

A few weeks ago, I wrote a blog post on face masks. It reviewed the evidence and found that they probably helped prevent the spread of disease. Then it asked: how did the WHO, CDC, etc get this so wrong?

I went into it thinking they’d lied to us, hoping to prevent hoarders from buying up so many masks that there weren’t enough for health workers. Turns out that’s not true. The CDC has been singing the same tune for the past ten years. Swine flu, don’t wear masks. SARS, don’t wear masks. They’ve been really consistent on this point. But why?

If you really want to understand what happened, don’t read any studies about face masks or pandemics. Read Smith & Pell (2003), Parachute Use To Prevent Death And Major Trauma Related To Gravitational Challenge: Systematic Review Of Randomized Controlled Trials. It’s an article in the British Journal Of Medicine pointing out that there have never been any good studies proving that parachutes are helpful when jumping out of a plane, so they fail to meet the normal standards of evidence-based medicine. From the Discussion section:

It is a truth universally acknowledged that a medical intervention justified by observational data must be in want of verification through a randomised controlled trial. Observational studies have been tainted by accusations of data dredging, confounding, and bias. For example, observational studies showed lower rates of ischaemic heart disease among women using hormone replacement therapy, and these data were interpreted as advocating hormone replacement for healthy women, women with established ischaemic heart disease, and women with risk factors for ischaemic heart disease. However, randomised controlled trials showed that hormone replacement therapy actually increased the risk of ischaemic heart disease, indicating that the apparent protective effects seen in observational studies were due to bias. Cases such as this one show that medical interventions based solely on observational data should be carefully scrutinised, and the parachute is no exception.

Of course this is a joke. It’s in the all-joke holiday edition of BMJ, and everyone involved knew exactly what they were doing. But the joke is funny because it points at something true. It’s biting social commentary. Doctors will not admit any treatment could possibly be good until it has a lot of randomized controlled trials behind it, common sense be damned. This didn’t come out of nowhere. They’ve been burned lots of times before by thinking they were applying common sense and getting things really wrong. And after your mistakes kill a few thousand people you start getting really paranoid and careful. And there are so many quacks who can spout off some “common sense” explanation for why their vitamin-infused bleach or colloidal silver should work that doctors have just become immune to that kind of bullshit. Multiple good RCTs or it didn’t happen. Given the history I think this is a defensible choice, and if you are tempted to condemn it you may find this story about bone marrow transplants enlightening.

But you can take this too far. After highlighting the lack of parachute RCTs, the paper continues:

Only two options exist. The first is that we accept that, under exceptional circumstances, common sense might be applied when considering the potential risks and benefits of interventions. The second is that we continue our quest for the holy grail of exclusively evidence based interventions and preclude parachute use outside the context of a properly conducted trial. The dependency we have created in our population may make recruitment of the unenlightened masses to such a trial difficult. If so, we feel assured that those who advocate evidence based medicine and criticise use of interventions that lack an evidence base will not hesitate to demonstrate their commitment by volunteering for a double blind, randomised, placebo controlled, crossover trial.

Did you follow that? For a good parachute RCT, half the subjects would have to jump out of a plane wearing a placebo parachute. The authors suggest maybe we enlist doctors who insist too stringently on RCTs over common sense for this dubious honor.

(good news, though, a parachute RCT did eventually get done)

Sometimes good humor is a little too on the nose, like those Onion articles that come true a few years later. The real medical consensus on face masks came from pretty much the same process as the fake medical consensus on parachutes. Common sense said that they worked. But there weren’t many good RCTs. We couldn’t do more, because it would have been unethical to deliberately expose face-mask-less people to disease. In the end, all we had were some mediocre trials of slightly different things that we had to extrapolate out of range.

Just like the legal term for “not proven guilty beyond a reasonable doubt” is “not guilty”, the medical term for “not proven to work in several gold-standard randomized controlled trials” is “it doesn’t work” (and don’t get me started on “no evidence”). So the CDC said masks didn’t work.

Going back to our diagram:

Goofus started with the position that masks, being a new idea, needed incontrovertible proof. When the few studies that appeared weren’t incontrovertible enough, he concluded that people shouldn’t wear masks.

Gallant would have recognized the uncertainty – based on the studies we can’t be 100% sure masks definitely work for this particular condition – and done a cost-benefit analysis. Common sensically, it seems like masks probably should work. The existing evidence for masks is highly suggestive, even if it’s not utter proof. Maybe 80% chance they work, something like that? If you can buy an 80% chance of stopping a deadly pandemic for the cost of having to wear some silly cloth over your face, probably that’s a good deal. Even though regular medicine has good reasons for being as conservative as it is, during a crisis you have to be able to think on your feet.

IV.

But getting back to the media:

Their main excuse is that they were just relaying expert opinion – the sort of things the WHO and CDC and top epidemiologists were saying. I believe them. People on Twitter howl and gnash their teeth at this, asking why the press didn’t fact-check or challenge those experts. But I’m not sure I want to institute a custom of journalists challenging experts. Journalist Johann Hari decided to take it upon himself to challenge psychiatric experts, and wrote a serious of terrible articles and a terrible book saying they were wrong about everything. I am a psychiatrist and I can tell you he is so wrong that it is physically painful to read his stuff (though of course I would say that…). Most journalists stick to assuming the experts know more about their subject of expertise than they do, and I think this is wise. The role of science journalists is to primarily to relay, explain, give context to the opinions of experts, not to try to out-medicine the doctors. So I think this is a good excuse.

But I would ask this of any journalist who pleads that they were just relaying and providing context for expert opinions: what was the experts’ percent confidence in their position?

I am so serious about this. What fact could possibly be more relevant? What context could it possibly be more important to give? I’m not saying you need to have put a number in your articles, maybe your readers don’t go for that. But were you working off of one? Did this question even occur to you?

Nate Silver said there was a 29% chance Trump would win. Most people interpreted that as “Trump probably won’t win” and got shocked when he did. What was the percent attached to your “coronavirus probably won’t be a disaster” prediction? Was it also 29%? 20%? 10%? Are you sure you want to go lower than 10%? Wuhan was already under total lockdown, they didn’t even have space to bury all the bodies, and you’re saying that there was less than 10% odds that it would be a problem anywhere else? I hear people say there’s a 12 – 15% chance that future civilizations will resurrect your frozen brain, surely the risk of coronavirus was higher than that?

And if the risk was 10%, shouldn’t that have been the headline. “TEN PERCENT CHANCE THAT THERE IS ABOUT TO BE A PANDEMIC THAT DEVASTATES THE GLOBAL ECONOMY, KILLS HUNDREDS OF THOUSANDS OF PEOPLE, AND PREVENTS YOU FROM LEAVING YOUR HOUSE FOR MONTHS”? Isn’t that a better headline than Coronavirus panic sells as alarmist information spreads on social media? But that’s the headline you could have written if your odds were ten percent!

So:

I think people acted like Goofus again.

People were presented with a new idea: a global pandemic might arise and change everything. They waited for proof. The proof didn’t arise, at least at first. I remember hearing people say things like “there’s no reason for panic, there are currently only ten cases in the US”. This should sound like “there’s no reason to panic, the asteroid heading for Earth is still several weeks away”. The only way I can make sense of it is through a mindset where you are not allowed to entertain an idea until you have proof of it. Nobody had incontrovertible evidence that coronavirus was going to be a disaster, so until someone does, you default to the null hypothesis that it won’t be.

Gallant wouldn’t have waited for proof. He would have checked prediction markets and asked top experts for probabilistic judgments. If he heard numbers like 10 or 20 percent, he would have done a cost-benefit analysis and found that putting some tough measures into place, like quarantine and social distancing, would be worthwhile if they had a 10 or 20 percent chance of averting catastrophe.

V.

This is at risk of getting too depressing, so I want to focus on some people who deserve recognition for especially good responses.

First, a bunch of generic smart people on Twitter who got things exactly right – there are too many of these people to name, but Scott Aaronson highlights “Bill Gates, Balaji Srinivasan, Paul Graham, Greg Cochran, Robin Hanson, Sarah Constantin, Eliezer Yudkowsky, and Nicholas Christakis.” None of these people (except Greg Cochran) are domain experts, and none of them (except Greg Cochran) have creepy oracular powers. So how could they have beaten the experts? Haven’t we been told a million times that generic intelligence is no match for deep domain knowledge?

I think the answer is: they didn’t beat the experts in epidemiology. Whatever probability of pandemic the experts and prediction markets gave for coronavirus getting really bad, these people didn’t necessarily give a higher probability. They were just better at probabilistic reasoning, so they had different reactions to the same number. There’s no reason generic why smart people shouldn’t be better at probabilistic reasoning then epidemiologists. In fact, this seems exactly like the sort of thing generic smart people might be.

Zeynep Tufekci is an even clearer example. She’s a sociologist and journalist who was writing about how it was “our civic duty” to prepare for coronavirus as early as February. She was also the first mainstream media figure to spread the word that masks were probably helpful.

Totally at random today, reading a blog post on the Mongol Empire like all normal people do during a crisis, I stumbled across a different reference to Zeynep. In a 2014 article, she was sounding a warning about the Ebola pandemic that was going on at the time. She was saying the exact same things everyone is saying now – global institutions are failing, nobody understands exponential growth, travel restrictions could work early but won’t be enough if it breaks out. She quoted a CDC prediction that there could be a million cases by the end of 2014. “Let that sink in,” she wrote. “A million Ebola victims in just a few months.”

In fact, this didn’t happen. There were only about 30,000 cases. The virus never really made it out of Liberia, Sierra Leone, and Guinea.

I don’t count this as a failed prediction on Zeynep’s part. First of all, because it could have been precisely because of people like her sounding the alarm that the epidemic was successfully contained. But more important, it wasn’t really a prediction at all. Her point wasn’t that she definitely knew this Ebola pandemic was the one that would be really bad. Her point was that it might be, so we needed to prepare. She said the same thing when the coronavirus was just starting. If this were a game, her batting average would be 50%, but that’s the wrong framework.

Zeynep Tufecki is admirable. But her admirable skill isn’t looking at various epidemics and successfully predicting which ones will be bad and which ones will fizzle out. She can’t do that any better than anyone else. Her superpower is her ability to treat something as important even before she has incontrovertible evidence that it has to be.

And finally, Kelsey Piper. She wrote a February 6th article saying:

The coronavirus killed fewer people than the flu did in January. But it might kill more in February — and unlike the flu, its scope and effects are poorly understood and hard to guess at. The Chinese National Health Commission reports 24,324 cases, including 3,887 new ones today. There are some indications that these numbers understate the situation, as overwhelmed hospitals in Wuhan only have the resources to test the most severe cases. As of Tuesday, 171,329 people are under medical observation because they’ve had close contact with a confirmed case.

It is unclear whether China will be able to get the outbreak under control or whether it will cause a series of epidemics throughout the country. It’s also unclear whether other countries — especially those with weak health systems — will be able to quickly identify any cases in their country and avoid Wuhan-scale outbreaks.

The point is, it’s simply too soon to assert we’ll do well on both those fronts — and if we fail, then the coronavirus death toll could well climb up into the tens of thousands. It also remains to be seen if vaccines or effective antiviral treatments will be developed. That’s just far too much uncertainty to assure people that they have nothing to worry about. And misleadingly assuring people that there’s nothing to worry about can end up doing harm.

“Instead of deriding people’s fears about the Wuhan coronavirus,” Sandman, the communications expert, writes, “I would advise officials and reporters to focus more on the high likelihood that things will get worse and the not-so-small possibility that they will get much worse.”

She concluded that “the Wuhan coronavirus likely won’t be a nightmare pandemic, but that scenario is still in play”, and followed it up with an article urging people to prepare by buying essential food and supplies.

If we interpret her “likely won’t be a nightmare pandemic” sentence as a prediction, she got the prediction wrong. Like Zeynep, she has no special ability to predict whether any given disease will end in global disaster. But that didn’t matter! She gave exactly the correct advice to institutions (prepare for a worst-case scenario, stop telling people not to panic) and exactly the correct advice to individuals (start prepping). When you’re good enough at handling uncertainty, getting your predictions exactly right becomes almost superfluous.

The Vox article says the media needs to “say what it doesn’t know”. I agree with this up to a point. But they can’t let this turn into a muddled message of “oh, who knows anything, whatever”. Uncertainty about the world doesn’t imply uncertainty about the best course of action! Within the range of uncertainty that we had about the coronavirus this February, an article that acknowledged that uncertainty wouldn’t have looked like “We’re not sure how this will develop, so we don’t know whether you should stop large gatherings or not”. It would have looked like “We’re not sure how this will develop, so you should definitely stop large gatherings.”

I worry that the people who refused to worry about coronavirus until too late thought they were “being careful” and “avoiding overconfidence”. And I worry the lesson they’ll take away from this is to be more careful, and avoid overconfidence even more strongly.

Experts should think along these lines when making their recommendations, but if they don’t, the press should think along them as part of its work of putting expert recommendations in context. I think Kelsey’s article provides an shining example of what this should look like.

Maybe other people got this right too. I’m singling out Kelsey because of a personal connection – I met her through the same probabilistic reasoning forum where I did my cryonics survey years ago. I don’t think this is a coincidence.

[Related: Book Review: The Precipice; Two Kinds Of Caution]

Even if all we do is delay the inevitable, delay is very valuable.

As co-blogger Eugene Volokh points out, yesterday the Pennsylvania Supreme Court rejected a takings challenge to the governor's coronavirus shutdown order. In Friends of Danny DeVito v. Wolf, the Court ruled against several businesses whose owners argued that the governor's order forcing them to shut down was a taking of private property that requires compensation under the Takings Clause of the Fifth Amendment, and the similar provision in the Pennsylvania state constitution. The Court's reasoning is largely the same as that I laid out in my March 20 post addressing the same issue. Specifically, the majority ruled that the shutdown does not qualify as a taking because it is an exercise of the "police power" and because it is only a temporary restriction on the owners' use of property, which therefore does not destroy all of its economic value:

[W]e conclude that Petitioners have not established that a regulatory taking has occurred. The Executive Order results in only a temporary loss of the use of the Petitioners' business premises, and the Governor's reason for imposing said restrictions on the use of their property, namely to protect the lives and health of millions of Pennsylvania citizens, undoubtedly constitutes a classic example of the use of the police power to "protect the lives, health, morals, comfort, and general welfare of the people[.]" Manigault v. Springs, 199 U.S. 473, 480 (1905). We note that the Emergency Code temporarily limits the Executive Order to ninety days unless renewed and provides the General Assembly with the ability to terminate the order at any time. 35 Pa.C.S. § 7301(c). Moreover, the public health rationale for imposing the restrictions in the Executive Order, to suppress the spread of the virus throughout the Commonwealth,is a stop-gap measure and, by definition, temporary.

Chief Justice Saylor's partial dissent on behalf of three of the seven justices, takes issue with the majority opinion on several points, but still would not rule in favor of the plaintiffs outright—instead concluding that some of the issues they raise should be addressed more fully in the lower courts before reaching a final decision. In addition, the dissent does not argue that the takings issue is one of those that require additional consideration, though it does question the majority's argument that the losses inflicted on the owners are only temporary:

While the majority repeatedly stresses that such closure is temporary… this may in fact not be so for businesses that are unable to endure the associated revenue losses. Additionally, the damage to surviving businesses may be vast. Significantly, moreover, the Supreme Court of the United States has admonished that the impermanent nature of a restriction "should not be given exclusive significance one way or the other" in determining whether it is a proper exercise of police power. Tahoe-Sierra Pres. Council, Inc. v. Tahoe Reg'l Planning Agency, 535 U.S. 302, 337, 122 S. Ct. 1465, 1486 (2002)….

To me, the majority allocates too much weight to temporariness to defeat developed allegations of a lack of due process in the executive branch's determination of which businesses must close and which must remain closed…

Although Tahoe-Sierra is a takings case, the dissent cites it only to bolster the contention that the plaintiffs' businesses may have been shut down without proper due process—not the claim that they deserve compensation under the Takings Clause. Indeed, the word "taking" is not even mentioned in the dissent.

As discussed in my earlier post, I think the correct interpretation of Takings Clause would require compensation in at least some of these cases, and that compensation for owners of shut down businesses and other enterprises is often required as a matter of morality and policy, even if it is not dictated by the Constitution.  That said, the majority's decision in this case is the right one under current Supreme Court precedent.

The Pennsylvania Supreme Court's ruling in this case also  rejects several other challenges to the legality of the shutdown order, which I will leave to experts on those particular subjects. Eugene Volokh has blogged about them here, here, here, and here.

Read 16 remaining paragraphs | Comments

The second derivative is the rate of growth of the rate of growth. Over the past few weeks, the second derivative of total coronavirus cases switched from positive (typical of exponential growth) to zero or negative (typical of linear or sublinear growth) in most European countries. Over the past few days, it switched from positive to zero/negative in the United States and the world as a whole. These are graphs of the rate of growth – notice how they go from shooting upward to being basically horizontal or downward-sloping (source).

This graph shows the numbers a little differently, (source), but you can see the same process going on in individual US cities:

It would be premature to say we’re now winning the war on coronavirus. But we’ve stopped actively losing ground. If we were going to win, our first sign would be something like this. Current containment strategies are working.

As before, feel free to treat this as an open thread for all coronavirus-related issues. Everything here is speculative and not intended as medical advice.

The Bat Flu

SSC reader Trevor Klee has a great article on why humans keep getting diseases from bats (eg Ebola, SARS, Marburg virus, Nipah virus, coronavirus). He explains that because bats expend so much energy flying, they run higher body temperatures than other mammals, which degrades their DNA. Their DNA is such a mess that the usual immune system strategy of targeting suspicious DNA doesn’t work, so they accept constant low-grade infection with a bunch of viruses as a cost of doing business. Sometimes those viruses cross to humans, and then we get another bat-borne disease.

Subreddit user nodding_and_smiling doesn’t quite buy it:

I don’t think deep-diving into the bat immune system, while certainly very interesting, is necessary to explain the number zoonotic diseases from bats. I think a more important point is there is just a crazy number of bats, and the post doesn’t seem to fully appreciate this.

There are over 1,250 bat species in existence. This is about one fifth of all mammal species. Just to get a sense of this, let me ask a modified version of the question in the title:

“Why do human beings keep getting viruses from cows, sheep, horses, pigs, deer, bears, dogs, seals, cats, foxes, weasels, chimpanzees, monkeys, hares, and rabbits?”

That list contains species from four major mammal clades: ungulates (257 species), carnivora (270), primates (~300), and lagomorphs (91). Adding all these together, we don’t even get to 3/4 of the total number of bat species…

Read the full comment (and the ensuing discussion) for more, including whether biodiversity vs raw numbers is the appropriate measure here.

Mail Suffrage

The Wisconsin Democratic primary (plus some unrelated elections) went ahead as usual this week, with people going out to voting booths instead of voting by mail. Democrats wanted to allow (mandate?) mail voting, but Republicans refused.

Presumably Republicans assumed mail voting would benefit Democrats? The last time a state instituted vote-by-mail, in New Jersey, it did seem to increase the Democratic share of the vote.

I’m surprised by this, because I would have expected mail voting, as opposed to booth voting, benefits people with good executive function who are familiar with doing things by mail – ie older, richer people, ie Republicans. It would appear that I am wrong.

What if the epidemic isn’t done by November? There will probably be a discussion of lifting the shutdown to have a normal election, vs. voting entirely by mail, vs. combination where people who want to vote by mail can but the polls are open for everyone else. I don’t know if the second option is in the Overton Window right now (or if it should be). The party lines here seem to be the same: Nancy Pelosi is already pushing for it, and conservatives are already denouncing it as a liberal plot.

I’m in favor, obviously, but also terrified that something goes wrong. In one scenario, failure to agree on vote-by-mail rules (or failure to implement them competently) delays the election, with no clear way to get it back on track. In another, the sudden panicked switch to a less-tested voting method goes wrong in unpredictable ways and creates ambiguity over election results. It could be Bush v. Gore x 1000.

The Neoliberal Project has an analysis of what we should do and how to make postal voting work. I just really hope it doesn’t come to this.

Charity Update

Last week I linked a list of potentially good coronavirus charities cobbled together by some random people on the EA forum. Now a more serious organization, 80,000 Hours, has posted their own list.

The top option is still the Johns Hopkins Center for Health Security, which researches and advocates for biosecurity policy. Last week someone in the comments doubted the quality of their work, pointing out that one of their flagship efforts is a ranking of how prepared different countries are for a global pandemic; their 2019 listing put the US at the top, which now feels like a cruel joke. But I’m not sure how much to hold it against them. Looking at their webpage, it mostly investigates whether a country has good plans addressing various issues of a crisis, and lots of resources that it can deploy if needed. As best I can tell, the US had great plans and didn’t follow any of them, and lots of resources which it totally failed to deploy effectively. Responsible think tanks are probably not allowed to add a -10000 points at the end of their analysis for “but its leaders are idiots”. This might still be a good time to reread Samzdat on hokey country rankings and no_bear_so_low on hokey country rankings.

Speaking of charity, you can read on Twitter about the trials and tribulations of people trying to donate face masks to hospitals, and here’s an article from three years ago about issuing pandemic bonds as a novel insurance-type way of funding global disease response. Pretty neat.

And you might think that a page called The COVID Challenge where you sign up to deliberately get infected with coronavirus is a bad idea, but it’s actually some volunteers trying to make a list of people who would be willing to get deliberately infected (if it came to that) in order to test vaccines, which they will hand over to vaccine-makers once they get to the testing stage. Rationalist John Beshir did something like this for a malaria vaccine last year and earned $3200 (plus the warm glow of having made a difference) by letting himself getting bitten by infected mosquitoes in an Oxford laboratory.

There Is No Coronavirus In Ba Sing Se

Turkmenistan is a strange country. You probably remember it for its wacky former dictator Turkmenbashi, who among other things renamed the month of March after his mother, and told citizens that anyone who read his book three times would enter Heaven. Or for its wacky current dictator Gurbanguly Berdymukhamedov, who NPR describes as a “dentist/rapper/strongman”. Or for its impressive accomplishment of beating out North Korea to be named the most repressive country on Earth by Reporters Without Borders.

Its coronavirus response will do nothing to improve its reputation: early reports claimed it had banned mentioning the word ‘coronavirus’ or acknowledging its existence in any way.

The Diplomat argues this is not quite true; some state media seems to be using the word. But they are definitely arresting people for talking about it outside official government organs, and they are definitely denying that there are any cases in the country. Since Turkmenistan is right next to Iran, which has had thousands of cases for months, this is pretty implausible.

The Diplomat also requests that people try not to focus on the country’s wacky dictators so much every time they talk about it, since that makes it hard to get people to take its suffering seriously. Sorry, Diplomat and Turkmen people 🙁

And SSC reader Castilho describes their home country of Brazil, which seems to be right up there with Turkmenistan:

We’re one of the few countries in the developing world that actually could handle the pandemic reasonably well (We have around 61.000 ventilators, or 1 ventilator per 3.300 people, which isn’t actually that bad and could be expanded for a decent epidemic response)…

However, our president has decided to go all-in on denying how serious the virus is. The Atlantic even called him “the new leader of the Coronavirus denial movement“. He’s accusing local politicians who have instituted lockdowns of plotting to destroy the country’s economy in order to use it against him later. His sons, who are local politicians in the wealthy parts of the country, have been saying this is all a plot by leftist politicians together with the People’s Republic of China to make him and Trump look bad. I wish I was kidding…

The worst part is that he’s led a nationwide movement telling people to leave their homes and go back to their normal lives. The government actually wanted to make “Brazil can’t stop” into a nationwide campaign, but when a significant part of the population didn’t appreciate it, they just deleted the social media posts and now they claim there never was such a campaign.

Read the full comment for more.

And last month I wondered about the surprisingly slow spread of cases in Iran. I can’t find anyone saying so outright, but it seems like the numbers are probably wrong. At least that’s what I gather from articles like this and Twitter accounts like this highlighting the scale of the crisis there, which seems at least as bad as anywhere in the world. I don’t know if they’re deliberately lying about case numbers (why start now, after the numbers were so bad a few weeks ago?) or if testing has just completely broken down there. See also this article on how their form of government has led to power struggles and a garbled response. I would say something mean about radical Islamic fundamentalism, except that the whole thing mirrors blow for blow what happened between Cuomo and de Blasio in New York.

And finally, here’s a great article on the mystery of Japan. Tl;dr: cultural traditions like mask-wearing and bowing helped it for a while, crowded trains aren’t as bad as you’d think because nobody’s talking, banning large gatherings very early was a really good move, their weak half-hearted version of test-and-trace worked for a while out of sheer luck, but now cases are finally starting to rise and there probably won’t be a mystery to explain for much longer.

Economic Unanimity

The IGM Economics Experts Panel surveys a view dozen top economists on the issues of the day. This month they’re focusing on coronavirus. Here are some sample results:

…they pretty unanimously support the lockdown, even when asked only to reflect on its economic impact.

Some socialists on social media are trying to spread a narrative where capitalists think the economy is more important than lives and want to lift the lockdown immediately, and it’s only socialists who are standing up for the importance of saving people. Top economists aren’t a perfect stand-in for capitalists, but it’s still pretty clear that they’re wrong.

Also, there are starting to be some econ papers trying to more rigorously analyze the pros and cons of lockdown. The Benefits and Costs of Flattening the Curve for COVID-19 says that “assuming that social distancing measures can substantially reduce contacts among individuals, we find net benefits of roughly $5 trillion in our benchmark scenario”.

USA! USA!

Is there anything Americans can be proud of here?

@noahpinion reminds us of America’s long history of being late on the trigger but doing a great job once we get started (Churchill: “You can always count on Americans to do the right thing – after they’ve tried everything else.”). We were late entrants into both World Wars but had an outsized effect on both of them. In that spirit, although we were very slow to start testing, we’ve ramped up impressively fast – from almost none to 1/3 of South Korean levels per capita within a few weeks.

Also worth celebrating – during the Wuhan phase of the pandemic, China built an impromptu 1,000 patient hospital in ten days. US media reported this as unbelievable – a sign that a young and vigorous country could accomplish feats that a decadent America could never dream of. But last week in New York, the Army Corps of Engineers converted the Javits Convention Center into an impromptu 2,000 patient hospital in…about ten days.

I don’t know, maybe this was easier because they’re converting an existing structure instead of building a whole new one (though even the Chinese used prefab units). But it’s nice to know we still have it in us to do things quickly. There’s no civilizational decline. If the government ever legalized building things quickly again, we’d be mopping the floor with China within weeks.

Legal Immunity

There’s a Jewish legal principle called marit ayin, which means that it’s illegal to do something which is legal but looks illegal. For example, you can’t eat some kind of plant-based Impossible Bacon, because it would look like you were eating real bacon. Some authorities say it is sometimes permissible to eat the Impossible Bacon if you leave the box out in a prominent position so that it doesn’t look illegal; I’m not sure of the details.

The argument is that widespread flagrant unpunished violation of the law makes the law uncompelling and unenforceable, and this is true whether the violation is real or imagined. If you never see anyone eat bacon, you probably won’t eat it yourself; if everyone around you seems to be eating bacon all the time, it feels less taboo. Also, if you’re a police officer, it’s hard to identify the real bacon eaters if there are a bunch of people eating Impossible Bacon who get annoyed every time you question them.

I was thinking about this recently with the news that Germany is considering issuing immunity certificates for people who have gotten coronavirus, recovered, and are now safe to do normal activities. It’s a good idea, but suffers from the same problem as Impossible Bacon – if there are hundreds of people going outside maskless, eating at restaurants, and sunning themselves on the beach, it’s going to be hard for the rest of us to take lockdown seriously enough.

The equivalent of the rabbis’ put-the-box-out solution would be for governments to issue not just a certificate but some kind of unique article of clothing people could wear to mark their status. For example, they might give an unusually shaped red cap – if the beaches are full of people in red caps, that’s fine and doesn’t say anything about whether you personally should go sunbathe. And if the beachgoers see someone without a red cap, they can question them or keep their distance.

This would take a lot of centralized coordination, though. I’m not sure how you could send the same message without a government order explaining what the cap meant to everybody. Though (as per this Onion article) wearing a fake pangolin snout over your nose would send a strong signal.

A reader who has overcome the disease emailed me to ask whether there are any useful volunteer opportunities for people like him – anyone have any advice?

Short Links

Last week I expressed confusion about how to measure population density so that arbitrary choices of border don’t distort the results. Commenters delivered by finding me this article on population-weighted density, which solves my theoretical concerns but doesn’t really change any of the numbers much.

The Netherlands is another country which, like Sweden and Brazil, is volunteering to be the control group for the great experiment of whether national lockdowns work. Maybe someone should compare them to Belgium or somewhere like that in a few months and see how they did.

An aircraft carrier captain publicly complained that the Navy was failing to address an epidemic aboard his ship; the Navy fired him for whistleblowing. I’m having a hard time thinking of any perspective other than “the Navy is bad and should be torn down totally to the foundations, preferably using some sort of land-based weapon so they can’t fight back”, but here’s a different ex-captain trying his best to give a nuanced perspective.

Say what you will about the New York Times’ coverage lately, but their cover design remains second to none.

This Tumblr post has a discussion of how/whether a Clinton administration might have responded differently to the pandemic, but the part I like is the discussion of the phrase “follow the pandemic response playbook”. It turns out this is a literal document, called the Playbook For Early Response To High Consequence Emerging Infectious Disease Threats And Biological Incidents, and you can read it here.

Marginal Revolution: are hospitals really saving that many people?

UK clinical guideline body NICE now officially recommends against using NSAIDs for coronavirus. Still not completely proven, but I think they’re right to advise caution. While most experts themselves behaved appropriately, this is more egg on the face of the media, which until a few weeks ago was running stories telling people this was a myth and they should ignore it.

538 surveyed infectious disease experts around the US, asking them to predict the number of cases in X days’ time, with confidence intervals. The results are in, and the experts did worse than just continuing the exponential curve on the graph would have. EDIT: But see here.

If you’re following Robin Hanson’s variolation proposals, you can watch Hanson debate vs. Zvi Moskowitz and vs. Greg Cochran (and here’s Cowen on Hanson). Anyway, viral dose seems to have gone mainstream, though nobody seems to be doing anything about it yet.

The two different interpretations of “flatten the curve”. I think this explains why so much of the discussion around this phrase has been confusing.

Trump Asks Medical Supply Firm 3M To Stop Selling N95 Respirators To Canada, and also Key Medical Supplies Were Shipped From US Manufacturers To Foreign Buyers. I think we’re supposed to be outraged about both of those things simultaneously but I can’t manage it, maybe some of you will have better luck.

How much risk do young people really face from coronavirus? What are the risks of long-term complications? Sarah C investigates.

Last week, Elon Musk got widespread praise (including here) for donating a thousand ventilators he managed to procure through his Tesla supply chain. Now the picture has become more confusing. Reporters looking at a picture of his shipment noticed that the boxes pictured are for BiPAP machines – technically a kind of ventilator, but not the kind hospitals need to fight coronavirus. Was the whole thing a giant mistake or cynical PR stunt? But then some hospitals tweeted thanking Tesla specifically for delivering “Medtronic invasive ventilators”, which are the kind hospitals need to fight coronavirus. Some people are theorizing that maybe hospitals don’t want to offend Musk since he might have real ventilators later, other people that maybe Musk got both some useful and some non-useful ventilators in his shipment. I dunno. In any case, he’s still promising to make some at Tesla factories, though.