The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer.
I think this really needs to substantiated before claiming it is true (I realise this is a quote but still).
Personally I think people are looking at the wrong denominator for Japan - Japan’s tests / population is low but their tests / positive test is high (20:1 or so, S Korea is 30:1, Western nations are <10:1).
As a new reader of lesswrong, just wanted to say thank you for putting this together. This is super helpful! Eagerly awaiting your future updates.
It's not confusing that Nigeria, in particular, has few cases. They have a really well-developed containment (disinfection + contact tracing + case isolation) infrastructure.
During the 2014 West African Ebola epidemic, an Ebola-positive patient showed up in Lagos, one of the most dense cities on the planet, and yet the country only ended up with 20 cases total.
My understanding (can't seem to find a great citation for this, learned it from a CDC person at a conference) is that Nigeria's internationally-funded efforts to eradicate polio (no wild polio since 2016!) helped to build world-leading containment expertise. The fact that Nigeria was able to contain Ebola was cited as an example of why international aid to fund healthcare infrastructure is worthwhile.
For more background, here's Ebola in Nigeria on Wikipedia, and a Scientific American article called How Did Nigeria Quash Its Ebola Outbreak So Quickly?
Anyway, people have been talking about how many Southeast Asian countries have been well-prepared for COVID-19 because of all of the institutional knowledge developed during the 2003 SARS outbreaks. We should expect many West African countries to have similar infrastructure from the 2014-2016 Ebola epidemic- here's a QZ Interview with Chikwe Ihekweazu, an African epidemiologist who sits on the board of the Public Health Foundation of Nigeria suggesting just that.
Don’t touch your face (duh)
Wash your hands (duh)
You need to practise these things, and get others to hold you accountable for doing them. I have seen people on TV tell everyone not to touch their face and then *touch their face*.
You are only as smart as your dumbest mistake.
You need to practise these things
So true. I'm trained to surgical sterility and am very aware of everything I touch and when I'm contaminated but it is hard to be vigilant ....
Although my constant 'helping' of others in the household to maintain standards may get me beaten to death before coronavirus gets me. : )
Hmm - the charts show daily changes in proportion to the previous day - this is not exactly second derivative. For example the function x*x has a constant second derivative - but it would slope down on such a chart.
...See the latest in my 2 Apr Brief!
COVID-19 is a rapidly changing situation and it is hard to keep up to date. However, right now I am following COVID-19 full time and I read widely and I read a lot. I’m going to experiment with providing a public consolidated brief that tries to consolidate everything I read into one short, actionable list so other people don’t have to re-create my work. This way I can save time and fight research debt.
This brief assumes you are up to date on most things that have happened since around the 25th of March and will aim to keep you up to date on the latest over the past three days or so.
Note that I am not a domain expert and I urge some caution in over-relying on my selection and interpretation of these links.
This brief follows my research agenda. I am going to keep that up to date as well. I will also keep eyes on the LessWrong Coronavirus Agenda and submit to the LessWrong links database. Further discussion will be in the EA Coronavirus Facebook Group.
Doing Your Part! How You Can Stay Safe and Help the Fight!
Rob Besinger offers some advice for staying safe that I have not had the time or expertise to verify, but will reprint uncritically:
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80,000 Hours puts out a list of things people can do to help with COVID:
80,000 Hours thinks it is people should switch to working on COVID-related projects if they’re roughly in the top 4% of people best suited to work on it - typically people who:
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Here’s my personal list of things you can do:
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80,000 Hours also suggests donations for COVD-19 relief: Center for Health Security at John Hopkins, Gates Foundation COVID-19 Funds, and the Center for Global Development.
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You can now help fight COVID using your laptop’s spare cycles via Folding@Home.
A Glance at The Latest Situation
Things are still getting bad quickly. See FT’s latest graph reprinted below. ...As Justin Wolfers puts it: “Project the U.S. line forward just 7 days, and we'll be at 10,000 deaths in total. Project it forward a week after that, and we'll be at 10,000 per day.” (Hopefully we’ll have flattened the curve a bit since then.)
The case numbers look bad, but at least the second derivative (growth in growth) shows some good news. The New York Times reports:
However, the situation still is dire: “The rate of increase in cases [in New York City] is far higher for the number of cases than it was in Wuhan or Lombardy, once they had reached similar numbers of cases. Other metropolitan areas, like Detroit and New Orleans, stand out as places where a coronavirus outbreak might escalate quickly without preventive measures. The Seattle and San Francisco areas, in contrast, seem to have made serious progress in flattening the curve.”
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Here’s a very good visualization of percent of people infected by region in the world.
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Note that case numbers are related to testing numbers, differences in who gets tested, and how cases, tests, and deaths are reported - and these all can differ country-to-country. This might be why Germany has such a low death-per-case rate. Italian data may also be underreported. Same with Spanish data. We should be prepared for the data to be a bit wonky and for comparisons to not be entirely apples-to-apples.
For example, I’ve been watching China-related COVID-19 reporting with a lot of anticipation… they seem to be doing very well at containing the virus and could become a model for the rest of the world. However, there’s also a lot of disinformation and misinformation around China. There’s good reason to distrust their numbers. There’s also good reason to distrust the distrust of their numbers. Some Chinese doctors who tested negative for coronavirus have later tested positive. ...One thing that is easy to verify: China re-closes all cinemas over fear of a second coronavirus outbreak.
Similarly, I share Scott Alexander’s deep confusion over what the hell is going on in Japan, Iran, Nigeria, and Mexico:
Japan should be having a terrible time right now. They were one of the first countries to get coronavirus cases, around the same time as South Korea and Italy. And their response has been somewhere between terrible and nonexistent. A friend living in Japan says that “Japan has the worst coronavirus response in the world (the USA is second worst)”, and gets backup from commenters, including a photo of still-packed rush hour trains. [...]
But actually their case number has barely budged over the past month. It was 200 a month ago. Now it’s 1300. This is the most successful coronavirus containment by any major country’s, much better than even South Korea’s, and it was all done with zero effort.
The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer.
But at this point, it should be beyond their ability to cover up. We should be getting the same horrifying stories of overflowing hospitals and convoys of coffins that we hear out of Italy. Japanese cities should be defying the national government’s orders and going into total lockdowns. Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am. [...]
Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation. [...]
The third world …is in really deep trouble, isn’t it?
The numbers say it isn’t. Less developed countries are doing fine. Nigeria only has 65 cases. Ethiopia, 12 cases. Sudan only has three!
But they probably just aren’t testing enough. San Diego has 337 diagnosed cases right now. The equally-sized Mexican city of Tijuana, so close by that San Diegans and Tijuanans play volleyball over the border fence, has 10. If we assume that the real numbers are more similar (can we assume this?), then Mexico is undercounting by a factor of 30 relative to the US, which is itself undercounting by a factor of 10 or so. This would suggest Mexico has the same number of cases as eg Britain, which doesn’t seem so far off to me (Mexico has twice as many people). [...]
Nigeria and Mexico and so on make me confused in the same way as Japan – why aren’t they already so bad that they can’t hide it? If the very poorest countries in sub-Saharan Africa were suffering a full-scale coronavirus epidemic, would we definitely know? In Liberia, only 3% of people are aged above 65 (in the US, it’s 16%). It only has one doctor per 100,000 people (in the US, it’s one per 400) – what does “hospital overcrowding” even mean in a situation like that? I don’t think a full-scale epidemic could stay completely hidden forever, but maybe it could be harder to notice we would naively expect.
Tyler Cowen also asks “Where does all the heterogeneity come from?”: “Can anyone shed light on why the death rate is not higher in Iceland? Is it that the death rate is about to burst a week from now? [...] Similarly, Sweden hasn’t restricted public life very much and they do not seem to be falling apart? [...] It is possible that Cambodia, Thailand, and Vietnam still will be hit hard, but so far the signs do not indicate as such. Warm weather may play a positive role, though that remains speculative. The latest weather paper appears credible and indicates some modestly positive results. Of course weather won’t explain the relative Icelandic and Swedish success, if indeed those are truly successes.”
Similarly, why aren’t a ton of Swedes on their way to being dead?
Maybe it’s still just a matter of time? Vox argues that Mexico’s coronavirus-skeptical president is setting up his country for a health crisis and Japan’s coronavirus crisis may be just beginning.
...Also, beware Goodhart’s Law in these metrics - originally US states were strongly incentivized to underreport, but now that relief is tied to caseload, they are strongly incentivized to overreport.
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There is now data on ICU beds by US county.
...So Just How Bad Could This All Get?
"From Spain to Germany, Farmers Warn of Fresh Food Shortages" warns a Bloomberg article, mainly due to fewer workers being available to pick fruit. I’m pretty skeptical of COVID-related food shortages, but I still think it is important to monitor and be on the lookout. The NYTimes reports that there is still plenty of food in storage and supply chains are currently getting replenished just fine.
Gaze into the Crystal - The Latest Modeling and Forecasting
A Stanford team produces a stochastic model to forecast a "lightswitch approach” to lockdowns, where we alternatively lockdown and un-lockdown to continually keep the case load manageable enough to not overwhelm hospitals.
Vipul Naik estimates when we will get out of lockdown. He thinks the strict “shelter in place / go out for emergencies only” might get relaxed back to “most things closed”-level lockdown by mid-June and to the “most things open except large groups still banned”-level lockdown by summer 2021 and back to business as usual by summer 2022.
A survey of 18 epidemiologists say COVID-19 will cause approximately 195,000 deaths in the US and that a “second wave” of the virus is likely to occur between August and December.
Dr. Fauci predicts over 100,000 Covid-19 deaths in the United States.
A hospital-specific model tries to use more specific information about shortages. And another model, not tied to specific hospitals, but still modeling the impact of PPE shortages.
Now Let’s Talk Policy Response
Harvard Business Review outlines some key lessons from Italy:
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Rhode Island essentially declares war on New York City:
Rhode Island police began stopping cars with New York plates Friday. On Saturday, the National Guard will help them conduct house-to-house searches to find people who traveled from New York and demand 14 days of self-quarantine.
“Right now we have a pinpointed risk,” Governor Gina Raimondo said. “That risk is called New York City.”
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WHO is very cagey / weird about Taiwan. WHO Director General, Bruce Aylward is asked about Taiwan’s membership in WHO… he responds by hanging up and then pretending to have not heard the question. Taiwan is not a member of WHO due to China’s insistence that Taiwan is a part of China.
A Bit About Life Under Quarantine
Americans have been changing their plans a lot:
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Wild... “Our estimate is that about 12-13% [of churches in the US] were still open to in-person worship as of this week.”
The Psychologists Also Have Something to Say About This
For those studying the social psychology of the pandemic, there is now a research tracker.
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The EA Australia Research Collaboration is running surveys to help policymakers with decision making about how to allocate resources to tackle COVID-19:
We doing something quite different from other ongoing surveys. Most of these are about country level comparisons and not about understanding behavioural drivers. For example, we can report things by location and demographic, but also why people are not doing the behaviours, e.g., 75% of males between 30 and 40 are social distancing but only 50% of males between 20-30. At only 55% adherence, the inner west region reports the lowest amount of social distancing. The main capability barriers are commuting and desire to see friends. 97% of those surveyed are always washing their hands, suggesting that this need no longer be a key communication target. [...]
Please consider joining us in collaboration. You can contribute by:
If you contribute to this project in any significant way then you will be recognised on all outputs and be an author on any subsequent paper. The bar for recognition will be relatively low (perhaps ~5 hours of work).
If You Still Own Envelopes, Check Their Backs - Here’s the Latest Cost-Benefit Analysis
The IGM Forum regularly polls economists about US economic policy. Economists rarely agree. But this time, economists are unanimous that the large contraction in economic activity is worth fighting coronavirus, we should not abandon the severe lockdowns, and the government should invest more in policy response.
“A comprehensive policy response to the coronavirus will involve tolerating a very large contraction in economic activity until the spread of infections has dropped significantly.”
“Abandoning severe lockdowns at a time when the likelihood of a resurgence in infections remains high will lead to greater total economic damage than sustaining the lockdowns to eliminate the resurgence risk.”
“Optimally, the government would invest more than it is currently doing in expanding treatment capacity through steps such as building temporary hospitals, accelerating testing, making more masks and ventilators, and providing financial incentives for the production of a successful vaccine.”
A study using data from the 1918 Flu found that greater economic growth was connected with lockdowns as opposed to the opposite. Faster social distancing also saved a lot of lives during the 1918 Flu.
Now Just What are the Tech Overlords up to?
Apple launches a COVID-19 screening tool. According to TechCrunch: “The site is pretty simple, with basic information about best practices and safety tips alongside a basic screening tool which should give you a fairly solid idea on whether or not you need to be tested for COVID-19.”
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The New York Times calls for “Big tech needs to rapidly build and scale a cloud-based national ventilator surveillance platform which will track individual hospital I.C.U. capacity and ventilator supply across the nation in real-time. Such a platform — which Silicon Valley could build and FEMA could utilize — would allow hospitals nationwide to report their I.C.U. bed status and their ventilator supply daily, in an unprecedented data-sharing initiative.” Probably already being done by 18 different groups now, but might still be worth exploring?
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Zuckerberg donates $25M to the Gates Foundation to fight coronavirus. It’s an accelerator to find new possible antiviral drugs and total funding for the accelerator is now at $125M.
Not to be outdone, Google pledges to donate $800 million and 3 million face masks in an effort to combat the coronavirus… however, over 75% of this fund comes in the form of Google ad grants and cloud computing credits.
Lastly, Mayo Clinic and Amazon launched a collaboration to increase COVID-19 testing and vaccine development: “The private industry effort, spearhead by Mayo Clinic's John Halamka, M.D. and other industry leaders, plans to leverage the strengths of healthcare organizations, technology companies, non-profits, academia, and startups to provide a focused response to the coronavirus outbreak.” It’s not super clear what this means but I’m glad it’s happening.
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Maybe we shouldn’t be using Zoom? Consumer Reports reports “Zoom Calls Aren't as Private as You May Think”. Engadget reports “Zoom happens to be a privacy nightmare with a terrible security track record” and that “Zoom collects your physical address, phone number, your job title, credit and debit card information, your Facebook account, your IP address, your OS and device details, and more and traffics that data with whomever it's doing business with”.
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Predictably, Edward Snowden warns about the dramatic increase of tech surveillance.
And How Do We Get Out of this Mess? Vaccines, Treatments, Testing, Tracing, etc.
US testing is no longer increasing exponentially:
...But I’m told this is a game changer: Abbot launches molecular point-of-care test to detect novel coronavirus in as little as five minutes. They’ve already received FDA emergency use authorization.
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Dr. Fauci outlines ambitious plan to scale up COVID-19 vaccine. Looks like the proposal is to start ramping up production of a vaccine while the candidate is still in Phase II clinical trials. This risks spending a ton of money producing a vaccine that ultimately might not get approved by the FDA. Dr. Fauci has suggested hundreds of millions in incentives to make this work.
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The Washington Post reports that “hVIVO, a clinical research group in London, has attracted more than 20,000 volunteers willing to be infected with tamer relatives of the virus that causes Covid-19 in exchange for a fee of £3,500 ($4,480).”
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To stop COVID-19, test everyone, repeatedly: “We propose an additional intervention that would contribute to the control of the COVID-19 pandemic and facilitate reopening of society, based on: (1) testing every individual (2) repeatedly, and (3) self-quarantine of infected individuals. By identification and isolation of the majority of infectious individuals, including the estimated 86% who are asymptomatic or undocumented, the reproduction number R0 of SARS-CoV-2 would be reduced well below 1.0, and the epidemic would collapse. This testing regime would be additive to other interventions, and allow individuals who have respiratory symptoms due to other causes to return to work, but would have to be maintained until a vaccine becomes available. Unlike sampling-based tests, population-scale testing does not need to be very accurate: false negative rates up to 15% could be tolerated if 80% comply with testing, and false positives can be almost arbitrarily high when a high fraction of the population is already effectively quarantined.”
And Now a Word From the Lamestream Media
Kelsey Piper is the best. Vox, and other media outlets have not apologized for continually downplaying the coronavirus and calling out people as fearmongering. For example, on 13 February, Vox made fun of the prescient tech industry, deriding them with “Although public officials in the area say the virus is contained for now, some in the tech industry fear the virus will spread out of control.” Kelsey Piper, Vox Future Perfect author, is at least willing to admit she made a mistake. No one else seems to be… yet Kelsey is getting all the hate for it. :(
(I also made a mistake by privately stockpiling on 8 February, but not telling anyone of my fears out of a meta-fear of looking like some dorky prepper. I also apologize for this.)
The Non-Profit Impacts
American non-profits that (a) existed before 1 March 2020, (b) have fewer than 500 employees, and (c) keep staff on payroll can get what might amount to free money from the government. This deserves urgent further investigation.
Don’t Forget About the Nonhumans!
Amid continued panig egg buying, US grocers boosted egg orders by as much as six times normal and USDA relaxes rules to allow older eggs to make grade.
Vietnam’s prime minister, Nguyen Xuan Phuc, has asked the country’s agriculture ministry to draft a directive to stop illegal trading and consumption of wildlife over fears it spreads disease.
Your Regular Dose of WTF
Fun (Online) Distractions, Because We All Still Need to Enjoy Life
The Rotterdam Philharmonic Orchestra delivers Beethoven's 'Ode to Joy' with 19 musicians playing their parts from their homes.
Cute dog undertakes a sisyphean task of constantly fetching the ball, only for it to roll back down the hill.
Dad learns how to Tik-Tok dance.
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Thanks to Elizabeth Van Nostrand, Robert Krzyzanowski, and countless others for assistance in aggregating and editing this list.