Taking Initial Viral Load Seriously

In part a response to (Overcoming Bias): Variolation May Cut Covid19 Deaths 3-30X

Also related: This is an expansion of parts of this debate with Robin Hanson.

Epistemic Status: Thinking out loud. Food for thought. Not an expert.

Initial viral load seems likely to have a large impact on severity of Covid-19 infection. If we believe this, we should take this seriously, and evaluate both general policy and personal behavior differently in light of this information. We should also do our best to confirm or deny this hypothesis as soon as possible.

Robin Hanson and I had a debate on Sunday regarding his proposal of variolation: Deliberate Covid-19 infection of volunteers, using small viral loads, followed by isolation of those volunteers until recovery. I felt it was an excellent discussion. As with all such discussions, some key points are glossed over, lost or not stated as well as one would like in hindsight, there are areas that never come up, and one thinks of important additional things afterwards.

What evidence do we have that viral load matters?

Let My People Stay Home

When the Jews left Egypt, they were in such a hurry that they did not have time for their bread to rise.

When we packed up the most important things in our apartment, we were forced to leave the bread behind. The pizza was ready in eighteen minutes.

What is a School?

Previously: The Case Against Education

You don’t know what you’ve got till it’s gone.

In a belated triumph of sanity, schools around the world are closing their doors in the wake of the Coronavirus outbreak.

The debates about schools closing make it clear how schools provide value.

Here in New York City, and in many other places, we are refusing to close to schools until (two weeks after the) last minute because schools provide free meals to poor children.

The other stated reason is because if children are not in school, their parents would be unable to work, and some of their parents are healthcare workers or cannot afford any missed paychecks.

(In the case of universities, we also have places like Harvard that took away students’ housing and thus left them with no place to live.)

These are good, real concerns. We need solutions to these problems.

But we also now know what real problems are being solved.

We have school because our society believes that one cannot leave children unsupervised or terrible things would happen, for very broad values of children. We also have school because we don’t have another way to ensure that children get to eat. And in some narrow cases, we have a very partial fix for a housing crisis.

Clearly, regardless of what the best solutions are, one could goal factor for these problems much better than ‘mandatory schooling.’

The concern that I have heard literally zero people mention is that closing the schools will prevent children from learning.

I do realize that no one is grappling with how long this is likely to last, and that in the long term they would raise this concern.

But still, I find all of  this enlightening. And refreshing.

 

An Open Letter To The Congregation Regarding The Upcoming Holiday

Under normal circumstances, in a few days we would gather together to celebrate the festival of Purim. We celebrate by reading together the megillah. It tells a timeless story for every generation about standing up and avoiding death.

Since, as we all know, the whole megillah is a long megillah, I will suggest this shortened version that I think today’s people of all beliefs can relate to.

Coronavirus is Here

Even in the best case scenarios, things are going to get a lot worse from here before they get better.

Please, please, please, do not rely on me here to tell you what is going on or what to do. Even more than that, please, please, please, do not take this as saying that you shouldn’t do a lot more than the things I’m saying here.

This is me doing what various stupid reasons prevented me from doing earlier, deciding that saying something is a lot better than saying nothing, and hoping it will do some good.

This is not a model of what is happening, or an attempt to justify what you should do, because attempting to do that would cause me to continue to say nothing, and that seems worse.

If you already are taking the situation seriously and making serious preparations, this probably won’t tell you anything new. I am totally fine with that.

This is me seeing something and saying something.

If you need some sort of permission to yourself to acknowledge that this is happening, and that you need to take action now to prepare, this is one more instance of that. You have it.

It will be important that you retain the ability, when things get bad, to keep your head on straight. Prepare now, including mentally, as best you can, for people you know and care about getting sick and dying, because this might well happen to you regardless of what actions everyone involved takes.

Here is an article describing the symptoms, if you are not yet familiar with that. It’s primarily dry cough and pneumonia.

From the statistics I have seen, with super wide error bars, overall risk of death if you do get infected could be up to about 2%. But that is only an average. It varies wildly based on age and prior health, and presumably access to health care. I’ve also seen reasonable claims that initial degree of exposure matters here.

Risk of death chart by age:

Age Death Rate
80+ years old    14.8%
70-79 years old 8.0%
60-69 years old 3.6%
50-59 years old 1.3%
40-49 years old 0.4%
30-39 years old 0.2%
20-29 years old 0.2%
10-19 years old 0.2%
0-9 years old no fatalities

Co-morbidity is very high for conditions such as heart attacks, cancer and diabetes. If you are elderly and/or have conditions such as cancer, a prior heart attack or diabetes, you are at much greater risk, and should take all precautions more aggressively.

If you have not yet prepared for quarantine in place for at least several weeks, and ideally longer than that, you need to do at least that much now. Get a three month supply of any medications you need. Make sure you are stocked with the necessary food and water, soap and toilet paper and so on. Here is a quick LessWrong post on quarantine preperations.

Decide now what would make you impose this quarantine on yourself rather than waiting for an authority figure to do it for you, and what would cause you to impose other lesser restrictions. Decide what would cause you to stop going to restaurants, stop going to work, stop going outside for any non-emergency reason, and so on.

Figure out what news sources, including people who you trust, you are going to be willing to trust for information going forward.

If you are not prepared, including mentally, for approximately everyone around you to freak the hell out about this in various ways, you need to do that now.

If you have any plans to fly or attend conferences or sporting events or other major gatherings of people, at least beyond the next few days, cancel them. Period. Where and when you draw the line is up to you, but draw a line and adjust it quickly as news comes in.

If you can do your job from home rather than a crowded office, do your job from home. If you have to commute, don’t do it on crowded subways or buses.

Do not shake hands or otherwise make other unnecessary physical contact with anyone.

If you are not yet doing your best to get good hand washing practices or avoid touching your face and other similar basic hygienic actions to avoid infection, get on that. Here is a post on how to properly wash your hands.

Remember that the virus can survive on surfaces for days, that it takes people several days of incubation to show symptoms, and that it takes two weeks to play itself out.

If there are people you care about who don’t know that this is happening or aren’t taking it seriously, fix that.

Here is a practical advice post that seems good that has detail. Biggest impact actions from its perspective are avoiding people in general, avoiding people who seem potentially sick in particular (at least 2 meters away at all times), frequent proper hand washing and keeping a reasonable stock of supplies.

Here is the LessWrong advice thread where people offer advice and justifications for potentially ‘weird looking’ actions. One piece of advice is to stock electrolyte drinks in case someone is unable to eat due to illness. They recommend copper tape be placed on commonly touched surfaces and the backs of phones, you can buy some here. Also they endorse a pulse oximeter. One interesting suggestion is Vitamin D supplements since you might be unable to go outside.

Here is a basic ‘the CDC expects this is happen’ thing from a few days ago in case anyone needs to share something that basic with someone, otherwise ignore.

If you live in a major city, and leaving that city is practical, it is at least reasonable to do so, especially if you are at greater risk.

Do not take this as anything like a complete list of things to do or consider doing. Seriously consider doing more things to prepare, and avoiding more things more aggressively, based on what you believe to be helpful.

Again, DON’T PANIC. Let’s all stay safe as best we can.

 

Mazes Sequence Roundup: Final Thoughts and Paths Forward

There are still two elephants in the room that I must address before concluding. Then I will discuss paths forward.

Moloch’s Army

The first elephant is Moloch’s Army. I still can’t find a way into this without sounding crazy. The result of this is that the sequence talks about maze behaviors and mazes as if their creation and operation are motivated by self-interest. That’s far from the whole picture.

There is mindset that instinctively and unselfishly opposes everything of value. This mindset is not only not doing calculations to see what it would prefer or might accomplish. It does not even believe in the concept of calculation (or numbers, or logic, or reason) at all. It cares about virtues and emotional resonances, not consequences. To do this is to have the maze nature. This mindset instinctively promotes others that share the mindset, and is much more common and impactful among the powerful than one would think. Among other things, the actions of those with this mindset are vital to the creation, support and strengthening mazes.

Until a proper description of that is finished, my job is not done. So far, it continues to elude me. I am not giving up.

Protecting Large Projects Against Mazedom

Previous Post: Create a Full Alternative Stack

If we wish to accomplish something that would benefit from or require a larger organization or more levels of management and bureaucracy, what should we do in light of the dangers of mazes?

There are no easy answers. Real tradeoffs with real sacrifice are the order of the day. But we can do some things to expand the production possibilities frontier, and choose wisely along that frontier.

As is often the case, this starts with admitting you have a problem. 

Too often, it is assumed that one should scale without worrying about the costs of scaling, or without counting becoming a maze as one of the biggest costs. Not stretching oneself maximally thin, or getting in the way of this process, becomes the sin of not maximizing effectiveness or profits.

That ensures failure and rapid descent into a maze. Start by getting out of this mindset. 

If you are looking to accomplish a big thing that requires lots of organization, management and bureaucracy, here are ways to help contain the damage. 

None of them should come as a surprise by this point. This is more of a synthesis of points already made, and not a place I feel I have special additional insights. So I will keep this short.