Covid-19 5/7: Fighting Limbo

Last week: Covid-19 4/30: Stuck in Limbo

Recently: Covid-19: New York’s Antibody Tests 2On “COVID-19 Superspreader Events in 28 Countries: Critical Patterns and Lessons”

Background Assumptions: On R0Taking Initial Viral Load SeriouslyOn New York’s Antibody TestsMy Covid-19 Thinking: 4/23 pre-Cuomo Data

Spreadsheet where I do work: Access it here as read only

Deaths By Week in the 5 Big Regions:

WEST MIDWEST SOUTH NE ex-NY NY
Mar 26-Apr 1 164 450 182 143 364
Mar 19-Mar 25 424 1894 667 856 1988
Apr 2-8 764 3873 1331 2248 4694
Apr 9-15 890 4853 1596 3605 5318
Apr 16-22 1033 5189 1727 5165 3716
Apr 23-29 1128 5234 1694 4742 2666
Apr 30-May 6 988 5126 1740 4921 1862

Positive Tests By Week By Region:

WEST MIDWEST SOUTH NE ex-NY NY
Mar 26-Apr 1 7176 7812 9927 11923 33106
Mar 19-Mar 25 16665 22121 28412 37339 55123
Apr 2-8 19925 31460 38989 60433 67556
Apr 9-15 16291 29267 35570 62293 64463
Apr 16-22 20065 34130 33932 65080 43437
Apr 23-29 21873 42343 34683 62355 42475
Apr 30-May 6 23424 49205 37595 52232 24287

Tests each week (New York’s 5/6 negative rate assumed to be same as 5/5):

USA Pos% USA ex-NY Pos % NY Pos % USA Tests USA ex-NY Tests NY Tests
Mar 26-Apr 1 16.2% 10.7% 32.0% 347577 258695 88882
Mar 19-Mar 25 20.2% 15.4% 45.1% 728474 611073 117401
Apr 2-8 19.8% 15.8% 45.5% 1067220 922947 144273
Apr 9-15 20.1% 16.5% 40.1% 1039790 878931 160859
Apr 16-22 15.7% 13.8% 30.2% 1253535 1109565 143970
Apr 23-29 13.7% 12.6% 21.0% 1480101 1277602 202499
Apr 30-May 6 10.6% 10.3% 13.3% 1733601 1550320 183281

Total Positive Tests:

USA Positives USA Ex-NY Pos
Mar 26-Apr 1 56198 27769
Mar 19-Mar 25 146888 93987
Apr 2-8 211095 145491
Apr 9-15 209067 144604
Apr 16-22 197111 153674
Apr 23-29 202934 160459
Apr 30-May 6 184614 160327

 

New York: Rapidly Making It Here

The news keeps getting better, with each day seeming to be a more rapid decline in positive test rates and the implied R0. Last week I had R0 ~ 0.78, and now I have more like R0 ~ 0.74.

I believe that this reflects a real drop in the effective R0 over time. Some of that is shifts in behavior. Some of that is additional herd immunity, especially in the places it is most valuable. Some of that is selection, as the infection shifts to where it can better be contained. Some of that is that we have more resources fighting fewer infections.

That means more rapid improvement in the near term, and also more flexibility to work with before things start getting worse again. We see the opposite of what one might fear, where people start going stir crazy or get desperate for funds, and stop respecting the rules in bad ways.

We’ve still got a ways to go here. I estimate just over 20,000 new infections are still happening every day in the state. But on 5/17, unless there is a major change, I think that is likely to be down to around 10,000. I do not think Cuomo’s “Phase 1” reopening will impact R0 much.

How did New York succeed where others failed?

Was it herd immunity? That’s my main hypothesis, and what I mostly believe.

Was it that things were so bad that people actually changed behavior more than elsewhere? Cell phone data doesn’t seem to back this up enough.

Was it Cuomo’s great leadership? I guess it didn’t hurt once we got started.

Was it that New Yorkers now have enough experience that they’re making the right changes more than elsewhere? I don’t see much evidence of anything like that.

If anything, New York is by default uniquely vulnerable, as we saw early on, so that’s a huge factor working the other way. Herd immunity is the only thing that makes sense to me. I continue to believe in about 21% ever-been-infected rate for the state, which at current pace will stabilize at 23% if there is no second wave here.

That is about where I would expect herd immunity in practice to be big enough, so that makes sense to me. You have an 80/20 rule slash power law for interactions. It shouldn’t take much beyond that to get us home.

Seriously, Stop Thinking It Takes 75% Infected To Get Herd Immunity

Shame on anyone who treats herd immunity as a boolean, rather than something that doesn’t do anything until you hit a threshold. Also shame on anyone who doesn’t realize that you get partial immunity much bigger than the percent of people infected. And of course, shame once again on everyone who tries to look responsible by saying we don’t know if antibodies grant immunity at all (as opposed to be being uncertain about how long it lasts and worrying it might wear off in a year) – once again, W.H.O. delenda est.

General reminder that people’s behavior and exposure to the virus, and probably also their vulnerability to it, follow power laws. When half the population is infected and half isn’t, the halves aren’t chosen at random. They’re based on people’s behaviors.

Thus, expect much bigger herd immunity effects than the default percentages. Ignore any SIR or SIRD models that both are trying to model things under large (20%+) infection rates, and also treat all people the same. It’s garbage assumptions that yield garbage results, even if the rest of the assumptions are perfect.

Also shame to anyone who ‘warns us’ that because R0 changes that things are even harder to deal with and we won’t get proper herd immunity essentially ever. For example, the usually excellent and intellectually honest (even when I strongly disagree) Interfluidity claimed that you need to be more responsible than three quarters of those you interact with because until most of them are infected, you won’t get the herd immunity benefits.

But of course this is utter nonsense multiple ways. If your local group never gets infected because the virus doesn’t spread any more, you’re safe. Also, if your local group has safe practices you can keep R0<1 locally without any help from herd immunity.

Herd immunity will be even more helpful if people get antibody tests, and we place those who are immune in key positions.

Other Regions: Making Not Much

The Midwest and South are clearly in limbo.

The West sees a ~10% improvement in deaths, which is good. It continues to be at a low baseline rate, which is also good. And its positive test count likely reflects increased testing and a slight improvement. But this is effectively still being stuck in limbo.

The Northeast outside of New York did see a decline in positive test counts, which seems to be real rather than a decline in testing, but it didn’t see a decline in deaths. Data is indeed terrible, but we also see an accelerating decline in New York where I’ve looked in greater detail. So there’s some chance that the region has turned an important corner. That’s the good news.

That still leaves three of our four major regions in a limbo situation.

The positive testing rates went up. Some of this does seem like an indication of progress. But outside of New York a lot of the effect seems to be an artifact of where we’re doing the testing. The regions that are doing relatively well seem to be ramping up testing more than regions which are doing poorly. This does not seem like a coincidence. Areas that have their act together in some ways also get it together in others, and are more likely to do the correct amount of testing when given time to acquire it.

This Is How The Country Reopens

Not with a bang, but with a wimper.

There are some reports of lines around the block for newly opened nail salons. That makes sense, as for some people such things are considered essential services, and they went without for a long time. There’s bound to be a temporary surge in demand. However, places one frequents like restaurants and bad axe throwing ranges (and yes that’s the name and it’s a thing) are seeing few if any customers coming by. Just because you allow something to open today doesn’t mean people are eager to do or in the habit of doing what was banned yesterday.

Last week we were in a worst case scenario situation of sorts in many parts of the country. We were locked down, devastating the economy, yet we were neither gathering substantial herd immunity nor were we successfully squashing the virus. A week later, we were looking at being in the same situation except poorer and with fewer options. It is one thing to do a lock down initially, when one hopes it will allow squashing of the pandemic, and time was needed to get testing online and health care ready. Now that all further big progress on such fronts seems so far away, it seems like folly – as we do in end of life care, it looked like we are going to bankrupt the patient’s family so they can die a few weeks later.

So, because of all that and because I am optimistic about people’s private adaptations – see this post along similar lines, Dumb Reopening Just Might Work –  I wasn’t feeling great about things overall, but it seemed like partially reopening was likely to be the lesser of two evils.

A week later, it is still too early to know what effect those reopenings had on infection rates. Probably very little will happen that wasn’t already going to happen. Since very little was already going to happen, that means little will happen.

Projections

There has been talk of alarmingly rising projections of infection counts and death rates. The ‘internal model’ that The New York Times asserts Trump was using, that would show hundreds of thousands of infections per day in a month, may or may not have actually been an administration model. That wouldn’t actually be a big jump, if it’s real infections rather than positive tests, since we know the death rates are undercounts and we can then extrapolate, we’re almost at that level now.

People continue to talk as if we have one-time effects rather than continuous effects. Reopening to drive R0>1 will result in ‘X deaths’ where X is not that much bigger. But if you really think a policy leads to R0>1 then you need to bite the bullet and believe it causes herd immunity levels of infection wherever implemented. How could it not? Rates of change remain a thing whether we admit it or not.

Similarly, whether or not things have just gotten better or worse seems to be driving people’s feelings about the danger level and what actions are appropriate. This is like when a ‘good economy’ is one where there’s growth and things are currently improving, and a ‘bad economy’ is one that isn’t growing and is getting worse right now, no matter what the levels of activity and wealth are. It’s emotionally resonant, but nonsense.

The Good Judgment project seems to think there’s about a 50/50 shot that deaths will be above several hundred thousand, but their definitions and categories are murky so it’s hard to pin down. In my predictions evaluations, I was willing to consider more than 300k deaths a solid favorite, and 100k deaths almost a can’t happen. I still think those are both true.

The project does have some good news – they are confident baseball will be back within two months. I could really, really use that, and I am not alone.

It still does not seem like we have the will necessary to squash this virus without help from herd immunity. Our lock down methods, absent massive infection rates or herd immunity help, get us R0 only slightly below 1. That’s not good enough, because we can’t sustain such tactics. So we are unlikely to see death rates much lower than we see now until we see a spike first.

How we do will depend on whether we are able to find sustainable ways to bring down rates of infection, and our willingness to let things run their course if we cannot do so.

The good news is there is lots of low hanging fruit we can use to improve. The bad news is that we seem incapable of grabbing it through government/collective action.

At every turn, the government’s role in this has been to try and get through the next week without things looking too bad. Actions are taken as part of a general trend of motion towards that which does not look blameworthy in the near term. No one, on any side or at any level, is building physical models, or has a plan for how to make this actually work that makes any sense. All the real plans that might actually work are in the hands of private actors.

Thus, we got lock downs because not doing so would have quickly seemed blameworthy. But there was no action taken with the time that bought us, because our system does not generate actions designed to achieve physical objectives. We’ve lost such abilities, and show no sign of being able to get them back. Eventually, private actors will figure things out sufficiently that there will be rising pressure to do useful things or at least get out of the way. We saw this for example on masks, which flipped from ‘governments conspire together to outright lie to us that they don’t work’ to ‘they’re mandatory and you’re horrible to not use one’ in the span of a week. Same will be true of antibody tests when their time comes.

I do think that ‘get out of the way’ is the best we can reasonably hope for from such people on the ‘contain the virus’ front. And it would do a lot of good. Simply getting out of the way at the beginning would have been far better than the active interference, shutting down, lying, banditry and piracy we’ve actually seen. That’s distinct from any looting and corruption on the financial rescue side. But it’s no surprise that we spent almost all the money on bribing people, and almost none of the money on health care or on research or on testing or on anything that might actually solve our problems.

If we do get ‘get out of the way’ to (vaguely and gradually) happen, then the future looks (relatively) bright. The big mystery remains, this virus is not actually that easy to catch, R0 starts only around four, we’re seeing dramatic behavior changes, why isn’t this enough?

It’s not enough, presumably, because the changes aren’t that big in some of the places that actually matter, we’re not enforcing the rules much, and we’re not doing the research to find out what actually matters, at all.

Low-Hanging Fruit

What are the easy slam-dunk things we should be doing, but aren’t doing, or aren’t doing enough?

There’s a long list. Do not consider this complete. It’s the things that I could come up with and remember today, nothing more, that I consider slam-dunk obviously correct to do. I don’t know of good arguments against any of this. I left off anything with political implications that are bad for a major party, even if they’re otherwise obviously right, and gave myself about 10 minutes. I’m also not listing anything I think we should do for economic reasons. Different post.

The basic conclusion: Yes. There’s treasure everywhere.

If I had to pick one thing to focus on one thing a private person can do, it’s we need to figure out how this spreads. One rich person, who cares, can fund the necessary work to figure this out. If you have the resources but need help figuring out how to do it, I will help you with that.

If I had to pick one thing to focus on for public choice, it would be allowing challenge trials for vaccination and also to gather other information. But if I wasn’t counting that because “ethicists” want us all to die, and I need something they would allow, I would point be our continuing failure to provide reasonable help with isolation of the sick outside of hospitals. But that’s mostly a question of where I think I could get traction.

  1. We should gather much better data, pay a lot to do so. Stop worrying so much about privacy and “ethics” of such matters. Do lots of surveys. Figure out how people get infected, what people’s actual behaviors are.
  2. Even better, actually run freaking experiments. Run them to figure out how people get infected. It’s crazy we still don’t know if surfaces even matter.
  3. If we can’t run freaking experiments, let’s find better ways to do the studies. If you give me a team I’ll design ways to figure things out. I can’t be the only one who can.
  4. Once you’ve agreed to that, next do challenge trials for vaccination.
  5. Then, once we’ve agreed to do that, we should do experiments to study variolation.
  6. Also, we should be spending even more massive and epic amounts on vaccines. We should be building facilities for everything plausible, running challenge trials, promising to pay premium prices, you name it. If we don’t feel like we overpaid and got robbed when it’s finally over, we didn’t pay enough.
  7. We should be spending massive, epic amounts on testing, both regular and antibody testing.
  8. Anyone who has a positive antibody test should be given an easily visible sign of this, and encouraged to do whatever the hell they want. Passports ho.
  9. We should actually enforce the rules we care about. People who test positive need to actually be quarantined. Likely even more than that, social gatherings that flaunt the rules need to be stopped, and if necessary severely punished. This can’t go on.
  10. We should have our contact tracing app working, seriously what the hell is taking so long, Apple and Google?
  11. We should be raising prices on the things we want more of, rather than calling for action against price gouging.
  12. We should in general stop preventing people from doing useful things, via the regulatory state, unless absolutely necessary.
  13. We should pass laws allowing people to wave liability for potential infection, so business can operate reasonably and people can generally choose what risks they want to take. Consider limiting liability even further than that.
  14. We should reopen essentially all outdoor spaces.
  15. Where things need to be in short supply to prevent crowding, instead of ruining it for everyone, we should mandate allocation by price. Best kind of tax. Anyone who frames “those who would pay less for it get money and those who would pay more for it get the thing” as making inequality worse rather than better should be banned from all activities and resources in short supply, permanently. How hard is it to get that a transfer of money from rich to poor reduces inequality?
  16. We should provide free accommodations and meals, at hotels and on campuses, for anyone with a doctor’s prescription for quarantine, at least on a voluntary basis, until all available lodging is full.
  17. We should ensure Covid-19 positive people are kept out of nursing homes, rather than literally requiring that they take them. Insanity.
  18. We should provide large subsidies to grocery store and restaurant store-run delivery and pick-up services, to prevent crowding and exposure, and provide indirect help to those in need.

Paths Forward

My plan is to do a weekly update with the national statistics and some of my general thoughts, and continue to supplement with other posts on other stuff, whether Covid-19, gaming, rationality or otherwise. I’m hoping these have been helpful – I’ve been extremely frustrated that it seems plausible that someone like me could be useful in this situation, since literally everyone has one job and this is it. And yet.

I also want to say I appreciate the thank yous I’ve been getting. They help me keep going. It would also be helpful, if you think these are useful, to provide signal boosts, so others can be helped as well.

 

 

 

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11 Responses to Covid-19 5/7: Fighting Limbo

  1. Chris says:

    I am extremely skeptical that any track and trace based on an app will be effective and could very possibly be worse than nothing. The false positives and false negatives and the behaviors that drives will overwhelm any positive effects.

    Bruce Schneier lays out the argument better than I could:
    https://www.schneier.com/blog/archives/2020/05/me_on_covad-19_.html

  2. KPM says:

    Thank you! I really appreciate your work.

  3. Michael says:

    And yet. Ha.

  4. myst_05 says:

    I’ve noticed a pattern where the “general consensus” is 3-4 weeks behind the “Twitter-sphere” consensus:

    1. Masks were anathema in the US until early April, but Twitter wanted them since early March
    2. Contact tracing started forming in late April in the US, even though it was widely known to work since late March
    3. Case isolation is now gaining traction
    4. Calls for the contact tracing app to be made mandatory or less it would be useless – finally implemented by India in early May
    5. Acceptance of outdoor activities – finally gaining traction, with Dr. Bonnie Henry in Canada actually advising people to go out
    6. Challenge trials are now discussed widely, although we’ve yet to see any government approvals

    So I have high hopes that we will see many of your 18 action items implemented (or at least widely discussed) by early June.

  5. Sebastian H says:

    For things like beaches and parks in any non NY setting just close half the parking lots and your work is done.

  6. Weronika says:

    A very good list of things! I hope at least some of them happen. And I appreciate all your posts, they’ve been very helpful in making sense of what’s going on.

  7. Pingback: Covid 5/21: Limbo Under | Don't Worry About the Vase

  8. David Speyer says:

    Most of what you have written in your “Seriously, Stop Thinking It Takes 75% Infected To Get Herd Immunity” section strikes me as badly wrong. I’ve also read your blog enough to know that you are very good at thinking about this sort of problem, so I should consider the likelihood that I am wrong. Here are the points I disagree with most strongly; tell me where I am wrong. I hope I am the wrong one, because your views in this section are much more optimistic than mine.

    “When half the population is infected and half isn’t, the halves aren’t chosen at random. They’re based on people’s behaviors.” Most of those infections have happened post-lockdown, so it is based on people’s behaviors in the locked down environment. The museum tour guide who is currently sitting alone in his apartment is very unlikely to be infected, but once his job starts up again and he spends 8 hours a day in loud crowds, he is at high risk. Old people who cancelled their cruise reservations to sit at home are very low R, but they will be very high R if they book a replacement cruise in August. I fear that, each time a new portion of life goes back to normal, a new population will suddenly develop a high effective R and be colonized by the virus until, indeed, we reach 60-75% of everyone.

    “If your local group never gets infected because the virus doesn’t spread any more, you’re safe.” Literally true, but if your local group above 1.5 or so, it only takes a few incursions of the virus to set off a major infection. If we could squash to Korea or Hong Kong’s level, I’d agree with this point. But if we keep going at 1 in 20,000 people infected a day, and if my social graph has a few hundred people in it, over the course of year we are likely to see an infection take root in my network.

    “Also, if your local group has safe practices you can keep R0 < 1 locally without any help from herd immunity.” As you point out elsewhere, our current lock downs only get R0 slightly below 1. I can believe that some very smart social groups might develop protocols which allow them to stay below 1 in an unlocked world, but it seems unlikely to me that many would.

    Please tell me why I’m wrong!

    • TheZvi says:

      Sure! Happy to debate / help.

      Last point first. Yes, as an aggregate we are currently only slightly below 1 for the nation. However, that’s not a reflection of ‘every group is around 1 unless it is very smart.’ It is a reflection of some groups being very very low and others being high. What do you think your *personal* R0 is, e.g. the number of people you’d have infected if you’d gotten infected somehow? What would it be in a future world where you’re being careful?

      Keep in mind that in the before times, R0 ~ 4, most of that risk is coming from extreme exposure events where people are in a room for an hour or more talking, or similar. It seems very easy to see that one can create a ton of variation on that, and a group can act responsibly on this level. Getting to 0.5 or less does not seem hard. Right now I’m at 0.1 or less, probably far less! And again, that’s pre any immunity from the herd.

      Your second point: Yes, if we keep going at 0.05% a day (your rate, which I think is very close to current NY State conditions of 0.06% a day today, 0.05% will be about right on Sunday evening or so) then eventually your local group will get exposed. I was simply saying that, *if* we mostly win, having local exposed groups won’t cause us to suddenly lose.

      Your first point is the strongest, so I saved it for last: The patterns of behavior right now are in lock down, which are importantly different than later. I agree that is true. Right now we should see *extreme* reactions to new infections in terms of immunity, because we have even more power law differences in rates. Right now I (and probably you) are under R=0.1, and many people are R=0.01. In a true post-lockdown world that will be less common, but I don’t think we’ll have one. We’ll have people with a wide variety of reactions to the situation, in terms of what they want to do and what they must do. Some of us will continue taking serious precautions indefinitely. Others will resume having house parties. That behavior will be highly correlated with current, but not identical.

      Still, consider the museum tour guide. Her job is gone. It’s not coming back, sorry. There’s no way we’re going to want people walking around with us in person, talking about things in a museum. That’s the before times. Perhaps she will answer questions on Skype remotely through a fixed video screen on the wall, or people use guided automatic tours. But she was previously high risk, and now she’s… well, unemployed, but what she finds will be safer. The cruise ship industry won’t recover so long as there’s an endemic virus. Who would go? And if they do go, they likely won’t be welcome near anyone for weeks afterwards. These behaviors will change.

      The biggest risks right now are from people who are ignoring, for whatever reason, the safety orders. I think those groups keep doing that!

      The question is, how different are current and future patterns in terms of relative risk. But i think your model of “oh we are done we can just go back to normal” is the big disagreement here. Beyond that we’re arguing over price/details. That’s the *other* main reason I think that 75% infection rates are a joke. You need 75% to solve the issue if everything else goes back to exactly what it was. That will not happen. Handwashing is permanently up. Handshaking is permanently down. Et cetra.

      • David Speyer says:

        Yeah, I think the crux of the issue is how far from the old world our new world is. I agree that my personal R, right now, is under 0.1 . Outside my household, I am in the presence of less than one person per week and all of these are either briefly standing masked near a grocery clerk or else outdoors at distances of > 10 feet. I agree that each of these has less than 0.05 chance of transmitting disease, conditional on disease being there. On the other hand, I would be very unhappy to continue like this until we see a vaccine!

        So the question of whether infection levels below 75% are meaningful is the question of how low an R I can have while living a life I want to sustain for over a year.

        By the way, in case it causes confusion, I am Daniel Speyer’s brother. Daniel has no household and is much more isolated than I am, probably with R < 0.01. It occurred to me that the first paragraph might be confusing if you think I am him.

  9. Pingback: Covid-19 5/29: Dumb Reopening | Don't Worry About the Vase

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