We are at a very interesting stage in the Coronavirus crisis.
Most of the big important questions are still not answered.
How many people will it kill if left unchecked? Anywhere from about 0.1% to about 10% of the population.
How long until we have a vaccine? Anywhere from six months to never.
Will it die out once enough people are immune, or stick around for ever, or come back from time to time as it mutates? Don’t know.
How much effect does intensive hospital treatment have on the death rate? Definitely some. Maybe a lot. Don’t know.
Will we have treatments that will significantly reduce the death rates? Don’t know.
Will it have similar impact all over the world, or is its geographic range restricted? Don’t know.
What does it take to stop it spreading out of control? Can it be done by just being careful, wearing masks in public, and quarantining detected cases, or do all group activities need to be drastically curtailed? Not sure.
In spite of this, governments need to act. Policies need to be made, and, with all this democracy malarkey, people are getting attached to policy proposals and arguing very strongly for one or another. In fact, people often are getting more strongly and emotionally attached than usual, I assume because this more obviously is a life-or-death issue than most political questions.
I am not (yet) really attached. Given all this ignorance, policy choice is very sensitive to estimates of the probable answers to all the open questions, as well as being sensitive to all the values and principles that make other political questions controversial. With a few exceptions, I don’t think any government has acted in a way I can say is very bad. The exceptions are very widespread — all governments were caught underprepared. Most governments ought to have been quicker to impose restrictions on movement of people into the country — by far the most efficient way of protecting from any infectious disease is to stop it getting in. But once we hit the pandemic phase, I can see good arguments for any policy we have seen, from doing very little and letting it run its course, to temporarily shutting down all non-essential activity until we know more. It might even turn out that the optimal policy is to let it rip, falsify the statistics, and pretend that it’s gone away (as some are accusing the Chinese government of doing). Governments actively discouraging masks seems almost definitely a bad idea, and the tendency to let the perfect be the enemy of the good is obstructing execution of policy in the matter of equipment, treatments and testing. But beyond that most governments have responded in reasonable ways.
Where I am getting a bit excited is where people, in attempting to argue for one policy or another, are claiming that facts are established that really aren’t.
The big one is the impact on hospitals. I wrote on March the 12th that what we were expecting was:
The government view is that [Italy] is just the beginning. It is going to get that bad. And then it is going to get worse. And then it is going to carry on getting worse. What they are concerned with is just how much worse it’s going to get.
That’s still probably the most likely projection: currently the UK is getting about 6000 confirmed cases per day, that could well go up tenfold: we could have a million people sick at once and there’s no reasonable way to put them in hospitals and treat them, so mostly they will be on their own.
But we absolutely do not know that. No population we know of has reached that stage, not even the Diamond Princess cruise ship.
What is getting me upset is that some people are saying this is already happening. I’m pretty sure it isn’t. It’s a reasonable projection, based on our limited knowledge, but I’ve seen no evidence anywhere has actually got to that yet, and there should be evidence. I’ve had arguments on twitter with people claiming a few breathless TV news reports from Italian towns prove it, but TV news is always stripped of context and presented to give a strong impression. Certainly, a few hospitals have been reduced to states of chaos, but that actually happens from time to time. Britain’s health service is notorious, but I’m sure it’s not the only one where a much smaller shock than that which we are anticipating from the peak of the pandemic can temporarily throw a single hospital into chaos.
(I’m also getting upset by people saying “the pandemic is a nothingburger”, but that is not generally coming from people I otherwise respect).
This really does bring up the parallel with climate science. Because it was once in the same place. My view is that the original modelling of the greenhouse effect in the 1980s was good science, and the idea that rising CO2 concentrations could affect the climate in a very damaging way was very much worth worrying about. But by say 1990 that is where we were. We had some models, some very questionable historical data, and a threat that demanded we take precautions and find out more.
Then it got political. The oil companies, very unwisely, tried to get the idea dismissed. Anti-capitalists got very excited about a reason to suppress industrial civilisation. And everyone claimed the facts supporting their position were known. In reality, we still didn’t know anything.
Over the last 30 years, the alarming climate models have been completely invalidated, the paleoclimatology claiming that current conditions are unprecedented has been debunked, but none of it matters because it is now simply a political question. People lined up on one side or the other of the open scientific questions because their enemies were on the other side, and no new information would have shifted them. Most strikingly, there are people claiming that the climate has already changed by so much that it is obvious to direct personal experience, when the officially measured change in average temperature over a human lifetime is way below what anyone could actually notice.
That’s what the claim that COVID-19 is already causing health system collapse reminds me of. Now, if it does get to that point in the next 4 or 8 weeks, which of course is quite likely, then it doesn’t matter. Some people just anticipated it. But what if it doesn’t? How do we persuade somebody that it isn’t going to happen, when they’ve been defining themselves politically by the claim that it happened already? The big question in climate, the only one now that really interests me, is what it will take for the alarmists to give in. If the Coronavirus fizzles out, which as of today is still a possibility, what will it take for people to admit it?
Very insightful point by @mnwoodhouse on twitter:
the slatestarcodex post about masks points out that the “masks don’t work” propaganda goes back several years, so it can’t be entirely related to current supply concerns for medical workers. instead i think it might be an example of the notion in contemporary liberalism that any “fears” or risk/harm avoidance — with some specific exceptions — are necessarily irrational
You can see how this happened. Egalitarians do not want us to fear the other. The natural tendency of humans is to fear the other. Liberalism started in the 1700s (if you like) in the environment where there was exaggerated fear of people who were different. They argued that the fears were incorrect, that people of other countries, other races, other religions were not nearly as dangerous as people thought. They were right! Society became less fearful, more accepting, and saw concrete benefits as a result.
But in the late 1900s that process stalled. As reduced fearfulness came closer to actual equality, the concept that fears of the other were exaggerated ceased to be true, to the point that today, “FBI Crime Statistics” is a far-right slogan in its own right.
It was easy to argue against irrational fears. You used facts. How, though, do you argue against rational fear?
Well, I skimmed for arguments against John Derbyshire’s piece, but I couldn’t find any — just pointing and sputtering. And I think that’s the answer. You argue against rational fear by not even beginning to engage with it, but by ruling it out-of-bounds from the start. Derbyshire is wrong to tell his children to fear blacks, because it is bad to argue that some people are dangerous. We won’t even go into detail about exactly what is and isn’t bad to fear: we don’t want to get into tricky questions over FBI crime statistics, or anything, we will just say “stuff like that is bad” and leave it at that.
If Derbyshire is factually wrong, which he might be, that doesn’t actually change the argument. The important point isn’t that he is right, it’s that his critics do not dispute him on factual grounds, only on vague moral grounds. Everything else follows.
If someone had posted on Twitter that, in the fight against the novel Coronavirus, the World Heath Organisation had decided to take the side of the virus, I would have taken it as a joke, and a rather feeble and unfunny one. But I would have been wrong. The result of having a bucket of “ideas that are bad”, which you aren’t allowed to reason about in detail, is that “wear a mask to protect yourself from viral infection”, or “don’t let planeloads of people from an area with a dangerous epidemic land in your country” end up in the same bucket as “If planning a trip to a beach or amusement park at some date, find out whether it is likely to be swamped with blacks on that date”
Internationalists are literally defending the virus from prejudice in the same way they would defend minorities from prejudice. They are doing so in spite of the indisputable fact that the virus is dangerous, because you’re not allowed to get into facts when defending minorities from prejudice. They are doing so without having any actual desire for the virus to flourish, because you are not allowed to consider whether you desire specific oppressed minorities to flourish when combating prejudice. “You must protect yourself from this dangerous thing” makes liberals feel immediately uneasy, and they are conditioned to avoid even digging into that unease.
There is one exception. If the thing you are warning against is rich white people, or if you can at least claim it’s rich white people, you are safe. nobody is uneasy about that. So if you are in, say, the World Health Organisation, founded to fight infectious disease, your whole life is a little bit uncomfortable until you can shift attention to something where the only fear is directed at rich white people. Like, say, climate change.
“The evidence is overwhelming: climate change endangers human health. Solutions exist and we need to act decisively to change this trajectory.”
Dr Margaret Chan, WHO Director-General
Climate change is the greatest threat to global health in the 21st century.
28 March 2020
We’re about a month in to a one-in-a-lifetime happening. I want some kind of record of what I was thinking and doing. Most of my thinking is out loud on Twitter, so I’ll be dredging that for material.
“Plague Year” is probably a misnomer. I don’t expect this to be over in 2020.
It started for me in January. An epidemic in Wuhan wasn’t terribly interesting, but @MorlockP on Twitter posted that he saw it as likely to become a global pandemic, and was making preparations for a prolonged isolation. I followed his reasoning, and told the family after dinner that it looked like getting bad, and we should make sure we had long-term stocks in the house for food, water and cleaning equipment. Over the following couple of weeks we bought large plastic boxes and filled them with emergency supplies.
Several other people have said they were spurred into preparations by MorlockP’s tweets. Twitter locked him out of his account a week ago, ever careful to protect us from misinformation.
I remember when I was planning to go to London on January 31st, to celebrate Brexit, I contemplated whether it was safe to head into crowds and underground trains. I decided that it was still early and we could go without worrying, but it might be the last time. I haven’t been in London since.
Things moved slower than I expected through February. We built up our stocks, I mentioned it to friends and colleagues, who thought I was a bit silly. Curtis Yarvin’s American Mind piece asserting that globalism would be ended by pandemics like this one was 1st Feb.
On February 22nd I retweeted a UK government notification, that 9 positive cases of COVID19 had been found in Britain.
By the end of February it was still only a minor subject on Twitter: @thespandrell had already started calling it “boomerpox”, one or two others were saying they had stocked up, Nick Szabo was complaining that the FDA was preventing testing from happening in the US.
By March 2nd, I’d stopped going swimming. It seemed an unnecessarily easy way to catch a virus. I kept going to the gym for a few days more. I’m now back to my pre-gym self: not exercising and living on bread and biscuits. I’m going to put on 20lbs and lose a lot of strength before this is over.
The virus was still behind the US presidential primaries and Georgina Bloomberg’s horse novels in volume of discussion on my twitter timeline
I heard a friend of a friend story that the NHS was putting testing pods in every hospital, and were generally gearing up for a major crisis.
By March 9th, the argument had started about whether the British Government was doing enough, or whether it should be closing schools and stuff. “Flattening the curve” had appeared as a concept, illustrated with what I consistently refer to as the graph-with-no-scale.
Gregory Cochran posted his “nuke the curve” piece on the 10th, arguing that it was necessary to eliminate the virus, not just slow the spread. I expressed scepticism over the feasibility, given that if infection rates were kept very low, it would keep reappearing for a long time.
On March 11th, I saw a tweet by @vaughanbell. “If you want to make sense of why the UK government are making the decisions they are making with regard to coronavirus: they have prepared over the last decade for a pandemic (focusing on pandemic flu) and the strategy and evidence based is public”, with a link to the Pandemic Flu planning information document. I studied this. I noted that the plan anticipated a lot of deaths — it advised local authorities to be prepared for “210,000 to 315,000 additional deaths across the UK over a 15-week period”. I noted that the focus of the plan was on keeping government going, not on minimising deaths, and not at all on preventing infections. I tweeted, Most of the strategy document is explicitly ‘we’re all going to get it, so just carry on’. I noted that COVID19 was spreading faster and causing more hospitalisations than the government plan had anticipated, writing What I hope is that behind the summary strategy document, there’s a range of contingency plans that includes this fast-spreading high-hospitalisation extreme. But they’re not showing it. At time of writing, 28th March, these points are still the centre of the arguments.
The 12th of March was the last day I went to work. I find I work more effectively in an office with my colleagues, but I always was able to work from home on occasion, and I’ve been doing it now for two weeks.
The evening of 12th of March, before I left the office for (so far) the last time, I watched Boris Johnson’s press conference. This was where it really became clear that the government was expecting at the very least tens of thousands, and possibly hundreds of thousands of deaths, didn’t believe it could prevent the virus spreading through the entire population, and wasn’t going to try. I wrote a blog post on my understanding.
Though shocked, I believed, and still believe, that that was a sensible position. As I had suggested to Cochran, though some countries in Asia had reduced the size of the epidemic, nobody had proved that it could be eliminated, or that the measures taken to reduce it could be sustained for the duration that would be required.
I was in a minority, at least within my twitter community. I spent the next four days largely arguing with people who believed the UK strategy was insane or was being changed.
The strongest objection is Taleb’s. His central point is the one that made his name, that mathematical modelling of unknown situations will systematically underestimate the probability of extreme outcomes. He is right. His deduction from that is that governments should take extreme measures to combat the pandemic, because nobody knows how bad it could get. My objection to that is that the outcome of the extreme measured being taken is also an unknown situation, where we do not know how bad it could get. I don’t think it will lead to the collapse of states and a new dark age, but I don’t think the virus will kill two million people in Britain either. How to model the probability of either of these outcomes? Taleb’s whole argument is that you can’t.
Still, it is the best argument for trying to put the brakes on and at least buy some time to get better information. And it seems that my claims through the weekend of 14-15 March that the UK government was not changing course were wrong. Though they are being obfuscatory about it, the models from Imperial College they are using are now modelling “suppression” rather than “slowing”. Unlike under the previous, clear, strategy, there is now no long-term outcome described.
Here of course we are into the realm of politics. “We do not really know what is going to happen, so we’re trying to keep the disease under control for now and we’ll make more decisions later” may be the most rational position, but it doesn’t sound good on TV.
The other news was that a revision of the Imperial College model had shown much more demand on hospitals than had been foreseen earlier, and that therefore different measures would have to be taken to ensure patients could continue to get care. I was and am mystified by this. Firstly, that was obvious from the start — I had tweeted on the 11th that the hospitalisation rate was going to be the really nasty bit, and my interpretation of the announcement on the 12th was that the government knew that hospitals were going to get much worse than even the horror stories we had already heard from Italy. At the same time, if they believed on the 12th that it was not possible to prevent the virus spreading through the population, how did that become possible on the 13th just because the hospitalisation rate was worse? My guess is that in reality there was an ongoing division in the cabinet and the cabinet office over whether to slow or suppress, and Boris Johnson gave in under pressure produced by the revised model.
This is all Britain-centric, but the same thing has been playing out throughout the West. The UK strategy was not an outlier, it was the standard pandemic response used by international organisations and governments, just presented a bit more transparently than in other countries. Most governments have backed away from it, and are in this no-mans-land of lockdowns and no long-term prognosis. Sweden seems to be the only place going ahead with it at this point. To this day, the government is only officially talking about slowing down the spread, but is happy for people to think it is trying to prevent it.
The critical question, from the 12th March, was whether the Asian countries that appeared to be “winning” against the virus could sustain that. As of 28th March, that still isn’t clear. South Korea and Taiwan still seem OK. Japan and Hong Kong are getting a bit of a resurgence of cases. Nowhere is fully back to normal except parts of mainland China away from Hubei province.
Anyway, it was the following week that the masks thing started to really come up with a vengance. From the beginning, we were told not to wear masks, that they didn’t help, and they were in short supply for hospitals so we shouldn’t disrupt supply. Most of my twitter timeline has settled on the theory that masks are the one vital difference between Asia and the West that has enabled the former to get numbers down, where they are still growing throughout the latter. This is pretty plausible, but I note it is a long way from proved.
I need to mention somewhere that there is an amazing split between twitter and the outside world. Both Trump and Boris are at all-time highs in popularity, while twitter is 90% screaming at them — even from their supporters — for being evil and incompetent.
20th of March was when @MorlockP got locked out of his twitter account. From reports, it was not an actual suspension, it was the same thing as happened to me — they demanded confirmation by SMS, but he no longer has the phone number.
I think I’m the only one making the case that half a million extra deaths in the UK would not be all that big a deal. It would be about double the normal rate for the year, mostly elderly. I mentioned that I think I’ve had one elderly relative die, generally of respiratory disease, every year for the last few, and if it were two or three one year that wouldn’t show up as a catastrophe. Yes, younger people die of it too, but rarely. It is unlikely that anyone you know under the age of 60 would die, though quite likely that you would know someone who knew someone who died.
Related, I’ve expressed scepticism about the “health system breakdown” stories. Not that it’s unlikely — it’s likely to happen. I just don’t think it’s happened yet, anywhere. We have detailed stories from one hospital in Lombardy and one in New York. Meanwhile both systems are publishing statistics that show they are not (yet) overloaded. See for instance this March 13 report from Lombardy. That was two weeks ago now, but the first “collapsed” stories I saw were from before that. The reporting I’ve seen saying there is a collapse has been Damien Day style TV, with no detail or authority comparable to that JAMA session.
The other part of this is that people are jumping to conclusions about things they don’t know about based in implications of media reporting, which is a very dangerous thing to do. As I have repeatedly observed, Triage is standard practice in the NHS, and hospitals frequently get overloaded and don’t have beds for everyone. Enormous emphasis has been put on supply of ventilators. From early on, we were told that was the critical factor, that there would not be nearly enough ventilators in intensive care units for every COVID19 patient that needed one.
My experience, that I mentioned above, of relatives dying is that elderly patients with respiratory problems are never put into intensive care. I don’t know if with an infection like this one they generally would be, but nobody has actually said that they would — it’s just been left as an unstated implication of news reports. It’s hard to find the answer, because it’s not something people talk about. Anyway, I don’t know.
However, the reality is, if you just find extra space and beds for patients until they die or get better, then my expectation is that the effect of this pandemic would be otherwise not noticeable to the general population. It would be a very distinct peak in any statistical treatment, but in concrete terms all it would mean that if you knew of twenty old people who died over a ten year period, three or four of them were in 2020. Stalin was exactly right: one million deaths is a statistic. If spread over months and a big country, it’s not a directly observable event.
(One other possibility is that for many, none of them would be in 2021. One reason why this pandemic is more deadly is because we are able to keep people alive for whom every breath is an effort. Were our lives less easy, there would be many fewer in that state).
Also for these reasons, I expect the pandemic to be a non-event in the third world.
This last week (from March 22nd), the conversation has mainly gone to the economic effects (“Money printer go Brrrrr”) and outrage over the still-continuing anti-mask propaganda from Western agencies, as well as the past anti-travel-restriction propaganda from media, governments and NGOs that was continuing well into February. The Lancet condemned travel restrictions on 13 February
There was a bit of a fuss on the 24th over a model published by an Oxford epidemiological group suggesting that possibly over 90% of infections are asymptomatic and that therefore we could be already halfway to herd immunity. This was quite useful as a reminder that we don’t really know how many people will suffer, but there’s no reason whatsoever to assume that it’s that low. The model used only early case data from Italy and the UK to calibrate. Inevitably, media reporting of the publication was absolutely execrable.
On the 25th, in response to completely non-existent popular demand, I published my own pandemic modelling code on GitHub. While the actual model is of little relevance, some of the conclusions I drew from the process may be: “
Of course, nobody would really rely on such crude mathematical treatments when planning for unlikely events, would they?”
So that’s where we stand today. This isn’t a series, it’s a record. I will append to this piece as I go along. As such I don’t think it’s a useful focus for discussion, so comments should go on Twitter or under other posts with more focus.
I watched the British Government press conference this evening, and now I understand the government’s view of the epidemic, and where it differs from those who are accusing it of not taking the situation seriously enough.
In the view of the government, its critics have a significant misunderstanding of how bad the epidemic is.
It’s much worse than we think.
People are pointing at Italy, and saying “look at that — it could be like that here, don’t you understand?”
The government view is that that is just the beginning. It is going to get that bad. And then it is going to get worse. And then it is going to carry on getting worse. What they are concerned with is just how much worse it’s going to get.
Conversely, when people point at South Korea, or Taiwan, the response is that they are only putting the problem off. Korea has had 8,000 confirmed cases. Maybe 80,000 actual infections (probably less given their heavy testing) out of a population of 50 million. The measures they have taken to prevent a rapid spread will have to stay in place basically indefinitely. Only one in a thousand of the population has had the disease, so there is nothing other than their protective measures stopping it. They can carry on having a hundred new cases a day for years. They can wipe it out with even stronger measures, but it will come back.
Italy has 12,000 confirmed cases, maybe 150,000 infections, out of a population of 60 million. Again, that’s only the start. 0.25% of the population. It’s going to get much worse than that. It’s going to get much worse than that everywhere.
The government’s view is that this isn’t going away until most of the people who are going to get it have got it. They don’t know how many that is — anywhere from 10% of the population to 80%. But they’re very clear that whatever that number is, it is not something they can affect. It’s going to spread until enough people have had it that it can’t spread any more. So the policy is not aimed at reducing the spread — only at slowing it over a longer time and protecting the vulnerable. In general, if you’re a young or middle aged healthy person, the government thinks you’re probably going to get it and that’s OK.
They also say the fatality rate is up to 1%. So if 80% get the virus and 1% of them die, we are looking at half a million dead this year in Britain. They spelled that out, explicitly stopping just short of doing the multiplication, because the 80% is just a worst-case estimate: it may be a quarter of that and half the death rate, and only 60,000 deaths.
If 60,000 are going to die, mostly over about 90 days at the peak of the epidemic, that means a minimum of hundreds of deaths a day, day after day after day. That’s what the government is telling us to expect. (On top of the thousand or so who die every day normally).
Are they right? How the hell should I know? If they’re wrong, there’s only a few ways they could be wrong.
Maybe the disease can just be wiped out. Nuke the curve, push the R0 below one, and hold it there until the virus doesn’t exist any more. That’s basically what happened to SARS. But even the places where they seem to be doing well are still getting a steady drip of new cases, and there are large regions where it is not under any control, so halting the spread would need a Moldbug-esque abolition of globalisation, which whatever its merits is not politically on the cards.
Maybe we could hold it off until there are better treatments, or a vaccine. The general view is that a vaccine is at least a year off, while treatments might improve over the next couple of months, but the government is already aiming to keep the peak a couple of months away.
Maybe most people just aren’t susceptible for some reason, so the total infections to expect is much lower, and snuffing the epidemic out is much more feasible.
Maybe the virus will just go away somehow. I’m not clear on how that would happen, but I’m no microbiologist.
Note that now it is the government that is taking the pessimistic view, and the critics that are clinging to the hope of a way out.
This is the most important question. If you want to know the future, the most important thing to look at is the places where the virus seems to be on the decline. Is it really finished, or is it just temporarily suppressed? If you can actually get rid of the disease with less than 1% of the population having suffered, then the government has got this completely wrong.
The other side of things is that, aside from protecting the weak and elderly, the government is expecting a big chunk of the population to get sick and doesn’t care whether you or I are in that chunk or not. But you and I can care. In this view, trying too hard to avoid catching it is antisocial: disrupting society and endangering the policy of having the virus burn out in a controlled way over a season, with well-timed interventions to smooth the worst of the peak. But a little selfishness is allowed. Frankly, I’m OK with being ill for a couple of weeks, but I have a close family member with respiratory issues, and I am prepared to go well beyond official advice to avoid introducing the disease to my home. That’s good policy for me even if it doesn’t help the government achieve its goals.