Last week: Covid-19 6/18: The Virus Goes South
Off-topic reminder that this is happening: New York Times, Please Do Not Threaten The Safety of Scott Alexander By Revealing His True Name
The United States has failed to contain Covid-19. The fight is over in large sections of the country. We have lost.
There is no state capacity left to fight this. No will. Faced with this disease, large sections of the country have chosen herd immunity.
We can only hope it kicks in at a relatively low threshold, that our treatments have improved, and that immunity is long lasting.
Hospitals are already being overwhelmed throughout the South. Things there rapidly getting worse day by day. Even here in New York, where hope for containment is strongest, there are troubling signs. My declaration of local victory might prove premature, at least when it comes to the city itself.
Let’s run the numbers. They’re pretty alarming.
Note that starting next week I plan to truncate the numbers for space reasons, unless I get feedback that I shouldn’t do that.
Positive Tests by Region
Positive Test percentages:
Things are even scarier than these numbers imply. The scariest part is that this jump is largely concentrated in the last few days.
Here’s the daily trend in positive test rates over the last two weeks, Ex-NY:
May 16 was the last time prior to this that we had a positive rate (excluding New York) of 7.1% or higher. We have to go back to May 9 to see one above 8%.
Unless something highly unexpected has already happened to prevent it, things are about to get very bad, very quickly.
People are bad at exponential growth. We now have had the opportunity to run a natural experiment. Having been bitten not only internationally but also domestically, will people act any differently the next time around? The answer is no. They will not.
Twitter is full of people trying to help who feel the need to repeatedly and forcefully say that this result is not due solely to a rise in testing. Who feel the need to keep insisting that things are getting worse, that the epidemic is not essentially over.
It seems that only when the ICUs are full, which is happening about now throughout several southern states, do normal people take notice that something might be wrong. Only when the death rate itself rises do people think that there might be danger.
Others think that so long as the situation is getting worse sufficiently slowly, things will turn out fine. That is not how this works. That is not how any of this works. When Cuomo put up the slide that said goal of R0 less than 1.1, the mind boggled. If your R0 is 1.05, everyone gets infected. This isn’t a hard thing to reason out. And yet.
He also held a rally in Tulsa.
At that rally, he said that more tests meant more positives, which looked bad. So I told my people, “slow the testing down.”
I will repeat that. The President of the United States ordered coronavirus testing slowed down.
The defense was that he was kidding.
He wasn’t kidding.
When asked to deny the statement, he sidestepped it. When asked about whether he had been kidding, he responded, and I quote: “I never kid.”
I do not point this out to ask why it has yet to become an article of impeachment. I point it out for its logical implications. We need to understand what is actually happening.
To what extent are our numbers manipulated or fraudulent? In predicting the path of the pandemic, to what extent will our government actively interfere with our attempts to save people’s lives and their livelihoods? We know that the federal government has at many points actively interfered with our ability to test for Covid-19, and has waged a war of banditry and piracy to seize medical supplies.
I have seen numerous reports that Florida, along with other states, is manipulating data in order to justify reopening.
This all helps us answer the next question, which is:
There has been a dramatic worsening of the trend lines over this past week. Even here in New York, what looked like clear steady improvement now risks falling apart. What made things go so wrong so quickly?
My current model says that it is a combination of factors.
The central thing that I believe is going on is lockdown fatigue combined with a relative-to-others sense of responsibility, and no state capacity to do anything else.
It has been several months. A lockdown can be a fun change of pace for a week. It can be not so bad for a few months. But after a while it takes its toll. One goes stir crazy. You miss your friends. You lose your job and your savings start to run out. You can’t take it anymore.
Combine that with people adjusting to the behaviors and norms they notice around them. When most people judge who is being responsible, they are grading on a curve. If others are doing unsafe things, and you’re doing unsafe things but things that are less unsafe than others are, or that seem to you more justified, then that’s not being irresponsible. That’s doing what is necessary. That’s living one’s life.
The dam broke on that. The secondary effect of the protests was something between the straw that broke the camel’s back and the unleashing of a tidal wave. People saw others breaking the rules to protest. Many did so mostly to blow off steam after such a long lockdown. The rhetoric shifted to things like ‘defund the police’ and other unpopular far-left agenda items.
People noticed. Then others noticed them noticing, and adjusted expectations. Then others noticed them in turn, and so on. With the perception that a large portion of people was doing whatever it wanted, when a lot of other people ran the program ‘be about as responsible as other people’ that quickly spiraled in many places to very little in the way of precautions.
That is then combined with the problem of air conditioning, especially central air, and it being too hot to want to be outdoors throughout the South.
Mask wearing helps where it is present, but has turned into a political issue. And it turns out that in many places, most people will do an annoying thing for only a brief period before they stop doing it. What I saw in Westchester was an exception.
Then state capacity comes in.
We don’t have any ability to reimpose restrictions at least until after the death rates skyrocket. It’s unclear we’d be able to do anything even then.
We can’t contact trace, even in places like New York City where we hired the people to do it and have a manageable case load. A tracking app is dead in the water. Our blue cognoscenti has decided that anonymity for protesters overrides any motivations to trace. Our red cognoscenti was never on board with the idea.
In Texas it’s like New York in March, ICU capacity is being maxed out and we can’t even get proper PPE to the hospital workers let alone take extra measures.
The good news is we’re starting to finally see a consensus that masks are the only way forward without complete disaster. The mask message is increasing in intensity and more people are getting on board, including red voices.
The bad news is we’re starting to finally see a consensus that masks are the only way forward without complete disaster. We’ve agreed that we don’t have the ability to do much else that is useful.
My real answer to what went wrong is that our civilization is profoundly inadequate. We have lost our ability to do things. If you haven’t read the Moral Mazes sequence, it may help explain how we got to this point. So will understanding simulacra levels. That post was originally intended to be called ‘Simulacra Levels and Covid-19’ and to connect it to the claims of Covid-19: My Current Model, but that turned out to be too ambitious for one post. My work is not yet done to connect it back to our general situation, but essentially we have lost not only the ability to focus on the object level, but where decisions are made we have lost the ability to acknowledge the object level even is a thing. Our top people don’t believe in a physical world the way our grandparents did, and deny that anyone ever believed in one in that way. I’m working on explaining this further, and hope to get the next post out in a few weeks. Can’t rush this.
For many months I have yearned for the return of Major League Baseball. Nothing would be better suited to passing the summer days while maintaining social distance. The game carries minimal risk relative to many other activities. A few can entertain so many for so long. Yet things kept being postponed, as the owners and players were locked in a battle over money.
That battle seems to have ended with the players getting most of what they wanted, through a willful (in my reading) misinterpretation of an agreement the parties reached in March. The owners of course also did not cover themselves in glory on this one. But in the end, they did agree to play ball. Whether or not circumstances let it happen is unclear. I really, really hope we find a way, even if things get bad again. Baseball will be a huge help in getting us all through this.
Football will be even more important, and that much trickier. Football is dangerous under the best of circumstances. I’m not convinced introducing Covid-19 is that big an increase in danger in percentage of risk terms for the activity, but that is not how people will think about it. We can only hope the huge psychic cost of not having it is properly respected.
I know my readers don’t get this. I do. Sports are important. Sports go sports. Athletics are number one. Participants are heroes. Go team, yeah. For real. Let me put it this way, not as a demand but as a warning and declaration of fact:
No Football, No Peace.
If you are in the area seeing the explosion in cases, expect things to look like New York City looked in March and April.
We can hope that our improved knowledge will help us better protect the most vulnerable. That is good. It does not make the world around you any less dangerous when deciding what activities to do.
This actually could make things worse. It was criminal that we let our elderly down early in the pandemic, especially by letting the virus into nursing homes. But those very deaths drove home the need for measures that contained the virus. With the new lower death rates, by the time that statistic gets people’s attention, we will be much farther along in the infection rate. A younger person’s real risk will be several times higher relative to average risk, and thus they will take even less of the precautions they need to than they would have before. Then that greater rate means the elderly in turn can’t be protected.
Florida focused early on protecting nursing homes. That is the right strategy if and only if it still lets you contain infections in general. Fail, and nothing you did will save you, unless you can protect them through full herd immunity. That’s a tall order.
Herd immunity is where the South and West are headed. A few Western states might still escape, but something would have to change. Hawaii was down to one case in an entire week, but if you don’t handle things, they come back anyway, and now they’re back up to 91 and growing fast. I think New Mexico, Colorado and parts of Northern California are the only ones who might be all right. In the South, Kentucky and Virginia might muddle through, which not coincidentally are the most northern members of the region, while Florida and Texas are looking like the biggest disasters.
The Midwest is starting to trend back in the wrong direction, and several Northeastern states looks vulnerable as well. If there’s been the same level of cultural shift here as there was down South, but delayed and/or starting from a better point, we are at severe risk of tipping back above the critical R0~1 level, and having things start to get worse again. Once that happens, unless something changes, things might go slower, but it’s only a matter of time.
You can look at my spreadsheet for further numerical details under the tab Infections by State.
If you are in the Northeast, Midwest or a relatively safe local region, enjoy your relative safety responsibly while it lasts. Wear a mask. Remember to keep things outdoors. Don’t sweat the small stuff. Get yourself psychologically prepared for things to potentially get worse again, perhaps soon. Keep an eye on local numbers.
If you are in most of the West or South, this is when the real crisis likely starts for you. Due to exhaustion and adjustment, chances supply chains break down are relatively low, but not zero. Chances the medical system collapses are very high. Be prepared. If you need to see a doctor in the next three months, now is bad but next month is worse. Be ready to not go outside for several months, or to stay within your own region of space if you have one of those within your property, if it comes to that.
New York, New Jersey and Connecticut are now telling travelers who have been to any state with positive test rates above 10% that they must quarantine for fourteen days. It would not surprise me if the rest of our regional alliance followed. The rate overall of positive tests outside New York was over 8% yesterday, so it might not be long before this is the majority of the country.
Last time this was tried, we in New York were the ones being told to quarantine and stay out. It definitely feels good to turn the tables. The question of how this could be enforced remains unclear. It is also unclear whether the rest of the country will tolerate it. What will the federal government do when a blue state says red citizens aren’t welcome? So far, it seems to have been quietly accepted. These days, it’s hard to predict what will or won’t get a reaction. Perhaps the reaction will come when enforcement is attempted.
We live in interesting times.
As far as truncated numbers go, I find the graphs far easier to parse. In general if it's possible to do graphs instead of charts of numbers I'd find that more useful as a reader.
(numbers seem useful if I were actually trying to do analysis, but I'm guessing those people prefer an actual spreadsheet link)
Yeah, that's the feedback I've been getting. The plan is to do ~2 months of chart plus the full graph in future.
When you say that "our civilization was inadequate [to the task of suppressing COVID-19]", I just want to emphasize that "our civilization" means only the USA, not Western civilization in general. The EU got hit harder at first and has since then performed well; you can blame them for not taking it seriously early enough, but you certainly can't accuse them of the level of dysfunction you see here.
In general, I like the framing that the United States is running on the worst legacy code of any Western democracy; the UK's is older but was more amenable to modern patches. Never underestimate the degree to which the US government is just the least efficient government of any developed nation.
The series of updates is clearly focused on the United States. I agree that Europe seems to have been less inadequate. I don't think it covered itself in glory.
I'm not sure I understand your response. Yes, the series of updates is clearly focused on the United States, but your claim is that "civilization" explains why the US handled Covid-19 so poorly. Since human civilization is a factor present in all countries in the world, the fact that other countries handled Covid-19 very differently constitutes evidence against the "civilizational inadequacy" hypothesis. That your post wasn't focused on these other countries seems irrelevant.
your claim is that "civilization" explains why the US handled Covid-19 so poorly
your claim is that "civilization" explains why the US handled Covid-19 so poorly
The claim is not that civilization itself is inadequate. It's that a particular civilization is inadequate.
the fact that other countries handled Covid-19 very differently constitutes evidence against the "civilizational inadequacy" hypothesis
the fact that other countries handled Covid-19 very differently constitutes evidence against the "civilizational inadequacy" hypothesis
The "civilizational inadequacy" hypothesis is not that civilization = bad. It's that a particular civilization is not living up to the standard of what you would expect from a well-functioning civilization.
Maybe it seems odd to describe different countries as different civilizations, but the fact that different countries have different outcomes seems very much in line with the "civilizational inadequacy" hypothesis, as I understand Zvi to be using the term.
When Eliezer and others talk about "civilizational inadequacy", they generally refer to something much broader than the United States. Eliezer mentions the example of Japan's monetary policy, for instance. He also contrasts the civilizational inadequacy thesis with "the view that in general, on most issues, the average opinion of humanity will be a better and less biased guide to the truth than my own judgment." (emphasis added) And he relies (I think) on that thesis to draw conclusions about how he expects humanity to handle AI risk; such an inference wouldn't work if the thesis was restricted to the prevailing culture or institutions of a particular country. At the very least, if usage deviates from this established meaning I think this should be made clear.
The way I see it (I live in the UK) is that most western European governments are able to respond to a sufficiently unambiguous warning from experts that disaster is coming within a month if we carry on as normal, and react strongly to that warning, but not much more. That's why we get blunt instruments like local lockdowns and a slow-to-scale contact tracing system that could easily be made to work with, say 20 times its current budget.
That's because the Morituri Nolumus Mori effect applies everywhere, but has to combine with some basic collective ability to perceive physical facts to work properly, as you say and I argued in that post.
The MNM effect is what we credit instead of clever planning or reasoning, for why things aren’t as bad as they could be - the differences between e.g. America and Germany are due to any level of planning at all
I think the extreme version of your 'no ability to perceive physical facts' claim applies to some US states, the US federal government and maybe Brazil and the various developing countries that just don't have good enough information flow for people to stay informed, but doesn't apply to Europe, let alone East Asia.
But I strongly suspect that when things do get New York-bad in those other states, we will see individual and state responses trying to keep in under control that will bring the R back to near-1, even if it seems hopeless right now.
The Morituri Nolumus Mori effect, as a reminder, is the thesis that governments and individuals have a consistent, short-term reaction to danger which is stronger than many of us suspected, though not sustainable in the absence of an imminent threat. This effect is just such a hard limit - it can’t do very much except work as a stronger than expected brake. And something like it has been proposed as an explanation, not just by me two months ago but by Will MacAskill and Toby Ord, for why we have already avoided the worst disasters. Here’s Toby’s recent interview:
being much larger it often makes sense to pay more attention to the state by state breakdown for comparison to, say, EU countries.
"My real answer to what went wrong is that our civilization is profoundly inadequate. We have lost our ability to do things."
This is the only conclusion I would challenge — we actually did do things, for a while. We locked down (almost) completely for a month. But the emerging consensus as the numbers resolved was that the disease wasn't catastrophic enough to shut down society over for a year, or two, or three.
Does this mean that we couldn't lock down and quarantine for a disease with a CFR of 20%? I don't know. Maybe, and if not, it would suck. Hopefully this disease has given us a trial run and the skill to actually do it. But I don't think especially evidence-based to extrapolate society's response to COVID-19 to diseases with a CFR > 1%.
I think on the whole the US' lockdown was pretty weak and had low compliance; I think compliance was to a large extent dependent on things already looking bad enough locally to feel dangerous, at which point it's too late to get case levels low with the duration and severity of lockdown people have been up for. ('Compliance' might even be the wrong word for it, since I think people were mostly just avoiding things based on how dangerous things looked to them personally, not based on any top-down rules or guidelines.)
My real answer to what went wrong is that our civilization is profoundly inadequate. We have lost our ability to do things.
Civilization is made of people, and people aren't wired for scale. We haven't lost our ability to do things, we never had it. We have only ever done things at scale by accident, or for short periods of time (mostly wars and the Space Race).
When you live in a village of ~100 people, either you figure out norms for drought/famine/disease/etc quickly, or >90% of your community dies and the rest scatter.
In major cities, it's fundamentally an issue of everyone-for-themselves. You walk down the street and see a bunch of strangers. You may wish they were wearing masks, but there's no social norm. The norms are enforced at shops, waiting in line, entering with reduced capacity, wearing a mask (or not) in both cases.
If not enough people care on average, your friendly neighborhood megalopolis is doomed.
Agree that we aren't wired for scale. Disagree that we haven't lost the ability to do things. However, eradicate COVID-19 was not something we ever had the ability to do--certainly not in the U.S.--I suspect that places like New Zealand will eventually be forced to open up out of desperation, as no miracle cure with be forthcoming, though I hope I'm wrong on that. But it was certainly a huge gamble for the countries that have sealed their borders and gone for eradication, and I totally disagree with the judgment that it was obviously the right move, though it might turn out to be.
I'm looking forward to the simulacra post, because I do agree that we've gotten to the point of denying the existence of the object level and that it is incredibly disturbing and unsustainable. Were this not the case, we would have handled COVID-19 much more sensibly, but we would not have contained it. I'm very confident of this. Humans have never tolerated or been able to plan for the kind of restrictions it would require, and it is likely literally impossible anyway---the economic and social dysfunction will probably render it unsupportable before we got a miracle cure, if that ever happens. (I use the term miracle cure instead of vaccine because I'm thinking of a vaccine that we get within a few years, that we are confident doesn't have major side effects and is widely effective, that we are able to mass produce and distribute at sufficient numbers to basically eradicate the illness worldwide, that would provide fairly long-lasting immunity, etc.---a truly effective vaccine that we actually are able to somehow give to huge numbers of people, including those hard to find and resistant to being vaccinated. This is a much taller order than "a vaccine.")
The West region seems to now be showing signs of important subregional distinctions: in particular, (IIRC) a lot of the increase in cases in the West is being driven by increases in southern California.
The Midwest is starting to trend back in the wrong direction, and several Northestern states looks vulnerable as well.
I assume "Northestern" is a typo for Northeastern, but some might think it's a typo for Northwestern.
Northeastern. Mods can go ahead and fix in this version then delete these.
How are other countries doing? Nobody has a vaccine, nobody (as far as I know) got hit hard enough to even talk about herd immunity. I saw some stuff that Sweden had stayed open too long, and got hit, but no details on what that means in terms of ICU capacity and deaths.
I don't think I've heard of any endgame steady-state except herd immunity or vaccine. Is your comment about R0=1.05 meaning everyone gets it intended to lay out another scenario?
There's plenty of blame to go around, but even so, blaming "our civilization" is too broad a brush. US voting methods — the electoral college, gerrymandered single-seats in the House, and the malapportioned Senate — are horrible. They get obviously wrong answers far too often, including 2000 and 2016; and even when they don't, they encourage partisan polarization, which increases the mind-killing potency of politics. Both of these can be directly connected to the level of epidemiological failure in the US.
This is all fixable, without needing constitutional amendments. In practice, Republicans are almost certain to veto a fix if they can, while Democrats may allow a fix if we pitch it right. Thus, one clear and important step in fixing this is to elect Democrats to a trifecta — White House, House, and Senate.
I had such an urge to write a bunch to this, but felt like it was breaking some sort of basic code. Then I remembered that the only reason I have this urge is because we're focusing on Covid news as an exception to the general frowning-on-new-and-politics norms of the site. But I still don't think I'll engage with this discussion here today.
Your comment makes me want to be more explicit about the norm I was using, so that I don't contribute to eroding the overall group norm.
I believe it is OK to post about politics if all of the following are true:
-Some point you make is non-obvious.
-Some point you make is potentially useful.
-Every point you make is beyond reasonable debate in your mind. That is to say, you are so confident that you are right that most readers would agree with you even after seeing someone post the other side, that you'd be willing to leave a contrary response without a public answer.
When I posted the above, I roughly thought that it met all those criteria. On second consideration, I think I was wrong about that in some regards.
Claim 1: The electoral college substantially contributed to the degree of failure of the US with regard to COVID-19. I consider this beyond reasonable debate. By saying so I am not casting aspersions on those who disagree or challenging them to express their disagreement, merely stating my considered opinion.
Claim 2: Gerrymandering and/or Senate malapportionment contribute to hyper-partisanship of the kind that could, at least in theory, in turn contribute to polarized acceptance of basic hygeine measures such as masks. Again, I consider this beyond reasonable debate.
Claim 3: The odds ratio for accepting voting reform between Republicans and Democrats is considerable, such that if a time traveller from the future told me that voting had been reformed before 2030, I would be confident that it had been done by Democrats. In my book, beyond reasonable debate.
Claim 4: Republicans would be able to veto reform by holding just 1 of the 3 loci of power I mentioned: WH, House, and Senate. Beyond reasonable debate.
Implicit claim 5: these are the three bodies that are most key to success. Debatable; should have explicitly disclaimed.
Claim 6: Democrats have non-negligible chance of carrying out reform. Debatable; shouldn't have said this.
Claim 7: Because of all of the above, you, dear USA reader, should vote for Democrats. Highly debatable and should have been out-of-bounds.
Note: by writing all this out, I am NOT encouraging object-level discussion. I'm sure there are people here who'd disagree with one or more of my judgements on what is or isn't debatable. I'm simply trying to be explicit about the interpretation of the rules I was implicitly using to justify writing my original post, and about how in retrospect, I think I was letting myself be too loose about that interpretation. I'd be happy to discuss these issues of norms insofar as it doesn't get bogged down at the object level.