It’s been almost a month since my last COVID Consolidated Brief and I hope you are all doing ok. I’ve personally been settling into the new normal. On the other hand, I’ve witnessed first hand some of the risks that might be coming with COVID. I had to take shelter in a tornado warning for the first time in my life. While the tornado and the destruction were luckily quite minimal, there was a power failure for about a day and social distancing made it a lot harder to wait out the power failure in a nearby library or Starbucks. Overall, I’m lucky my life is so safe that this is the biggest problem, but I am worried about people who might be a lot less likely and face strong hurricanes or wildfires while also having to maintain social distancing. More on this in a bit.
If you’re just joining us, I follow COVID-19 a lot and this is my third semi-regular installment of a public consolidated brief that tries to consolidate everything I read into one short, actionable list so other people can stay up to date without reading a ton on their own. For this issue, I spent over 25 additional hours trying to get to the bottom of everything so that you don’t have to. This way I can save time and fight research debt and save you time from having to read all of this yourself. That being said, do keep in mind that I am not an expert and I have not been able to cover everything going on - I had to be fairly selective to make this brief actually somewhat brief.
I’m not sure how often I will do these, but I still intend to do them as I am able. Maybe it will be a monthly newsletter. Maybe I’ll be able to do it every other week. We’ll see!
Previously:
See also:
Doing Your Part! How You Can Stay Safe and Help the Fight!
Masks
Masks are a good idea - tell your friends! The opinion on masks has changed a lot since I last reported about a month ago.
WHO is now onboard: “The World Health Organisation says it supports government initiatives that require or encourage the public wearing of masks, marking a major shift from previous advice amid the Covid-19 pandemic. [...] The WHO added that surgical masks should be reserved for medical professionals, while the public should use mainly cloth or home-made face coverings.”
The American CDC is now onboard: “CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.”
A lot more information on masks is now available in Thomas Pueyo’s “Coronavirus: The Basic Dance Steps Everybody Can Follow”.
Masks may even become mandatory as a part of the reopening plans - see more below.
Giving
Want to help give money to help people most affected by COVID-19 have a chance to get back on their feet? GiveDirectly is now helping you give cash directly to those in most need.
Want to give money to helping analyze and treat COVID? I would donate to the Center for Health Security at Johns Hopkins, which researches biosecurity and has been tracking COVID since early January. You can donate here, or you can donate through the Effective Altruism Funds.
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My previous 29 Mar Brief has a bunch of advice on how to stay safe and contribute.
A Glance at The Latest Situation
The last time I wrote, we were just about reaching the one millionth case worldwide. Now we’re above one million cases just in the US and we’ve exceeded three million cases worldwide.
Here’s the latest based on cases...
and deaths...
It seems that the UK has now likely peaked and is coming down, whereas it is still too early to tell for the US. However, the descending part of the curve seems to be much slower than the sharp ascending part of the curve. It seems increasingly likely (and is even now acknowledged by the IHME) that we won't get a steep, bell-curve-type “mirror image” decline in cases / deaths as previously hoped for.
It looks like Austria, Australia, New Zealand, and Norway are joining Taiwan, South Korea, and Hong Kong as potential case studies in successful handling of COVID. On the other hand, previous darlings Japan and Singapore now look to each be facing a moderate outbreak.
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Indeed, in good news, New Zealand has already declared victory:
"There is no widespread undetected community transmission in New Zealand. We have won that battle," Ardern said Monday. "But we must remain vigilant if we are to keep it that way."
Asked whether New Zealand had eliminated COVID-19, Ardern replied: "currently."
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Though Singapore’s previous victory is now revoked and shows security may not be as absolute as it seems. They previously had ~20 cases per day in mid-March but jumped to ~1000/day in mid-April, declared a lockdown on 7 April and added additional measures on 21 April, and have seen cases drop to ~500/day.
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Here’s another way to look at the numbers, which looks at new deaths per capita, averaged over the past week to smooth out some (but not all) reporting issues… makes you wonder what the heck is happening in Belgium and Ireland (if it is anything more than differences in how countries report death stats).
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Reporting deaths is hard. Looking to “excess deaths”, the death toll could be even worse than currently imagined:
The death toll from coronavirus may be almost 60 per cent higher than reported in official counts, according to an FT analysis of overall fatalities during the pandemic in 14 countries.
Mortality statistics show 122,000 deaths in excess of normal levels across these locations, considerably higher than the 77,000 official Covid-19 deaths reported for the same places and time periods.
If the same level of under-reporting observed in these countries was happening worldwide, the global Covid-19 death toll would rise from the current official total of 201,000 to as high as 318,000.
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Also, Business Insider reports that latest forensics show that people died from COVID in the US earlier than we thought:
[A]utopsy results this week revealed that COVID-19 killed two people in Santa Clara County on February 6 and 17. That's at least three weeks earlier than the coronavirus death California officials previously considered the state's first. Indiana is also attempting to trace cases back to mid-February. The state reported its first death on March 16, but officials revised that date to March 10 earlier this month, according to the Indianapolis Star.
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As a further sign of how difficult all this death-counting is - “NYC death toll jumps by 3,700 after uncounted fatalities are added”:
Previously, the city had not counted people who died at home without getting tested for the coronavirus, or who died in nursing homes or at hospitals, but did not have a confirmed positive test result. Mayor Bill de Blasio admitted last week that the true number of deaths was far higher than the official tally, and said the city would start including presumed coronavirus cases in its data.
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In “Coronavirus: Learning How to Dance”, Tomas Pueyo also breaks trends down on a country-by-country basis (numbers shaded based on relative size of new cases within that country):
It’s worth taking a look at the bigger image, which shows that while outbreaks may be steady in more developed countries, they’re just beginning to start taking hold in less developed countries. Here, we can see a lot of countries are just starting to see their outbreaks, while other countries have peaked and declined. From here we can visualize where all the countries are on a curve from handling the virus:
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Here’s a world map of current COVID deaths per person:
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It’s easy to get lost in the numbers, but the amount of death we’ve seen so far is a lot - the amount of deaths in the US over the past few months far exceeds American deaths in September 11th and the Iraq War and recently also just exceeded the total number of American deaths in the twenty years of the Vietnam War (source):
And COVID has become the leading cause of death in the US:
...So Just How Bad Could This All Get?
Just as we might start getting good news about coronavirus, some other disasters might make it worse. For example, Colorado State University just issued a hurricane season forecast that doesn’t look good:
As the world battles the coronavirus crisis, researchers are warning of a potentially active Atlantic Ocean hurricane season, which kicks off June 1 through the end of November. [...]
Specifically, the team forecasts 16 named tropical systems; 12 is the average. Eight of those named systems are forecast to reach hurricane status, with winds greater than 74 mph; Six is the usual amount per year. CSU is also forecasting more major hurricanes than is typical per year: four as opposed to the average of 2.7.
[...] The forecast is also alarming in that it's calling for a nearly 70% chance of a major hurricane — which is at least a Category 3 storm with sustained wind speeds of 111 to 129 mph — makes landfall somewhere along the U.S. coast.
Needless to say, a hurricane like Katrina, Harvey, or Maria is devastating enough on its own, but would combine with already overloaded hospital systems in a very bad way. And as if hurricanes aren’t bad enough, there will almost certainly be large-scale wildfires again as there were last year.
Also, needless to say, social distancing may be difficult during evacuations and this could lead to new outbreaks facing an even more overburdened hospital system.
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Many conflicts could be potential time bombs amid the coronavirus. I’m still particularly worried China may take the opportunity to be more aggressive in the South China Sea, especially after China rammed a Vietnamese fishing boat at the beginning of the month. China has also been bullying Taiwan with military flybys. The US has already called for $20B in new military spending to deter China.
Meanwhile, Politico reports that the US State Department has continued to warn that Russia, China, and Iran are pushing a host of matching propaganda disinformation messages, including that the coronavirus was an American bioweapon.
Americans are increasingly negative on China. A new Pew Research survey finds 66 percent of Americans say they hold an unfavorable view of China, up 6 points from the previous year. And of course, recent ads from the Trump camp referring to Biden as “Beijing Biden” and Biden retaliating by tying Trump to China suggest this may only get worse.
While I am all for due criticism of the Chinese government and think there is a lot to rightfully criticize, I do worry that declining American sentiment toward China could risk us closer toward armed conflict.
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To make matters worse, the World Food Programme warns of “multiple famines of biblical proportions”:
David Beasley, head of the World Food Programme (WFP), said urgent action was needed to avoid a catastrophe. A report estimates that the number suffering from hunger could go from 135 million to more than 250 million.
Those most at risk are in 10 countries affected by conflict, economic crisis and climate change, the WFP says. The fourth annual Global Report on Food Crises highlights Yemen, the Democratic Republic of the Congo, Afghanistan, Venezuela, Ethiopia, South Sudan, Sudan, Syria, Nigeria and Haiti.
This is really bad.
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Another question - less important but still of interest - will those famines happen in the developed world too?
On 27 March, I wrote that Metaculus had put the probability of a food shortage in a major US, UK, or EU metropolitan area before 6 June at 30%. I thought this was insanely high and offered my own prediction of 5%.
I see Metaculus has now come to their senses and now has a median prediction of 6%. However, now things might be starting to feel a bit different. It’s hard to get more blaring than Tyson Foods takes out full-page ad: 'The food supply chain is breaking'. This seems to mainly be limited to meat production in slaughterhouses, of which a lot have had to be closed or limited due to spread of COVID among slaughterhouse workers.
The Wall Street Journal reports:
U.S. grocers are struggling to secure meat, looking for new suppliers and selling different cuts, as the coronavirus pandemic cuts into domestic production and raises fears of shortages.
Covid-19 outbreaks among employees have closed about a dozen U.S. meatpacking facilities this month, including three Tyson Foods Inc. TSN -0.16% plants this week. Other plants have slowed production as workers stay home for various reasons.
Tyson isn't the only company to shutter plants. Smithfield Foods, the world's largest pork processor, has temporarily closed plants across the country as some of its workers have become sickened. The company's CEO also warned of supply chain issues when it closed its Sioux Falls, South Dakota, plant after more than 400 employees tested positive for the coronavirus. Smithfield says the Sioux Falls plant is one of the largest pork processing facilities in the U.S.
Still, a meat shortage doesn’t mean a food shortage writ large, and 6 June is now just a little over a month away and I expect we have more than a month of slack in food production, so overall I continue to put very low odds on this question (personally dropping now to 3%).
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Covid-19 May Worsen the Antibiotic Resistance Crisis: A bit of a double-whammy where patients ill with COVID are prescribed antibiotics to protect against other possible infections, thus increasing antibiotics use and thus increasing potential antibiotic resistance… at the same time antibiotics manufacturers are slowing the development of new antibiotics to focus on anti-COVID treatments instead.
And How Do We Get Out of this Mess? Vaccines, Treatments, Testing, Tracing, etc.
The Grand Reopening
Getting out of this mess is top of mind as the biggest news of the moment seems to be how we handle re-opening.
The United States
NBC reports that according to US Vice President Pence sixteen US states have unveiled “formal reopening plans” to lift coronavirus restrictions.
It’s worth reiterating the “National Coronavirus Response: A Roadmap for Re-Opening” plan from the American Enterprise Institute that I last covered in my previous brief as it is now basically the official plan endorsed by Donald Trump. As I mentioned before, this proceeds in three broad phases:
Phase I: Slow the Spread. Widespread school closures, work-from-home, close malls and gyms, and limit restaurants.
Phase II: State-by-State Reopening. Individual states are able to move to Phase II as they are identified to be able to safely diagnose, treat, and isolate COVID-19 cases and contacts. Testing must be scaled up rapidly. These states can gradually reopen schools and businesses, but will likely need to maintain some degree of physical distancing and limitations on larger gatherings. Older adults will also need to remain at home.
The trigger for issuing a stay-at-home advisory in a US state is when case counts are doubling every three to five days (based on the current New York experience) or when state and local officials recommend it based on the local context (for example, growth on track to overwhelm the health system’s capacity). The trigger for issuing a recommendation to step down from a stay-at-home-advisory back to “slow the spread” is when the number of new cases reported in a state has declined steadily for 14 days (i.e., one incubation period) and the jurisdiction is able to test everyone seeking care for COVID-19 symptoms.
Phase III: Lifting restrictions. Phase III will also be gradually reached on a state-by-state basis “once a vaccine has been developed, has been tested for safety and efficacy, and receives FDA emergency use authorization” OR “there are other therapeutic options that can be used for preventive or treatment indications and that have a measurable impact on disease activity and can help rescue very sick patients”.
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The point of these lockdowns has been to buy us time to (1) build up hospital capacity to handle a larger future wave and (2) build up testing/tracing/isolation capacity to be able to more finely quarantine just those with COVID. Insofar as we’re accomplishing (1) and (2), we can start reopening the economy.
My current guess about re-opening is that there won’t be a single binary “everything back to normal” event like it seems people are conceptualizing it. People think of “reopening” as “everything goes back to how it was before the coronavirus”, but that seems quite unlikely.
Instead, I expect the country to gradually reopen, largely in reverse of the way that it closed, except a lot slower. That is, the things that were closed last (e.g., parks) will be reopened first - potentially really soon - whereas the things that we closed first (e.g., concerts, conferences) will be reopened last - and potentially not until after we have a widespread vaccine.
For a look at what the very first step might be, look to the new “Safer at Home” policy of Colorado that basically reopens private gatherings with less than ten people, one-to-one real estate home showings, curbside pickup, and not much else:
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Some governors and mayors have been a bit more gung ho about reopening, however.
The semi-serious Georgia is permitting a reopening of “gyms, fitness centers, bowling alleys, body art studios, barbers, cosmetologists, hair designers, nail care artists, estheticians” with “screening workers for fever and respiratory illness, enhancing workplace sanitation, wearing masks & gloves if appropriate, separating workspaces by six feet, teleworking if possible & implementing staggered shifts”.
Even Trump seems to think this is too much, saying “I disagree strongly with [Governor Kemp’s] decision to open certain facilities which are in violation of the Phase One guidelines [...] I think spas, and beauty salons, and tattoo parlors, and barber shops, in Phase One … is just too soon. … They can wait a little bit longer.”
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Tennessee is also reopening restaurants and some other businesses:
The new restrictions include limiting capacity to 50% and ensuring tables are no less than 6 feet apart, with no more than half a dozen people per table. They also say businesses should screen both employees and customers for signs of illness.
Bar areas will remain closed, "live music should not be permitted" and employees must wear masks and gloves at all times, the governor's rules say. Self-serve buffets are also ruled out.
Retail businesses will follow similar guidelines on Wednesday, when they are slated to start reopening.
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It gets worse - the widely mocked Las Vegas Mayor Carolyn Goodman just wants to offer up Vegas as a "control group" to measure the effects of lifting restrictions.
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Maryland has a proposal that recommends lifting restrictions only after COVID deaths and new hospitalizations have seen a consistent two-week decline - more conservative than Trump’s guidance of two weeks of decline in new cases.
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Threading the needle between Georgia and Maryland, Texas is going with a 25% plan:
Along with retail stores, restaurants and movie theaters, Abbott said that museums and libraries can also reopen on Friday at a 25 percent capacity. Sole proprietors of businesses can also open and doctors and dentists can resume normal operations as well. […] Churches and places of worship, which were allowed to remain open during the state’s stay-at-home orders, are also allowed to expand their capacity provided safe social distancing measures are still enacted. Barber shops, hair salons and bars will still remain closed.
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The Bay Area is extending their lockdown through the end of May, but now allowing drive-in religious services (stay in the car), one-on-one residential real estate viewings, golf courses, and driving ranges.
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So when all is said and done, what might things begin to look like? CNN suggests that "America's 'new normal' will be anything but ordinary", potentially seeing some of the following changes:
- The world will be able to reopen somewhat
- People’s temperature will be taken everywhere
- Face masks will be mandatory
- Sports and entertainment venues remain empty
- Lots of monitoring of cellphone locations
- Schools reopening to staggered classes ("You could have 9th and 10th grades come in the morning and 11th to 12th grades in the afternoon [...] Or half of the students could come Monday, Wednesday and Friday. The other half on Tuesday, Thursday and Saturday.") with smaller class sizes
- Elimination of school assemblies, physical education, and recess.
- Increased sanitization efforts and deep cleaning become standard
- Restaurants cut down the number of seats
- Mask-wearing diners greeted by servers in masks and gloves with disposable menus in their hands.
- Unessential airport travel will continue to be limited and airline passengers would be required to have the contact tracing app, confirm no proximity to a positive case, and have a temperature check or show documentation of immunity.
Another take from the Washington Post asks “How much of our lives will coronavirus change?” and speculates:
Deborah Birx, the White House’s coronavirus task force coordinator, warns that social distancing will be in place through the end of the summer. [...]
Even if New York’s plan and those put out by states such as Maryland come off without a hitch, they will take weeks, if not months, to ramp up, subject to any setbacks (e.g., a second wave). These states are coming to grips with the reality that much of life will not change to something approximating “normal” before we get a vaccine.
You likely will not enter a store without a mask, sit in a crowded movie theater or restaurant, or fly on a plane. Before there is a vaccine, you might not go to a gym, the beach or a mall — no matter what the social distancing. If you are working from home now, you may very well still be working from home six months or a year from now. Moreover, your employer may eventually decide the business can lease half the space it currently does and have you work from home permanently.
Students at K-12 schools and at colleges may go through a full year in which they never physically meet a teacher or attend a school play or an athletic event in person. Instead of live theater, concerts and sports, we might get our entertainment in a pay-per-view format. Movie theaters were dying off anyway with streaming services and big home televisions; most of the rest may vanish as well. Don’t bank on watching a summer blockbuster movie in a theater.
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It's hard to know when and how we should be reopening, and I imagine that many governors are willing to take on some additional death and some risk of disaster in order to reopen their states.
Furthermore, it’s also unclear how much people will voluntarily take up these recently reopened businesses versus stay at home. While Georgia is allowing stores to reopen, one reporter reached out to twenty different small businesses and not one of them said they had plans to reopen this week.
...All of this could introduce a lot more uncertainty into the future of the effects of the coronavirus.
Again, caution is warranted about making predictions about how things will unfold:
it’s so seductively easy to double down on sweeping pronouncements: E-sports will replace football and basketball, movie theaters will never return, and telemedicine will become the new normal.
Anything is possible, but take a closer look at how often definitive predictions about permanent change are simply extrapolations of recently observable trends taken to some maximum extreme. [...]
Look back, for example, at pronouncements forged during our most recent financial crisis. In early 2009, in the depths of the Great Recession, Time magazine declared “The End of Excess.” [...] All of this was perfectly plausible. But it is not what happened. For better or worse, unpredicted developments such as the fracking boom and other factors put an end to talk of “peak oil.” [...] Some of this proved true but far less lasting than predicted. Consumer spending has risen by about a third since 2009, from about $10 trillion a year to around $13.5 trillion last year, and still accounts for more than two-thirds of the total economic activity. [...]
This is not an argument against predictions (and it is certainly not a critique of any specific prediction). Speculation about what might happen is useful; it can actually start interesting discussions about a future in which shareholder rights aren’t so predominant or provoke us to imagine the implications of cities segregated by immunity status. Predictions of death rates or economic consequences can help shape or inspire responses that prevent those predictions from coming true.
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We also have to wonder about the political will to roll this out. So far, we’ve done reasonably well at adhering to social distancing for long periods of time with only minimal protesting. I hope this can last for many more months, but I’m unsure. As Ezra Klein summarizes - "I’ve read the plans to reopen the economy. They’re scary. There is no plan to return to normal.":
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How dangerous will coming out of lockdowns too early be? The real point is that we just don’t really know, as we don’t know how much voluntary social distancing will remain in place, among many other uncertainties. But previously we knew that it actually took an exceptionally strong lockdown to keep deaths down, so reversing that back to a not-all-that-strong lockdown could be disproportionately bad. Hence “New Model Shows How Deadly Lifting Georgia’s Lockdown May Be”:
As of Friday, by official counts in Georgia, at least 871 people statewide had lost their lives to COVID-19. If Georgia had maintained its pre-Friday lockdown policy, the Harvard/MIT team’s simulation—which used data from the Johns Hopkins Coronavirus Resource Center and accounts for local demographics and health conditions based on Census and survey data—estimated the state would have logged a total of between 1,004 and 2,922 coronavirus fatalities by June 15. That fatality range, like all such ranges detailed in this article, includes deaths that had already been documented (in this case, 871).
By contrast, under Kemp’s current plan to reopen, if approved businesses returned to just 50 percent of their pre-pandemic activity (or “contact”) levels, that range could reach 1,604 to 4,236 deaths. At 100 percent of pre-shutdown activity, the projected final body count could soar to a range between 4,279 and 9,748.
One potential cautionary tale might be Japan’s northern island of Hokkaido:
It acted quickly and contained an early outbreak of the coronavirus with a 3-week lockdown. But, when the governor lifted restrictions, a second wave of infections hit even harder. Twenty-six days later, the island was forced back into lockdown.
However, again, uncertainty remains a concern. If we make dire predictions that overestimate the return to normal activity or underestimate potential beneficial effects of mask wearing, weather, etc., it’s possible things might not be as dire as they sound, which could lead to people distrusting these expert predictions more. ...On the other hand, things could end up worse than projected.
Colleges
For another question, when and how will Harvard reopen for the fall term? Here’s how they’re thinking about it:
Harvard will be open for the fall semester, but some or all instruction may continue to be online, the university's provost said Monday. [...] Several criteria must be met for the school to safely reopen its doors, Garber wrote, including models showing the disease is "mostly behind us," and that another outbreak is unlikely.
Here’s an alphabetical list of colleges that have either disclosed their plans, mentioned them in news reports, or set a deadline for deciding. It looks like most of them are aiming to have in-person classes.
...I’m personally wary about how a large campus is supposed to reopen. After all, the risk of spreading COVID is proportional to the amount of people, their density, and the length of contact and college has a lot of all of that.
Indeed, one study found that “[t]he average student can “reach” only about 4% of other students by virtue of sharing a course together, but 87% of students can reach each other in two steps, via a shared classmate. By three steps, it’s 98%.”
Even on campus, presumably students will have to be aggressively pre-tested and quarantined before joining the campus population. Also, at least some steps to ensure isolation and some social distancing will have to take place on campus even after all of that.
Another place to look to might be Facebook. Per their latest announcement, they will be (1) requiring nearly universal work from home through at least the end of May, (2) cancelling all business travel through at least the end of June, and (3) and cancelling all large physical events with more than 50 people through June 2021.
The United Kingdom
Buzzfeed News reports on the UK’s reopening plan:
A “best-case scenario” being worked on by the Scientific Advisory Group for Emergencies (SAGE) hopes to end lockdown restrictions for certain nonessential shops and industries in the short term, from early to mid-May.
Some social distancing measures could then gradually be relaxed in the medium term, in June and July, eventually leading to the reopening of pubs and restaurants towards the end of summer.
Long-term “shielding” for elderly and vulnerable people could mean limits on people seeing their parents or grandparents over 70 for as long as 12 to 18 months until a vaccine is found.
The timeline relies on SAGE scientists calculating how many new COVID-19 infections per day the UK’s test and trace capabilities can manage and an “impossible” political decision for Downing Street on how many deaths per day they are willing to accept in order to be able to lift some restrictions before there is a vaccine.
South Korea
South Korea has remained relatively open, albeit with substantial restrictions in place.
One contact says people don't really notice the impact of COVID any more, though February and March felt pretty chaotic. Working from home is encouraged, esp. for employees that would have to use public transport, but many people come to offices. The next few weeks will be critical: will see if clubs and grocery stores can reopen in Seoul without causing a huge spike in infections.
COVID-19: Testing, Isolation, Geolocation in Korea gives a bit of a glimpse at how seriously South Korea is taking this:
The guy in the video has just returned to Korea from abroad. He is tested right away (results by next day), and asked to self-quarantine for 2 weeks. His location is monitored via phone (GPS) during this time. During quarantine the government supplies him with food free of charge.
Africa
It looks like some African countries are coming out of lockdown:
Some, like Ghana, are now easing these measures, concerned about their impact on the poor and because they've taken other steps against the virus.
Ghana did place lockdown restrictions on its major cities - which it has now largely lifted. But social events and public gatherings are still banned, and school closures will remain in place for the time being.
However, lockdowns in developing countries often force people to choose between starvation or disease.
How can lockdowns cause more harm in poor countries than rich ones? When almost everyone works in an informal economy and needs to work every day to put food on the table — the situation in some of the poorest countries — calling a halt to economic activity can get rapidly disastrous. [...]
“If you’re a day-wage laborer in a rural area of a developing country, and you don’t have much of a buffer of savings, you may be reliant on your wage earnings in a given day or a given week in order to feed your family,” Mobarak argues. “If their family is going hungry that week, they’re not going to follow all of your guidelines."
Worse yet - for many African countries, this is still just the beginning:
Vaccines
What kind of treatments and vaccines might we expect? Derek Lowe outlines “The Order of the Battle” where first we try repurposing existing drugs (e.g., remdesivir, hydroxychloroquine, azithromycin, falapirivir, ivermectin), then monoclonal antibodies, then vaccines, and then potentially new treatments. It’s possible existing drugs or new treatments could greatly reduce the danger of COVID and allow for faster reopening, but it would take a vaccine to truly make it go away.
So let’s zoom in a bit on vaccines. Keep in mind that producing a vaccine in 1.5 years is by far the landspeed record for making vaccines. The ebola vaccine took five years and as I researched in 2017, it historically takes on average thirty (!!) years. We expect unprecedented acceleration here, however, because we have unprecedented resource mobilization and an unprecedented willingness to not undergo all the same rigorous safety measures.
Derek Lowe provides updates on “Coronavirus Vaccine Prospects” - we need to make a vaccine (of which there are several possible types to try), it needs to be effective at treating COVID, it needs to be safe (not introduce any new diseases or symptoms), and it needs to be effectively manufactured and rolled out at scale. Any of these three prongs could slow down vaccine progress.
And Derek Lowe also provides “A Close Look at the Frontrunning Coronavirus Vaccines As of April 28”, tracking eight major efforts:
So by my count, the biggest and most advanced programs include two inactivated virus vaccines, three different adenovirus vector vaccines, two mRNA possibilities, a DNA vaccine, and a recombinant protein. That’s a pretty good spread of mechanisms, and there are of course plenty more coming up right behind these. You cannot do the tiniest search for such information without being inundated with press releases about companies working on coronavirus vaccines
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The aptly named VisualCapitalist tracks the status of some ongoing treatments and vaccines:
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A much more detailed tracker of over 280 treatments and vaccines is available from the Milken Institute.
Gaze into the Crystal - The Latest Modeling and Forecasting
Metaculus has been doing some cool stuff, and I always like checking on their latest dashboard:
It looks like compared to the numbers from 2 April, the lower 25% and median bounds of estimated infections and cases confirmed by testing have gone up. But some good news - the median estimated number of deaths has gone down slightly.
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Another prediction dashboard, from Good Judgement Inc., also looks at cases and deaths, though over a slightly different timeframe, and seems to come up with fairly similar results:
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Looking at the actual models themselves used by the expert forecasts above, we can see they actually struggle a bit to agree:
Calibration of these models also continues to remain a concern:
We have found that the predictions for daily number of deaths provided by the IHME model have been highly inaccurate.
The UW-IHME model has been found to perform poorly even when attempting to predict the number of next day deaths. In particular, the true number of next day deaths has been outside the IHME prediction intervals as much as 70% of the time. If the model has this much difficulty in predicting the next day, we are concerned how the model will perform over the longer horizon, and in international locations where the accuracy of the data and applicability of the model are in question.
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More good news - the timeline for the vaccine has gotten much more optimistic over the past month, with the lower 25% and median both shifting six months earlier, the upper 75% shifting 1.5 years earlier, and the chance of a vaccine waiting until after March 2027 fell from 8% to 6%.
On the other hand, the Good Judgement forecasters appear a lot more pessimistic, putting almost double the odds (50% vs 25%) on a vaccine not appearing by April 2022. (Note that the scale of the distribution is different, but I’m doubtful this matters much for the timeline at this scale.)
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Metaculus has also been trying to forecast the easing of lockdowns. As seems confirmed by the reporting above, they’re imminent. However, be careful to not interpret easing of lockdowns as anything but the first step in a gradual process - the way these questions are worded, any easement will count as a positive case, even if it is a lot less than would make it possible to enjoy the world to the extent we used to.
To get a bit more granular, Metaculus currently has 47% odds on “most of the classes for courses at Harvard College that would usually be scheduled to occur on September 2nd have in person instruction on September 2nd, 2020.”
Some other questions in a similar vain we might want to ask to get at the granularity of reopening… and my personal predictions:
- When will Chicago reopen Lincoln Park to the public (even with enforced social distancing)? Median 15 May, 80% CI 1 May to 1 July
- When will it be legally permitted in Chicago to get a haircut? Median 1 June, 80% CI 7 May to 1 September
- When will Chicago CTA subway cars reopen for non-essential travel? Median 15 June, 80% CI 15 May to 1 September
- When will it be legally permitted to eat dine-in in a Chicago restaurant? Median 30 June, 80% CI 7 May to 1 September
- When will the Chicago Symphony Orchestra have a public performance inside their concert hall (even with massively reduced and spaced-out attendance)? Median 1 September 2020, 80% CI 1 June 2020 to 1 June 2022
I made these about Chicago because that’s the area where I live and I know well and because Chicago and Illinois have historically been more cautious about COVID. I added these questions to Metaculus to see what others think.
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Laypeople can make a prediction too… it looks like most people are expecting a full “return to normal” sometime this year. I personally find it unlikely we would be able to see a “return to normal” until after we have a vaccine, which does not seem likely to happen in 2020 at all.
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Even cooler, Metaculus will be taking these forecasts head-to-head with experts:
We're excited to inform you that Metaculus will be participating in COVID-19 Expert Surveys, in collaboration with researchers at the University of Massachusetts Amherst. Your skills will be compared to the forecasting ability of infectious disease experts!
Each week we will be launching up to 8 questions in which the community will have 30 hours to lock in their predictions.
Researchers will concurrently distribute the same questions to some of the worlds leading infectious disease experts.
The resulting Metaculus predictions (your predictions!) and expert forecasts will be gathered into a weekly report that is sent to the CDC.
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If you want cool and useful plots about COVID cases, deaths, and testing broken down by US state, county, and city, check out covid19watcher.com!
Now Just What are the Tech Overlords up to?
Google and Apple are joining forces on contact tracing. This is big news, as Google’s Google's Android and Apple's iOS have approximately 100% of the mobile OS market share with 3 billion combined users. The plan is for Apple and Google to release interfaces next month for health officials to build apps and for contract tracing to be enabled over the next few months.
The app works by running Bluetooth in the background and broadcasting beacons that are logged by nearby phones. Once someone is diagnosed with COVID, they can consent to sharing the past two weeks of beacon logs with health professionals, who can then broadcast anonymous alerts to those who have been in contact.
Google and Apple emphasize that the system is built on a decentralized stack that does not broadcast any data without user’s permission and does not use location data at all (only data of who you came in contact with, not where).
However, the app needs about 60% of the adult population to use it for it to be fully effective at controlling COVID on its own, but it could still be an important part of a larger contract tracing effort.
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Bill Gates is spending billions of dollars building manufacturing facilities for many vaccine candidates, even though many of these facilities will go unused:
Gates said he was picking the top seven vaccine candidates and building manufacturing capacity for them. "Even though we'll end up picking at most two of them, we're going to fund factories for all seven, just so that we don't waste time in serially saying, 'OK, which vaccine works?' and then building the factory," he said.
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People sometimes criticize billionaires for not donating enough. Jack Dorsey gets it and is donating a full billion (~28% of his wealth) to fund global COVID-19 relief. He’s tracking his donations here and it looks like he’s already dispersed $8M.
Now Let’s Talk Policy Response
Polls consistently show that Americans still strongly support social distancing:
In fact, support among freedom-loving Americans seems to largely be in line with strong support in other countries:
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How can we scale up vaccine progress? There are many ways but one compelling way might be option-based guarantees:
Effectively tackling COVID-19 will require rapidly scaling up the production of diagnostic tests, pharmaceutical treatments and vaccines. In each case, preparations for large-scale manufacturing, such as building factories, are typically delayed until the product is proven safe and effective. This makes sense from a commercial perspective, but incurs great costs in terms of lives lost and damage to the economy.
There are several potential solutions, but the most promising appears to be “option-based guarantees”. In essence, the government commits to paying a proportion of the manufacturer’s preparation costs should the product turn out not to be viable. (If the product is viable, it can be sold as normal.) This reduces the risk to the company while maintaining an incentive to produce a high-quality product quickly and at scale.
A Bit About Life Under Quarantine
COVID certainly is taking a toll on all of us. Pete Davidson and Adam Sandler have teamed up to sing about it. Self-reported well-being in the US is at a 12 year low:
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What does all of the current modeling imply for your summer vacation?:
Everyone is asking, “Can I travel this summer?” And the answer may be a cautious and optimistic “maybe,” at least for some of us to some destinations. Keep listening to government officials and research destinations that may make sense for a summer sojourn in our current more distanced realities. While a theme park visit may not be in the cards right away, a trip to a more secluded beach or mountains may be just what you need to recharge from your months spent at home once it is safe to do so.
Of course it depends on the month - travel in August seems a lot more likely than travel in June… and I don’t expect you’ll be going anywhere internationally.
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Baseball might be coming back this year:
“Over the past two weeks, as states have begun to plan their reopenings, nearly everyone along the decision-making continuum -- league officials, players, union leaders, owners, doctors, politicians, TV power brokers, team executives -- has grown increasingly optimistic that there will be baseball this year. [...]
Finalize a plan in May. Hash out an agreement with the players by the end of the month or early June. Give players a week to arrive at designated spring training locations. Prepare for three weeks. Start the season in July. Play around an 80- to 100-game season in July, August, September and October. Hold an expanded playoff at warm-weather, neutral sites in November.
Now: This is not set in stone or anywhere close to it. But from the league to the players to the owners to TV executives, this, or some derivation of it, registers as the most realistic option at this point.”
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The real important question - how long until we run out of new TV? Luckily it looks like Netflix can keep producing shows well into 2021.
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The latest victim of COVID-19? The hotel mini-bar.
If You Still Own Envelopes, Check Their Backs - Here’s the Latest Cost-Benefit Analysis
A new paper has come out that may be the first proper attempt to evaluate COVID policy in terms of wellbeing and suggests that net benefits of releasing lockdown will be positive from June:
In choosing when to end the lockdown, policy-makers have to balance the impact of the decision upon incomes, unemployment, mental health, public confidence and many other factors, as well as (of course) upon the number of deaths from COVID-19. To facilitate the decision it is helpful to forecast each factor using a single metric. We use as our metric the number of Wellbeing-Years resulting from each date of ending the lockdown. This new metric makes it possible to compare the impact of each factor in a way that is relevant to all public policy decisions.
The paper has some shortcomings - among others, it would be good to have more probabilistic analysis given the highly uncertain inputs, the effect on mental illness remains guesswork, the GDP loss estimates may be overestimates, and there are some questionable assumptions. Therefore I wouldn’t put much stock in the actual results, but I do like it as a better attempt at methods and much better than merely looking at death rates given an assigned statistical value of a life.
And Now a Word From the Lamestream Media
The media is being impacted rather directly: “Roughly 36,000 workers at news companies in the U.S. have been laid off, been furloughed or had their pay reduced. Some publications that rely on ads have shut down.”
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But assuming the media survives long enough for a retrospective, can we ask what went wrong with the media’s coronavirus coverage? And can we do better? Writing for Recode, Peter Kafka argues that the issue was about properly communicating uncertainty and risk, a question of which experts to trust, and how to properly communicate what they were saying. While the media was wrong, in many cases the experts were fairly wrong too. (This is why the only place you can truly trust is LessWrong.)
Scott Alexander writes “A Failure, but Not of Prediction”, arguing that predicting the spread of COVID was very difficult but we need to get better about making clear recommendations that are the best given the uncertainty:
Predicting the coronavirus was equally hard, and the best institutions we had missed it. On February 20th, Tetlock’s superforecasters predicted only a 3% chance that there would be 200,000+ coronavirus cases a month later (there were). The stock market is a giant coordinated attempt to predict the economy, and it reached an all-time high on February 12, suggesting that analysts expected the economy to do great over the following few months. [...]
Their main excuse is that they were just relaying expert opinion – the sort of things the WHO and CDC and top epidemiologists were saying. I believe them. People on Twitter howl and gnash their teeth at this, asking why the press didn’t fact-check or challenge those experts. But I’m not sure I want to institute a custom of journalists challenging experts. [...]
But I would ask this of any journalist who pleads that they were just relaying and providing context for expert opinions: what was the experts’ percent confidence in their position?
I am so serious about this. What fact could possibly be more relevant? What context could it possibly be more important to give? I’m not saying you need to have put a number in your articles, maybe your readers don’t go for that. But were you working off of one? Did this question even occur to you?
Nate Silver said there was a 29% chance Trump would win. Most people interpreted that as “Trump probably won’t win” and got shocked when he did. What was the percent attached to your “coronavirus probably won’t be a disaster” prediction? Was it also 29%? 20%? 10%? Are you sure you want to go lower than 10%? [...]
And if the risk was 10%, shouldn’t that have been the headline. “TEN PERCENT CHANCE THAT THERE IS ABOUT TO BE A PANDEMIC THAT DEVASTATES THE GLOBAL ECONOMY, KILLS HUNDREDS OF THOUSANDS OF PEOPLE, AND PREVENTS YOU FROM LEAVING YOUR HOUSE FOR MONTHS”? Isn’t that a better headline than Coronavirus panic sells as alarmist information spreads on social media? But that’s the headline you could have written if your odds were ten percent! [...]
The Vox article says the media needs to “say what it doesn’t know”. I agree with this up to a point. But they can’t let this turn into a muddled message of “oh, who knows anything, whatever”. Uncertainty about the world doesn’t imply uncertainty about the best course of action! Within the range of uncertainty that we had about the coronavirus this February, an article that acknowledged that uncertainty wouldn’t have looked like “We’re not sure how this will develop, so we don’t know whether you should stop large gatherings or not”. It would have looked like “We’re not sure how this will develop, so you should definitely stop large gatherings.”
I worry that the people who refused to worry about coronavirus until too late thought they were “being careful” and “avoiding overconfidence”. And I worry the lesson they’ll take away from this is to be more careful, and avoid overconfidence even more strongly.
Vox (owner of Recode) Co-Founder Matt Yglesias has a rejoinder that maybe we can’t have nice things:
This is a good take from @slatestarcodex on the media, but I hope people who read it will take seriously the question of what would happen to a media outlet that constantly featured blaring headlines warning about low-probability catastrophes.
Beyond the specific content of any one article any publication ran, the real "media failure" is the ratio of articles dedicated to early coverage of the 2020 election vs global public health issues is objectively indefensible.
But you've gotta do stories people want to read.
Rob Wiblin counters that we actually could’ve predicted things just fine (and Wiblin basically did):
In this post Scott Alexander says that in early February forecasting tournaments, financial markets, journalists, random public health people, and amateurs all gave a low likelihood to a serious SARS2 pandemic (<5%), and this shows it was legitimately hard to predict.
This is generous of Scott. But I want to argue it is wrong and we should not give up on better prediction, because our performance here was just surprisingly and unnecessarily bad.
These groups could have and should have given a much higher probability to what happened happening. Even, or especially, given the little we knew at the time.
[...] We suggest there's a ~20% chance of it being wiped out like SARS1. We don't understand how that could happen, but we also don't understand how SARS1 was eliminated, so uncertainty means there has to be a decent shot that the same will happen again. This leaves an 80% probability that it will spread widely, which means there's a decent chance it will go on to cause millions or tens of millions of deaths.
What great ability did we use to gain this insight which others missed? Nothing complicated. For myself, I just actually formed a super simple inside view of what was going on, and bothered to use it. [...]
As it turns out I was wrong about China not being able to control it internally. But it also turned out, i) SARS2 was pretty good at asymptomatic spread, ii) it was already in many countries by that point, and iii) most developed countries mounted no useful response early on. Any of these alone would likely have been enough for a serious global pandemic to result.
The mechanisms operating here were not so mysterious we needed to rely primarily on a general 'outside view' to see the future. But if we did, a single success with SARS1 should not have been that reassuring, relative to our failure to control almost all (maybe any?) human-transmissible respiratory viruses — something so difficult we've very rarely bothered to try. [...]
Saying the risk of a major global pandemic was 5% or lower was a strange contrarian bet against i) the really obvious, and ii) expert opinion, more narrowly defined. And as far as I could see it was a contrarian bet that nobody at the time was trying to justify.
What was everyone thinking? I don't know. Some possibilities are i) pinning too strongly to the recent examples of H1N1 and SARS1 not being so bad, ii) just not paying attention, as there's lots of things to worry about in the world, iii) general skepticism that any one thing going on can be such a big deal, especially something so random and meaningless as a virus jumping from cats to people.
I'm sympathetic, especially to the fact that there's always so many damn things going on that nobody has the capacity to form a sensible view about all of them.
But I maintain that our forecasters did worse than they realistically could have, people should learn from this and improve their thinking, and we should aspire to give the world more sensible credences and forewarning next time.
Don’t Forget About the Nonhumans!
Rethink Priorities researcher Daniela R. Waldhorn wrote a bunch about how nonhumans are being impacted:
The ongoing coronavirus pandemic is having several important consequences on the lives of non-human animals. In this report I overview its main direct effects on animals used for human consumption. Some main findings are:
Welfare concerns: Transport restrictions have prevented animal feed from getting delivered to farms. As a consequence, young chickens have been killed in massive numbers, in horrific ways. Moreover, animals who are transported alive are being subjected to extraordinary precarious conditions.
Fishing and aquaculture are the economic activities that have suffered the worst consequences of the pandemic.
Production and consumption of animal-based products: The disease is also affecting international meat and egg prices due to disruptions in supply and demand. While consumption of some animal-based products is temporarily rising (e.g., chicken meat, eggs), consumption of other types of meat (e.g., sea animals) is decreasing. Still, the future of the animal protein market looks complex and changing.
Plant-based meat: If the U.S. and Europe dip into a recession, the business of plant-based companies will probably be disrupted. In China, because of the coronavirus outbreak along with other health threats, consumers’ willingness to try new plant-based proteins is likely to increase.
Finally, some practical implications of the pandemic are presented. One is that consumers are likely to be more concerned about obtaining safer and healthier food. Another is that organizations running corporate outreach campaigns should probably consider some strategic changes, focusing less on restaurant and hotel chains and more on grocery chains.
It should be noted that the situation is evolving rapidly and other factors not considered here may come into play in upcoming weeks. For the same reason, please note that we have waived our normal review and quality check standards to publish this report as soon as possible.
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Previously I wrote about a short, scientific e-book about pandemics and animal farming. That e-book is now available in a significantly prettier version.
Your Regular Dose of WTF
A Second Dose of WTF
Fun (Online) Distractions, Because We All Still Need to Enjoy Life
If “Friends” were in quarantine.
Here’s everything coming to Amazon Prime Video in May 2020.
Banksy’s Working From Home and Says His Wife Hates It
Looking for a little something to spice up your next meeting? Invite a llama or goat to your next video call. The pricing is definitely on the pricey side but could make it happen! “For $65, you get a 20-minute virtual tour of the farm for up to six call participants. For a bigger meeting, you can pay $100 for a 10-minute animal cameo or $250 for a 25-minute virtual tour.”
It’s now possible to get a virtual haircut: “How it works? Step 1: Get tools ready. Find or buy your best pair of haircutting scissors or razor for you men’s, women’s or kid’s haircut. Step 2: Book an appointment. Step 3: Video chat with your stylist who will coach you (or your friend) through your haircut session.”
A Seaside Irish Village Adopts Matt Damon: “Sightings of Mr. Damon have become common in recent weeks in Dalkey, a seaside resort town southeast of Dublin, where his presence has added yet another surreal layer to life under lockdown.”
Prickles the Sheep Returns Home After Seven Years: “After missing years of shears, the voluminous creature had ballooned to about five times the size of a typical sheep”
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Today’s briefing was made possible with significant work by Peter Hurford, Derek Foster, Daniela Waldhorn, and Neil Dullaghan. This brief greatly draws upon reporting by Johns Hopkins, The Dispatch, FiveThirtyEight, STAT News, Foreign Policy Magazine, Politico, and others.