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LessWrong Coronavirus Agenda

by Elizabeth5 min read18th Mar 202065 comments

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I’ve gone through a lot of introductions to this post but maybe this is the most honest one:

I am scared. Quite scared, actually. My chances of catching COVID-19 are actually quite low, and my chances of surviving it if I do are quite high, and I’m still scared. What if I get into a car accident and have to go to the ER? Will they have a bed for me? Will I leave with coronavirus? What are my pregnant friends going to do? What is anyone over 70 going to do?

My goal, and the goal of everyone on the LW staff, and I assume most everyone who’s participated in all the coronavirus threads, has been to figure out what is happening and what we can do about it. We’ve already done a lot. Posts like Seeing the Smoke got coronavirus on people’s radar faster than it otherwise would have been, aided by the numerous modeling threads backing it up. The Quarantine Preparations thread gave people a starting place to act from. The Justified Practical Advice (summary) thread let us share our expertise, in ways that led to concrete behavioral changes. More recently we examined asymptomatic transmission. I’ve had a legit, reasonably high ranking government official say they look at us to see where everyone else will be in weeks.

This is currently the LessWrong team’s top priority, and they’ve done a number of things over the recent weeks to facilitate research and action on coronavirus, including hiring me to be a point person on it. To facilitate as much progress as possible over the coming weeks, habryka and I have compiled a list of what we consider the most important questions in fighting COVID, and are asking anyone with the skill to help us answer them.

That list is at the end of this post. But first, what is the overall plan here?

Who are we trying to help?

We have three broad categories of potential beneficiaries in mind:

  1. Individuals making choices for themselves and their loved ones, who need accurate information about the current threat level and how to lower it with existing tech.

  2. Individuals creating the tools for the people above, meaning anything from noticing that copper tape is anti-viral to creating plans for DIY non-invasive ventilators, who need accurate information about how COVID-19 operates and where the current gaps and bottlenecks are. We’d like to help people in this group get volunteers and money when appropriate.

  3. Organizations and institutions making decisions that affect many people, who need all the information the previous two groups do, plus more to know what the effect of their decisions will be.

How Are We Doing That?

I am managing a Coronavirus Agenda, composed of what myself and habryka think are the most important coronavirus-related questions to answer (think we missed some? Please comment). But the full agenda is kind of overwhelming, and there are benefits to coordinating multiple people around the same question, so every so often I’ll pull out Spotlight Questions to generate a critical mass of attention around the most critical questions. I want to say “every so often” will be once a week, but I feel like those kinds of commitments are for situations where I know within an order of magnitude how many people are going to die in that week. I will spotlight as often as seems merited by the situation at the time.

If your eye is caught by a question on the agenda that’s not currently spotlighted, of course pursue your interest. That’s the point of sharing the whole agenda. And if you think the agenda is missing something important, of course pursue that, and add a comment explaining it if you have time so I can add it.

Without further adieu, the spotlight questions...

Spotlight Questions

What is the impact of varying initial viral load of COVID-19?

The hypothesis that lower initial viral load leads to better outcomes, and might be worth pursuing deliberately, is a central assumption is Zvi’s post Taking Initial Viral Load Seriously. Is it true?


Economics Questions

The Full Agenda

These are the questions about coronavirus I and habryka (and in the future, commenters on this post) most want answered. We’ll be nudging LessWrong to pursue them over the coming weeks, but for clarity wanted to share the whole thing as a package.

Some of these someone has already answered, or attempted to answer, in which case I’ve linked to the (attempted) answers. I’ll continue to update as more answers come in:

  • How many people are infected?
    • Worldwide
    • In a location of your choosing
    • No one suggested a dashboard that met all of my or habryka's goals. PlaguePlus.com is the placeholder winner for at least attempting to do estimates of the true count instead of just reporting test results, and for showing any history instead of just cumulative cases, but I'd sure love for it to be replaced by something that can show history broken down by region.
  • What projects need volunteers or donations?
    • We collected a number of suggestions and aggregations in the LessWrong Coronavirus Links DB (see Work & Donate tab), but ultimately didn't find any that were both widely applicable and exciting to us.
  • What should I do if I get sick or am caring for someone sick?
  • What is my prognosis if I get COVID-19?
  • What will the economic effects of covid be?
  • What is the basic science of coronavirus?
    • My favorite was this talk by a virology professor, it answered basically all of my questions, but requires too much background biology knowledge to be a perfect intro for everyone.
  • What is the impact of varying initial viral load of COVID-19?Q
  • What are the most predictable second order disasters?
  • What problems are people running into when trying to work on all of this? Are there more things like the link database that we need?
  • What skills should I be rapidly acquiring to be most useful to this whole situation?
  • What mental health problems can we expect to spike hard in the next 1-6 months given people feeling shut in and helpless?
  • What are the basic epidemiological parameters of C19, such as incubation rate, doubling times, probability of symptomatic infections, delay from disease onset to death, probability of death among symptomatics, etc?
  • How much food do I need to have stored?
    • I’ve seen anywhere from 2 weeks to 9 months and given that neither the money nor the space is trivial to everyone, I’d really like to see model-backed estimates.
  • What is actual hospital elasticity? Is there an existing gathering of data on this from previous disasters?
  • How long should I be in isolation given the median assumptions about the world and the specifics of my area?
  • Which physical objects have longer supply chains and thus can be expected to be less robust to disruption?
  • What can we do to raise the standard of home care?
  • Is there an asymptomatic infectious phase?
    • Probably. Mean incubation period is 4-9 days, but the mean serial interval (period from when person A is infected to when they infect person B) is 4-6 (and estimates are closer to 4, although averaging different studies is not really appropriate)
  • What are the risks of…
    • Accepting delivery food
    • Accepting packages
    • Using public transit
    • Going to work
      • For a variety of workplace types
    • Hosting a large gathering
    • Hosting a small gathering
    • Shaking hands with with an infected individual
    • Walking past an infected individual in a hallway
    • Standing or sitting 4 feet from an infected individual and having 5 minutes of conversation
    • Opening a piece of mail handed to you by an infected person
    • Opening a piece of mail left in your mailbox by an infected person 1 hour ago
    • Holding a grocery bag handed to you by an infected person
    • Picking up an item in the grocery store that was placed on the shelf by that person 1 hour ago
  • How do I convince others to act?
  • What is the value of handwashing, when you are currently healthy? How much better is WHO-approved handwashing than what we do by default?
  • What is the value of copper taping high-touch surfaces?
  • What is the value of masks, when you are currently healthy?
  • What is the value of goggles, when you are currently healthy?
  • What is the value of contact tracing? How do you do it?
  • What are the chances of vaccine development?
  • What are the chances of treatment development?
  • Do we actually have any chance of an approach that is not herd-immunity based? Is there still any chance at containment?
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Build new vaccine production facilities.

It seems clear that focusing on the vaccine pipeline will become critical in the coming months, and we need to get ahead of it ASAP. Currently, the plan is to wait for safety approvals, then start manufacturing. That will obviously change - when we have moderate confidence that a vaccine is effective, we will want to start manufacturing, but there are several candidates, and too little productive capacity to make large quantities of several different vaccines. In fact, there is too little productive capacity to make any one vaccine in global quantities without stopping manufacture of other vaccines.

Vaccine manufacturing is very complex, and needs specialized facilities with clean rooms, sterilization facilities, very specific types of HVAC, etc. Building these is capital intensive, and there has been too little capacity for quite a while, leading to occasional vaccine shortages. I think we should be pushing large companies and governments to figure out how to create greater production capacity for vaccines. This is a global public good anyways. There are a few economic concerns for companies doing this, but right now is the perfect time to get government subsidies for such capital intensive projects.

9ChristianKl8moHow specific are vaccine production facilities to individual vaccines? To what extend can we build them before knowing which of our vaccines will succeed in the clinical trials?

From what I understand, we use eggs to incubate and clean-rooms to produce the final product for all of them, and I understood that vaccine producers can switch between which ones they make, with a couple month delay for incubation and switching over.

FWIW, eggs are actually specific to influenza vaccine manufacturing. Page 3 of this book chapter ( https://reader.elsevier.com/reader/sd/pii/B9780128021743000059?token=F492A74B3C4545B108379536769CF93D7F1DB89321DADE859256496F5D85CB6259372D34376809219BBBE2FFFDEF25FB ) has a really nice table showing the production process of a number of different vaccines - they are all very different from one another. This is why we need new vaccine platform technologies - i.e., tech that can be used to produce multiple different vaccines. mRNA vaccines would fall into this category and is a reason why Moderna's mRNA vaccine candidate for COVID-19 would be so exciting if it works.

6Davidmanheim8moThat's not quite right. I can't get to that book right now, but measles and mumps for MMR are also done in Chicken eggs, IIRC, as are Herpes and Poxviruses, while cell lines and other media can be used to grow other viruses - but the remainder of the facilities are still similar, and can be repurposed. But I agree that we do need new platform technologies.
4brianwang7128moHmm, well that book chapter claims measles and mumps vaccines are produced in chick embryo cell culture, which is different from propagation on chicken eggs. My quick Googling revealed that we don't have a licensed herpes vaccine, and that while there might be one or two smallpox vaccines that are produced in chicken eggs, many are done in cell culture. You might be right about the broader (and more important) point about ease of facilities repurposing, however - I don't know enough to say, although the table in the book chapter makes me doubtful, given that pretty much all steps in the manufacturing process (production, isolation, purification, formulation) seem unique to each vaccine.
5leggi8moyellow fever vaccine is one that springs to mind that also uses eggs in production
2brianwang7128moGood to know, thanks!
6Spiracular8moI've heard that the eggs used are special, more sterile than usual (you don't want the chicken to have other diseases now, do you?), and usually require ordering at least a year in advance. (Came up when I was researching flu-vaccine development.) Some other vaccine production methods involve cell cultures, but the output of different cell cultures is pretty wildly variable and the preferred cell culture is different depending on the specific virus. This is probably a more expensive means of production. You may be able to scale it up faster and with less early prep-work, however. Fair warning: While there have been coronavirus vaccines that have just worked, there have also been a lot of them that seemed to make the course of infection worse, probably due to antibody-dependent enhancement or a similar phenomenon. The set that were somewhat challenging to develop vaccines for seemed to include SARS-1. The lengthy process of animal testing would probably spot this, but it may make getting a reliable vaccine slower and harder than it would be with viruses that don't have this problem.
2ChristianKl8moWhy do you need the eggs in the first place? Couldn't you just feed animo acids that you get when you electrolyse proteins instead of having the proteins from the eggs?
7Spiracular8mo...I'm confused about what method you're even trying to gesture at. They're viruses*, they need a full set of environmentally-provided cell machinery to replicate or produce proteins: ribosomes, transcription machinery (ex: t-RNAs), ATP, the works. They need cells, so you'd need need at least a cell culture. All of biology has heavily optimized protein assembly lines, you're not going to beat it acellularly. The cells near the outside of an egg are probably used because they're an elegant and self-contained little solution to sterilization (against everything but your virus) and the quality-control problems you'd have to contend with otherwise. It's not really about the protein content, mostly. (Cell culture is probably more expensive than eggs because 1) bioreactors are kinda expensive, 2) bioreactors are a bit of a pain to maintain, and sterilization is hard, two problems that using an egg pretty neatly solves, and 3) which cell culture will work best is surprisingly hard to predict, you basically have to test it experimentally.) * Well, technically it's weakened viruses, or single-gene plasmids, or something similar. The need for cells still holds either way.
4ChristianKl8moEggs do have a lot of ovalbumin where it's not really desireable for that to end up in your final vaccine but I don't think this is a discussion to have at a point where our key issue is scaling up vaccine production. If you have to order the steralized eggs a year in advance, and we want our COVID-19 vaccine before a year is over, that suggests to me that we also have other problems. If I understand the work Moderna [https://www.modernatx.com/modernas-work-potential-vaccine-against-covid-19]is doing for their COVID-19 vaccine and read the paper [https://www.sciencedirect.com/science/article/pii/S0092867417301952]where they describe their framework, it seems to me that they use human cell lines: Just like Moderna, CureVac which is another of the companies that want to produce a COVID-19 vaccine also focuses on delievering mRNA and not viruses. I didn't immediately find information about how CureVac gets their mRNA but it wouldn't surprise me if they also don't use eggs.

Whoah, lipid-coated mRNA vaccines, not as an intermediate step but as the actual delivery method? That's actually new to me! Sounds like it's mRNAs coding for some subset of the viral proteins, which probably get assembled into proteins in your cells and then get used as something for antibodies to respond against. mRNAs should then just degrade themselves with time.

I have no idea what the most efficient method for producing those is; I am very used to vaccines being protein-based. This probably is in the realm where it's simple enough that modifying PCR-protocols to produce RNA instead might actually work reasonably well, although RNA is generally more fragile and error-prone and that could be a problem.

You'd be using nucleotides, not amino acids, but mRNA from DNA is a short-enough assembly line that you might not need cells to do it.

(Protein production has a lot of dependencies. mRNA transcription should basically just require your DNA of interest, nucleotides (x4), and a transcriptase protein. Maybe add a transcription factor or two.)

HeLa definitely is a human cell line (although that was for Ebola, they may end up using a different cell line). That's good, that probably scales up easily.

6ChristianKl8moFrom last year: From CEPI awards US$ 34M contract to CureVac to advance The RNA Printer™ [https://www.bioregio-stern.de/en/news/cepi-awards-us-34m-contract-curevac-advance-rna-printertm-disruptive-transportable-mrna] It seems that the third mRNA vaccine company is BioNTech. It seems that Johnson & Johnson is still developing a vaccine the traditional way [http://Johnson & Johnson]: There's a forth company with Inovio Pharm that also develops a COVID-19 vaccine. It's technology is based on delievering DNA based. I have the impression that the mRNA/DNA ways of vaccine delievery allow for faster development of a vaccine then the old fashioned protein based way.
2Davidmanheim8moAt scale? Not easily - eggs are cheaper, more effective, and easier to deal with.
8Matthew Lewis8moThe peer-reviewed literature has several papers talking about GI symptoms of COVID19, and there are several GI cells that are ACE2+ that are plausible targets. What I am wondering is the following a potential vaccine strategy? innoculate with live strain in GI tract to avoid respiratory infection
2Davidmanheim8moInteresting - I'd ask Robin Hanson if that fits with his variolation suggestion.
1jmh8moRelated to that observation I have wondered, but never posted/asked, if how one gets infected might influence severity as well. If I touch a contaminated surface and then rub my eye or then eat a sandwich without washing my hand is that more likely to end up somewhere other than my upper and lower respiratory systems?
4ryan_b8moIf the same type of facility works for almost every kind of vaccine, do we think there would be interest in constructing the facilities as a speculative venture? Consider: 1. The economy is in chaos and may remain so, which I expect to produce unusually affordable access to design firms, construction crews, raw materials, and land. 2. There will be a strong incentive for regulators/inspectors to move with best speed, and the current administration at least in the US has a track record of being friendly to shortcuts. 3. If the facilities are already built, this allows a limit to the risk the companies producing the vaccines need to absorb in order to increase supply. 4. We could squeeze out unscrupulous opportunists.

Contact Tracing at Scale!

One thing we need, that the Less Wrong community could likely help with, is contact tracing capability at scale. I know of one such project in the US - https://www.covid-watch.org/ The Covid Watch project, based out of Stanford.

I think the major tech companies need to set up and throw a ton of engineering and design resources at contact tracing efforts. They currently control the software supply chain to most mobile devices on earth, and thus are ideally placed to help track the spread of infections.

The more testing we have, the more effective contact tracing will be, so this needs to be paired with an increase in testing world-wide, as previously mentioned in the thread.

2landfish8mohttps://www.lesswrong.com/posts/fxfsc4SWKfpnDHY97/landfish-lab?commentId=4ftZGNxtNRiwgXTbf [https://www.lesswrong.com/posts/fxfsc4SWKfpnDHY97/landfish-lab?commentId=4ftZGNxtNRiwgXTbf] My collection of links to the projects I know about in this space and some news coverage of them.
2ChristianKl8moThere might be benefits to having an privacy sensitive open-source solution like the one proposed in Covid-Watch over a Google/Facebook solution.

I would strongly encourage people to try brainstorming some questions. Even if you don't come up with anything directly useful you might jog someone else's creativity. Remember to go for quantity over quality on your first pass.

Epidemiology questions that, while we probably can't do much about, would be useful to try to ad hoc model given how bad official info has been so far:

Are estimates of doubling time off from bad modeling of rapid test ramping making it seem faster than it is?

What is actual hospital elasticity? Is there an existing gathering of data on this from previous disasters?

How long do human trials need to be before they are rolled out to the majority of the population? Just to the extremely vulnerable? What is the gears level model here?

What granularity of travel restriction makes the most sense? In general, how can cities and counties act knowing that federal response may (will continue to be) be too slow?

Which physical objects have longer supply chains and thus can be expected to be less robust to disruption?

What mental health problems can we expect to spike hard in the next 1-6 months given people feeling shut in and helpless?

What are the most predictable second order disasters?

Does moral hazard show up anywhere here?

What's most likely to be ignored during this? Civil liberties? Already seen discussion of that. What's even more ignored?

I've seen people from a Stanford lab asking on facebook about being put in touch with someone from an MIT lab. How can lab cross talk increase?

If UV 210nm turns out to be effective, how can you build your own flashlight/lightsaber (from the virus' perspective) out of off the shelf parts?

Which continuing failures of the FDA are highly predictable? What can be done to mitigate that expectation at the hospital and lab level?

How can models take into account reference classes. e.g. Many models are averaging naively which means essentially all the data points are from the least controlled regions with the widest error bars.

I would strongly encourage people to try brainstorming some questions. Even if you don't come up with anything directly useful you might jog someone else's creativity. Remember to go for quantity over quality on your first pass.

Thanks Romeo.

Setting a 5 minute timer:

  • How will this effect markets / supply chains etc, assuming it lasts for different lengths of time.
  • How likely are various containment interventions by governments?
  • How does de-escalating quarantine / lock-down in countries that have instituted those work? Is there a chance the the virus will bounce back after de-escalation?
  • How long do I have to wait before interacting with an object / location in order to make sure it is safe? (eg could I rent an airbnb, or a rental car, several days in advance, and then use it without risk of catching the virus?)
  • How bad is this really for people in my age group? I would love to have information from people I know, who catch it.

Pushing to get to a total of 10 items:

  • How much health risk is there to social isolation?
  • Do I still need to have extreme hand-washing / disinfectant procedures if I'm not leaving the house?
  • What could be done to help emergency workers and other par
... (read more)
5romeostevensit8moThe requirements on multiplying ventilator use through sharing is 1. Equal tube lengths. 2. Equal lung capacity. 3. Equal lung resistance. 4. Same patient weight (approx) the question is can any of these requirements be broken though clever use of 3d printed valves or other JIT solutions?
4jmh8moNo answer here but a subquestion might be what are the essentials for an effective "hospital bed" for a COVID-19 patient? What are the binding/constraining elements? We know ventilators for critical cases are one. Others? What about those for serious versus critical -- if we can treat serious cases well but in some makeshift hospital room (say an empty hotel) does that help us limit the demand for ICU space? Second thought here. You have investors like Ackman suggesting a slow bleed process may well kill hotel owners. Is there an opportunity to address two things as once? If government (and insurance companies) can support quarantining and treating less serious cases in hotels then the industry gets some relief and society perhaps gets both better allocation of medical resources and improved quarantines.

Scaling up testing seems to be critical. With easy, fast and ubiquitous testing, huge numbers of individuals could be tested as a matter of routine, and infected people could begin self-isolating before showing symptoms. With truly adequate testing policies, the goal of true "containment" could potentially be achieved, without the need to resort to complete economic lockdown, which causes its own devastating consequences in the long term.

Cheap, fast, free testing, possibly with an incentive to get tested regularly even if you don't feel sick, could move us beyond flattening the curve and into actual containment.

Even a test with relatively poor accuracy helps, in terms of flattening the curve, provided it is widely distributed.

So I might phrase this as a set of questions:

  • Should I get tested, if testing is available?
  • How do we best institute wide-scale testing?
  • How do we most quickly enact wide-scale testing?
2John_Maxwell8moRelevant thread: https://www.lesswrong.com/posts/pjLgE2efAozz82JmR/sars-cov-2-pool-testing-algorithm-puzzle [https://www.lesswrong.com/posts/pjLgE2efAozz82JmR/sars-cov-2-pool-testing-algorithm-puzzle] I'd love to work on this if someone can put me in contact [http://calendly.com/book-john/discuss-covid-19-testing] with a medical professional who understands how these tests work.
4ChristianKl8moWhenever you ask people to create a contact it would make sense to be explicit about why the contact would be valuable, and what good will come out of it.
8John_Maxwell8moI want to develop a web app that will make group testing fast and easy. This problem happens to relate closely to my machine learning research interests, and I have an algorithm in mind that I'm excited about. However, the first step to developing software is always to talk to potential users and understand their needs in order to make sure your software will actually solve them. You can share my linkedin profile [http://www.linkedin.com/in/johnmaxwell0] if you think that will help.

Why doesn't Japan have a huge outbreak already? (924 reported cases today, according to the Johns Hopkins tracker): https://www.bloomberg.com/news/articles/2020-03-19/a-coronavirus-explosion-was-expected-in-japan-where-is-it

Why does India have so few cases? (160 reported cases today): https://www.weforum.org/agenda/2020/03/quarantine-india-covid-19-coronavirus/

For each country – what proportion of newly reported cases comes from ramping up testing, and what proportion comes from newly infected people?

Will the economic impact of coronavirus be inflationary or deflationary on net? (for USD)

It would be great to have a list with the current teams that are working on a COVID-19 vaccine. Is such a list out there or otherwise, does someone want to create one?

1micpie8moSee here: https://www.statnews.com/2020/03/19/an-updated-guide-to-the-coronavirus-drugs-and-vaccines-in-development/ [https://www.statnews.com/2020/03/19/an-updated-guide-to-the-coronavirus-drugs-and-vaccines-in-development/]

Does hydroxychloroquine + azithromycin effectively treat COVID-19?

See Gautret et al. 2020, a small trial of this (not randomized) that found a big effect.

6ioannes_shade8moI looked into this a bit with a friend who's an MD, and it turns out that this paper isn't very good. Study not randomized, groups not balanced by disease severity, several treatment-group patients excluded from the data after trial started because they got worse (some went to ICU; one died). From p. 10 of the paper [https://www.mediterranee-infection.com/wp-content/uploads/2020/03/Hydroxychloroquine_final_DOI_IJAA.pdf] :
5CellBioGuy8moThat paper is indeed a piece of crap. This being said, there is other preliminary data from Asia that chloroquine and hydroxychloroquine could hasten recovery, and there were multiple biochemical reasons to suspect it could help which are the reasons it was being used in the first place. I would call the French studies nearly useless to determine actual efficacy, but I am still fairly optimistic they will have at least some positive effect.

Why haven't we ever created a vaccine for a coronavirus before?

Is coronavirus vaccine development more limited by need for technological innovation or economic incentive?

8Elizabeth8moThere was a twitter thread I didn't save that said: 1. we have vaccines for cat and dog CVs 2. Human CVs are unrewarding to vaccinate against because they only cause 30% of colds, so you can only advertise a reduction, not total prevention, of colds.
7leggi8moSame virus family. Different pathogenesis and shouldn't be directly compared but more for information: There are vaccines for coronavirus for dogs and cats. They are not commonly used for multiple reasons. The main species that get vaccinated are cattle. Bovine coronavirus (BCoV) is an important livestock pathogen with a high prevalence worldwide. The virus causes respiratory disease and diarrhea in calves and winter dysentery in adult cattle. Bovine coronavirus disease info. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094360/] Vaccine methods: * pregnant cows (to create antibodies to pass immunity to calves via colostrum) info on a product available. [https://www.msd-animal-health.ie/Binaries/R10-024_Rotavec_Corona__A4_brochure_Dec_2010_tcm102-94048.pdf] (multi-virus vaccine) * intranasal (IN) vaccination of calves with a modified live BCoV (It's been years since I've worked with cattle but don't think the situation has changed)

To Address the Problem: “How do I convince others to act?”

By now it seems clear that social distancing and shelter-in-place protocols are the most effective for reducing the spread of infection. I don’t know about other regions, but compliance in the US is unfortunately low. If increasing compliance is desirable, even when balanced against economic concerns, how do we encourage it?

Part of the problem is that people have to seek out information to become informed. Time and energy have to be invested for a person to figure out how important it is to stay home, and what sources of information are reliable.

Proposed Solution: Hospitals and medical groups should write letters to their entire mailing list pleading with people to stay home if possible. A message from your doctor’s office is far more persuasive than a general government announcement or news report. It’s local, personal, and credible. Everyone opens an email from their doctor.

Medical providers can explain the staff and resource shortages they face. They can explain that if everyone stays off the road as much as possible, this reduces accidents and frees up first-responders and scarce emergency room capacity (how significant would this be?). They can encourage a moratorium on other risky activities like extreme sports, even though those don’t violate social distancing rules (how significant would this be?).

This proposal is virtually costless, near effortless, can be implemented immediately, and would hopefully be effective.

Is it worthwhile to focus on getting medical providers to do this? If so, how do we reach out to them and maximize the number who do it ASAP?

What sources are governments using for decision-making?


The biggest impacts seem to me to be via influencing government. The UK government, for instance, is still very reticent to enforce widespread testing or mandatory quarantine. Their 'quarantine guidance' for households with symptoms looks like this, which seems patently foolish for a number of reasons.

Influencing governments' decision making is high-impact and potentially tractable via getting modelling and trial data to them. The UK Government publish their 'scientific basis for decision making' but it appears to be weeks out of date and unreferenced.

With that in mind, how do we get better decision-making information into government? What theory of change can we find for influencing policy makers? I believe this should be primarily targeted towards larger organisations and researchers who can have more direct influence, but may be useful for individuals as well.

4ChristianKl8moSir Patrick Vallance seems to be the key figure behind the UK policy. The guy was a professor of medicine in the past and who heads the Government Office for Science. Their policy is likely much more driven by modeling then the policy of other countries where the policies are decided by politicians instead of people with that kind of credentials. To the extend that they have data on that page that's weeks out of date it's likely because the page has little to do with their actual decision making processes. Vallance might still be wrong, but I think it's wrong to model him as being simply misinformed.

9 Related Questions

5Rob Bensinger3moWhat's your current epistemic state re hydroxychloroquine?
4Wei_Dai3moI haven't been following developments around hydroxychloroquine very closely. My impression from incidental sources is that it's probably worth taking along with zinc, at least early in the course of a COVID-19 infection. I'll probably do a lot more research if and when I actually need to make a decision.
3Rob Bensinger3moA couple minutes after I wrote this question I found out Scott Alexander said July 29 [https://www.reddit.com/r/slatestarcodex/comments/hzoxh1/learned_epistemic_helplessness_covid19_and_hcq/fzlkb6e/?context=3] :
1Theodore Ehrenborg3moLast week I read [http://lettertok.com/index.php/2020/08/26/rethinking-hydroxychloroquine/] the literature and concluded: The 10% is a relative reduction, not absolute. I don't know how Scott Alexander defines "clinically significant". Some authors thought that "significant" meant a 50% or 90% relative reduction in cases, although I personally think that a 10% reduction matters. But I have no medical experience and no medical training. If you read Stat News, you know more about medicine than I do. I also conclude: And: That fact comes from a large (n = 4716) randomized controlled trial, which found that hydroxychloroquine is almost certainly unsafe for treating patients who have been hospitalized with COVID-19. The drug caused about a 7% relative increase in deaths. Bear in mind that I redid some of the statistics from the studies because I thought they were incorrectly concluding that hydroxychloroquine had no effect. If you don't trust my math (I wouldn't trust a stranger's math), you can see my work here [https://share.cocalc.com/share/949ddd254812fe99536345c87e051585b07eebb1/Theodore_Ehrenborgs_Public_Notebooks/Hydroxychloroquine%20statistics.ipynb?viewer=share] . And I wrote the post for an audience who might not know what Bayes is.
1helohe7moI would advise against taking zinc lozenges. Zinc may at best shorten the duration of a cold caused by rhinovirae by 1 day. But the side effect may be a permanent loss of smell. AFAIK there are no studies showing it to have any measure-able effect on COVID. Chloroquine does not seem to be useful against COVID whatsoever. Initial studies of it were flawed and had a too small sample size. Taking Chloroquine probably does more harm than good.
5Answer by William Walker7moAgree with the Vitamin D, C, and zinc. Also take nicotinamide riboside (a B3 variant) to raise PARP10 levels. (Recent paper on this): https://www.biorxiv.org/content/10.1101/2020.04.17.047480v2 [https://www.biorxiv.org/content/10.1101/2020.04.17.047480v2] And don't forget to stagger around the neighborhood biting everyone... millions of movie fans have been waiting for this for decades.
9Gabbagool8moHello - this is the best resource I have found! I am currently on day 7 of presumed covid-19. I wanted to make some suggestions about viral pneumonia, which is often experienced by those who become ill when their conditions start to worsen. Viral pneumonia alone is not admissible criteria for EMD at this point. My first sign that I had it was on day 3 if my illness, by far my most severe day. I was awoken by the sound of my own breathing, the sounds also caused my dog to scare and bark. I could hear purring/snoring/perculating/crackling from my lungs when I laid on my back, only when I was exhaling. Sometimes it sounded like a strip of explosive firecrackers going off. My PCP gave me no helpful information for palliative support or home remedies. She encouraged me to go to the ER without ever talking to me in person. They would have sent me home because I was never sick enough to be there. Some things I found online to support at home care of pneumonia are: * Consuming a cup of regular coffee daily as caffeine is a bronchial dilator. * Avoiding all cough suppressants and instead take an expectorant. I took extra strength 12-hour Mucinex twice a day and was coughing up watery phlegm nonstop. Sorry for the visual. * Lying down prone and forcing yourself into coughing. * When sleeping, avoid your back and try to sleep on your right side as this is less pressure for your lungs and heart. * Use it cool humidifier or warm mist vaporizer. * Get up from bed and do light stretching every few hours. Take a few deep breaths and hold them for 10 seconds. Don't let your lungs become rigid. If you are able to validate or research any of these suggestions, or add to the list, I think it would greatly help people. I am finally turning a corner and my pneumonia has not yet turned into respiratory distress. Thanks for the hard work you put into this.
3Answer by SamDeere8moEA Funds now supports [https://app.effectivealtruism.org/funds/partners/biosecurity-and-pandemic-preparedness] donations to NTI Biosecurity [https://www.nti.org/about/biosecurity/] and the Centre for Health Security [http://www.centerforhealthsecurity.org/] [http://www.centerforhealthsecurity.org/]at Johns Hopkins. The Open Philanthropy Project has made grants to both [https://www.openphilanthropy.org/focus/global-catastrophic-risks/biosecurity/nuclear-threat-initiative-projects-to-reduce-global-catastrophic-biological-risks] orgs [https://www.openphilanthropy.org/focus/global-catastrophic-risks/biosecurity/center-health-security-biosecurity-global-health-security-and-global-catastrophic] previously. Both seem like strong donation options, both for their immediate role in coordinating COVID-19 response efforts, and for their work on the more general problem of biosecurity and pandemic preparedness.
4Answer by Jayson_Virissimo8moflattenthecurve.com [https://www.flattenthecurve.com/] is an informational website about the coronavirus with (as of this comment) over one million visitors. It has since become open source and is hosted on GitHub here [https://github.com/flattenthecurve/guide.]. Consider contributing to the project. See here [https://github.com/flattenthecurve/guide/pull/131] for a successful interaction involving the removal of an anti-mask wearing section (partially inspired by information obtained here on LessWrong).
4Answer by Jayson_Virissimo8moMy co-worker and her husband, partially backed by my current employer, have modified the design of a device invented in Taiwan for reducing the exposure of ER doctors/nurses to COVID-19. If you have basic fabrication skills you can build your own using the instructions here [https://intubationbox.com/] or else donate here [https://www.gofundme.com/f/intubation-boxes-for-covid19-providers] to help them manufacture more to ship to hospitals already on their waiting list. EDIT: Signal boosted by @RealSexyCyborg here [https://twitter.com/RealSexyCyborg/status/1243722190257872896].
2Jayson_Virissimo8moMy co-worker and her husband, partially backed by my current employer, have modified the design of a device invented in Taiwan for reducing the exposure of ER doctors/nurses to COVID-19. If you have basic fabrication skills you can build your own using the instructions here [https://intubationbox.com/] or else donate here [https://www.gofundme.com/f/intubation-boxes-for-covid19-providers] to help them manufacture more to ship to hospitals already on their waiting list. EDIT: I meant this to be a new answer, not a comment.
2Raemon8mo(you can move comments back and forth between Answers/Comments using the triple-dot menu on the right of the comment)
2Jayson_Virissimo8moWhoops, I already created another "answer". Thanks, did not know about that feature.
2Answer by Elizabeth8moFront line medical professionals can volunteer for this prophylactic hydrochloroquine + other treatments study: https://www.covidtrial.io/ [https://www.covidtrial.io/]
5xarkn7moA critical care doctor speculated in the This Week in Virology -podcast that getting the virus gastrointestinally might result in worse outcomes. They had observed that in hospitalized patients, those with GI symptoms tended to have worse outcomes, and one theory for why was that the GI system has the widest surface area for the virus to multiply in before spreading to the rest of the body. I don't have the expertise to judge how plausible this is.
1CheerfulWarrior8moI would ask about testing: if there were any tests, when were the samples gathered, what were the results, what kind of test was used (RNA/antibodies), which country/institution performed the test (that last one might help infer what kind of test was used)
3Elizabeth8moFixed, thank you.

Ok, I will do it when I get a chance. If anyone knows any strategies for maximizing engagement on Reddit let me know so I can get a good sample size.

4Bucky8moIt isn't clear - that's a good point and would suggest that the upper bound might actually be higher than it appears at first glance. If we take 10% [https://www.lesswrong.com/posts/qapqE86xrjQkD8eZ2/april-coronavirus-open-thread?commentId=Pm9sB9RQTCTFnAXdF] of infections being hospital based (which might not be accurate as that statistic is from South Korea and the above paper is in China outside Hubei) then 16% of the outside-the-home transmission might be hospital based. I should say that only 284 of the 468 transmission events are included in either household and non-household. I don't know what the other 40% of cases were but I guess the researchers weren't able to identify the relationship from the public data that they were using. It does appear that this undefined 40% has a lower serial interval than either of the two defined groupings as the serial interval of all cases together is lower 3.96 [3.53, 4.39].
9Answer by libero8moThe evidence on viral load is still poor https://www.cebm.net/covid-19/sars-cov-2-viral-load-and-the-severity-of-covid-19/ [https://www.cebm.net/covid-19/sars-cov-2-viral-load-and-the-severity-of-covid-19/]
5libero7moNew paper [https://www-bmj-com.ezproxy.unibo.it/content/369/bmj.m1443] on downstream viral load stratified by source and severity
1jmh7moI suspect the inside issue is something that will eventually have to be addresses via ventilation and filtration (as in planes) and attention to just how the air flows seems important here. That probably doesn't get us back to distances pre-COVID-19 but at least gets to some new workable normal. (Unless we're giving up direct social interactions and go to pure virtual reality solutions). Outside might still need some work I think. If you're thinking not overly crowded settings not nearly as much to worry about. However, things like open air markets, rallies, large spectator sporting events outside or even tightly packed streets may still be a bit problematic. I think a lot there will depend on infection density at that point. I would expect some type of cloud to still emerge from the crowd of people that may remain localized in a lot of weather settings.
2Raemon8moFound this link, which I think corroborates the paper Wei Dai linked. Haven’t review it yet. https://globalnews.ca/news/6815551/cough-chamber-physical-distancing-coronavirus-western-university/?fbclid=IwAR2mdghjc-3x6S2PyAIrjdyx6J0mUTDxXdT4FJCV5jPMkeMtgoZ8Gzq8gXo [https://globalnews.ca/news/6815551/cough-chamber-physical-distancing-coronavirus-western-university/?fbclid=IwAR2mdghjc-3x6S2PyAIrjdyx6J0mUTDxXdT4FJCV5jPMkeMtgoZ8Gzq8gXo]
2Ruby8moThis came up on my Facebook feed. I have only glanced at a briefly, but is probably of interest here: Belgian-Dutch Study: Why in times of COVID-19 you should not walk/run/bike close to each other. [https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in-times-of-covid-19-you-can-not-walk-run-bike-close-to-each-other-a5df19c77d08]
7Answer by Raemon8moI'm not yet sure how related this is to Wei_Dai's answer, but found a medium article [https://medium.com/@jurgenthoelen/belgian-dutch-study-why-in-times-of-covid-19-you-can-not-walk-run-bike-close-to-each-other-a5df19c77d08] exploring "how far away to be from others who are walking in front of you". It references a couple other non-english articles, and one english... translation (I think?) on urbanphysics [http://www.urbanphysics.net/Social%20Distancing%20v20_White_Paper.pdf]. Some researchers ran computer modeling of what happens to saliva
1jmh7moThis suggests to me that we don't just want to consider distance. Time and speed are both elements here too. I think that is actually something people can understand intuitively if they get some basic information. Most people are not challenged with knowing where they need to be to catch the fly ball. Here they just need to have a reasonable sense of where not to be. So the message really isn't X distance but several factors that can include a distance metric. However, the other aspect here is not safe (pick you metric) versus not safe. It's about level or risk and what that implies about actions to take. This could be anything from what types of PPE one uses to thinks like everyone adopting inside versus outside clothing (a bit like biohazard suits in those labs but probably more like a mechanic's overalls) and increased use of "mud rooms" in housing.
4Raemon8moThere is a critique of this here [https://www.facebook.com/jenniferkastenmd/posts/120574959595451]. I haven't yet read it thoroughly.
6Raemon8moThanks, this is great. I think the main followup question I have is "what's the rate of falloff for outdoors?" (given that my goal here is not "100% safe", its "the risk is comparable (i.e. within a factor of 2ish) to the usual background default level of micromorts", for the range of stuff humans typically do.)

Kinsa, a company that sells smart thermometers, has a dashboard that shows which regions of the US have an unusually high number of fevers. They have previously used these methods to track regional flu trends in the US. (FitBit has done something similar.)

I wrote a post here describing my attempt to turn their data into a rough estimate of the total number of coronavirus infections in the United States. Something similar could be done for smaller regions.

2Answer by Zian8moA few theoretical data sources that are pretty geographically specific: * Hospital patient care records * 911 calls * Patient records from 911 calls * 311 calls * 911 detailed questions and answers In the United States, some more concrete thoughts : * 911 calls can be aggregated by asking my day job to integrate with your database. * Detailed Q and A in 911 can be aggregated by the Q and A software vendor's partners (hi!) or themselves. * Patient data from 911 is aggregated sporadically at the state level (NEMSIS) and my employer * Hospital data is aggregated by ESSENCE (CDC and state level) with an unknown delay * There are also other sporadic aggregators of hospital data. If this is too much advertising, you can edit or reject this comment. To summarize, your question is somewhat technically feasible. It's just a lot of work.

There's currently a Foretold community attempting to answer this question here, using both general Guesstimate models and human judgement taking into account the nuances of each country. We've hired some superforecasters from Good Judgement who will start working on it in a few days.

3Answer by Sam Brenner8moThe Johns Hopkins Center for Systems Science in Engineering has time series data at the state and province level for some countries (US, China, Canada, Australia). They used to have county-level data for the US but no longer provide it. Unfortunately the case numbers are only confirmed + presumptive positive, so it's not everything you're asking for, but it seems like it gets close. https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data/csse_covid_19_time_series [https://github.com/CSSEGISandData/COVID-19/tree/master/csse_covid_19_data/csse_covid_19_time_series]
6Ruby8moThese papers on viral load probably help inform the answer. It was flagged to me that Ct might not have straightforward interpretation, but I haven't looked into it. So posting these as resources. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30113-4/fulltext?fbclid=IwAR3crOZxhVP1eVPMcO_wujJBxHFAjp2fj4_jNj30ld_nVcKTqtcT1IjXozI https://www.nejm.org/doi/full/10.1056/NEJMc2001737
1Answer by waveman8moWorth pointing out that if we quarantine for X days and do not actually test, relying on symptoms, then we are selecting for slow incubation and/or mild/no symptoms before X days.
5Answer by lexande8moSince apparently some confirmed cases never develop symptoms (this [https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180#findingsfromtherealtimeoutbreakanalysis-1] study of Diamond Princess passengers estimates 18%), it seems the answer to your second question is "never"?
2Raemon8moSorry, I worded that wrong. Edited the OP.
1Sjcs8moTL;DR We don't know, it's variable case to case, and could be longer than 25 days from symptom onset if you get sick In patients admitted to hospital with COVID-19, there are cases (Korea [https://www.journalofhospitalinfection.com/article/S0195-6701(20)30102-X/fulltext] , Singapore [https://jamanetwork.com/journals/jama/article-abstract/2762688]) of viral RNA detectable up to 25 days after symptom onset. This is not the same as still being infective, so we don't really know. In people exposed to SARS-CoV-2, 14 days is an estimation that the vast majority will have developed symptoms by this time (here [https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported] ). However, this doesn't take into account cases that remain asymptomatic throughout their infection (maybe 15-20% from Diamond Princess data [https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180] )
5Scott Garrabrant8moYou should (more strongly?) disambiguate between how long after being sick are you safe, or how long after being 100% isolated are you safe.
2Raemon8moUpdated OP to explicitly flag that there are two sub-questions here. (I assume both will benefit from similar aggregated information)
8adamzerner8moI haven't been able to personally try or validate much from the book. It's more that the things in the book make a lot of sense to me, and that I have a good amount of trust in the authors. That said, there are some things that I do have personal experience with and can contribute my data point. I just started an actual remote job three weeks ago, and before that I've spent years as a solo founder of a startup, and autodidacting. * The biggest thing (by far?) I've encountered is that it's important to have an off switch. Working from home, it can be tempting to check in and do a few tasks at 10pm. But when I do that, it makes it hard for my mind to properly "shut off" and relax. * I've found cabin fever to be a minor issue when I stay home too much, but never a major one. * I don't feel like I can get away with slacking off at home. I feel like I'm ultimately just being judged on my output, the same as it is in a physical job. At the end of the day if my output isn't there, I feel like my job would be at risk. * At the job I'm currently at we do something called donuts [https://www.donut.com/] where every two weeks we're paired with someone on the team to have a video chat with to get to know each other, and where talking about work is off-limits. The donut call I had made me feel closer to the people on the call, but I've also started to feel closer with the people I've been interacting with in general. And it's not clear to me that feeling closer to people translates to more productivity at all. * Some people on my team aren't native english speakers and have trouble with writing, but despite that, I don't think it actually is much of a barrier. It involves a little bit more back and forth, but soon enough the signal comes through. This goes against one of the chapters in Remote. Perhaps being a clear thinker is what is important versus being a clear writer.
4Raemon8moThanks! Fwiw I'd also be interested if you essentially wrote up a mini-book review of REMOTE (maybe editing it into the original answer-comment?)
4adamzerner8moIt's been a while since I read REMOTE, sorry.
Answer by RaemonMar 20, 202014

Elizabeth had previously written some notes on a Lit Review of how effective distributed teams were, which may be relevant to re-review.

Highlights and embellishments:

  • Distribution decreases bandwidth and trust (although you can make up for a surprising amount of this with well timed visits).
  • Semi-distributed teams are worse than fully remote or fully co-located teams on basically every metric. The politics are worse because geography becomes a fault line for factions, and information is lost because people incorrectly count on proximity to distribute informa
... (read more)
1Answer by rmoehn8moI would follow Manager Tools guidance. They have a whole section called Remote/Virtual Teams [https://www.manager-tools.com/map-universe/remotevirtual-teams] and a new cast on Managing During a Pandemic - The COVID-19 Cast [https://www.manager-tools.com/2020/03/managing-during-pandemic-covid-19-cast-part-1] . I don't have any experience as a manager. But I've been following their guidance in many other areas with success. And they usually give a detailed justification of their guidance within each cast.
2Raemon8moAh, I meant this in a more generic sense – I expect "how do I run a remote organization?" to be a highly important question for everyone in the coming months, and I thought it was worth including in the LW Research Agenda. Updated the title to be a little more clear.
3jmh8moOkay. From a practical point, one thing I've found is working remotely from the office introduces two immediate challenges. First is the loss of the informal information flow -- the remote person just quickly drops out of the loop. When the whole team suddenly becomes becomes remote that informal information flow is just gone. New communication patterns might help mitigate that. I now one of the clients I used to work with had a policy that all emails related to work got sent to everyone. That might not be what you need but they strongly felt that insured the corporate distributed knowledge was preserved and in some cases extended -- sometimes really good insights came from people not directly working on a particular project; sometimes brand new opportunities were seen because multiple teams notices some common threads. Avoiding the pressure to micromanage will likely be important. Clear goals statements, progress milestones and probably some good mechanism to raise a hand to point up an emerging problem. When people get moved from the office to working remotely you will likely find that there were all sorts of things taken for granted that made one more productive -- or just made the work easier. Before cutting ties with the office everyone should closely survey their remote work environment to make sure they can do the job remotely as well as in the office from pure procedure steps. Do I really have sufficient desk space or am I trying to work off the kitchen table? With the table work -- is the light right? Too many distractions maybe? What about things like screen space? Access to applications remotely -- does the VPN really kill the connection so you know it will take twice as long to get results back? If the organization doesn't already have experience with operating on a remote basis it really needs a few dry runs to learn what it doesn't know. So will be the people. Does the organization have time to do that? Contact lists -- yes, everyone has the offic
3Answer by Tristan Burgess7moThis answer will be addressing the use of software for social life. Recently my extended family has been making use of Zoom to celebrate birthdays, while my friends have been primarily using Discord. Overall, I've found Discord provides a better user experience. Of the two, Zoom has been comparatively easier to set up and run, however, the audio and visual quality seemed variable while we were using it. Also of note is the multiple security issues that have been raised with Zoom recently. Another advantage of Zoom that I've found is that it seems better able to handle large numbers of participants, as Discord generally starts to slow down and cause connection issues above ~10 people, though your mileage with that may vary as internet speeds are not great in Australia. Zoom also seems to be easier (though not easy) for people less familiar with digital technology to navigate. The main benefits of Discord are better quality audio and video with under ten users, and the ability to create servers and chats that last for more than one call. From using Discord fairly regularly since before the pandemic began for keeping on contact with friends I haven't seen recently, their servers are fairly stable and the audio quality does not suffer significantly from slow internet connections. The ability to create servers and chats is also very useful for keeping in contact with friends and family, as it means you can organise meetings and chat outside of them in the same place. As a result of sharing a server, I have been able to keep significantly closer to my friends due to the low level of effort required to send a message and ask them about their day or share an interesting video. To summerise, Zoom seems more appropriate for large meetings, where low-quality audio and visuals is not a game-breaker, and where people who may struggle with navigating user interfaces will be present, whereas Discord is better suited to smaller groups who wish to keep in regular contact easily.
3ChristianKl7moWhat do you think Discord does that provides higher quality audio and video? Both depend a lot on the hardware setup and if you just compare your family to your friends, those groups might have different hardware. As a company, Zoom invested much more into getting high quality video then Discord.
3Tristan Burgess7moThat's a reasonable point, I hadn't considered differences in hardware, and I think controlling for that would probably explain a lot of the difference in my experience performance wise between the two. Thank you for the input, after that I'd update my conclusion to the main benefit of Zoom being ease of use, and the main benefit of Discord being the functionality provided in addition to calling, with significantly less confidence in any diffferences in performance.
2Answer by Raemon7moI ended up writing an extensive post [https://www.lessestwrong.com/posts/hswzBzHSMGxz8rcXg/the-best-virtual-worlds-for-hanging-out] about what virtual worlds are best (if you're aiming for something more immersive than a videocall). The tl;dr is: 1. Town Siempre is best if you want a simple app you can easily invite people to for an informal party. You walk around a teeny pixelated world, able to videochat with people nearby. 2. Minecraft is best if you want a fully featured virtual world to "live" in, and (potentially) if you want to go on "online hikes". 3. Mozilla Hubs is similar to Town Siempre, but 3D instead of 2D. It has more features, but I found it a bit overwhelming to use. 4. AltspaceVR is like Mozilla Hubs, but requires either VR or Windows. It's a bit more polished and smooth, but higher barrier to entry.
1gilch8moI learned that RingCentral is a kind of rebranding of Zoom. Having not tried Zoom, I'm not exactly sure how similar the clients are, but some of my review of RingCentral may apply to Zoom as well.
1gilch8moI have not tried Zoom yet.
3Raemon8moNod. I definitely agree "keep in contact" is the main thing and if people are arguing over the details, probably better to roll with what a given person is comfortable with. This question was oriented around groups of people where everyone agrees that that it's worth some experimentation and investment in a good longterm product, or who don't yet have a solid default. (For example, I've found that video-call-quality matters a lot more now that I'm doing them for hours at a time on a regular basis, whereas before I'd have been happy to grab a google hangout or slack or whatever for the occasional 45 minute call)
4Answer by Bucky8moThe ILO (international labour Organization, a UN agency) has a report [https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/briefingnote/wcms_738753.pdf] on this. Some key findings: Estimated increase in unemployment of 5-25 million - c.f. 22 million for 2008-9 crisis These based on assumptions of 2-8% drop in global gdp Value add from Chinese Industrial was down 13.5% in Jan/Feb
2bmc8moNot really. It's perfectly possible to make accurate quantitative economic predictions. 1. I think we are all relatively confident that by 2021-01-01 more than 100k deaths will be attributed to COVID-19 (globally). Even though the market has certainly "priced it in", that change in prices doesn't change the underlying reality. There are economic realities, such as the number of people who are likely to be unemployed, which are not meaningfully influenced by changes in asset prices. 2. We know that tourism revenue will be greatly depressed over the next few months. Carnival Corporation, for example (the largest cruise ship operator), will probably make 80% less money than it would have had the pandemic not happened. I know this because the price was at $52 and now it's at $13. Asset prices *are* strong quantitative predictions! I agree that we're unlikely to be able to make predictions which beat those of the market. But epistemically that's great news! You now have a mountain of asset prices to make predictions with. e.g. VIX futures are still expensive, the market is expecting the situation to evolve rapidly.
9maia8moSource: NPR https://www.npr.org/2020/03/20/819293063/our-covid-19-indicators-of-the-week [https://www.npr.org/2020/03/20/819293063/our-covid-19-indicators-of-the-week]

Lessons from China

Although certainly not a perfect comparison, I've been interested in the first trends in consumer behaviour emerging out of China after 3 months of social distancing and strict quarantine in key areas.

Disclaimer: The report quoted below has limitations but is also one of the very few English sources of market data I could find so far. I still think it might be an interesting exercise to look at the data and try to ask how might the trends be different in the US.

Link to report

Sample:

  • 900 respondents, 300 people from three Tier 1 cit
... (read more)
5Elizabeth8moUChicago professors use survey data to estimate 1/3 of jobs can be done at home, accounting for 44% of payroll. See here [https://bfi.uchicago.edu/insight/blog/key-economic-facts-about-covid-19/#], scroll down to "How Many Jobs Can Be Done At Home?"
3Answer by RedMan8moWe need a rapid test to identify people with immunity, so they can go back to work. Quarantine is worth it, hospitals are overwhelmed, but it is failing, and will continue to fail. The sooner we can identify people who have gotten it and recovered, then put those people to work in high exposure occupations, the sooner we can restart the economy. The classes of treatment needed here are as follows: Rapid pcr test: expensive, and needed for surveillance of key workers, as well as contact tracing. We have this, but it won't scale. Vaccine: this enables eradication, but is a minimum of 18 months away, and the effort may fail Post exposure prophylaxis: something given before or immediately after exposure that stops the disease in its tracks (healthcare workers need this, if antimalarials do the job, yay we know those are safe and effective prophylactically) Symptomatic relief: something given when early symptoms show, which pregents the development of catastrophic symptoms (the malaria drug will hopefully fit this) Catastrophic care: more and better ventilators and ways of managing ards/cytokine storm. Gl with this, we wanted it before thia crisis. Rapid antibody test: identifies patients who are exposed. Two weeks after a positive test, if the patient hasn't been admitted to a hospital, it will be safe to say that that particular patient will not require that level of care and is probably no longer contagious. We need the rapid antibody test, and we need about a billion of them, do rolling tests, if someone has a positive test and thinks they had symptoms > 1 week prior, return them to work and tell them to avoid anyone with a negative test for a week, if they can.
3RedMan9dAntibody tests are here but are not being used to reopen (worries that people will variolate to go back to work, if that's the case wtf is wrong with your economy). Prophylaxis and symptomatic relief appears to be 'Vitamin D to mitigate the bradykinin storm': https://www.nature.com/articles/s41598-020-77093-z [https://www.nature.com/articles/s41598-020-77093-z] "As per the flexible approach in the current COVID-19 pandemic authors recommend mass administration of vitamin D supplements to population at risk for COVID-19." Sure ok, one weird trick that actually works, nice. Rapid PCR and in New Zealand, full genome sequencing for contact tracing is a thing, awesome. Rapid antigen tests are a thing too, but not helping the economy. Idk about what works in hospitals, but ventilators and fentanyl scare me more than 'happy hypoxemia' so if I'm conscious enough to say don't take me to a hospital, that's what I'm saying. Remdesivir is not widely available enough for me to bother thinking about. The DIY corona vaccine appears from what research has been done to be safe (no biologists who took it died) and according to animal model studies, effective. I have the wherewithal to construct it if I want, I haven't bothered, therefore I probably won't screw with the official one when it hits. Based on present death rates and the state of the economy, quarantine wasn't worth it. Edit: my best guess about 'long hauler' symptoms is that they're consistent with permanent damage to the lungs and long term low-moderate hypoxia, lung transplants and oxygen bottles are really the only treatments for that (if you can cure scarring and regenerate lung tissue, let the asbestosis and silicosis communities know), so long-haulers are probably screwed. Vitamin D should limit or halt this process. This supercomputer model seems trustworthy so far: https://elemental.medium.com/a-supercomputer-analyzed-covid-19-and-an-interesting-new-theory-has-emerged-31cb8eba9d63 [https://elemental.medium
1sh4kesbeer3moYou miss (amongst others) division of labour and specialisation / non-uniform skills. In your example the GDP might not be a good measure because every participant can stand on either side of each transaction, which makes it kind of a zero sum game. It is well known that economic interchange is not a zero sum game (citation needed, could not come up with a precise one). Extrapolating this, you would need to be able to stand on each side of all interactions that lead to the global GDP. Your example even breaks down when you assume that the bread-baking neighbour is baking bread not only for you but for others, too. In that case economies of scale come into play which favour specialisation towards one baking all the bread and others (maybe investing into better lawnmowers and their handling skills) mowing the lawns.
2Dagon3moSure, I absolutely agree that that specialization and trade very often makes all participants better off. I only claim that not all financial transactions are this, and I claim that many beneficial behaviors are not tracked financially. Financial aggregates are only a proxy for what we want, and our current common measures have been Goodhart-ed to the extent that they're actively misleading on many topics. I hold little hope for adding other measurements, and I recognize that Goodhart will apply to them as well, but it would be nice if people were more cognizant that money != value.
3Answer by Max Hodges7moI think you make light of the fact that 861,664 families lost their homes to foreclosure in 2008
2Viliam7moMy experience seemed in the opposite direction. The government was like: "stop buying face masks, you worthless muggles will waste them on yourselves, and there will be not enough left for doctors," and my neighbors on Facebook were like: "so I am staying at home with nothing much to do, and I happen to have a sewing machine, so if anyone would like to have a nice face mask for $X, just send me a private message; there are also kid-sized ones with pictures of cute animals". And in a few days I brought home a full bag of them. So it's like industry: 0; government: 0; random agenty individuals: 1. Many shops and restaurants who didn't do this before, now offer online shopping. Sometimes starting with amateur solutions like: "I am not allowed to let people enter my restaurant these days, but cooking and selling food is technically still allowed, so if you send me a private message, I can meet you in front of my restaurant and sell you the food in a box". And a month later you see an official web application that obviously needs some more testing, but hey, it mostly works, and now you can pay online and come for the product. Not only food, but also other products which are considered non-essential, so it is not allowed to open the shop, but buying online is allowed, and this hybrid "you pay online, then you knock on my door and I give you the box in front of my shop" is technically considered online shopping. I think it is likely I could buy a handmade cocktail on Facebook. The problem is, this is mostly black market. My neighbors who sell the face masks are almost certainly violating dozen different regulations. But they can relatively safely assume no one would snitch on them. (Because they trade with neighbors; and because they provide something that is considered necessary but difficult to obtain using the official channels.) Offering home-made cocktails would probably be more risky. In the economy full of regulations, trading on the market has a non-trivial fi
8Answer by Elizabeth8moPrediction: Births will decline precipitously (BOTEC: 20%-60%). A normal recession [https://www.lesswrong.com/posts/5mWjazfyLCka6Knk2/what-happens-in-a-recession-anyway#fJgmcixYkukqdmcP2] sees a drop in birth rates of ~9%, although that is typically made up mostly of delays rather than entirely foregone children. Due to fear around interaction with the medical system, I expect it to drop much more than that. BOTEC: ~40% of births in the US [https://abcnews.go.com/Health/cdc-40-percent-us-births-unintended/story?id=16840288] result from unplanned pregnancies. If no one took any additional precautions due to covid and everyone who was planning a pregnancy chose to postpone, that would decrease births by 60%. In reality I expect some "unplanned" pregnancies to be planned out of existence as people take more precautions, and some people to plan pregnancies even given the circumstances (disproportionately older women whose fertility window is running out, although births using fertility treatments will decline), but 60% is still a good upper bound. I expect at least as many people to prevent pregnancy due to covid as prevent pregnancy during a recession, so there should be a minimum of 2x as many foregone or delayed births. With rounding, that's a 20% floor.
2PeterMcCluskey8moI don't see any signs that inflation calculations are expected to become less honest. There are certainly lots of opinions about how well the CPI measures what we want it to measure, but it has worked pretty well for Fed policy issues in the past, and I expect that to continue.

Technically the current recession won't be an official recession until the end of Q2, after two months of GDP decline. But this won't be a recession like any other we've seen in the 21st or 20th Centuries, so let's not quibble over definitions.

We've never before seen 10 million jobs lost in two weeks. And still haven't. The actual number is likely far higher, but most unemployment is run by the States, and many States have antiquated systems that couldn't handle the application load. Here in April it's months too... (read more)

Trends in divorce continue basically unabated

This paper, the only long-time-scale survey I could find, reports a minor negative correlation between unemployment rates and divorce. However looking at their graph, the relationship is obviously mild.

Image

For posterity: I expected there to be a large, detectable drop in divorce rates during recessions and then a spike as soon as the recession ended.

Religious Service Attendance Stays Flat

I was really surprised to find a single academic paper in the last 40 years on religiosity and economic conditions, which was not available online. It reports a "strong" countercyclic effect in religious participation in evangelical Protestants but procyclic effect in mainline Protestants, in the 2001 recession. Meanwhile a Pew poll and a Gallup poll show no change in religious participation during the 2008 recession.


For posterity: I'd predicted an increase in attendance.


People die a little less often, especially in nursing homes.

Note: data is for the United States only

Deaths go down during recessions; according to Ruhm 2002, a 1% decrease in the unemployment rate is associated with an average 0.4% rise in total mortality (about 13,000 deaths, relative to the average of ~2.8m). This is counterintuitive, because wealth is associated with longevity (e.g. Chetty et al. 2016) . There were a lot of potential explanations for this centering on how work was dangerous and didn’t leave time for health, but it turns out most... (read more)

4PeterMcCluskey7moRobin Hanson has blogged a bit about the healthy-recession puzzle: less exercise [http://www.overcomingbias.com/2011/09/recessions-cut-exercise.html]; he also mentioned nursing employment somewhere that I can't seem to find.

Here's a very compressed summary and some links on standard economic theory around recessions. Of course economists argue about this stuff to no end, so take it all with a grain of salt.

First, there's a high-level division around what causes recessions. Two main models:

  • Real shocks: a hurricane, war, virus, etc directly decreases economic output.
  • Sticky prices + volatile currency: contracts are denominated in dollars, so if the value of a dollar goes up relative to everything else, lots of debtors/employers/etc are unable to pay.

The former is the d... (read more)

6Vaniver8moOne interesting point on this front is that the cost to road work and infrastructure improvements is lower now than it normally is, so if you figure out a way to do construction work safely, you could justify above-baseline investment in some major capital sinks. (It's unclear to me how licensing restrictions come into play here; you have millions of unemployed, but you might not be able to use them to build and repair bridges and roads.)

Effect of Economic Downturns on Fertility

The effect of economic downturns on births is surprisingly complicated. On one hand, people have less money and kids are expensive*, which you would expect to lead to fewer children. On the other hand, a reduction in employment expectations reduces the opportunity cost of children, which you would expect to lead to more.

For the rest of this article, I will by default be referring to WEIRD countries.

Based primarily on Economic recession and fertility in the developed world and spot checking its sources, my conclusi... (read more)

3William Walker7moOne thing we can do is eliminate inventory taxes... this is one reason that companies were forced into just-in-time. We currently punish people for being prepared for any emergency ;)
4Answer by Elizabeth7moArticle claims beer and soda are endangered by the reduction in driving. CO2 comes mostly from ethanol production, which is on the decline. https://www.foxbusiness.com/markets/beer-may-lose-its-fizz-as-co2-supplies-go-flat-during-pandemic.amp [https://www.foxbusiness.com/markets/beer-may-lose-its-fizz-as-co2-supplies-go-flat-during-pandemic.amp]
2alkexr8moBeing self-sufficient and robust as a national economy is accepting a competitive disadvantage relative to a global just-in-time supply chain in times of prosperity in exchange for a competitive advantage during a crisis. Selection pressures will push economies accepting this tradeoff towards being actively interested in a world with more crises.
2CellBioGuy8moYou ascribe too much agency to the great hulking amoebas that human societies are.
2orthonormal8moThe idea that having insurance from another bank counts as passing a stress test doesn't match any source on the first page of Google search results for "stress test banks"; the more specific ones mention that the requirement is maintaining at least 4.5% capital (as Dodd-Frank requires) on hand at the peak of the stress test scenario. Is there a source which says that banks are using massive insurance policies to pass these in place of capital?

Found my source.

What regulators spotted a couple of years ago is that banks were buying very focused packages of insurance that would pay off in exactly the scenarios of the stress tests. They had no commercial reason whatsoever, and were in fact probably quite expensive pieces of insurance to purchase. But it meant that the bank could, with a really straight face say, 'Well, you know what? In this stressful scenario we'd be totally fine.' And what's going on under the table is, 'Yeah, because our bet that this scenario would happe
... (read more)
2orthonormal8moThat's unfortunate to hear, and it seems like it could have been different. In the case of food supply chains, though, it would be just a literal matter of counting and not accepting IOUs for food in lieu of actual physical food.

micpie's answer here is good! I don't have a lot to add to it.

Here are a few related reference-links* and a tiny bit of commentary.

... (read more)
7Answer by Elizabeth8moBill Gates is on it. [https://www.businessinsider.com.au/bill-gates-factories-7-different-vaccines-to-fight-coronavirus-2020-4]
2Raemon8moWell that's reassuring.
1Kenny8moFrom this comment [https://siderea.dreamwidth.org/1607569.html?thread=13370001#cmt13370001] on a post to which I recently linked on this site [https://siderea.dreamwidth.org/1607569.html?thread=13370001#cmt13370001]: So, as a sort of sub-question to this one: What are the costs, benefits, and logistics of opening new facilities for the entire supply chain for vaccine facilities?
2ChristianKl8moAccording to the main investor in CureVac, there current plan is to make the vaccine generally available at the end of the year: https://www.focus.de/finanzen/boerse/weil-biotech-leben-rettet-curevac-investor-im-fruehsommer-koennen-wir-mit-dem-test-des-impfstoffs-am-menschen-beginnen_id_11829181.html [https://www.focus.de/finanzen/boerse/weil-biotech-leben-rettet-curevac-investor-im-fruehsommer-koennen-wir-mit-dem-test-des-impfstoffs-am-menschen-beginnen_id_11829181.html]
2ChristianKl8moThey said that currently they can produce 10,000,000 per campaign and with the new facility they can produce 1,000,000,000 per campaign in the press call. Unfortunately, they didn't specify how long a campaign is going to last. Last year they got some funds to develop a portable facility (The RNA Printer) that can produce 1,000,000 doses in two weeks.
2Davidmanheim8moUnfortunately, 1bn doses is likely no more than a quarter of the world's need - less if COVID is stopped more places.
21 comments, sorted by Highlighting new comments since Today at 2:22 AM

Hey everyone who is following this closely- I've been sprinting madly for the last six weeks and hit my limit. You can expect a retrospective post and perhaps a phase 2 agenda in the next few weeks, but for now I am resting.

Welp, I did not make that deadline. Unfortunately the conditions that led me and the LW team to miss that deadline- high opportunity costs- are not likely to change soon, so instead of holding out for perfection I'm just going to share a couple of thoughts.

I was brought on to lead covid research efforts at LW as an experiment. The hope was that there was significant untapped research capacity, which could be unlocked by providing some structure (hence the research agenda). The structure was not only supposed to give people a sense of what would be useful to research, but reassurance that their research would actually be used, and social reinforcement. This mostly did not pan out- I think I did useful research during the time in question, I think other people produced useful research during that time, but questions I asked tended to be answered by only me.

The experiment was well worth running, and the team got a lot of information on infrastructure useful to support coordinated research (most notably it led to some reworks of Questions). But after 6 weeks it was not achieving its stated goal and had not found something clearly high value to pivot to, so I called it.

I'm currently working with Kyle Scott and Anna Salamon on an estimate of deaths due to hospital overflow (lack of access to oxygen, mechanical ventilation, ICU beds), which we'll hopefully post in the next few days. The post will review evidence about basic epidemiological parameters.

Great, looking forward to the post!

Update: We decided not to finish this post, since the points we wished to convey have now mostly been covered well elsewhere. But Kyle may still write up his notes about the epidemiological parameters at some point.

Alas. Could you briefly link to the other places that have conveyed the ideas sufficiently well for your tastes? 

I wouldn't describe any posts I've seen as conveying the idea sufficiently well for my taste, but would describe some—like this NY Times piece—as adequately conveying the most decision-relevant points.

When I started writing, there was almost no discussion online (aside from Wei Dai's comment here, and the posts it links to) about what factors might prove limiting for the provision of hospital care, or about the degree to which those limits might be exceeded. By the time I called off the project, the US President and ~every major newspaper were talking about it. I think this is great—I much prefer a world where this knowledge is widespread. But given how fast COVID-related discourse was evolving, I think I erred in trying to make loads of points in a single huge post, rather than publishing it in pieces as they became ready.

There is one potentially decision-relevant point that I hoped to make, that I still haven't seen discussed elsewhere: there may be two relevant hospital overflow thresholds. The ICU bed threshold and the ventilator threshold are fairly low; given our current expected supply in a crisis, we'll exceed them if more than about 70k people require them at once. But I think (not confident in this yet) that our capacity for distributing oxygen is something like 10x higher. And if that threshold gets exceeded, the infection fatality rate may rise by something like 10%. So on this model, while it would obviously be ideal to push the curve below both thresholds, it's imperative to at least flatten the curve beneath the oxygen threshold. Which is easier, since it's higher.

I'm not sure this model is accurate, and I haven't yet decided whether to try figuring it out/writing it up. I feel a bit hesitant, after having wasted 10 days or so underestimating the efficiency of the coronavirus modeling market, but it does seem useful to propagate if true. If someone else is interested in looking into it, I would happily talk them through what I've learned.

I'm looking for opinions on this video, by a virology professor. which so far is my favorite explanation of basic coronavirus science. It covers basic things others didn't (that there are literally no enzymes in a coronavirus capsule, it's just mRNA), and some more specific things that I really wanted to know (like where in the lifecycle chloroquine and azithromycin appear to be disruptive). Before I crown it king, I'd like to get feedback on how easy-to-understand and useful this is for other people.

Caveats: spends a fair amount of time on things I found interesting but not on a straight path to usefulness, like swine flu.


Other contenders are

This post was edited on 3/22 to add answers

This post was edited on 3/23 to add new questions to the agenda and swap out the spotlight questions. (Thanks to elityre and romeostevensit for suggestions)

This post was edited on 3/30 to add two answers to "What are the basic epidemiological parameters of C19?"

This post was edited on 4/6 to:

What is the basic science of coronavirus? E.g. this guide is trying, but requires more background knowledge than ideal and leaves a lot out.

It's very unclear to me how you can simultaneously overcome both "requires more background knowledge than ideal" and "leaves a lot out", at least without just giving someone a stack of textbooks to read.

I'm like ~2/3 of the way through writing a post on coronavirus structure, which might turn into a series of posts on coronavirus biology if I have time, and this is actually pretty hard. The amount of background knowledge required to really understand what's going on is huge; I have a biology PhD and I'm only skimming it.

So any post that attempts to attack this has a high chance of being at least two of incomprehensible, useless, very long, and dull. I'm doing my best to overcome this, but it's tricky.

I ended up being pretty happy with both of the following, although neither was complete.

Okay, but those are textbook chapters. If you're looking for those I recommend Chapter 28 of Fields Virology, 6th edition (similar information to Fehr & Perlman, better presentation, somewhat more comprehensive).

But do you really think LessWrong should be going for something more comprehensive than that? I don't really see the value in that, as opposed to getting a smart-person's-summary that links to more comprehensive resources.

But do you really think LessWrong should be going for something more comprehensive than that

...no, for the reasons you state. And I'm not sure why you think I do. Having found those I wasn't planning on actively searching for a better answer (although I'm looking forward to checking out both the chapter you recommend and the posts you are writing).

Sorry, I think these comments came across as more aggressive than I was intending. I think there's mutual confusion/talking at cross-purposes here. I'm not sure it's worth digging into too much since I'm not sure there's actually any decision-relevant disagreement, so feel free to disregard the following (uh, even more than usual) if you don't fancy digging into this further. :-)


I'm not sure why you think I do.

From my perspective, my confusion arises from the following:

  1. You included basic coronavirus biology on something called a LessWrong coronavirus agenda, as an example of something you wanted to "nudg[e] LessWrong to pursue";
  2. You then gave a counterexample of something that both assumed too much background knowledge and left too much out, suggesting that you'd like whatever LessWrong pursued in that area to not have those deficiencies;
  3. This suggested to me that you'd like LessWrong coverage of basic coronavirus biology that simultaneously assumed less background knowledge and left less out than that counterexample;
  4. But I don't see how that would be possible without someone on LessWrong writing a complete from-first-principles molecular biology course.

Based on this conversation I think I'm probably misinterpreting what inclusion on the agenda implies you'd like to see LessWrongers do.

Please apply the Coronavirus tag to this post.

From what I understand, the lack of proper protection in healthcare workers is a huge issue. I've heard that some hospitals don't even have enough masks for doctors and nurses, this could potentially (or is already) cause a massive increase in healthcare professionals infected. Is there a possible solution to this?

To answer these questions it seems like it would be quite helpful to have domain specific expertise. So then, along the lines of comparative advantage, wouldn't it be more effective to earn to give? And following that thought, while the coronavirus is certainly scary, is it actually worth putting resources towards over things like existential risk reduction?

Perhaps the response to these points is that in practice, the coronavirus is particularly salient, and people are more likely to help out by doing research into these questions than they are with eg. existential risk reduction or earning to give.

Do you know of places that would make good use of donations? If so, I strongly encourage you to write them up, ideally as an answer here.

I also think a top-level post making the case for or against focusing on COVID vs. (other?) X-risk is a great idea.

Do you know of places that would make good use of donations? If so, I strongly encourage you to write them up, ideally as answer here.

No, I don't know of places that would be particularly good to donate to. The WHO seems like a safe bet. Also, GiveWell is looking in to it (which I also noted in the other post).

Personally I suspect that even without knowing the best place to donate to, earning to give would be a more efficient use of time. However, I don't feel too confident in that. I don't know enough about how effective professionals actually are in practice, and LessWrongers in general seem to be extremely capable, even when venturing outside of their areas of expertise.

I also think a top-level post making the case for or against focusing on COVID vs. (other?) X-risk is a great idea.

I agree. I just posted this question.