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LessWrong Coronavirus Agenda

by Elizabeth5 min read18th Mar 202065 comments



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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12 Answers

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.

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.

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.

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?

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?

Does hydroxychloroquine + azithromycin effectively treat COVID-19?

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

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.