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?

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?

Does hydroxychloroquine + azithromycin effectively treat COVID-19?

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

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.