MichaelLowe

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How We Failed COVID-19

This is a very important topic and question, but I fear that you generalize too much and your assessment of Western politicians' understanding lacks subtlety.  In particular, my opinion is that the obviously good strategies were just not politically feasible. In the beginning of the pandemic, I used to treat arguments of the form "The successful strategy of country A is just not possible in country B" as defeatism and status-quo bias, but I  now believe that the South Korean model is indeed not possible in Western democratic countries. This can be seen by creative and smart initiatives of some Western countries that nevertheless failed.

You mention that the government holds the following misconception: 

It's fine to hover just below the point where hospitals get overwhelmed - it's not important to bring down the number of active cases as low as possible

However, the German government is perfectly aware of the meaning of exponential spread, here is chancellor Angela Merkel explaining what R means and why a value of 1.1 would be too high. 

While hand-washing was an important recommendation in the beginning here as well, our public health messaging has been focused for some time now on droplet and aerosol transmission. School and university classrooms are often required to be ventilated at regular intervals (which for most schools is not doable, but that's a different topic). Hand sanitizer is also much easier to implement than any ventilation measure in Winter.

You also invoke the risk society thesis, but this would apply to Asian countries as well, which were able to contain the virus.    

In addition, I think "the summer success in Western countries was not due to measures but due too weather effects" is far too strong a claim. European countries had a decent contact tracing system and cancelled mass events, while the US did not have the first part and had far worse numbers in summer.

 

Why the South Korean model would not work in the West: 

South Korea did contact tracing very well, with huge invasions of privacy like checking CCTV data, publishing the whereabouts of infected individuals and using credit card transaction history. In the US and the UK contact tracers are happy if contacted individuals pick up their phone at all. It's paradoxical, but it seems to me that Western populations would rather accept a wrecked economy, restriction of movement AND hundred  thousands of deaths than a temporary surveillance program. 

 

Examples of Non-Asian countries with smart but failed initiatives:

As far as I can tell, there has only been one Western country to try to eradicate the virus, namely Israel which implemented very tight border control policies and a mobile phone surveillance initiative very early.  However, my impression is that cooperation of the populace is just not high enough, which is why a second lockdown had to be imposed.   

A to me pretty saddening case is the initiative of the Slovak government to test its entire working age population through cheap antigen tests.  Testing was semi voluntary, with the other option being mandatory quarantine. New infection numbers fell very rapidly, but because the testing was done in  parallel with a partial lockdown it's not exactly easy to determine causality. However, since many other European countries with similar lockdowns have at best a flattened curve it seems very likely that mass testing was a great idea which is why it's copied now in parts of England, Austria and Italy.  Despite the large success and subsequent reopening, another round of mass testing has in Slovakia been postponed indefinitely, mostly because the mandatory quarantine got many voters angry and popularity of the government has been waning rapidly.

 

So in conclusion, many smart policies are much harder to implement in Western countries and may actually reflect the preference of the population, and that our current situation is not because of governments "[...] making some silly errors, not updating their information, and not thinking through the long-term effects. " 

However, there was/is room for fairly cheap wins  through scientific and regulatory adaptation. This post is already too long, but briefly put the failure seems to be in those two areas. Despite strong theoretical justifications, no country (AFAIK) has so far approved at home, cheap antigen testing. 

Open & Welcome Thread – November 2020

Does anybody have recommended resources that explain the timeline of clinical trials of interventions? Specifically why they take so long and whether that is because of practical necessity or regulatory burden. Bonus points if Covid-19 is included as a context. 

Why are young, healthy people eager to take the Covid-19 vaccine?

You are applying the incentive heuristic inconsistently. On the one hand you infer that if there was string evidence of long term effects, governments would be very vocal about it. But on the other hand, you ignore that these incentives would also apply to the Vitamin D effects that you cite. Governments would also surely have an interest to publicize an intervention that has  a 25 fold reduction in risk.  So the estimate is wrong or your conception of how governments work is wrong.  

I suggest that it is both. Other answers have already mentioned that a 25 fold reduction in risk would be ridiculous, and governments just do not respond to incentives like that.  

This study is a strong reason to fear  prevalent long term consequences for cognitive performance after even mild Covid-19 infections. 

On the other hand, you do not mention the strongest reason for supporting your view: the relatively underexplored long term effects of mRNA vaccines. However, if you worry about those, you should just get the traditional-style Oxford or J&J vaccines. Since they use the same technology as well established vaccines, taking them should be fundamentally as safe as getting your flu shot.

Covid 11/12: The Winds of Winter

The Cuomo video does not have the quote "stop the distribution of the vaccine", the clip says that Cuomo wants to shape or stop Trump's *plan*. This could mean that an alternative plan would be implemented  that would fulfill the Cuomo's requirements. 

I feel that getting the quote right is necessary if one is literally calling for pitchforks.

Does BioNtech's vaccine result of 90% disease prevention mean that 90% of the vaccinated can't pass the virus to other people?

but I will bet you ANYTHING that those who DO get infected are at least less infectious. 

I am less sure, based on the results of the Oxford vaccine trial: "Viral gRNA was detected in nose swabs from all animals and no difference was found on any day between vaccinated and control animals." Viral load is indeed lower in the lower respiratory tract, but my understanding is that infections spread mainly from the upper respiratory tract. And if you factor in how most infections are detected, namely by an individual experiencing symptoms, it is conceivable that vaccinated and thus asymptomatic Sars-Cov 2 carriers will be in effect more infectious.   

https://www.nature.com/articles/s41586-020-2608-y

Teach People to Recognize the Sound of Covid?

Reposting my comment under Zvi's post: 

Due to the online collection method I suspect that most of the positive samples were already quite advanced in their disease progression.  Since Covid-19 deposits in the lungs mainly in the latter part of the disease it is easier to identify them at that point, but also not that useful anymore because most of the transmission happens during the earlier part of the infection (both for symptomatic and asymptomatic people). 

These researchers  had a much better sample procedure, cough samples were mostly acquired at testing sites, where participants did not know yet whether they have Covid (much less risk of subconscious bias) and were presumably at an earlier stage of their disease. They also had much worse results, which I suspect are more realistic for a real world setting.  

What actually needs to be done is to do a longitudinal analysis, i.e. you record your baseline cough when you are healthy. Then if you want to check if you are infected, you cough again and compare that "potentially sick" cough against your baseline "non-covid cough". The potential of this approach is much higher since  baseline characteristics of the cough can be accounted for (smoker, asthmatic, crappy mic in phone). 

I have been thinking that it should be possible to gather training data for this quickly by identifying a subset of people that are somewhat likely to get sick in the near future like e.g. people participating in big parties, and acquire coughs from them prior and subsequent to infection. If somebody has ideas how to collect such data quickly, feel free to share.

Covid 11/5: Don’t Mention the War

Regarding the cough identifying AI: Due to the online collection method I suspect that most of the positive samples were already quite advanced in their disease progression.  Since Covid-19 deposits in the lungs mainly in the latter part of the disease it is easier to identify them at that point, but also not that useful anymore because most of the transmission happens during the earlier part of the infection (both for symptomatic and asymptomatic people). 

These researchers  had a much better sample procedure, cough samples were mostly acquired at testing sites, where participants did not know yet whether they have Covid (much less risk of subconscious bias) and were presumably at an earlier stage of their disease. They also had much worse results, which I suspect are more realistic for a real world setting.  

What actually needs to be done is to do a longitudinal analysis, i.e. you record your baseline cough when you are healthy. Then if you want to check if you are infected, you cough again and compare that "potentially sick" cough against your baseline "non-covid cough". The potential of this approach is much higher since  baseline characteristics of the cough can be accounted for (smoker, asthmatic, crappy mic in phone). 

I have been thinking that it should be possible to gather training data for this quickly by identifying a subset of people that are somewhat likely to get sick in the near future like e.g. people participating in big parties, and acquire coughs from them prior and subsequent to infection. If somebody has ideas how to acquire such data, feel free to share. As an aside, I am somewhat surprised that we as a community interested in AI and out-of-the box thinking have not focused/discussed AI for Covid detection much earlier.

Covid Covid Covid Covid Covid 10/29: All We Ever Talk About

We need more discussion of Slovakia's approach: Mass testing everybody with cheap antigen tests, testing is semi voluntary, if you don't have a negative test result you have to quarantine.  

I maintain that the Slovak government has shown extraordinary competence here, when compared against an admittedly low international baseline.  Even more astonishingly, the Lancet article makes it seem like they went against the advise of their scientific advisors who pushed for a 45 days lockdown.

  1. Before doing nationwide testing, they implemented a successful local test run.
  2. They understand what an incubation period is, and are therefore doing two runs, last weekend and this weekend.
  3. With antigen tests they settled for a good enough solution, understanding that they will catch the vast majority of infectious people who PCR tests would have caught as well.
  4. They managed to mobilize this whole initiative seemingly in a span of 2-3 weeks, with soldiers making sure distances are kept in waiting lines.

What I find most surprising is how discerning the government was in picking out the right advice and ignoring the bad scientific advice (at best governments follow one set of advisors completely, mostly they implement their recommendations in a worse than random way). Why bad? Because most epidemiologists only consider medical harm but not economic, and let the perfect be the enemy of the good: 

 The bad advice included: Antigen tests are less reliable than PCR tests, that there would be high infection risks at the testing sites, that not enough doctors would be available, that it would be immoral to forcibly quarantine people who do not want to be tested (apparently much better to effectively quarantine everybody in a lockdown), that a lockdown that would crush the economy was the better approach( what comes after the lockdown when the numbers will most likely rise again?) 

This is not to say that each individual point was wrong or unlikely to happen, just that the epistemic standard  when trying something new should not be "this will definitely work without any problems" but "this is worth a shot", particularly when the other alternatives have huge downsides as well. Neither am I saying that everything was done perfectly (I am unsure whether it is best to exclude 65+ citizens, citizens could maybe also do the swab testing supervised but themselves) 

The jury is still out on whether this will flatten the numbers, but we should all hope that it works out for them so we have a viable alternative.

Covid 8/27: The Fall of the CDC

Any remark on the recent reports of reinfections? In previous pieces you were quite critical of such reports, IIRC you estimated a minimum of 4 months of immunity. However, the US reinfection case seems to have been reinfected after less than two months, and with a much more serious reinfection to boot.

Are we in an AI overhang?

Your quoted cost for training the model is for training such a model **once**. This is not how the researchers do it, they train the models many times with different hyperparameters. I have no idea, however how hyperparameter tuning is done at such scales, but I guarantee that the compute cost is higher than just the cost for training it once.

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