Comments, observations and thoughts from two bloggers on applied statistics, higher education and epidemiology. Joseph is an associate professor. Mark is a professional statistician and former math teacher.
The reactions to Isaac Chotiner's interview Richard Epstein. This picks up our ongoing conversation about how conservative movement financing subsidizes and undermines the discourse (in this case through the Hoover Institution).
We'll start off with Hizoy's detailed take-down.
Richard Epstein, with the same genius for self-preservation that led him to publish his views on how we should respond to a pandemic despite his lack of expertise, has agreed to be interviewed by Isaac Chotiner.
One consequence of a fact-free presidency is that the entire evidence-based world lines up against it. That tempts learned people of a contrarian bent to conclude "must be wrong." The more resistance they get, the more certain they feel. Watch it play out. https://t.co/CjKtOG0geW
Always good when
things take this turn: "You just don’t know anything about
anything. You’re a journalist. Would you like to compare your résumé to
mine?" https://t.co/j2Ufhbk2Rs via
@NewYorker
By any rational
standard this should be the epitaph or perhaps the death warrant for a
generation of law and economics types. (And yes, I know there are more
subtle, intelligent version of it. But a lot of it is this.) pic.twitter.com/Bq28VNa5fR
Blogger ate the post that was supposed to run this morning, so here's a quick rant so I can vent.
You know all of those stories about clever and inspiring workarounds to medical equipment shortages? Engineering team invents new ventilator, local resident uses 3d printer to help local hospital, grandparents volunteer to sew surgical masks. They are hopeful stories, they make you feel good and they need to stop.
We have, as a culture, become enamored of the trivial non-solution. Something interesting to talk about while giving us an excuse to put off what we need to do. In this case, we need to start producing tens of thousands of ventilators, millions of pieces of protective gear for health care workers and billions of cheaper surgical masks and gloves for the general public. We need to do it now. Any plan or suggestion that doesn't approach that scale is a dangerous and self-indulgent distraction.
This is the country that put out three Liberty Ships every two days. We are capable of filling warehouses with cheap plastic goods.
Since most of us are lock in to varying degrees, this seems like a good time to expand our musical horizons.
I've been chipping away at 1001 Albums You Must Hear Before You Die over the years, focusing on albums I'd missed (or thought I'd missed -- turns out that I'd heard a lot of George Clinton in college).
Green Day - American Idiot is a little on the nose for this moment, so here's something a bit cooler for the weekend.
You may have noticed an uptick in the bullshit coming from the recent press briefing (a situation that's gotten so bad that there's a heated journalistic debate over the ethics of broadcasting them at all). It's a combination of medical pseudo-science, arrogance, and obliviousness. Where could something like that be coming from?
Sources
say that Trump is leaning toward telling at least some Americans to
return to work after the 15-day social-distancing period ends on March
31. This puts Trump on a potential collision course with Fauci that many
fear will end with Fauci being fired or quitting. “Fauci is the best
medical expert we have. We can’t lose him,” a former White House
official said. Signs of tension between Trump and Fauci have been
emerging. Over the weekend, Fauci gave a series of candid interviews.
“I’ve been telling the president things he doesn’t want to hear,” Fauci
told Maureen Dowd. “I have publicly had to say something different with
what he states. It’s a risky business.” Fauci told Science magazine:
“When you’re dealing with the White House, sometimes you have to say
things one, two, three, four times, and then it happens. So, I’m going
to keep pushing.”
Trump’s view that he can ignore
Fauci’s opinion may be influenced by advice he’s getting from Jared
Kushner, whose outside-the-box efforts have often rankled those in
charge of managing the crisis. According to two sources, Kushner has
told Trump about experimental treatments he’s heard about from
executives in Silicon Valley. “Jared is bringing conspiracy theories to
Trump about potential treatments,” a Republican briefed on the
conversations told me. Another former West Wing official told me: “Trump
is like an 11-year-old boy waiting for the fairy godmother to bring him
a magic pill.” (The White House did not respond to a request for
comment.)
What executives? Well, for starter, there's ...
Worth noting that
Larry Ellison's previous medical research work — his foray into
life-extension research, on which he spent hundreds of millions of
dollars — is broadly seen as a scientific failure.
What Ellison's disruptive visionary attitude here appears to be popular among his fellow tech billionaires. Elon Musk suggested the virus would turn out to be no worse than a bad cold, but the funniest exchanges have been coming from another member of the PayPal Mafia, Keith Rabois.
randomized
controls are horrible ideas. largest impediment to progress in health
spans.
It's
possible that Keith Rabois is the dumbest, most over-confident piece of
shit VC in the US today. This kind of stuff is
dangerous and wrong. This is basic stats. If you
don't randomize, you can't be sure the intervention
you're testing actually drives the outcome. https://t.co/NkDXEF2JaP
at some level of
n, you avoid bias because of the real world. that is the whole point.
in cardiology, there is a vigorous debate about whether statins induce
memory loss even though no double blind study has confirmed
it.
Two sources close to the White House tell Sherman that Trump increasingly feels that “he can ignore Fauci’s opinion” because Kushner has been telling him about experimental coronavirus treatments he’s been hearing about from Silicon Valley entrepreneurs.
Yet here we are even having a discussion of “getting back to work” because the President is antsy after about a week of lockdowns in some parts of the country and is hearing from friends that the economic downturn could cost him reelection and (though we haven’t talked much about this) could drive him into personal bankruptcy.
But there is a real issue here with a president facing severe economic penalties and a lack of high quality advice. It is not that non-experts cannot be important voices. But would you want a car mechanic to debug software? Or a software engineer to repair a car? In a high stakes and high pressure situation? Sure, it might occasionally work out, and the outsider might have important perspectives, but there is a lot of trial and error in jumping to a new field that maybe isn't ideal in a pandemic.
Mark and I have often talked about next steps in covid-19. It's an active area of correspondence between us. One area of frustration that I have is how the messaging is always focused on the current crisis and not the problems coming next.
For example, masks. Early on in the epidemic we were told masks did not help:
The simplicity of those recommendations is likely unsettling to people anxious to do more to protect themselves, so it’s no surprise that face masks are in short supply—despite the CDC specifically not recommending them for healthy people trying to protect against COVID-19. “It seems kind of intuitively obvious that if you put something—whether it’s a scarf or a mask—in front of your nose and mouth, that will filter out some of these viruses that are floating around out there,” says Dr. William Schaffner, professor of medicine in the division of infectious diseases at Vanderbilt University. The only problem: that’s not effective against respiratory illnesses like the flu and COVID-19. If it were, “the CDC would have recommended it years ago,” he says. “It doesn’t, because it makes science-based recommendations.”
Now the CDC says surgical masks can replace N95 masks under these dire conditions. Not only did the messaging backfire by reducing trust in government, it made it necessary to change messages.
The newest (correct) narrative is that we need to preserve masks for health cure workers in the current crisis. This is, unfortunately, completely correct. They bear extreme risk curves and this equipment is necessary to engage in patient treatment and to preserve the existing work force. The desperate circumstances in the hospitals is an ongoing emergency. Target even apologized for putting masks out for sale -- things are so desperate markets don't work.
But the real key will be the cost of distancing for the poor and disenfranchised. Right now there is a lot of goodwill. Rent is being forgiven or extended. Mortgages will be increased. But even if we halt evictions for the full 18 months, there are going to be some brutal social costs. In the US health insurance is linked to employment, and some small businesses will simply not be able to stay open for 18 months without revenue. People living in small apartments with 5 roommates will be in for a tough time. And most cities lack enough green space for half the population to be outside with appropriate social distancing.
So what else can we try?
Well, the goal of social distancing is to reduce the rate of transmission and flatten the curve. Do you know what else would do that? Compulsory mask wearing when outdoors. Preferably a properly fitted N95 mask. With big fines for not being masked, training sessions on mask fitting, and free masks for all.
Could this be done?
Well, if it really is going to be 18 months we can make more. Current supplies are pitiful. But we are heading into a recession with a whole bunch of soon to be unemployed workers. What about making more? A lot more?
In the short run this will stop the tragic shortages at hospitals, which are getting worse before they get better. In the medium term this will let us ease some of the restrictions and permit a limited amount of public space use with lower transmission rates. Remember, they aren't magic and there will still be some transmission -- the goal is to lower R0 so that we can control the epidemic and eventually starve it of hosts.
And it is clear medical masks work. Here is a cluster randomized trial of cloth masks versus medical masks in Vietnam looking at respiratory infections.
The control group was wearing masks occasionally:
After providing informed consent, 1607 participants were randomised by ward to three arms: (1) medical masks at all times on their work shift; (2) cloth masks at all times on shift or (3) control arm (standard practice, which may or may not include mask use). Standard practice was used as control because the IRB deemed it unethical to ask participants to not wear a mask.
So consistent mask use seems to help with respiratory illness, relative to only using them for high risk. Now, to be clear, obviously in the face of a shortage they need to be rationed for health care providers. My question is: why don't we alleviate the shortage with increased production?
In the long run I am betting on the biomedical community succeeding with one or more of the multitude of vaccines under development (wikipeda tracks 30), with at least one in phase I trials. There are successful coronavirus vaccines in dogs and something in cats, although the research leaves questions I would want answered in a human trial.
There is more here, about tests and about mitigating long term impacts, but this post is long enough. Maybe a sequel?
Interestingly, in
China people have expressed similar pride in the self-sacrifice they’ve
undertaken during the coronavirus pandemic — but that sacrifice was to
self-quarantine for weeks, not to return to business as
usual.
Researchers pointed out the potential health care disaster.
In last 24 hrs
there've been prominent US voices calling for a stop to social
distancing, citing rationale that they're worse than impact of
COVID itself. It’s worth looking very closely at that claim, where we
are in US COVID epidemic and what happens if we stop.
1/x
Even sane conservatives pointed out that less containment might cause even more damage to the economy.
The truly
soul-shaking thing about it is nobody has the evidence they'd
need to be justified in the belief that easing up on containment to keep
the economy humming now won't just make the economy even worse
later, amidst the mass death. But it's a gamble they're
willing to take?
While others pointed out that easing the lock down wasn't really Trump's call.
I don’t really
understand this discourse around Trump and reopening the economy ... the
federal government didn’t order anything closed in the first place,
it’s all state/local. His contribution has been
spreading misinformation and foot-dragging on boosting PPE
production.
While we are all quarantined, it may be time to start thinking about long term economic impacts as well. Look at this amazing chart:
This is a very atypical recession. There is no moral hazard involved as these people are losing their job to a pure external shock. But the risk that this will blossom into something worse is worth considering, especially if the epidemic lasts for a while. Schools and universities (and daycares!) are currently closed for months. This will impact hiring and employment. It is hard to job search while you are social distancing and economic activity is down. These numbers are unimaginable when compared to normal times:
Government of Canada has received 500,000 applications for Employment Insurance this week, PM Justin Trudeau says. That compares to 27,000 for the same week last year.
The time to be considering these consequences, and how to mitigate them, is now. We are so far outside the range of previous data that we should be thinking carefully about heroic measures and not hoping that normal measures will work.
Early Friday morning, Sen. Kelly Loeffler (R-GA) denied any wrongdoing when she sold millions of dollars worth of stocks soon after a closed-door briefing with the entire Senate on the COVID-19 pandemic, which has wreaked havoc on the stock market.
That first transaction was a sale of stock in the company Resideo Technologies valued at between $50,001 and $100,000. The company’s stock price has fallen by more than half since then, and the Dow Jones Industrial Average overall has shed approximately 10,000 points, dropping about a third of its value.
It was the first of 29 stock transactions that Loeffler and her husband made through mid-February, all but two of which were sales. One of Loeffler’s two purchases was stock worth between $100,000 and $250,000 in Citrix, a technology company that offers teleworking software and which has seen a small bump in its stock price since Loeffler bought in as a result of coronavirus-induced market turmoil.
Now it possible that she just got lucky. Or that the "multiple third-party advisors" were independently seeing evidence of the turmoil in China. But the optics are terrible. At the very least I would like to know a lot more about the very prescient advisors, who were able to mimic the insider information that she had.
The idea that the rich can get out of the markets while my retirement funds (worth far less to begin with) strikes at the very heart of free and open markets. This is a big deal
Edit: Also this is kind of damning:
So a big and very prescient stock sale after a period of no trading that starts the day of the briefing. I really want the advisors to come forward and explain, because otherwise this is clearly insider trading.
The Palo Alto-based company has been operating the factory — which normally employs about 10,000 people, making model S, X, 3 and Y vehicles — this week despite a multi-county Bay Area lockdown order issued Monday to reduce the spread of coronavirus. Tesla told Alameda County Wednesday that 2,500 workers are now at the plant.
“We had a good conversation with Tesla today,” said Alameda County spokesman Ray Kelly. “They understand our position. The county explained they cannot continue their business as usual. They have to go on a minimum operations basis.”
The lockdown order allows companies to continue minimum basic operations, defined as payroll, security, and preservation of inventory value. That list does not include car making, Kelly acknowledged, and said “it sounds like they’re still making cars.”
Tesla did not return calls for comment.
Asked what, if anything, the county would do if production continues, Kelly said, “Tesla is not going to decide what the law is.” Enforcement, he said, will be handled by Fremont Police.
...
In an email sent to factory workers at 8:49 a.m. Wednesday, Tesla human resources head Valerie Capers Workman said, “There are no changes in your normal assignment and you should continue to report for work if you are in an essential function” which she said include “production, service, deliveries, testing and supporting groups.” Sick workers could stay home and use their accumulated paid time off, she said.
She cited “conflicting guidance from different levels of government” on how to handle the coronavirus pandemic.
Workman didn’t detail conflicting government guidance, but in an email to employees early Tuesday morning she said “the federal government has directed that all National Critical Infrastructure continue to operate during this global pandemic,” which she said covers “business sectors crucial to the economic prosperity and continuity of the United States.” That includes auto manufacturing, she said, but didn’t include a source.
“People need access to transportation and energy, and we are essential to providing it,” she wrote.
Tesla Chief Executive Elon Musk had minimized what he called “panic” reaction to the virus on Twitter and in an email Monday night. In his email, Musk said, “My frank opinion is that the harm from the coronavirus panic far exceeds that of the virus itself,” and he said that COVID-19 cases “will not exceed 0.1% of the population.”
...
Thousands of workers streamed into the factory Tuesday, many arriving by bus.
More than a dozen employees sent messages to The Times complaining about Tesla’s failure to comply with the lockdown order. Several said they feared catching the virus and spreading it to family but also feared losing their jobs if they stayed home.
On late Wednesday afternoon, one worker who did not want to be identified for fear of losing her job said via a Twitter direct message that “all production still running” on the assembly line.
I don't have numbers but I'm reasonably certain this is the largest number of Americans working from home since the advent of the internet and the smart phone.
There's no good technological reason why most knowledge workers need to live within a hundred or even a thousand miles of where they work. The obstacles are cultural but they are still formidable. Despite a tight job market and a growing housing crisis centered around a handful of overcrowded and overpriced cities, employers have been slow to consider alternative models.
Now new models are being forced upon everybody. New things will be tried. Adaptations will be made. Bugs will be worked out. Attitudes will shift.
Fifty years from now, this might be what Covid-19 is remembered for.
Smart people, like statisticians' models, are often most interesting when they are wrong. There is no better example of this than Arthur C Clarke's 1964 predictions about the demise of the urban age, where he suggested that what we would now call telecommuting would end the need for people to congregate around centers of employment and would therefore mean the end of cities.
What about the city of the day after tomorrow? Say, the year 2000. I think it will be completely different. In fact, it may not even exist at all. Oh, I'm not thinking about the atom bomb and the next Stone Age; I'm thinking about the incredible breakthrough which has been made possible by developments in communications, particularly the transistor and above all the communications satellite. These things will make possible a world where we can be in instant contact with each other wherever we may be, where we can contact our friends anywhere on earth even if we don't know their actual physical location. It will be possible in that age, perhaps only 50 years from now, for a man to conduct his business from Tahiti or Bali just as well as he could from London. In fact, if it proved worthwhile, almost any executive skill, any administrative skill, even any physical skill could be made independent of distance. I am perfectly serious when I suggest that someday we may have rain surgeons in Edinburgh operating on patients in New Zealand. When that time comes, the whole world will have shrunk to a point and the traditional role of a city as the meeting place for man will have ceased to make any sense. In fact, men will no longer commute; they will communicate. They won't have to travel for business anymore; they'll only travel for pleasure. I only hope that, when that day comes and the city is abolished, the whole world isn't turned into one giant suburb.
Clarke was working with a 20 to 50 year timeframe, so it's fair to say that he got this one wrong. The question is why. Both as a fiction writer and a serious futurist, the man was remarkably and famously prescient about telecommunications and its impact on society. Even here, he got many of the details right while still being dead wrong on the conclusion.
What went wrong? Part of this unquestionably has to do with the nature of modern work. Clarke probably envisioned a more automated workplace in the 21st century, one where stocking shelves and cleaning floors and, yes, driving vehicles would be done entirely by machines. He likely also underestimated the intrinsic appeal of cities.
But I think a third factor may well have been bigger than either of those two. The early 60s was an anxious but optimistic time. The sense was that if we didn't destroy ourselves, we were on the verge of great things. The 60s was also the last time that there was anything approaching a balance of power between workers and employers.
This was particularly true with mental work. At least in part because of the space race, companies like Texas Instruments were eager to find smart capable people. As a result, employers were extremely flexible about qualifications (a humanities PhD could actually get you a job) and they were willing to make concessions to attract and keep talented workers.
Telecommuting (as compared to off shoring, a distinction will need to get into in a later post) offers almost all of its advantages to the worker. The only benefit to the employer is the ability to land an otherwise unavailable prospect. From the perspective of 1964, that would have seemed like a good trade, but those days are long past.
For the past 40 or so years, employers have worked under (and now completely internalized) the assumption that they could pick and choose. When most companies post jobs, they are looking for someone who either has the exact academic background required, or preferably, someone who is currently doing almost the same job for a completely satisfied employer and yet is willing to leave for roughly the same pay.
When you hear complaints about "not being able to find qualified workers," it is essential to keep in mind this modern standard for "qualified." 50 or 60 years ago it meant someone who was capable of doing the work with a bit of training. Now it means someone who can walk in the door, sit down at the desk, and immediately start working. (Not to say that new employees will actually be doing productive work from day one. They'll be sitting in their cubicles trying to look busy for the first two or three weeks while IT and HR get things set up, but that's another story.)
Arthur C Clarke was writing in an optimistic age where workers were on an almost equal footing with management. If the year 2000 had looked like the year 1964, he just might have gotten this one right.
Consider that the
only thing Trump knows how to do is bully, lie, bribe, and engage in
underhanded, immoral conduct. This tells me he knows
there's a problem, and he knows mean tweeting, lying, and
bribing won't help. https://t.co/Pwjv9zMR8B
what's
not clear to me about this is we don't think the German national
government wouldn't happily nationalize the company before
letting this happen? https://t.co/t4HuPwQq3O
Germany ends any
possibility of US stake in Pharma firm CureVac over fear that “America
first” would apply to corona vaccine. The depth of distrust revealed by
this episode is shocking even in these days. https://t.co/0sH8qk5oDC
The ignorance of
@dhookstead
here is stunning. Sacrifices for the common good defined the era. The
idea that families that sent sons off to war, their wives off to
munition plants, and lived under rationing would complain about a
cancelled game is an insult to the generation.
three days before
Fox acted, President Trump sent Regan’s commentary and a defense of its
content to his 73-million Twitter followers https://t.co/OVTPYlDMFA
I expect Devin
Nunes to be stupid enough to contradict the advice of health
professionals. Shouldn't someone at Fox know
better? Are literally trying to kill their own viewers? https://t.co/UmiOFaYpj1
When your own
people are passing along bad information in a public health disaster,
putting at grave risk your core viewership, you don't just take
one show host — the least powerful — off the air. It's a
professional crisis for every person working there. https://t.co/vK2iw4PSLM
The best face I
can put in this is that it is risky to the point of recklessness. But if
you are going this way, I recommend mass testing (to allow people to
isolate while they are sick) and a lot of field hospitals with breathing
support. Because you will need
them
Difficult to
overstate the extent to which the press has fanned these flames.
Overblown coverage of isolated cases created a self-fulfilling prophesy.
Nonexistent shortages of toilet paper got more attention than real and
desperate shortages of tests. https://t.co/hSUbAPY8k0
Put another way,
would anyone argue that South Korea's aggressive approach
DIDN'T pay for itself economically if it averted Italy-level
consequences? https://t.co/ampzHxkU1Q
Wash Post, May
2018: Story quotes experts saying disbanding of White House global
health security office will make country more vulnerable to a pandemic.
https://t.co/eGey0L5tF1
We've been arguing for about a decade now that the Straussian strategy and tactics has the dominant factor in American politics since the late 90s, both in the undermining of reliable and trusted information sources and the spread of disinformation.
This essential piece from our best press critic points out how costly this disinformation has become.
When Trump says “jump,” the network leaps into action. And what the president hears on Fox News often dictates his own pronouncements and policies — which, in turn, are glowingly represented in Fox News’s coverage and commentary.
That’s never been anything short of dangerous, since the effect has been to create a de facto state-run media monster more devoted to maintaining power than shedding light on the truth. But now the mind-meld of Fox News and Trump is potentially lethal as Trump plays down the seriousness of the coronavirus and, hearing nothing but applause from his favorite information source for doing so, sees little reason to change.
There’s one person who could transform all that in an instant: Fox founder Rupert Murdoch, the Australian-born media mogul who, at 89, still exerts his influence on the leading cable network — and thus on the president himself.
...
The network’s influence on Trump is clear from the presidential tweets that follow fast on the heels of a Fox News broadcast. He was always a fan of Fox News, but after entering the White House, he made it even more of an obsessive daily habit, Bloomberg News reported in 2017, to the extent of blotting out dissenting voices from other sources.
Trump made specific reference to his reliance on Fox News during his misleading press event Friday, when he offered unwarranted reassurance rather than urging extreme caution and decisive action: “As of the time I left the plane . . . we had 240 cases — that’s at least what was on a very fine network known as Fox News.”
The message: Go about your business, America, and it will all disappear soon.
Days later, 30 deaths and more than 1,000 cases have been reported in the United States, with those numbers expected to grow exponentially. (By contrast, German Chancellor Angela Merkel is telling hard truths: As much as 70 percent of that country could end up being infected.)
Matt Gertz, a Media Matters senior fellow and the foremost chronicler of the insidious Trump-Fox News feedback loop, connected the dots: “Roughly an hour before his comments, a Fox News medical correspondent argued on-air that coronavirus was no more dangerous than the flu; a few hours later, the same correspondent argued that coronavirus fears were being deliberately overblown in hopes of damaging Trump politically.”
He added: “The network's personalities have frequently claimed that the Trump administration has been doing a great job responding to coronavirus, that the fears of the disease are overblown, and that the real problem is Democrats and the media politicizing the epidemic to prevent Trump's reelection.”
On Fox Business Channel, host Trish Regan drew widespread condemnation for her over-the-top rant in Trump's defense: “The chorus of hate being leveled at the president is nearing a crescendo as Democrats blame him and only him for a virus that originated halfway around the world. This is yet another attempt to impeach the president.”
(By contrast, her Fox News colleague Tucker Carlson has taken the threat seriously, though using it as an excuse to stoke anti-China sentiment along the way.)
...
Even if all that changed today, great harm has already been done. As The Washington Post and others have documented, the administration has repeatedly squandered chances to prepare for and manage the global epidemic.
But every moment still counts. Lives can be saved by prudent practices and aggressive government action — and lost by their absence.
But it takes leadership from the top. And so, let’s acknowledge the obvious: There is no more important player in influencing Trump than Fox News. And no more powerful figure at Fox than its patriarch.
Murdoch might consider, too, that with the median age of Fox’s viewers around 65, they are among the most vulnerable to the virus’s threats.
