Wednesday, June 3, 2020

Deferred Tuesday Tweets








Lifestyles of the Rich(?) and Famous.

 I'm not going to weigh in on the scientific debate, but the politics of hydroxychloroquine is worthy of study.


 
Flack-to-Hack ratio at work.

 
Mandatory hyperloop reference.

 
Common sense from Krugman.

 
At least the Onion's on a roll.

 
Zuckerberg is a horrible person...


 
... and yet still better than....


 
One of the stories we're following closely.

 

Amazing how a company this well run could have lost over eight billion dollars in 2019.

 

Brought to you by the good people of MOD.

 
Time to revisit our dysfunction thread. Excellent by Fallows.


 The revolution will be tweeted



 



 


 



 





 




 




 


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Tuesday, June 2, 2020

LA is still not burning


I have great respect for the resilience of NYC journalists. If the New York Times were consumed in a great conflagration, I have  no doubt that the survivors would crawl from the wreckage, mix their blood with ashes for ink, and scrawl out an op-ed on how bad things are in Los Angeles.

Here are some tweets I posted Sunday.

[Should have been more clear, but the next part refers mainly to the national situation.]
Later that evening things got more intense, but not in a way that disproved my point.

Here's where the old city/county question reappears. When people talk about NYC , they are referring to a city comprised of various counties. When people talk about LA, they are usually referring to  a county comprised of different cities. The city/county distinction is important because, while the city is very big, the county is huge, with over 10,000,000 residents and land area of over 4,000 square miles.

In this case, almost all of the footage of riots and looting came from the cities of Long Beach and especially Santa Monica. This is clearly a county level story. Therefore it is essential to remember that the scenes that dominated the news were largely limited to two neighborhoods in a place with considerably more residents than NYC.

This is not to downplay the anger here or its causes or the damage it can do to innocent bystanders when it gets out of control, but when the media focuses all its attention on a tiny sliver of a town, the rest of the country gets a false impression, particularly when some people use the misinformation as disinformation.



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Monday, June 1, 2020

A few points to consider when reading about Tesla (2020 edition)

1. [As previously mentioned] Tesla's valuation has always depended more on the story than the fundamentals.

Finally, it is essential to remember that maintaining this “real-life Tony Stark” persona is tremendously valuable to Musk. In addition to the ego gratification (and we have every reason to believe that Musk has a huge ego), this persona is worth hundreds of millions of dollars to Musk. More than any other factor, Musk’s mystique and his ability to generate hype have pumped the valuation of Tesla to its current stratospheric levels. Bloomberg put his total compensation from Tesla at just under $100 million a year. When Musk gets tons of coverage for claiming he's about to develop telepathy chips for your brain or build a giant subterranean slot car race track under Los Angeles, he keeps that mystique going. Eventually groundless proposals and questionable-to-false boasts will wear away at his reputation, but unless the vast majority of journalists become less credulous and more professional in the very near future, that damage won’t come soon enough to prevent Musk from earning another billion dollars or so from the hype.

2. Since I wrote that, Musk made a big bet on the stock price and it has worked out very well for him.
Tesla confirmed that CEO Elon Musk earned the first tranche of his massive incentive payout, in a document filed with the Securities and Exchange Commission on Thursday.
The tranche is comprised of about 1.7 million shares of Tesla, and would be valued around $775 million based on Thursday’s closing market value. Shares in Tesla closed at $805.81 on Thursday, and the options have a strike price of $350.02.

Thursday’s filing, which also set a date of July 7 for the company’s annual shareholders meeting, said: “As of the date of this proxy statement, one of the 12 tranches under this award has vested and become exercisable, subject to Mr. Musk’s payment of the exercise price of $350.02 per share and the minimum five-year holding period generally applicable to any shares he acquires upon exercise.” It is not clear if Musk has yet exercised the options.

3. With this in mind, the recent surge looks a bit convenient.

As you can see from the 5-year chart below, Tesla's stock didn't do much for quite a while then, about a year ago, it more than quadrupled in about three quarters.




It's useful to compare this to the stock performance of the far larger and more profitable GM.


Particularly these numbers:
vs. Tesla's

4. These incentive plans can incentivize some bad behavior.

Jack Welch demonstrated how easy it was to nudge the books to create the profitability picture Wall Street likes. Running up a stock's value isn't that dissimilar, and there are lots of questions about Tesla's books. Add to that the power of the company's narrative, the cult of personality around Musk, and investors' willingness to reward even the distant promise of viability from any business that can label itself a tech company (we live in the WeWork age).

When Musk compares covid-19 to a cold, pushes miracle cures or lobbies hard for a quick end to the lockdown, it's important to remember...

5. What's good for Tesla isn't necessarily good for America.

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Friday, May 29, 2020

University as a business

This is Joseph

François Furstenberg has comments on cuts at Johns Hopkins, including the high pay of leadership. The whole thing is worth reading but I wanted to highlight a couple of things:
Then there is the issue of deferred compensation for top executives. According to the university’s latest audit, total liabilities related to deferred compensation amounted to over $130 million — or $30 million more than the institution will save by suspending contributions to its thousands of employee retirement accounts this year.
While a handful of top administrators will take a modest pay cut this year, the university has not said whether any of its executives will forfeit the sums accumulated in their deferred-compensation plans. I assume they won’t. There is a searing irony in the fact that these well-paid officers may keep their lucrative deferred-compensation packages even as staff and faculty sacrifice the value in their retirement funds — which are deferred compensation on a far more modest level. Altogether, these practices do not paint a portrait of an institution with robust mechanisms of oversight and accountability.
And the speed of the university being in crisis:
How does a university with a $6-billion endowment and $10 billion in assets suddenly find itself in a solvency crisis? How is one of the country’s top research universities reduced, just a month after moving classes online, to freezing its employees’ retirement accounts? 
This brings up, in my view, a deeply philosophical question about the role of Universities. If they are just tax advantaged businesses then the deep subsidization of these institutions needs to be carefully considered. If they are enduring institutions intended to last for the long term then isn't the point of the endowment to weather storms?

This fits into another post I read lately from Matt Reed:
Adjunct classes cost less than they take in; in business terms, they’re profit centers. The highest-paid faculty cost more than they generate; in business terms, they’re loss centers. By state administrative code, we have to eliminate the profit centers to protect the loss centers. In business terms, that’s backward. But those are the rules. 
This is an insane framing, but I think that was his point.  Obviously the tenured faculty also contribute to reputation and mission. But the point is that a business engaging in cuts would have very different rules and the consequences would be quite different. Imagine a University closing in year 3 or 4 (!!) of a professional program. The cost to students would be . . . severe. Similarly, reputation and integrity are why you can't be a "premium" student with an automatic high grade.

This is a challenging time for everyone and it is a good time to reflect on the social role that we ascribe to universities. This does not mean that I want to disrupt it -- disruption is a great plan for things that can fail or fall apart without huge consequences. Is anybody seriously considering disrupting the police or military?

But there is a real question about the priorities of our academic environment and how we move forward in a word where we start being asked to be more like a business. To me, the real question is why? Just to enrich people with an MBA?
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Thursday, May 28, 2020

Q-ing theory

For a long time now, we’ve been talking about conservative movement disinformation, and for almost as long (since 2015 at least) we’ve been suggesting that the movement has lost control of the process and while the disinformation is still being cranked out, it no longer serves its intended function.

2020 has provided an abundance of examples.
 


 

 


These last two represent a new development, Republicans objecting to right-wing conspiracy theories, but before anyone chimes in with a chorus of "good people on both sides," a little history would be useful.

I was living in Arkansas in the 90s and witnessed up close the birth of the modern style of weaponized batshit crazy conservative conspiracy theories. It was the beginning of what Charles Pierce calls happy hour at the Mena Airport cocktail lounge. Bill was a murderous drug dealer who raped his lesbian wife who, in turn, was also having an affair with Vince Foster before she had him killed.

(If you think I am exaggerating in anyway, read up on the subject. If anything, I’m understating the case)

In order to be truly effective, this approach required the disinformation to be carefully channeled and for the mainstream media to largely turn a blind eye. The lies you could tell on Rush Limbaugh‘s show got a dog whistle on Fox. The lies you could tell on Fox got a dog whistle on Meet the Press. The lies you could tell on Meet the Press is a topic for another post.

Not all journalists were AWOL. There was a great deal of outstanding reporting on the subject by people like Josh Marshall, Jonathan cheat, Jane Mayer, Ornstein  & Mann and, of course, Charles Pierce but these stories  though well reported,never really gained traction and the sources of the disinformation paid no real penalty.

The pattern would continue for a couple of decades, from the invented quotes of Al gore to the swiftboating of John Kerry to the birtherism and other absurd “scandals” of the Obama era all the way through the coverage of Hillary in 2016. Throughout all of this, you would have to look long and hard to find a Republican in good standing who objected with more than lip-service and crocodile tears.

But sometime in the Obama administration, the system started to show cracks. Theories and memes that had been relegated to dark corners and right wing radio call-in shows were suddenly showing up in quotes from Republican congressman and Senators. To those who had not been following the story closely, it appeared that there had been a huge uptick in craziness among conservatives. For those who had been keeping up, it was not at all clear that the craziness increased at all. Instead we were seeing a breakdown in the ability to control the flow of this craziness.

What had been a vital element in the party’s success for the past quarter century has now become a serious threat. By purest coincidence, Republican officials and conservative outlets decided to take a principled stand shortly after these conspiracy theories started to bite the party in the ass.
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Wednesday, May 27, 2020

Believe it or not, this is actually an improvement over the NYT's 2016 coverage.




Tuesday, May 3, 2016

Context only counts if it shows up in the first two dozen paragraphs

The New York Times has a good piece on the impact of voter ID laws but I do have a problem with a few parts (or at least with the way they're arranged).

Stricter Rules for Voter IDs Reshape Races

By MICHAEL WINES and MANNY FERNANDEZ MAY 1, 2016

SAN ANTONIO — In a state where everything is big, the 23rd Congressional District that hugs the border with Mexico is a monster: eight and a half hours by car across a stretch of land bigger than any state east of the Mississippi. In 2014, Representative Pete Gallego logged more than 70,000 miles there in his white Chevy Tahoe, campaigning for re-election to the House — and lost by a bare 2,422 votes.

So in his bid this year to retake the seat, Mr. Gallego, a Democrat, has made a crucial adjustment to his strategy. “We’re asking people if they have a driver’s license,” he said. “We’re having those basic conversations about IDs at the front end, right at our first meeting with voters.”

Since their inception a decade ago, voter identification laws have been the focus of fierce political and social debate. Proponents, largely Republican, argue that the regulations are essential tools to combat election fraud, while critics contend that they are mainly intended to suppress turnout of Democratic-leaning constituencies like minorities and students.
In the third paragraph, we have two conflicting claims that go to the foundation of the whole debate. If election fraud is a significant problem, you can make a case for voter ID laws. If not, it's difficult to see this as anything other than voter suppression. This paragraph pretty much demands some additional information to help the reader weigh the claims and the article provides it...

More than twenty paragraphs later.

Mr. Abbott, perhaps the law’s most ardent backer, has said that voter fraud “abounds” in Texas. A review of some 120 fraud charges in Texas between 2000 and 2015, about eight cases a year, turned up instances of buying votes and setting up fake residences to vote. Critics of the law note that no more than three or four infractions would have been prevented by the voter ID law.

Nationally, fraud that could be stopped by IDs is almost nonexistent, said Lorraine C. Minnite, author of the 2010 book “The Myth of Voter Fraud.” To sway an election, she said, it would require persuading perhaps thousands of people to commit felonies by misrepresenting themselves — and do it undetected.

“It’s ludicrous,” she said. “It’s not an effective way to try to corrupt an election.”

I shouldn't have to say this but, if a story contains claims that the reporter has reason to believe are false or misleading, he or she has an obligation to address the issue promptly. Putting the relevant information above the fold is likely to anger the people who made the false statements, but doing anything else is a disservice to the readers.
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Tuesday, May 26, 2020

Pharmacoepidemiology in debate

This is Joseph

Andrew Gelman was discussing the Lancet article on the safety of hydroxychloroquine. He posited three possible outcomes:

1. The criticisms are mistaken. Actually the research in question adjusted just fine for pre-treatment covariates, and the apparent data anomalies are just misunderstandings. Or maybe there are some minor errors requiring minor corrections.
2. The criticisms are valid and the authors and journal publicly acknowledge their mistakes. I doubt this will happen. Retractions and corrections are rare. Even the most extreme cases are difficult to retract or correct. Consider the most notorious Lancet paper of all, the vaccines paper by Andrew Wakefield, which appeared in 1998, and was finally retracted . . . in 2010. If the worst paper ever took 12 years to be retracted, what can we expect for just run-of-the-mill bad papers?
3. The criticisms are valid, the authors dodge and do not fully grapple with the criticism, and the journal stays clear of the fray, content to rack up the citations and the publicity.
I wrote a comment that went into what I see as a fourth possibility: the data is real and the analysis was done as stated but the question, itself, is not fit for observational analysis
I think there is a fourth possibility. We know that studies of drugs for their primary indication are fraught with risk. This was clearly articulated in the literature by 1983 (https://onlinelibrary.wiley.com/doi/abs/10.1002/sim.4780020222) bu Olli Miettinen but was built on a long tradition of problematic cases. More recently we have Tobias Kurth’s paper showing implausible results in cases with medical desperation (https://academic.oup.com/aje/article/163/3/262/59818). Treatment is not random when physicians, patients, and families are desperate.
We also saw this with hormone replacement therapy and CVD; the theory that it would help with CVD ended up channeling the drug to high SES individuals. This is why drug people insist on trials — too many results reverse direction when channeling effects are removed.
There is no possibility that these medications were being given for an indication other than covid-19. There is just not that much co-infection with malaria.
So option #4 is the study is fine. The data (despite some alarming patterns) turns out to be okay. But the result is simply wrong because they are studying an intended effect. Or they could be correct. Sometimes you end up accounting for channeling (people do, in fact, occasionally win the lottery) and the results are consistent with the causal association posited by trials. My favorite paper was looking at tricks to try and do this with observational data.
The real issue is the strength of the conclusions. Of course, the data issues are a separate and concerning factor as well. But I wish we’d show more humility with observational drug research. I do a LOT of it and it annoys me when these basics of interpretation are glossed over with bullet text about observational research having limitations (unknown confounders — grrrrr) and not a recognition that this is why we do trials — because these estimates are inherently unreliable.
#EndofRant
I see this as different than Wakefield, who faked data. Or an analysis structure that is incorrect. And people publish these studies all of the time. But they do so with known failure points and the use of the word "associated" is a thin veneer:
We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.
Obviously this paper is only of value for a general medical audience if we are supposed to conclude something about the effectiveness of hydroxychloroquine or chloroquine. I mean this stuff is kind of there in the limitations section, but the conclusion is written without these caveats. The first author, I note, is a cardiologist and not a pharmacoepidemiologist.

Now, this is a long rant but here is the other side of the  coin:  arrhythmia is not an intended effect. Yes, we can study the unintended drug effects and this paper brings up completely legitimate safety concerns, given that the issues with the data raised by Gelmen and others can be addressed. But that actual useful contribution is being buried under the far more "hot" mortality data.

James Watson even noted:
This caught my eye, as an effect size that big should have been picked up pretty quickly in the interim analyses of randomized trials that are currently happening. For example, the RECOVERY trial has a hydroxychloroquine arm and they have probably enrolled ~1500 patients into that arm (~10,000 + total already). They will have had multiple interim analyses so far and the trial hasn’t been stopped yet.
This is definitely a big point. It is totally plausible that arrhythmias could be missed (they are often in clinical practice) especially with such a sick patient population. But the mortality signal is awfully high for the trials not to have noticed (although the WHO is now checking their interim data, so maybe?). 

Anyway, I guess this is in my wheelhouse and I just wish we had a better interpretation of these studies in major journals.
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Tuesday Tweets -- "NEW from Aristocratic Murderer: Columbo Not As Smart As He Thinks He Is"




Tweets that age well.


We'll talk more about the consequences of the conservative movement losing control of the crazy.








Journalism's inability to deal with astroturf is proving costly.





Also worth noting that when billionaires do sacrifice a tiny sliver of their wealth for the public good they are praised to high heaven.
 
Fascinating example of data manipulation.



Anyone else see a potential for perverse incentives?


Calculus humor.


Speaking of the conservative movement losing control of the lunatic fringe (though in all fairness, plenty of anti-vaxxers on the left as well).
 
Not the same without the Bond  villain Nehru jacket.
 
This is going to be a difficult transition.


"Comment would be superfluous." -- Steve Allen

I'll admit it's kind of an easy one.
 
In the Coulter/Trump relationship, it's important to remember Ann has always been the Dom. That might make for some interesting developments.



Yes, they are.
 





















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Monday, May 25, 2020

More on journalistic context

This is Joseph

I want to follow up on Mark's post "The New York Times is incapable of learning part 4,234 -- Ignoring context is not part of balance". This article is a great example of ignoring the larger context of the story. The article begins:
US Rep. Alexandria Ocasio-Cortez wants to raise taxes on the rich — just not pay her own.
But as you read down further:
“The congresswoman is still in the process of contesting the tax warrant. The business has been closed for several years now, and so we believe that the state Tax Department has continued to collect the franchise tax in error,” said Lauren Hitt, an AOC spokeswoman.
“As anyone who’s tried to contest a tax bill in error knows, it takes time,” Hitt added. 
There is obviously a major difference between having a active tax dispute and not paying taxes. After all, the president has been apparently under audit (i.e., contesting taxes) for several years now.

The real interesting piece here is how this is showing up at the same time as the Supreme Court is ruling on keeping presidential taxes top secret. This does two things. One, it applies a very real double standard as to whether taxes are a private matter. Two, it removes the context of what tax information is relevant. It is quite plausible that somebody might not successfully close a business in a way that it still gets taxed or that a form could have been misplaced. Why is the question not the cumbersome and opaque nature of most taxation systems?
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Friday, May 22, 2020

The New York Times is incapable of learning part 4,234 -- Ignoring context is not part of balance





 If you look at the New York Times through an ideological lens , it’s fairly clear that on average the paper is a highly conventional establishment center to center left publication, but you won’t get much understanding beyond that. There are, however, explanatory variables that add great clarity. Hubris, the need to maintain and increase access, a profound attachment for the status quo, an upper class/Ivy League mindset, and the need to rationalize caving to pressure. Viewed in those terms, things start to make a great deal more sense. 

The Republicans got to be very good at manipulating the New York Times by playing on these weaknesses. One of the results was the obsessive embrace of false balance. Another was the related technique of discussing a candidate, particularly a Democrat, as if his or her opponent didn’t exist.

This was perhaps the essential component of the paper's coverage of Hillary Clinton in 2016. Any reasonably accurate side-by-side comparison would have so greatly favored Clinton over Trump as to infuriate Republican leaders, inevitably leading to blistering attacks and the loss of access to Republican officials and inside tips.

Just to be clear, I’m not saying that the paper set out to bias their Clinton coverage out of desire of the carrot and fear of the stick. I’m sure that the people who wrote and edited these stories honestly believed that they were upholding the highest standards of fairness and journalistic ethics. That’s the problem.

When someone is doing wrong and knows they’re doing wrong, you could argue they are more morally culpable, but it is also easier to get them to acknowledge and correct the behavior. When, on the other hand, bad behavior is rationalized and those self justifications are fully internalized, it becomes almost impossible for people to self correct.

This is why the New York Times has grown less journalistically than almost any major news organization in the country over the past five years and why they are already starting to repeat the mistakes of 2016.

Which brings us to this recent Dems-in-disarry piece by Katie Glueck, Lisa Lerer, Shane Goldmacher and Alexander Burns.
Some of the Biden campaign’s vulnerabilities were laid bare in recent weeks as he confronted an accusation of sexual assault by Ms. Reade, a former aide in his Senate office in the 1990s. After the allegation surfaced, his campaign weighed several approaches, with some arguing that it should not be elevated. Others wanted a more proactive posture.

Mr. Biden waited more than five weeks to address the matter directly, personally issuing a forceful denial only after a chorus of Democrats had urged him to speak out and several of his female surrogates fielded the issue first. In the meantime, the issue gained traction in social media posts by conservatives, Trump campaign officials and some in the liberal wing of the Democratic Party.

At one point Mr. Biden taped a video statement detailing his work combating sexual assault and harassment. But it did not mention Ms. Reade’s allegations, according to two people with knowledge of the matter, and the campaign did not release it. The campaign declined to comment on the video.

There are plenty of other problems with the piece -- more than I could cover in a blog post -- but this section is such a perfect example of how this contextless coverage lends itself to defending the indefensible.

"Because of the Tara Reade accusations, you should support Donald Trump" is not a defensible statement.This point is, of course, never spelled out in the piece but it's not a big jump and it has shown up elsewhere. It is only by ignoring aspects of Trump's history, aspects we all know, that the authors can maintain the appearance of reasonableness.

Any consistent discussion of the charges of sexual harassment and assault against the two candidates would result in a long and damning article about Donald Trump  with a couple of paragraphs near the end about Joe Biden, and this holds for every notable Biden "scandal" of the election.

"Mr. Trump has his own enormous problems politically, and he and his campaign have yet to get a handle on Mr. Biden, veering from attacks over China to personal jabs at his mental acuity and his son Hunter."

That one phrase, "has his own enormous problems politically" is as close to an acknowledgement of the elephants in the room as the article gets, and it noticeably dodges the strangest and most interesting aspects of this story.

Consider the list implicit in that sentence:

1. Corrupt business dealing by the candidate's children;

2. Mental acuity;

3. Influence by foreign powers;

And add to that the previously mentioned

4. Sexual harassment.

Would a detailed and genuinely rigorous examination of any of these issues benefit Donald Trump politically? If anything, these are topics that the campaign would want to downplay, unless they were assuming that the press would fall back into the habits of 2016, avoiding damaging comparisons and using wildly divergent standards when deciding what qualified as a newsworthy negative story.

Sadly, with  the New York Times, those assumptions may prove correct.

[The Reade story has evolved since I wrote this, but not in a way that would undercut my points here.]
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Thursday, May 21, 2020

The infection fatality rate is not a single number

This is Joseph.

So I was reading 2 preprints on covid-19 infection fatality rates (IFR). The first one concludes:
Based on a systematic review and meta-analysis of published evidence on COVID-19 until the end of April, 2020, the IFR of the disease across populations is 0.75% (0.49-1.01%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents the ‘true’ point estimate. It is likely that different places will experience different IFRs. More research looking at age-stratified IFR is urgently needed to inform policy-making on this front.
The second one concludes:
The infection fatality rate of COVID-19 can vary substantially across different locations and this may reflect differences in population age structure and case-mix of infected and deceased patients as well as multiple other factors. Estimates of infection fatality rates inferred from seroprevalence studies tend to be much lower than original speculations made in the early days of the pandemic. 
So let me start with one point that I think is true: IFR varies from place to place, for reasons that we don't fully understand. I am not sure that public transit is a great candidate, but maybe I am wrong about that. I personally think that long term care facilities are a big piece of it, but all of this thinking is non-causal in nature.

But, given that caveat, a general sense of the lethality of the disease is useful. Pre-print #1:
The meta-analysis demonstrated a point-estimate of IFR of 0.75% (0.49-1.01%) with high heterogeneity 
 Preprint #2:
Infection fatality rates ranged from 0.03% to 0.50% and corrected values ranged from 0.02% to 0.40%.
 So these are quite different estimates. One big difference is the that the second report did not include any of the government reports. But in hard hit places, the IFR is reaching 0.19% (New York) and 0.16% (Lombardy).

The clue to the difference is when the second pre-print talks about New York:
Massive deaths of elderly individuals in nursing homes, nosocomial infections, and overwhelmed hospitals may also explain the very high fatality seen in specific locations in Northern Italy and in New York and New Jersey. A very unfortunate decision of the governors in New York and New Jersey was to have COVID-19 patients sent to nursing homes. Moreover, some hospitals in New York City hotspots reached maximum capacity and perhaps could not offer optimal care. With large proportions of medical and paramedical personnel infected, it is possible that nosocomial infections increased the death toll. Use of unnecessarily aggressive management (e.g. mechanical ventilation) may also have contributed to worse outcomes. Furthermore, New York City has an extremely busy, congested public transport system that may have exposed large segments of the population to high infectious load in close contact transmission and, thus, perhaps more severe disease. A more aggressive viral clade has also been speculated, but this needs further verification. These factors may explain why preliminary press-released information on a seroprevalence survey in New York State suggests a much higher IFR. With 20% estimated crude seroprevalence in New York City, including a range between 17.3% in Manhattan to 27.6% in Bronx (adjusted seroprevalence figures have not been released), IFR would be as high as 0.8% in Bronx and 1% in Queens, and even higher if probable COVID-19 deaths are included in the calculation.
 Ok, so now we see a estimate much higher than that seen in the results section. Why? The author conjectures possibilities: poor decisions, hospital transmission, public transit, hospitals were bad, and maybe the virus was different. I kind of think that "we don't know" would be the best summary, but no harm in considering possibilities. But it is where we go next that reveals the real difference:
Moreover, even in these locations, the IFR for non-elderly individuals without predisposing conditions may remain very low. E.g. in New York City only 0.6% of all deaths happened in people
This quote connects to another oddity of the second pre-print: they use studies of blood donors (i.e. very healthy and typically younger individuals). The author argues that estimates from NY are contaminated by people over 65 and with pre-existing conditions (or at least that is how I interpret his comments). This is critical as a study that concludes the IFR ranges from "0.02% to 0.40%" probably has to deal with the population fatality rate of 0.19% and rising.

And so we get back to the title of the post. IFR is an average across many strata, of age, sex, health condition, and health care. The overall summary statistic is not especially meaningful to any specific person stripped of this context. Notice both studies point out heterogeneity in their estimates and that makes sense -- there are different care, demographic, and health characteristics in different populations (as well as the stochastic feature of who happens to get infected first). So there is a big limitation to global estimates of covid-19 IFR,

But the real limitation of preprint #2 is that they are asking a different question than what the title and abstract of the paper appear to imply: "what is the IFR among young, healthy, adults with good access to care". That explains the three blood donor studies (Denmark, Scotland, and the Netherlands) and this has been a central critique. What is really missing is a clear statement of the research question as IFR among the young and healthy.

The first paper states their objective (poorly placed in the paper) as:
This paper presents a systematic effort to collate and aggregate these disparate estimates of IFR using an easily replicable method. While any meta-analysis is only as reliable as the quality of included studies, this will at least put a realistic estimate to the IFR given current published evidence.
 The second paper had a clear objective:
To estimate the infection fatality rate of coronavirus disease 2019 (COVID-19) from data of seroprevalence studies.
 But it was missing a very important caveat: "among young and healthy individuals". In that context, the results from both studies make sense. If anything, this is a lesson that the population structure is the really interesting part. Obviously, a 50 year old with hypertension might have a couple of decades of life left. The CDC estimates that 37% of adult men between 40 and 59 have hypertension. So the estimate among the young and healthy is useful, but hardly can drive policy for the population as a whole.

One also thinks these caveats are needed here too, because this appears to be accurate only if the "young and healthy" caveat is included:
However, it is helpful to know that SARS-CoV-2 has relatively low IFR overall and that possibly its IFR can be made even lower with appropriate, precise non-pharmacological choices.
 Whereas I think pre-print #1 is uncontroversial in their conclusions:
Based on a systematic review and meta-analysis of published evidence on COVID-19 until the end of April, 2020, the IFR of the disease across populations is 0.75% (0.49-1.01%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents the ‘true’ point estimate. It is likely that different places will experience different IFRs. More research looking at age-stratified IFR is urgently needed to inform policy-making on this front.
 So, I think that what we are learning is that we need to be extremely precise in what we are measuring and including in our analysis of something with a complex structure like IFR. New York City might end up being a unique case, or it could be a harbinger of things to come elsewhere (especially if the speculation about strains of virus are true).

I suspect that sort of more complicated analysis is needed to really understand the policy risks of different pandemic mitigation strategies. I think what is most needed are nuanced estimates that transparently engage uncertainty and population differences. Hopefully both of these preprints will mature in the peer review process.

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Wednesday, May 20, 2020

There’s about to be a huge business travel shaped hole in the economy and we need to start thinking about how we are going to fill it up.




For most sectors, the post pandemic economy will probably look a lot like the pre-pandemic economy. For certain industries, however, we are probably looking at a permanent market contraction. In these cases, the business models will have to fundamentally change and it is likely that many of the major players will not see the end of the decade . The one sector I’m most bearish on is business travel. Both because travel in general is going to suffer from heightened pandemic concerns and because it is an industry that is long overdue a major downsizing.

One of the widely known but little talked about truths of the white-collar world is that most of the trips we take are an enormous waste of time and money not to mention being horrible from an environmental standpoint.

Ironically, the modern age of business travel started in the postwar era about the same time that modern telecommunication was about to make it increasingly obsolete. Even before the pandemic, companies were starting to catch on to the absurdity of flying people across the country to sit at a conference room and wait for 20 minutes while someone locates missing cords and tries to get the PowerPoint projection in focus on a beige wall when you could simply have everyone sitting at their own desk watching the presentations on large high definition monitors.

The one real value of these meetings was social, allowing people who had interacted only over the phone and through emails actually hang out together eat lunch and perhaps have a couple of drinks, but all too often, the participants are flying in early in the morning and flying out on an afternoon flight so their time together is spent trying to read a blurry projection rather than bonding.

Of course, some business travel is legitimately necessary, and there will certainly be at least a few companies that are still reluctant to embrace 21st-century approaches. The industry is not going to disappear in 2021. It will, however, inevitably be smaller and require leaner business models probably less dependent on the principal agent problem.

This is going to leave a hole in the economy and it is not too early to start the discussion of how we are going to fill it up.
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Tuesday, May 19, 2020

"In Georgia, either the numbers are being cooked, or they’ve accidentally fallen into the stew pot." -- a whole bunch of Tuesday tweets


 

Tesla Charts gives Musk a break and takes a hard, insightful look into airline travel. Essential thread.


  
As the New York Times grows increasingly out of step with the rest of the industry (particularly the Washington Post) on false balance, it reacts by becoming more and more invested in its own superiority. This is unlikely to work out well.

 

More on terrestrial superstations.
A few years ago, conventional wisdom insisted that over the air television was all but dead.https://t.co/sxWqCrNiEE https://t.co/DXQgtRtSVz
 
Looks bad.


More travel thoughts from the reliable James Fallows.


It is now impossible to tell the difference between scam artist and true believer (though the "Made in China" may be a clue). Either way I hope he sells a milliion.
 

Kemp's polling on the handling of the crisis is terrible. You have to wonder how it would be if the state was actually reporting the real numbers.
 
Two from actual epidemiologists.

  
For me, it's the handwritten RN badge that really sells it.

  


Related note.
 
 

Another from Fallows, one of the very few national journalists who can intelligently discuss agriculture.
  



Two steps forward, one step back.


We can't forget Musk.
 


And another favorite.
 



Somewhere out there, somebody is listening to Alex Jones.
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Monday, May 18, 2020

Challenge Trials

This is Joseph

I am a bit late to the Challenge Trial debate for covid-19. Here is a great piece written by Thomas Lumley, who points out the speed advantages in getting a vaccine to market. It is also likely that there will be several possible candidate vaccines. Derek Lowe discusses nine advanced candidates, with different approaches:
So by my count, the biggest and most advanced programs include two inactivated virus vaccines, three different adenovirus vector vaccines, two mRNA possibilities, a DNA vaccine, and a recombinant protein.
At least a couple look to be in Phase II human trials, which the the precursor to phase III (where we evaluate effectiveness). Now, one major barrier is manufacturing the doses, especially since we decided to off-shore a lot of our biomedical capacity in the name of efficiency (at the cost of robustness).

Now these are very important. First, it is possible for the vaccine to increase the cytokine storm intensity and make the disease more fatal. The good news is the immunology is suggesting good targets that should avoid this issue.  But the word "should" is important and it is rather important to be clear about this before millions of people are inoculated.

Second, we want an effective vaccine and it may be the case that candidates vary in their effectiveness. There are successful vaccines that do not grant 100% immunity. The original polio vaccines were only 60-70% effective versus one of the strains, but that still led to a vast decrease in the number of infections in the United States once vaccination became standard.

So, clearly we want trials. While manufacturing is about to be a massive hurdle, the vaccine can be focused on the most vulnerable first, which can help a lot, while slowly covering the whole population. Combined with public health measures, a vaccine would be pure good news.

Now we get to the point about medical ethics. A phase III trial takes a long time to conduct and there is some political pressure for a fast solution. It is exceedingly unhelpful that there is a US presidential election in November, as one can imagine there being a big difference in feelings towards the incumbent who botched the public health response versus the incumbent who started out poorly but managed to lead a uniquely fast solution to the crisis.

Now, if the virus is mostly under control, you need a lot of people and a long time to evaluate the effectiveness of a vaccine. People are rarely exposed so it takes a long time for differences in cases between the arms to show up. If it is not, that is a place where it is hard to run a trial. Just consider the dire conditions in New York city -- while clearly a place one could have tested a vaccine it may not be the best environment to run a medical experiment in.

Another option is the challenge trial. Likely only taking a few hundred participants, it would have no more deaths than a regular trial. But it would involve infecting people, treated with a placebo(!!), with a potentially fatal infectious disease. There are greater good arguments here, but the longer I think about them the more dubious they get to me. Informed consent for things that are so dangerous really does suggest coercion. In the comments, Thomas Lumley points out that organ harvesting could be consented to if the payout was big enough but that isn't evidence that it is ethical or morally defensible. This suggestion, for example, suggests immigration reform as a goal and not medical experiments:
If all you are asking for is “free informed individual consent”, the inhuman cruelties of first world immigration and asylum laws create plenty of opportunities where deliberate COVID-19 infection is better than any other option. 
For a healthy adult in the 20s a deliberate COVID-19 infection has a lower mortality than paying a smuggler to put him on a shaky boat over a sea hoping to get asylum elsewhere.
My concern is that the political pressure on scientists to cut corners and find ways to speed up the testing will be enormous. It isn't clear that in a crisis it is impossible to justify a challenge trial, at some point there are arguments about brave heroes and the sheer scale of the suffering (in the people killed by the virus, directly and indirectly). But I think there are a lot of issues that need to be carefully thought out first and I have concerns that the pressures of this unique situation will make it harder to think them through.


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