BBO Discussion Forums: Coronavirus - BBO Discussion Forums

The​ official death toll in the UK from Covid-19 – more than thirty thousand – is now the highest in Europe. It is the result of choices made at the beginning of the UK’s response to the pandemic. This is not necessarily to apportion blame: at the beginning of March, all choices seemed bad. The trolley problem, as posed by Philippa Foot in 1967, imagines the driver of a runaway tram who ‘can only steer from one narrow track onto another; five men are working on one track and one man on the other.’ This simple utilitarian problem becomes more challenging when you change the factors. Could you justify saving your mother at the expense of two people you’d never met? Intention, duty, relationships, societal consequences: all such things complicate the moral question. The epidemiological variation on the trolley problem would be something like: ‘With the most accurate models we have, what is our best course of action to minimise the statistically expected, age-adjusted, all-cause mortality?’

Sars-CoV-2 doesn’t by itself introduce moral complexity into the argument: it’s mechanically more intriguing than a tram, but just as unthinking. The dilemma, as presented to me by an epidemiologist, was whether to go for measures that might truly suppress the virus – at huge cost to the economy and to healthcare, with the very real risk of an even worse second and possible third wave of the disease later – or to accept that many deaths would occur no matter what you did. Your epidemiological duty is to minimise the expected number of life-years lost, which may mean accepting terrible suffering now to alleviate even worse suffering later. When you look at the numbers for Covid-19, the trolley problem becomes appalling, with hundreds of thousands of lives lost either way. ‘I wish I had a faith,’ she said – not a reassuring thing to hear from an epidemiologist.

The instinctive real-world response to the trolley problem isn’t to decide between one person and five, or between a loved relative and two strangers. It’s to shout and scream, pull on the brake, try to jam the wheels, do whatever you can to stop or slow the tram and get the people off the tracks. That’s what I’ve been doing in my work at the Crick Institute, as a member of a large, multinational team of scientists. We are part of an effort that extends across the world: I have never encountered such openness and generosity among scientists (we’re a competitive bunch).

The most immediately solvable problem we identified was a simple one: lack of testing. In March, during the early phase of the UK’s response, famous actors could get tested but healthcare workers couldn’t. If a healthcare worker can’t be tested, they can’t know if their mild symptoms mean they have the disease, or something trivial. It soon became clear that a substantial proportion of transmission occurs without symptoms: either because the symptoms start one or two days after an infected person becomes infectious, or because they never occur. One of the great mysteries of Covid-19 is that its severity ranges from negligible to lethal. A young, healthy person with mild or zero symptoms may easily transmit the virus to vulnerable others. You need meticulous barriers – personal protective equipment, masks especially – and a rigorous testing regime to ensure this doesn’t happen. We are short of PPE, and in March we had very little testing capacity.

On 31 March, the government blamed a shortage of chemical reagents. In reality it was a failure to prepare. On 19 March – at least a month after it should have been obvious that large-scale testing would be useful – a request was made on the prime minister’s behalf to universities and research institutes, asking them to send a particular brand of proprietary testing equipment (normally used for research) to the National Biosample Centre in Milton Keynes. By this point in the pandemic, every country in the world wanted proprietary reagents that would be compatible with these machines. You couldn’t get your hands on the resources needed. Never mind the chemicals, there was even a shortage of swabs, which are no more than glorified cotton buds. As a result, large testing laboratories have only just come online. The target of 100,000 tests per day has now been met, if you include the number of home testing kits sent out in the post with no guarantee they will be carried out, and if you take ‘per day’ to mean ‘on 30 April’. These are not the tricky antibody tests, but the comparatively simple tests for the virus itself. The chemistry has been well understood for thirty years, even if implementing it can be fiddly.

Unable and unwilling to use proprietary reagents and machines, which would have meant competing for resources with other providers, at the Crick we went for a DIY approach. We teamed up with hospitals and pathology labs, and got excellent input from Public Health Wales. Our downloadable protocols have helped other institutes to set up their own testing facilities, and we have given advice and homemade reagents to university departments and to the new large testing labs. We haven’t been especially clever; we’ve just worked hard.

Writing in the LRB dated 19 March (which went to press two weeks earlier), I assumed that well-organised democracies would follow the model of South Korea, where measures were quickly put in place to roll out testing, tracking and tracing through a moderately socially intrusive smartphone app. The wearing of masks is also widespread there – something I should have highlighted at the time. On 5 May, Angela McLean, the UK government’s deputy chief scientific adviser, endorsed this approach. ‘South Korea is really the place in the world that we can look to and say this worked,’ she said. ‘They are a fine example to us, and we should try to emulate what they’ve achieved.’ Better late than never.

South Korea suppressed its epidemic from a peak of 851 detected cases on 3 March to a long plateau at around a hundred cases a day by mid-March. Now it usually records fewer than ten new cases a day, most of them detected at Seoul’s main international airport. South Korea is reopening its economy, as are other countries that have brought their case numbers down to manageable levels: New Zealand, Australia, China, Taiwan, Vietnam. None of these countries allowed case numbers to get out of control in the way that most of Western Europe and the United States have. It remains to be seen if the South Korean approach will work to suppress a much bigger epidemic.

To suppress the epidemic you have to ensure that, on average, every person who catches the virus passes it to fewer than one other person. The lockdown measures in the UK and elsewhere have achieved this, though in an unsustainable way. When we ran our first samples at the Crick, from healthcare workers showing symptoms at the peak of the wave, we found lots of positive cases, noses and throats full of virus. Now the enemy is scattered, maybe one or two in a plate of 96 samples. If across the whole population we could find those cases, isolate them, and isolate and test all their contacts, we could stop transmission. We’d need to act fast and test thoroughly.

There appears to be a plan. Test as much as possible, and focus the tests on the people most at risk and those who look after them. For every person who catches the virus, symptomatic, pre-symptomatic or asymptomatic, isolate and test all their known contacts. Contact-tracing phone apps can help. You alert the system if you get symptoms. You can then be tested, and your contacts (determined by Bluetooth, and by old-fashioned tracing) can be isolated and tested. As I write, two different apps are under development by the NHS. Whichever ends up being chosen it should work well, provided enough people use it. But it won’t work if people want it to be perfect rather than useful, or refuse to use it because of privacy concerns. Of course it must be reasonably secure, but anyone using, say, Facebook routinely hands over more personal information than the proposed apps will ever require.

If we are determined and organised in the next phase of the pandemic – some aspects of the response so far have been good, but in other respects the first phase has been feeble and shambolic – there is a good chance this will make a difference. But for how long can we keep it up? Eventually we will need immunity to the virus. This can occur either by infection or by vaccination. The ‘strategy’ of immunity by infection – which appeared to be the UK government’s chosen route at one point – was characterised by one of my colleagues, a virologist, as ‘tantamount to surrendering before even one bullet has been fired’. Infection clearly leads to a degree of immunity in most cases, just as it leads to death in a small proportion. The problem is that coronaviruses have evolved many mechanisms to suppress immunity.

Measuring immunity is important, but it isn’t easy. The most obvious way is to look for the presence of antibodies. But antibodies to what? The virus has many components. Its main entry weapon is known as Spike. This is a large, sugar-coated protein complex that can rip a hole in the membrane of a cell to allow the virus to enter. Block Spike, and you keep the virus out. It’s easy enough to measure antibodies to Spike, but not all of them actually prevent the virus from entering cells. To find out whether the antibodies are doing their job effectively, you have to culture the virus in a high-containment facility, titrate tiny amounts of serum extracted from the test subject’s blood into the virus culture, and demonstrate that the serum blocks the virus. It’s painfully slow. We are working on ways to make these assays faster, easier and more accurate. So are many others, and for once I’m happy when another lab does something better. The procedure isn’t going to be useful for testing on a large scale: instead, we’ll have to correlate antibody tests with the neutralisation assays. Some of the newly developed commercial antibody tests will probably correlate well. Others will be useful only for epidemiologists as markers of infection. Until very recently, most of the widely available tests have been so inaccurate as to be useless.

If someone outside a high-end research lab has conducted a test for you purporting to show that you are ‘immune’, I strongly caution against assuming it means anything. Lots of people have had symptoms compatible with coronavirus. In a recent draft of a study from an excellent laboratory in New York, 99.5 per cent of people who had confirmed infection developed antibodies eventually, sometimes several weeks after the test for the virus itself. Only 38 per cent of people with likely symptoms of Covid-19 – but with no positive test – had developed antibodies. Assuming that probable infection means definite immunity is a very big mistake.

There are four ‘seasonal’ coronaviruses – 229E, OC43, NL63 and HKU1 – that cause mild disease in nearly everyone, only occasionally causing pneumonia. They can be given to healthy volunteers to study the immune response. They cause the ‘common cold’, and in experimentally infected humans they give rise to an antibody response. That response wanes after a few months, and the same people can be experimentally reinfected, though they tend to get milder symptoms the second time round. It is thought that adults get reinfected on average about once every five years. Sars-CoV-2 causes mild disease in most cases, and gives rise to antibody responses in nearly all cases. We don’t know how long these responses will last, but it is likely that people who suffer only mild disease will be susceptible to reinfection after a few months or years. Humanity has never developed ‘herd immunity’ to any coronavirus, and it’s unlikely that Sars-CoV-2 infection will be any different. If we did nothing, a likely possibility is that Covid-19 would become a recurring plague. We don’t know yet. It may have seemed like an aeon, but we have been aware of this virus for only a few months.

We need a vaccine. The good news is that the virus is not mutating in such a way as to make immunisation especially difficult. One extremely crude vaccine consists of killed virus. This induces very decent immunity in experimental models. More sophisticated vaccines may well be better, and there are more than ninety in various stages of development. Vaccines that induce neutralising antibodies to the virus are strongly predicted to work: maybe not perfectly, and maybe not without complications, but I don’t know a single immunologist or virologist who thinks a vaccine is impossible.

Some are worried that because so many countries are instituting effective control measures it will be hard to demonstrate the effectiveness of a vaccine. However lackadaisical the UK response may have been, it has at least followed a vaguely scientific path. The situation in the US is different. The wealthiest country in the world, with the best bioscience and the largest testing capacity, is in the grip of the worst of the pandemic. It isn’t difficult to work out why this is. The Trump administration’s failures do mean, however, that it won’t be hard to generate the numbers required to show vaccine efficacy in the US. How quickly a vaccine can be rolled out is another matter. I have a bet with a colleague at the Scripps Institute. He thinks it will be four years. I think it will be 18 months, not least because the Bill and Melinda Gates Foundation and other large donors are backing initiatives to put promising vaccine candidates into production before there is conclusive proof they work. But I’d choose this hopeful pragmatism over the fatalism of the trolley problem.

Some stats from the UK Govt. Office of National Statistics

                   Deaths in     Avg. deaths    2020 higher
                     2020         prev 5 yrs    or lower

Weekly avg.         11,943         12,410         - 467 
 weeks 1-8
Week # 9            10,816         11,183         - 367
Week #10            10,895         11,498         - 603
Week #11            11,019         11,205         - 186
Week #12            10,645         10,573         +  72

and then the numbers start getting impacted by Covid
Week #13            11,141         10,310       + 1,011
Week #14            16,387         10,305       + 6,082
Week #15            18,516         10,520       + 7,996
Week #16            22,351         10,497       +11,854
Week #17            21,997         10,458       +11,539
Week #18            17,953          9,941       + 8,012

Note: Numbers exclude Scotland and Northern Ireland.

So our Govt. said that Covid deaths as of 01 May 2020 across the UK were 27,510. The excess deaths {in England and Wales only, excludes Scotland and N. Ireland} as per the ONS report were 46,500 a massive difference. And if one were to extrapolate, we might have had excess 55k-60k deaths in the UK since the Covid outbreak took hold.

I think this is terrible mismanagement by the UK Govt.

I think shyams is pointing to 55k deaths, not the ratio of excess deaths to reported deaths.
You want me to make the case the UK government handled this badly? How long do you have?

The Covid-19 crisis is the third major shock to the global system in the 21st century, following the 2001 terror attacks and the 2008 financial crisis. I suspect it is by far the most significant.

Although the earlier events will figure in history textbooks, both 9/11 and the Lehman Brothers bankruptcy will fade over time from popular memory.

By contrast, I believe, the coronavirus crisis will still be considered a seminal event generations from now. Students of the future will learn of its direct effects and of the questions it brings into sharp relief much as those of today learn about the 1914 assassination of the Archduke, the 1929 stock market crash, or the 1938 Munich Conference. These events were significant but their ultimate historical importance lies in what followed.

This crisis is a massive global event in terms of its impact. Take an American perspective. Almost certainly more Americans will die of Covid-19 than have died in all the military conflicts of the past 70 years. Some respectable projections suggest that more may die than in all the wars of the 20th century. This spring’s job losses have come at a far faster rate than at any point in history and many forecasters believe that unemployment will be above its post-Depression high for two years. As I write this from a small town I have not left in two months, I suspect that no event since the civil war has so dramatically changed the lives of so many families.

A month ago it would have been reasonable to suppose that the deaths, the economic losses and the social disruption would be transitory. This looks much less plausible today. The US has given its best shot (though certainly not the best possible shot) at locking down for two months now and it has not brought daily fatalities below 1,000 a day. Much of the country is now letting up isolation policies. Similar things are happening in much of Europe and new outbreaks have been reported in success-story countries including Singapore, South Korea and Germany. It now looks very plausible that there will not be an enduring improvement on the current situation in the west.

As significant as these events are, what they portend may be even more important, in two respects.

First, we appear to be living through a momentous transition in what governments do. Historically the greatest threat to the lives and security of ordinary people has come from either failures of domestic governance — disorder or tyranny — or from hostile foreign powers. This reality shaped the design of domestic and international political institutions. Progress has been made. Not only have we avoided a repeat of the world wars, but the chance that an individual on our planet will die a violent death is now about one-fifth of what it was a half century ago.

At the same time, threats that are essentially external to all countries have risen in significance and now exceed traditional ones. Over time, climate change threatens to engulf us. Aids, Ebola, Mers, Sars and now Covid-19 suggest that pandemics will recur with some frequency. Then there is terrorism, upheavals that cause mass movements of refugees, and financial instability. We also face challenges coming from new developments in artificial intelligence and information technology. Coronavirus is helping to usher in a world where security depends more on exceeding a threshold of co-operation with allies and adversaries alike than on maintaining a balance of power.

The second way in which Covid-19 may mark a transition is a shift away from western democratic leadership of the global system. The performance of the US government during the crisis has been dismal. Basic tasks such as ensuring the availability of masks for health workers who treat the sick have not been performed. Medium-term planning has been conspicuous by its absence. Elementary safety protocols have been ignored in the White House, putting the safety of leaders at risk.

Yet, For all of the Trump administration’s manifest failures, the US has not been a particularly poor performer compared to the rest of the west. The UK, France, Spain, Italy and many others all have Covid-19 death rates per capita well above the US. In contrast, China, Japan, South Korea, Taiwan, and Thailand all have death rates well under 5 per cent of American levels. The idea that China would be airlifting basic health equipment to the US would have been inconceivable even a year ago.

If the 21st century turns out to be an Asian century as the 20th was an American one, the pandemic may well be remembered as the turning point. We are living through not just dramatic events but what may be well be a hinge in history.

Almost every country across Europe and North America has put in place some kind of lockdown. But not every country has experienced the sharp increase in unemployment that the United States has.



What’s striking is that the countries with the smallest increases in unemployment have something in common. Their governments have put in place sweeping programs that directly pay companies to retain their workers.

The details differ. Australia, Denmark and New Zealand created new programs. France and Germany expanded existing programs. But all of them have tried to maintain the connection between employer and employee even as much of the economy is temporarily shut down.

The United States took a different approach, one supported by both Republicans and Democrats. The $2 trillion stimulus program passed in March did include a modest version of the approach other countries are taking. It’s the $350 billion Paycheck Protection Program, which quickly ran out of money because of high demand.

Yet most of the stimulus went to a mix of other programs. The largest was about $300 billion in checks sent to almost every taxpayer making less than $99,000 a year. The typical check was $1,200.

The evidence so far suggests that those checks haven’t been a very effective stimulus. People who have not lost their jobs — still a large majority of the work force — have instead tended to put the money in a bank account or pay down debt, neither of which helps halt an economic downturn.

“Much of the stimulus checks were saved,” Mark Zandi of Moody’s Analytics says. Jonathan Rothwell of the Brookings Institution is harsher: “Most of that money was entirely wasted.” And Jacob Funk Kirkegaard of the Peterson Institute for International Economics told me: “It is clear that E.U. countries have to date done far better.”

Still, many members of Congress continue to favor sending across-the-board checks. Doing so is simple, they say, and it does help people who’ve lost their jobs. The new stimulus bill that House Democrats expect to pass today includes another round of $1,200 checks.

Almost every country across Europe and North America has put in place some kind of lockdown. But not every country has experienced the sharp increase in unemployment that the United States has.



What’s striking is that the countries with the smallest increases in unemployment have something in common. Their governments have put in place sweeping programs that directly pay companies to retain their workers.

The details differ. Australia, Denmark and New Zealand created new programs. France and Germany expanded existing programs. But all of them have tried to maintain the connection between employer and employee even as much of the economy is temporarily shut down.

The United States took a different approach, one supported by both Republicans and Democrats. The $2 trillion stimulus program passed in March did include a modest version of the approach other countries are taking. It’s the $350 billion Paycheck Protection Program, which quickly ran out of money because of high demand.

Yet most of the stimulus went to a mix of other programs. The largest was about $300 billion in checks sent to almost every taxpayer making less than $99,000 a year. The typical check was $1,200.

The evidence so far suggests that those checks haven’t been a very effective stimulus. People who have not lost their jobs — still a large majority of the work force — have instead tended to put the money in a bank account or pay down debt, neither of which helps halt an economic downturn.

“Much of the stimulus checks were saved,” Mark Zandi of Moody’s Analytics says. Jonathan Rothwell of the Brookings Institution is harsher: “Most of that money was entirely wasted.” And Jacob Funk Kirkegaard of the Peterson Institute for International Economics told me: “It is clear that E.U. countries have to date done far better.”

Still, many members of Congress continue to favor sending across-the-board checks. Doing so is simple, they say, and it does help people who’ve lost their jobs. The new stimulus bill that House Democrats expect to pass today includes another round of $1,200 checks.

Not long after the Sept. 11 attacks, Warren Buffett wrote the classic line, “You only find out who is swimming naked when the tide goes out.” In the current crisis, which is kind of like a 9/11 that never ends, we’re learning the entire country was naked.

That we weren’t ready for a pandemic was obvious. We’re still scrambling for adequate medical supplies and testing equipment. But there are other weaknesses making this disaster worse than it had to be:

Nursing homes have been a particularly nasty vector of coronavirus spread, an indirect result of how poorly their workers are paid, writes Bloomberg’s editorial board. Many work in multiple homes to make ends meet, helping spread the disease. These people need better pay and health benefits so they can stay in one place and take time off when necessary.

The disease has also exposed the vulnerability of America’s food supply, notes Amanda Little. It’s too centralized and inflexible, so when the disease hit we suddenly had millions of unemployed people clamoring for food, even as tons of it was being destroyed. There’s got to be a better way, and it could start with a new Department of Food Security.

Global supply chains, meanwhile, have gone from a big benefit to American industry to a huge problem as factories shut down around the world. To avoid shortages in future calamities, U.S. manufacturing will increasingly come back home — or at least to Mexico, writes Brooke Sutherland. Unfortunately, much of it will be done by robots.

A universal basic income could help American workers get over the whole robots-taking-jobs thing. And this pandemic has made UBI suddenly look much more reasonable, write Tyler Cowen and Garry Kasparov. But the U.S. still needs more-productive economic growth to help pay for it first.

More-productive schooling might help with that. Tweens and teenagers are on to something when they complain about sitting in a classroom all day. All the remote-learning we’re suddenly doing hints at a future of education that is more flexible and active, writes Andreas Kluth. We just have to make sure it also benefits all students equally, another problem this crisis has exposed.

It’s hard to call big cities a national weakness, but their density may have helped spread Covid-19. They now have to calculate how to carve out more space to let people shop, eat and commute safely, writes Chris Bryant. Oh, and keep out all the extra cars people will suddenly be driving.

One of Elon Musk’s solutions to that last problem is tunnels for carrying Teslas instead of trains, for “individualized mass transit.” Sounds like you just invented the subway, but vastly slower and more expensive! Maybe another of our big pre-Covid weaknesses was paying too much attention to Musk and other Silicon Valley blowhards, writes Tim O’Brien. Somebody like Buffett may offer a better model. He’s at least more quotable.

Lying in bed on the night of 10 January, scrolling through news on his smartphone, Andrew Mesecar got an alert. He sat up. It was here. The complete genome of a coronavirus causing a cluster of pneumonia-like cases in Wuhan, China, had just been posted online.

Around the world, similar notifications appeared on the devices of scientists who first crossed swords with coronaviruses in the 2003 outbreak of SARS (severe acute respiratory syndrome) and then again with MERS (Middle East respiratory syndrome) in 2012. Instantly, the researchers mobilized against a new adversary. “We always knew that this was going to come back,” says Mesecar, head of biochemistry at Purdue University in West Lafayette, Indiana. “It’s what history has shown us.”

In Lübeck, Germany, Rolf Hilgenfeld stopped packing boxes for his retirement and started preparing buffers for crystallography. In Minnesota, Fang Li stayed up all night analysing the new genome and drafting a manuscript. In Shanghai, China, Haitao Yang rallied a dozen graduate students to clear their schedules. In Texas, Jason McLellan instructed laboratory members to start assembling gene sequences from the viral genome.

Within 24 hours, a network of structural biologists around the world had redirected their labs towards a single goal — solving the protein structures of a deadly, rapidly spreading new contagion. To do so, they would need to sift through the 29,811 RNA bases in the virus’s genome, seeking out the instructions for each of its estimated 25–29 proteins. With those instructions in hand, the scientists could recreate the proteins in the lab, visualize them and then, hopefully, identify drug compounds to block them or develop vaccines to incite the immune system against them.

“Here we go,” thought Mesecar. “I’d better get some sleep.”

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OK, let's talk about the COLLEGE APOCALYPSE.

Coronavirus, with a bit of help from Trump, is going to smash the U.S. university system. And it's going to smash the economic model that has sustained college towns.

These engines of regional growth will struggle with state funding cuts, fewer foreign students and destroyed household finances.

thread

Noah Smith @noahpinion said:

OK, let's talk about the COLLEGE APOCALYPSE.

Coronavirus, with a bit of help from Trump, is going to smash the U.S. university system. And it's going to smash the economic model that has sustained college towns.

These engines of regional growth will struggle with state funding cuts, fewer foreign students and destroyed household finances.

thread

There are some differences that might explain at least some of what's going on:
1. California has a big homeless population (151k people) and a high poverty rate (13.4%, just a bit higher than the US average), Switzerland basically doesn't have those things.
2. Switzerland has universal health coverage (less than 1% uninsured) while California doesn't (7% uninsured is good for the US though).
3. Unemployment has been a big problem in CA (up to 25% now, from 4% before the crisis) while Switzerland hasn't had this issue as much (3.3% now, from 2.5% before the crisis).

Ultimately, I think that one of the big problems that the US is going to need to deal with is that one of out political parties has spent decades deliberately cultivating a cult mentality in a broad swatch of the US population.

At the end of the day, conservatives lack basic skills around critical thinking that are necessary for them to participating in a democracy.
And, until these idiots die off, our country is going to go through some very very rough times.

At the national level this is surely a big factor. But the Democrats have control of California at all levels of government. Yes there are some random yahoos protesting the lockdown but we have that here too (okay they don’t have guns and Nazi flags when they protest in Bern but they do show up).

From Joe Sexton and Joaquin Sapien at ProPublica: https://www.propubli...s-as-california


According to recent disease model estimates, at least 10,000 NYers were infected on March 2 when the 2nd confirmed case was reported. Kudos to Breed for shutting down on the 16th when others were dithering but it's pretty obvious that nobody in a position of responsibility in the US was on top of this when they needed to be, i.e. during the first 10 days after the virus was confirmed to have spread to South Korea (Jan 20) and Taiwan (Jan 21) and during the last 17 years since the SARS outbreak and the last 8 since the MERS outbreak.