How many lives is hospitalization saving in the pandemic?

Friday, April 3rd, 2020

Do we have evidence that hospitalization of COVID19 patients is actually saving significant numbers of lives?

I’ve now seen multiple studies suggesting that up to 80 or 90 percent of patients who end up on ventilators ultimately die. At this point, I guess there’s no way to know if the other 10 percent would have lived without the ventilators. From what I can tell, most other hospitalized patients are getting supplemental oxygen, IV fluids and antibiotics. I have not seen any evidence on the effectiveness of these treatments. Many of those patients live, but we don’t know whether they would have recovered without hospitalization. It would obviously be impossible to do a RCT on that at the moment.

Answering the question about the efficacy of hospitalization would seem to be critical, though, since, as best I can tell, the main justification for shutting down society now is to prevent our health care system from being overwhelmed — especially the supply of ventilators. If our hospitals are overwhelmed, not only COVID19 patients, but others with treatable injuries/diseases might die. But if hospitalization is not actually saving COVID19 patients in large numbers, then all the costly social interventions we are implementing now are mostly just delaying the spread of infection.

Journalists would be better served by picking up a $6 Kindle edition of the relevant VSI volume instead

Thursday, April 2nd, 2020

As February turned to March, T. Greer realized he needed a better understanding of epidemics and disaster response:

It was clear to me then that the coronavirus was going to blow up in my own country, that I was going to be voicing opinions about it, and that in consequence I had a responsibility to inform myself as well as I could within the constraints of my budget and schedule. I wanted a stronger grounding in the history and past examples of American disaster response and the basics of epidemiology. Towards that end I bought about ten books, seven of which I have now finished. I do not have time to review them at all length, but I can provide some capsule-reviews for people who are interested in reading more on these topics themselves.

Christian McMillen’s Pandemics: A Very Short Introduction and Marta Wayne and Benjamin Bolker’s Infectious Disease: A Very Short Introduction are both excellent little primers. I am an unabashed fan of the Very Short Introduction series. Their basic idea is to find a noted expert in topic X and have them write an accessible-yet-intelligent 100-150 page introduction of their topic of expertise. Many journalists and commentators who spend several hours trawling Wikipedia whenever a new topic hits the news cycle would be far better served by picking up a $6 Kindle edition of the relevant VSI volume instead. These two books are oddly complimentary: McMillen is a historian, and his Very Short Introduction is focused on the social history of past pandemics. Wayne and Bolker are an ecologist and geneticist, respectively, and their focus is on modeling the dynamics of disease growth. McMillen devotes chapters to the bubonic plague, smallpox, cholera, malaria, tuberculosis, influenza, and AIDS; Wayne and Bolker also provide 20-page summaries of various diseases, their case studies being influenza, HIV, cholera, malaria, and Bd (the fungal disease wiping out many of the world’s amphibious populations). Together the two books provide a solid introduction to how various types of diseases work and the history of human attempts to treat or contain them.

We would find ourselves with an atomised society in which no one felt he had any duty to anyone else

Sunday, March 29th, 2020

Years ago, back in 2004, Anthony Daniels (perhaps better known as Theodore Dalrymple) picked up a book by André Maurois, published in 1931, called L’Amerique Inattendue. Maurois, who had taken a position teaching French literature at Princeton, preferred the character of the Americans in adversity to that in triumphal materialistic optimism:

I felt distinctly uncomfortable while reading Maurois. I am no economist and am not qualified to opine on economic affairs. Yet we seem to me to have been conducting ourselves in Britain as if the present economic climate will continue forever, regardless of what we do, as if there were no tomorrow, or at least no tomorrow that might be very different from today. On the one hand, our boom requires that we spend, or it comes to an end; on the other, we shall have nothing for our old age if we do.

Our public life is frivolous, but frivolous without gaiety. It is also earnest without being serious. The Chancellor, Mr Brown, warned us recently of the threat that China and India posed to our prosperity. We cannot compete with those countries in cost of labour, of course; but their success is based not just on cheap labour, but on a powerful combination of cheap labour and an educational system that is far more serious than ours. While we — that is to say, the government of which Mr Brown is a prominent member — are so obsessed with supposed social justice that we are prepared to tolerate any degree of mediocrity, India and China foster talent in a very Darwinian fashion, in the hope and expectation that everyone will benefit in the long run. Before long, there will be nothing that we can do better than they.

At the same time, we have destroyed, or at least undermined, all forms of social solidarity other than handouts from the state. If ever there should be a serious downturn in our economic fortunes, which would not be unprecedented in history after all, we would find ourselves with an atomised society in which no one felt he had any duty to anyone else. Widespread social, or rather antisocial, disturbances might very well result.

By the time I had finished Maurois’s forgotten but suggestive little book, I was almost trembling with fear.

You just need to turn off the central air conditioning

Friday, March 27th, 2020

The cordon sanitaire that began around Wuhan and two nearby cities on Jan. 23 helped slow the virus’s transmission to other parts of China, but didn’t really stop it in Wuhan itself:

Instead, the virus kept spreading among family members in homes, in large part because hospitals were too overwhelmed to handle all the patients, according to doctors and patients there.

What really turned the tide in Wuhan was a shift after Feb. 2 to a more aggressive and systematic quarantine regime whereby suspected or mild cases—and even healthy close contacts of confirmed cases—were sent to makeshift hospitals and temporary quarantine centers.

The tactics required turning hundreds of hotels, schools and other places into quarantine centers, as well as building two new hospitals and creating 14 temporary ones in public buildings. It also underscored the importance of coronavirus testing capacity, which local authorities say was expanded from 200 tests a day in late January to 7,000 daily by mid-February.

[...]

In New York City, federal authorities plan to set up mobile hospitals, with a total capacity of 1,000 beds, at the Jacob K. Javits Convention Center in Manhattan. New York has also been looking into converting entire hotels into hospitals, but it is unclear how many beds will be made available.

Zhang Jinnong, head of the emergency department at Wuhan’s Xiehe Hospital, said the most important thing was to separate the infected from the healthy, and recommended hotels as quarantine centers where people could be isolated in separate rooms.

“You just need to turn off the central air conditioning,” he said.

[...]

South Korea, which has tested more people than any other country, originally tried to hospitalize all confirmed cases. But as wards became overloaded, from March 1 it divided coronavirus patients into four categories: asymptomatic, mild, severe and critical.

Only severe and critical cases were hospitalized, while mild and asymptomatic cases were placed in makeshift hospitals known as “residential treatment facilities.”

In Singapore, all suspected cases have been isolated in hospitals, while close contacts of confirmed cases have been systematically tracked and quarantined in government-run facilities or at home.

[...]

Another critical factor was the deployment to Wuhan of thousands of extra doctors and nurses from elsewhere in China. Among them was Meng Xinke, a doctor from the intensive care department of the No. 2 People’s Hospital in Shenzhen.

He arrived in Wuhan on Feb. 9 and was put to work in an exhibition center newly transformed into a makeshift hospital with 40 doctors and 1,461 beds, for confirmed mild coronavirus cases. Separating milder cases “is a great way to save resources,” he said, adding that five doctors were able to look after 400 patients during each shift.

His daily routine included checking patients’ vital signs, giving them medication, conducting tests, and identifying those developing severe symptoms. After about two weeks, he said, his team noticed that about 10%-15% of patients discharged from some makeshift hospitals were later testing positive again—a possible indication they hadn’t fully cleared the virus.

On Feb. 22, Wuhan required all discharged patients to go to quarantine sites for another two weeks instead of heading home.

N95 versus KN95

Thursday, March 26th, 2020

3M has a recent technical bulletin that spells out the subtle differences in filtering facepiece respirator classes, such as FFP2, KN95, and N95 — and the differences are very, very subtle. Namely, the N95 masks that are out of stock across the country are indistinguishable from the KN95 masks that are sitting on the shelves, but the N95 masks are certified for use in the US medical system, and the KN95 masks are certified for use in China:

This document is only intended to help clarify some key similarities between such references, specifically to the following FFR performance standards:

  • N95 (United States NIOSH-42CFR84)
  • FFP2 (Europe EN 149-2001)
  • KN95 (China GB2626-2006)
  • P2 (Australia/New Zealand AS/NZA 1716:2012)
  • Korea 1st class (Korea KMOEL – 2017-64)
  • DS (Japan JMHLW-Notification 214, 2018)

As shown in the following summary table, respirators certified as meeting these standards can be expected to function very similarly to one another, based on the performance requirements stated in the standards and confirmed during conformity testing.

N95 Masks versus Comparables

Trump’s early adopters were alarmed over coronavirus

Wednesday, March 25th, 2020

When T.A. Frank’s coronavirus monitoring first kicked into gear, it was thanks to alarming tweets from Mike Cernovich in January:

Because I’d spent several frightening weeks in China and Hong Kong during the SARS outbreak in 2003, I needed no further encouragement to obsess over something reminiscent of it. In the weeks that followed, I began to look for the pronouncements of others who were most out in front of the pack in expressing concern. These included angel investor Balaji S. Srinivasan, geneticist Razib Khan, Dilbert cartoonist Scott Adams, Trump White House veteran Steve Bannon, Ars Technica cofounder Jon Stokes, Quillette editor Claire Lehmann, entrepreneur Jeff Giesea, author Matt Stoller, and Fox host Tucker Carlson. All of them, I noticed, stood at least a little outside of the mainstream. And a fair number of them were associated with the grassroots energy of Donald Trump’s campaign in 2016.

Here’s what was curious about this final point. Donald Trump, as we all know, spent several weeks downplaying the coronavirus problem and two crucial weeks, starting on February 26, when he suggested the number of cases was soon “going to be down to close to zero,” in outright denial. A whole host of Trump supporters joined the president in pooh-poohing the problem. “Healthy people, generally, 99% recover very fast, even if they contract it,” offered Fox’s Sean Hannity on March 10. Lots of man in the street Trump supporters were just as dismissive. But people like Bannon and Cernovich were not at all on board with Trump’s sinking ship of a message, and in some ways they’re more Trumpist than Trump. What, then, was the difference between Trumpists who followed the president into denial and Trumpists who, 180 degrees to the contrary, were in a vanguard of alarm?

It took me some thought and conversations about this question before I came up with an answer that turned out to be simple: It was Trump’s early adopters, the ones who supported him before he looked like a winner to the rest of the world, who were ahead of the average in expressing alarm over the coronavirus. It was Trump’s late adopters, the ones who would have lined up behind any Republican in power, who carried water for the message of denial.

The learning of this people is very defective, consisting only in morality, history, poetry, and mathematics

Friday, March 20th, 2020

After failing to impress the king of Brob­­ding­­nag, Gulliver tries another tack:

In hopes to ingratiate myself further into his majesty’s favour, I told him of “an invention, discovered between three and four hundred years ago, to make a certain powder, into a heap of which, the smallest spark of fire falling, would kindle the whole in a moment, although it were as big as a mountain, and make it all fly up in the air together, with a noise and agitation greater than thunder. That a proper quantity of this powder rammed into a hollow tube of brass or iron, according to its bigness, would drive a ball of iron or lead, with such violence and speed, as nothing was able to sustain its force. That the largest balls thus discharged, would not only destroy whole ranks of an army at once, but batter the strongest walls to the ground, sink down ships, with a thousand men in each, to the bottom of the sea, and when linked together by a chain, would cut through masts and rigging, divide hundreds of bodies in the middle, and lay all waste before them. That we often put this powder into large hollow balls of iron, and discharged them by an engine into some city we were besieging, which would rip up the pavements, tear the houses to pieces, burst and throw splinters on every side, dashing out the brains of all who came near. That I knew the ingredients very well, which were cheap and common; I understood the manner of compounding them, and could direct his workmen how to make those tubes, of a size proportionable to all other things in his majesty’s kingdom, and the largest need not be above a hundred feet long; twenty or thirty of which tubes, charged with the proper quantity of powder and balls, would batter down the walls of the strongest town in his dominions in a few hours, or destroy the whole metropolis, if ever it should pretend to dispute his absolute commands.” This I humbly offered to his majesty, as a small tribute of acknowledgment, in turn for so many marks that I had received, of his royal favour and protection.

The king was struck with horror at the description I had given of those terrible engines, and the proposal I had made. “He was amazed, how so impotent and grovelling an insect as I” (these were his expressions) “could entertain such inhuman ideas, and in so familiar a manner, as to appear wholly unmoved at all the scenes of blood and desolation which I had painted as the common effects of those destructive machines; whereof,” he said, “some evil genius, enemy to mankind, must have been the first contriver. As for himself, he protested, that although few things delighted him so much as new discoveries in art or in nature, yet he would rather lose half his kingdom, than be privy to such a secret; which he commanded me, as I valued any life, never to mention any more.”

A strange effect of narrow principles and views! that a prince possessed of every quality which procures veneration, love, and esteem; of strong parts, great wisdom, and profound learning, endowed with admirable talents, and almost adored by his subjects, should, from a nice, unnecessary scruple, whereof in Europe we can have no conception, let slip an opportunity put into his hands that would have made him absolute master of the lives, the liberties, and the fortunes of his people! Neither do I say this, with the least intention to detract from the many virtues of that excellent king, whose character, I am sensible, will, on this account, be very much lessened in the opinion of an English reader: but I take this defect among them to have risen from their ignorance, by not having hitherto reduced politics into a science, as the more acute wits of Europe have done. For, I remember very well, in a discourse one day with the king, when I happened to say, “there were several thousand books among us written upon the art of government,” it gave him (directly contrary to my intention) a very mean opinion of our understandings. He professed both to abominate and despise all mystery, refinement, and intrigue, either in a prince or a minister. He could not tell what I meant by secrets of state, where an enemy, or some rival nation, were not in the case. He confined the knowledge of governing within very narrow bounds, to common sense and reason, to justice and lenity, to the speedy determination of civil and criminal causes; with some other obvious topics, which are not worth considering. And he gave it for his opinion, “that whoever could make two ears of corn, or two blades of grass, to grow upon a spot of ground where only one grew before, would deserve better of mankind, and do more essential service to his country, than the whole race of politicians put together.”

The learning of this people is very defective, consisting only in morality, history, poetry, and mathematics, wherein they must be allowed to excel. But the last of these is wholly applied to what may be useful in life, to the improvement of agriculture, and all mechanical arts; so that among us, it would be little esteemed. And as to ideas, entities, abstractions, and transcendentals, I could never drive the least conception into their heads.

No law in that country must exceed in words the number of letters in their alphabet, which consists only of two and twenty. But indeed few of them extend even to that length. They are expressed in the most plain and simple terms, wherein those people are not mercurial enough to discover above one interpretation: and to write a comment upon any law, is a capital crime. As to the decision of civil causes, or proceedings against criminals, their precedents are so few, that they have little reason to boast of any extraordinary skill in either.

They have had the art of printing, as well as the Chinese, time out of mind: but their libraries are not very large; for that of the king, which is reckoned the largest, does not amount to above a thousand volumes, placed in a gallery of twelve hundred feet long, whence I had liberty to borrow what books I pleased. The queen’s joiner had contrived in one of Glumdalclitch’s rooms, a kind of wooden machine five-and-twenty feet high, formed like a standing ladder; the steps were each fifty feet long. It was indeed a moveable pair of stairs, the lowest end placed at ten feet distance from the wall of the chamber. The book I had a mind to read, was put up leaning against the wall: I first mounted to the upper step of the ladder, and turning my face towards the book, began at the top of the page, and so walking to the right and left about eight or ten paces, according to the length of the lines, till I had gotten a little below the level of mine eyes, and then descending gradually till I came to the bottom: after which I mounted again, and began the other page in the same manner, and so turned over the leaf, which I could easily do with both my hands, for it was as thick and stiff as a pasteboard, and in the largest folios not above eighteen or twenty feet long.

Their style is clear, masculine, and smooth, but not florid; for they avoid nothing more than multiplying unnecessary words, or using various expressions. I have perused many of their books, especially those in history and morality. Among the rest, I was much diverted with a little old treatise, which always lay in Glumdalclitch’s bed chamber, and belonged to her governess, a grave elderly gentlewoman, who dealt in writings of morality and devotion. The book treats of the weakness of human kind, and is in little esteem, except among the women and the vulgar. However, I was curious to see what an author of that country could say upon such a subject. This writer went through all the usual topics of European moralists, showing “how diminutive, contemptible, and helpless an animal was man in his own nature; how unable to defend himself from inclemencies of the air, or the fury of wild beasts: how much he was excelled by one creature in strength, by another in speed, by a third in foresight, by a fourth in industry.” He added, “that nature was degenerated in these latter declining ages of the world, and could now produce only small abortive births, in comparison of those in ancient times.” He said “it was very reasonable to think, not only that the species of men were originally much larger, but also that there must have been giants in former ages; which, as it is asserted by history and tradition, so it has been confirmed by huge bones and skulls, casually dug up in several parts of the kingdom, far exceeding the common dwindled race of men in our days.” He argued, “that the very laws of nature absolutely required we should have been made, in the beginning of a size more large and robust; not so liable to destruction from every little accident, of a tile falling from a house, or a stone cast from the hand of a boy, or being drowned in a little brook.” From this way of reasoning, the author drew several moral applications, useful in the conduct of life, but needless here to repeat. For my own part, I could not avoid reflecting how universally this talent was spread, of drawing lectures in morality, or indeed rather matter of discontent and repining, from the quarrels we raise with nature. And I believe, upon a strict inquiry, those quarrels might be shown as ill-grounded among us as they are among that people.

As to their military affairs, they boast that the king’s army consists of a hundred and seventy-six thousand foot, and thirty-two thousand horse: if that may be called an army, which is made up of tradesmen in the several cities, and farmers in the country, whose commanders are only the nobility and gentry, without pay or reward. They are indeed perfect enough in their exercises, and under very good discipline, wherein I saw no great merit; for how should it be otherwise, where every farmer is under the command of his own landlord, and every citizen under that of the principal men in his own city, chosen after the manner of Venice, by ballot?

I have often seen the militia of Lorbrulgrud drawn out to exercise, in a great field near the city of twenty miles square. They were in all not above twenty-five thousand foot, and six thousand horse; but it was impossible for me to compute their number, considering the space of ground they took up. A cavalier, mounted on a large steed, might be about ninety feet high. I have seen this whole body of horse, upon a word of command, draw their swords at once, and brandish them in the air. Imagination can figure nothing so grand, so surprising, and so astonishing! it looked as if ten thousand flashes of lightning were darting at the same time from every quarter of the sky.

I was curious to know how this prince, to whose dominions there is no access from any other country, came to think of armies, or to teach his people the practice of military discipline. But I was soon informed, both by conversation and reading their histories; for, in the course of many ages, they have been troubled with the same disease to which the whole race of mankind is subject; the nobility often contending for power, the people for liberty, and the king for absolute dominion. All which, however happily tempered by the laws of that kingdom, have been sometimes violated by each of the three parties, and have more than once occasioned civil wars; the last whereof was happily put an end to by this prince’s grand-father, in a general composition; and the militia, then settled with common consent, has been ever since kept in the strictest duty.

The most pernicious race of little odious vermin that nature ever suffered to crawl upon the surface of the earth

Thursday, March 19th, 2020

I’ve been listening to the audiobook version of Gulliver’s Travels. After leaving Lilliput and returning to England, Gulliver goes on another voyage and ends up in Brobdingnag, where he’s dwarfed by the giant locals and treated as a curiosity:

It is the custom, that every Wednesday (which, as I have observed, is their Sabbath) the king and queen, with the royal issue of both sexes, dine together in the apartment of his majesty, to whom I was now become a great favourite; and at these times, my little chair and table were placed at his left hand, before one of the salt-cellars. This prince took a pleasure in conversing with me, inquiring into the manners, religion, laws, government, and learning of Europe; wherein I gave him the best account I was able. His apprehension was so clear, and his judgment so exact, that he made very wise reflections and observations upon all I said. But I confess, that, after I had been a little too copious in talking of my own beloved country, of our trade and wars by sea and land, of our schisms in religion, and parties in the state; the prejudices of his education prevailed so far, that he could not forbear taking me up in his right hand, and stroking me gently with the other, after a hearty fit of laughing, asked me, “whether I was a whig or tory?” Then turning to his first minister, who waited behind him with a white staff, near as tall as the mainmast of the Royal Sovereign, he observed “how contemptible a thing was human grandeur, which could be mimicked by such diminutive insects as I: and yet,” says he, “I dare engage these creatures have their titles and distinctions of honour; they contrive little nests and burrows, that they call houses and cities; they make a figure in dress and equipage; they love, they fight, they dispute, they cheat, they betray!” And thus he continued on, while my colour came and went several times, with indignation, to hear our noble country, the mistress of arts and arms, the scourge of France, the arbitress of Europe, the seat of virtue, piety, honour, and truth, the pride and envy of the world, so contemptuously treated.

[...]

The king, who, as I before observed, was a prince of excellent understanding, would frequently order that I should be brought in my box, and set upon the table in his closet: he would then command me to bring one of my chairs out of the box, and sit down within three yards distance upon the top of the cabinet, which brought me almost to a level with his face. In this manner I had several conversations with him. I one day took the freedom to tell his majesty, “that the contempt he discovered towards Europe, and the rest of the world, did not seem answerable to those excellent qualities of mind that he was master of; that reason did not extend itself with the bulk of the body; on the contrary, we observed in our country, that the tallest persons were usually the least provided with it; that among other animals, bees and ants had the reputation of more industry, art, and sagacity, than many of the larger kinds; and that, as inconsiderable as he took me to be, I hoped I might live to do his majesty some signal service.” The king heard me with attention, and began to conceive a much better opinion of me than he had ever before. He desired “I would give him as exact an account of the government of England as I possibly could; because, as fond as princes commonly are of their own customs (for so he conjectured of other monarchs, by my former discourses), he should be glad to hear of any thing that might deserve imitation.”

Imagine with thyself, courteous reader, how often I then wished for the tongue of Demosthenes or Cicero, that might have enabled me to celebrate the praise of my own dear native country in a style equal to its merits and felicity.

I began my discourse by informing his majesty, that our dominions consisted of two islands, which composed three mighty kingdoms, under one sovereign, beside our plantations in America. I dwelt long upon the fertility of our soil, and the temperature of our climate. I then spoke at large upon the constitution of an English parliament; partly made up of an illustrious body called the House of Peers; persons of the noblest blood, and of the most ancient and ample patrimonies. I described that extraordinary care always taken of their education in arts and arms, to qualify them for being counsellors both to the king and kingdom; to have a share in the legislature; to be members of the highest court of judicature, whence there can be no appeal; and to be champions always ready for the defence of their prince and country, by their valour, conduct, and fidelity. That these were the ornament and bulwark of the kingdom, worthy followers of their most renowned ancestors, whose honour had been the reward of their virtue, from which their posterity were never once known to degenerate. To these were joined several holy persons, as part of that assembly, under the title of bishops, whose peculiar business is to take care of religion, and of those who instruct the people therein. These were searched and sought out through the whole nation, by the prince and his wisest counsellors, among such of the priesthood as were most deservedly distinguished by the sanctity of their lives, and the depth of their erudition; who were indeed the spiritual fathers of the clergy and the people.

That the other part of the parliament consisted of an assembly called the House of Commons, who were all principal gentlemen, freely picked and culled out by the people themselves, for their great abilities and love of their country, to represent the wisdom of the whole nation. And that these two bodies made up the most august assembly in Europe; to whom, in conjunction with the prince, the whole legislature is committed.

I then descended to the courts of justice; over which the judges, those venerable sages and interpreters of the law, presided, for determining the disputed rights and properties of men, as well as for the punishment of vice and protection of innocence. I mentioned the prudent management of our treasury; the valour and achievements of our forces, by sea and land. I computed the number of our people, by reckoning how many millions there might be of each religious sect, or political party among us. I did not omit even our sports and pastimes, or any other particular which I thought might redound to the honour of my country. And I finished all with a brief historical account of affairs and events in England for about a hundred years past.

This conversation was not ended under five audiences, each of several hours; and the king heard the whole with great attention, frequently taking notes of what I spoke, as well as memorandums of what questions he intended to ask me.

When I had put an end to these long discources, his majesty, in a sixth audience, consulting his notes, proposed many doubts, queries, and objections, upon every article. He asked, “What methods were used to cultivate the minds and bodies of our young nobility, and in what kind of business they commonly spent the first and teachable parts of their lives? What course was taken to supply that assembly, when any noble family became extinct? What qualifications were necessary in those who are to be created new lords: whether the humour of the prince, a sum of money to a court lady, or a design of strengthening a party opposite to the public interest, ever happened to be the motive in those advancements? What share of knowledge these lords had in the laws of their country, and how they came by it, so as to enable them to decide the properties of their fellow-subjects in the last resort? Whether they were always so free from avarice, partialities, or want, that a bribe, or some other sinister view, could have no place among them? Whether those holy lords I spoke of were always promoted to that rank upon account of their knowledge in religious matters, and the sanctity of their lives; had never been compliers with the times, while they were common priests; or slavish prostitute chaplains to some nobleman, whose opinions they continued servilely to follow, after they were admitted into that assembly?”

He then desired to know, “What arts were practised in electing those whom I called commoners: whether a stranger, with a strong purse, might not influence the vulgar voters to choose him before their own landlord, or the most considerable gentleman in the neighbourhood? How it came to pass, that people were so violently bent upon getting into this assembly, which I allowed to be a great trouble and expense, often to the ruin of their families, without any salary or pension? because this appeared such an exalted strain of virtue and public spirit, that his majesty seemed to doubt it might possibly not be always sincere.” And he desired to know, “Whether such zealous gentlemen could have any views of refunding themselves for the charges and trouble they were at by sacrificing the public good to the designs of a weak and vicious prince, in conjunction with a corrupted ministry?” He multiplied his questions, and sifted me thoroughly upon every part of this head, proposing numberless inquiries and objections, which I think it not prudent or convenient to repeat.

Upon what I said in relation to our courts of justice, his majesty desired to be satisfied in several points: and this I was the better able to do, having been formerly almost ruined by a long suit in chancery, which was decreed for me with costs. He asked, “What time was usually spent in determining between right and wrong, and what degree of expense? Whether advocates and orators had liberty to plead in causes manifestly known to be unjust, vexatious, or oppressive? Whether party, in religion or politics, were observed to be of any weight in the scale of justice? Whether those pleading orators were persons educated in the general knowledge of equity, or only in provincial, national, and other local customs? Whether they or their judges had any part in penning those laws, which they assumed the liberty of interpreting, and glossing upon at their pleasure? Whether they had ever, at different times, pleaded for and against the same cause, and cited precedents to prove contrary opinions? Whether they were a rich or a poor corporation? Whether they received any pecuniary reward for pleading, or delivering their opinions? And particularly, whether they were ever admitted as members in the lower senate?”

He fell next upon the management of our treasury; and said, “he thought my memory had failed me, because I computed our taxes at about five or six millions a-year, and when I came to mention the issues, he found they sometimes amounted to more than double; for the notes he had taken were very particular in this point, because he hoped, as he told me, that the knowledge of our conduct might be useful to him, and he could not be deceived in his calculations. But, if what I told him were true, he was still at a loss how a kingdom could run out of its estate, like a private person.” He asked me, “who were our creditors; and where we found money to pay them?” He wondered to hear me talk of such chargeable and expensive wars; “that certainly we must be a quarrelsome people, or live among very bad neighbours, and that our generals must needs be richer than our kings.” He asked, “what business we had out of our own islands, unless upon the score of trade, or treaty, or to defend the coasts with our fleet?” Above all, he was amazed to hear me talk of a mercenary standing army, in the midst of peace, and among a free people. He said, “if we were governed by our own consent, in the persons of our representatives, he could not imagine of whom we were afraid, or against whom we were to fight; and would hear my opinion, whether a private man’s house might not be better defended by himself, his children, and family, than by half-a-dozen rascals, picked up at a venture in the streets for small wages, who might get a hundred times more by cutting their throats?”

He laughed at my “odd kind of arithmetic,” as he was pleased to call it, “in reckoning the numbers of our people, by a computation drawn from the several sects among us, in religion and politics.” He said, “he knew no reason why those, who entertain opinions prejudicial to the public, should be obliged to change, or should not be obliged to conceal them. And as it was tyranny in any government to require the first, so it was weakness not to enforce the second: for a man may be allowed to keep poisons in his closet, but not to vend them about for cordials.”

He observed, “that among the diversions of our nobility and gentry, I had mentioned gaming: he desired to know at what age this entertainment was usually taken up, and when it was laid down; how much of their time it employed; whether it ever went so high as to affect their fortunes; whether mean, vicious people, by their dexterity in that art, might not arrive at great riches, and sometimes keep our very nobles in dependence, as well as habituate them to vile companions, wholly take them from the improvement of their minds, and force them, by the losses they received, to learn and practise that infamous dexterity upon others?”

He was perfectly astonished with the historical account gave him of our affairs during the last century; protesting “it was only a heap of conspiracies, rebellions, murders, massacres, revolutions, banishments, the very worst effects that avarice, faction, hypocrisy, perfidiousness, cruelty, rage, madness, hatred, envy, lust, malice, and ambition, could produce.”

His majesty, in another audience, was at the pains to recapitulate the sum of all I had spoken; compared the questions he made with the answers I had given; then taking me into his hands, and stroking me gently, delivered himself in these words, which I shall never forget, nor the manner he spoke them in: “My little friend Grildrig, you have made a most admirable panegyric upon your country; you have clearly proved, that ignorance, idleness, and vice, are the proper ingredients for qualifying a legislator; that laws are best explained, interpreted, and applied, by those whose interest and abilities lie in perverting, confounding, and eluding them. I observe among you some lines of an institution, which, in its original, might have been tolerable, but these half erased, and the rest wholly blurred and blotted by corruptions. It does not appear, from all you have said, how any one perfection is required toward the procurement of any one station among you; much less, that men are ennobled on account of their virtue; that priests are advanced for their piety or learning; soldiers, for their conduct or valour; judges, for their integrity; senators, for the love of their country; or counsellors for their wisdom. As for yourself,” continued the king, “who have spent the greatest part of your life in travelling, I am well disposed to hope you may hitherto have escaped many vices of your country. But by what I have gathered from your own relation, and the answers I have with much pains wrung and extorted from you, I cannot but conclude the bulk of your natives to be the most pernicious race of little odious vermin that nature ever suffered to crawl upon the surface of the earth.”

“With dread” is the only sensible answer

Tuesday, March 17th, 2020

If you’re a socialist, you have to be concerned that so many socialists before you defended totalitarian regimes as they committed atrocities, but you might say that the best socialists spoke out:

A reasonable position. I don’t want my views judged by the quality of the typical person who shares my label, either.

Still, this raises a weighty question: How should the best socialists react when they discover that a new socialist experiment is about to start? “With dread” is the only sensible answer. After all, the best socialists don’t merely know the horrifying history of the Soviet Union and Maoist China. The best socialists also know the psychotic sociology of the typical socialist, who savors the revolutionary “honeymoon” until the horror becomes too blatant to deny.

If dread is the sensible reaction to the latest socialist experiment, then how should the best socialists react to any earnest proposal for a new socialist experiment? It’s complicated. The proposal stage is the perfect time to avoid the errors of the past – to finally do socialism right. Yet this hope must still be heavily laced with dread. After all, socialists have repeatedly tried to learn from the disasters of earlier socialist regimes. When they gained power, disaster still followed.

That’s Bryan Caplan, by the way, and he continues:

At this point, it’s tempting to shift blame to the non-socialist world. Without American-led ostracism, perhaps Cuba would be a fine country today. Or consider Chomsky’s view that the U.S. really won the Vietnam War:

The United States went to war in Vietnam for a very good reason. They were afraid Vietnam would be a successful model of independent development and that would have a virus effect – infect others who might try to follow the same course. There was a very simple war aim – destroy Vietnam. And they did it.

If Chomsky is right about U.S. foreign policy, however, the best socialists should feel even less hope and even more dread. Even if the next generation of socialists finally manages to durably build socialism with a human face, the U.S. will probably strangle it.

Personally, I’m the furthest thing from a socialist. If I were a socialist, though, I would be the world’s most cautious socialist. Socialist experiments don’t merely have a bad track record; socialist self-criticism has a bad track record.

There are three reasons for our decaying institutions

Monday, March 16th, 2020

I suspect Mark Lutter, the founder and executive director of the Charter Cities Institute, was “radicalized” long before the pandemic, but I think he would have been radicalized by COVID if he hadn’t been already:

There are three reasons for our decaying institutions. First, we have become complacent. Second, vetoes have become too widely distributed, the tragedy of the anti-commons. Third, we have an elite that is fundamentally unserious.

First, Americans are complacent. They are too attached to their lifestyles, unwilling to make changes, even now in the face of catastrophe. We see this in the packed bars in Washington, D.C. and New York City. There is a total disconnect between the reality that our hospitals are days away from being overwhelmed, and the “reality” in which these people seem to think they exist.

And this complacency extends to the political class. One of the frequent reasons given for keeping schools open is that some students might go hungry without access to “free-lunch” programs. In 1948 America was able to supply an entire city by air. By the end of the Berlin Airlift more cargo was being transported into the city by air than had ever been by rail. And we are unable to deliver lunches to students staying at home today?

The bureaucracy is not immune to this complacency. The first test the CDC shipped for COVID-19 was faulty. The CDC, along with the FDA forced Dr. Helen Y. Chu, Seattle based infectious disease expert, to stop testing after she discovered a case in Seattle because she wasn’t using the approved CDC test.

The second cause of our institutional failures is the tragedy of the anti-commons, a situation where too many actors have veto rights, leaving valuable resources underused because it becomes too costly to appease all the actors. Larry Summers colorfully describes this as “promiscuously distributing veto power.” Who holds the veto power is typically unclear, leaving private actors unable to respond quickly to a worsening crisis.

The FDA is the worst offender in this regard. They blocked labs from making their own tests, to the point when Dr. Chu thought civil disobedience was better than waiting. It took until Feb 29th for the FDA to implement Emergency Use Authorization to expedite approvals. Until blocks are lifted, manufacturers looking to develop drugs and respirators will have to go through the same byzantine process, delaying their use. Simple solutions like reciprocity, where any drug or medical device approved by tier 1 countries can be used in the US, will likely go ignored.

The FDA is not the only player with veto authority. For a lab to get emergency authorization, for example, they need to be a clinical laboratory, approval of which can take months and is controlled by the Centers for Medicare and Medicaid Services. In discussion groups about developing apps to help track COVID, HIPAA keeps coming up as a main concern.

The final reason for our decaying institutions is that our elite is simply not serious. The response to the crisis has hitherto been to deny and to focus attention on pet concerns. Trump with the stock market. The left with prejudice. And so on. Our ruling class ignores the greatest threat to our way of life in a generation to focus on topics that aren’t relevant.

The World Health Organization a week ago tweeted against using the term infecting as “it implies blame.” The elite does not understand moral responsibility. The people who are still going to events should be blamed. The leaders who force their staff to work should be blamed. The politicians who have not closed schools should be blamed. The World Health Organization, presumably staffed by epidemiologists, was more worried about policing language than preventing the spread of the worst pandemic in a generation.

That all true believers break their eggs at the convenient end

Monday, March 16th, 2020

While listening to the audiobook version of Gulliver’s Travels, I came across this explanation — by Reldresal, principal secretary (as they style him) for private affairs — of an old and important controversy that explains the conflict between Lilliput and Blefuscu:

Which two mighty powers have, as I was going to tell you, been engaged in a most obstinate war for six-and-thirty moons past. It began upon the following occasion. It is allowed on all hands, that the primitive way of breaking eggs, before we eat them, was upon the larger end; but his present majesty’s grandfather, while he was a boy, going to eat an egg, and breaking it according to the ancient practice, happened to cut one of his fingers. Whereupon the emperor his father published an edict, commanding all his subjects, upon great penalties, to break the smaller end of their eggs. The people so highly resented this law, that our histories tell us, there have been six rebellions raised on that account; wherein one emperor lost his life, and another his crown. These civil commotions were constantly fomented by the monarchs of Blefuscu; and when they were quelled, the exiles always fled for refuge to that empire. It is computed that eleven thousand persons have at several times suffered death, rather than submit to break their eggs at the smaller end. Many hundred large volumes have been published upon this controversy: but the books of the Big-endians have been long forbidden, and the whole party rendered incapable by law of holding employments. During the course of these troubles, the emperors of Blefusca did frequently expostulate by their ambassadors, accusing us of making a schism in religion, by offending against a fundamental doctrine of our great prophet Lustrog, in the fifty-fourth chapter of the Blundecral (which is their Alcoran). This, however, is thought to be a mere strain upon the text; for the words are these: ‘that all true believers break their eggs at the convenient end.’ And which is the convenient end, seems, in my humble opinion to be left to every man’s conscience, or at least in the power of the chief magistrate to determine. Now, the Big-endian exiles have found so much credit in the emperor of Blefuscu’s court, and so much private assistance and encouragement from their party here at home, that a bloody war has been carried on between the two empires for six-and-thirty moons, with various success; during which time we have lost forty capital ships, and a much a greater number of smaller vessels, together with thirty thousand of our best seamen and soldiers; and the damage received by the enemy is reckoned to be somewhat greater than ours. However, they have now equipped a numerous fleet, and are just preparing to make a descent upon us; and his imperial majesty, placing great confidence in your valour and strength, has commanded me to lay this account of his affairs before you.

There is no substitute for victory

Thursday, March 12th, 2020

For weeks, the coronavirus news has been paralyzingly bad, Steve Sailer reminds us, but there might be light at the end of the tunnel — at least if we take action:

It now is conceivable that an aggressive response in America could not merely “slow the spread” and “flatten the curve” of this exponentially growing outbreak, but crush it altogether. America’s aim should not be moderation of the epidemic, but its eradication.

Our goal should be not just to lose more slowly and gracefully, but to win.

The most sophisticated idea back in February was that the best we could hope for was to spread out the incidence of infection over enough months to avoid the apocalyptic scenario in which America’s medical system is overwhelmed and exhausted doctors must make triage decisions between treating COVID-19 victims and, say, heart attack victims.

University of Washington biologist Carl T. Bergstrom developed this useful hypothetical graph below (which he specifies is “freely available for any use under the CC-BY-2.0 license”) to get across the idea of how slowing the spread can lessen the chances that your loved one will be turned away by the hospital.

Lower and Delay the Epidemic Peak

In Bergstrom’s graph, the horizontal axis is time and the vertical axis is the number of cases at any one point. Under uncontrolled transmission (the graph’s red curve) of the new coronavirus in the United States, it’s almost inevitable that our approximately 95,000 intensive care unit (ICU) beds would be filled, followed by the rest of the hospital beds in the country. Hospitals in northern Italy may be approaching this dire situation now.

If we can flatten the curve enough to follow the blue curve, the total number of cases wouldn’t be all that much different than under the unconstrained red curve, with both curves relying upon herd immunity to eventually reduce new cases to zero; but the total number of deaths from the pandemic under the slower trajectory will be much less because there would always be almost enough hospital capacity for everyone.

But slowing the spread, while a valid idea, is still a depressing goal, especially because the economic costs of the kind of social shutdowns imposed in China, and now in Italy, are no doubt enormous. The hope of flattening the curve reminds me of the dreary sports cliché that goes back at least to O.J. Simpson in 1968, “You can’t stop O.J., you can only hope to contain him.”

So, fighting a long, drawn-out war of attrition with COVID-19 has yet to galvanize the public or its leadership. Lots of Americans seem at present to be thinking: “Eh, just let it run amok and let’s get it over with.” But they don’t yet realize how awful the peak would be when the health care system overloads.

[...]

Via heroic shutdown measures (basically, confining most of the population of this huge city to their apartments), the Chinese cut the R0 in Wuhan by more than an order of magnitude down to 0.32. New infections fell by almost 95%.

[...]

In other words, the effort it takes to flatten the curve is almost as great as it takes to win outright.

No longer should the goal be a well-played defeat. As Cochran sums up by quoting Douglas MacArthur:

There is no substitute for victory.

You will be ridiculed as an extremist or an alarmist

Thursday, March 12th, 2020

We don’t yet know the full ramifications of the novel coronavirus:

But three crucial facts have become clear in the first months of this extraordinary global event. And what they add up to is not an invocation to stay calm, as so many politicians around the globe are incessantly suggesting; it is, on the contrary, the case for changing our behavior in radical ways—right now.

The first fact is that, at least in the initial stages, documented cases of COVID-19 seem to increase in exponential fashion. On the 23rd of January, China’s Hubei province, which contains the city of Wuhan, had 444 confirmed COVID-19 cases. A week later, by the 30th of January, it had 4,903 cases. Another week later, by the 6th of February, it had 22,112.

The same story is now playing out in other countries around the world. Italy had 62 identified cases of COVID-19 on the 22nd of February. It had 888 cases by the 29th of February, and 4,636 by the 6th of March.

Because the United States has been extremely sluggish in testing patients for the coronavirus, the official tally of 604 likely represents a fraction of the real caseload. But even if we take this number at face value, it suggests that we should prepare to have up to 10 times as many cases a week from today, and up to 100 times as many cases two weeks from today.

The second fact is that this disease is deadlier than the flu, to which the honestly ill-informed and the wantonly irresponsible insist on comparing it. Early guesstimates, made before data were widely available, suggested that the fatality rate for the coronavirus might wind up being about 1 percent. If that guess proves true, the coronavirus is 10 times as deadly as the flu.

But there is reason to fear that the fatality rate could be much higher. According to the World Health Organization, the current case fatality rate—a common measure of what portion of confirmed patients die from a particular disease—stands at 3.4 percent. This figure could be an overstatement, because mild cases of the disease are less likely to be diagnosed. Or it could be an understatement, because many patients have already been diagnosed with the virus but have not yet recovered (and may still die).

[...]

Meanwhile, the news from Italy, another country with a highly developed medical system, has so far been shockingly bad. In the affluent region of Lombardy, for example, there have been 7,375 confirmed cases of the virus as of Sunday. Of these patients, 622 had recovered, 366 had died, and the majority were still sick. Even under the highly implausible assumption that all of the still-sick make a full recovery, this would suggest a case fatality rate of 5 percent—significantly higher, not lower, than in China.

The third fact is that so far only one measure has been effective against the coronavirus: extreme social distancing.

[...]

As the [1918 flu] was spreading, Wilmer Krusen, Philadelphia’s health commissioner, allowed a huge parade to take place on September 28; some 200,000 people marched. In the following days and weeks, the bodies piled up in the city’s morgues. By the end of the season, 12,000 residents had died.

In St. Louis, a public-health commissioner named Max Starkloff decided to shut the city down. Ignoring the objections of influential businessmen, he closed the city’s schools, bars, cinemas, and sporting events. Thanks to his bold and unpopular actions, the per capita fatality rate in St. Louis was half that of Philadelphia. (In total, roughly 1,700 people died from influenza in St Louis.)

[...]

For a few days, while none of your peers are taking the same steps, moving classes online or canceling campaign events will seem profoundly odd. People are going to get angry. You will be ridiculed as an extremist or an alarmist. But it is still the right thing to do.

We should have worried about things other than climate change

Wednesday, March 11th, 2020

The Covid-19 coronavirus is indeed a wolf, Matt Ridley (The Rational Optimist) argues:

In Aesop’s fable about the boy who cried “Wolf!”, the point of the tale is that eventually there was a wolf, but the boy was not believed because he had given too many false alarms. In my view, the Covid-19 coronavirus is indeed a wolf, or at least has the potential to be one. Many people, including President Trump, think we are over-reacting, because so many past scares have been exaggerated. I think that’s wrong.

Coming from you, a friend said to me the other day, that’s scary. I am known as an obsessive and serial debunker of false alarms. I have been at it for almost 40 years ever since I realised as a science journalist in the 1980s that acid rain was being wildly overblown as a threat to forests (I was right). This scepticism has served me well. I did not believe that mad cow disease would kill hundreds of thousands of people, as some “experts” were claiming in the mid 1990s. In the end just 177 died. Likewise, I refused to panic over bird flu, swine flu, SARS or ebola.

I set out to debunk exaggerated claims about the population explosion, peak oil and peak gas, nuclear winter, the ozone hole, pesticides, species extinction rates, genetically modified crops, sperm counts, ocean acidification and the millennium bug. In every case this made me unpopular and unfashionable, but close to the truth. I said climate change would happen more slowly and with less impact on storms, floods, droughts, sea ice and sea level than even some experts were claiming in the 1990s, let alone the extreme environmentalists, and it has.

It is very easy, in other words, to bet on the tendency of journalists and their readers to engage in a competitive auction of unjustified alarm. “The whole aim of practical politics,” said H.L. Mencken, “is to keep the populace alarmed (and hence clamorous to be led to safety) by an endless series of hobgoblins, most of them imaginary.” And no, the fact that the millennium bug was a damp squib was not because we were well prepared; some countries and industries did nothing and were still fine.

So why don’t I think this hobgoblin is imaginary? First, because lethal plagues have a long track record. From the plague of Justinian to the Black Death to the Spanish flu of 1918 to the HIV epidemic, new diseases have proved they can burn through the human population with frightening efficiency. It’s true we have got better at eradicating infectious diseases through vaccinations, pills and public health, but most viruses are still very hard to cure and some are very easy to catch.

The second reason is that new diseases are often more dangerous than existing ones and this one has jumped from bats, possibly via pangolins. In the past respiratory viruses have generally proved to be low in virulence once they become highly contagious: hence the large number of rhinovirus, adenovirus and coronavirus strains that we call collectively, “the common cold”. Even flu has been relatively less lethal since the special wartime conditions of 1918. But when they first infect our species, viruses can encounter a vulnerable immune system and run riot.

The third reason for alarm in this case is the speed with which Covid-19 has crossed regional and international boundaries. It does seem to have acquired an unusual skill at getting passed on from one person to another, usually not making them so sick that they stay away from meeting other people, which is what prevents ebola causing pandemics, but yet being capable of killing about 1% of people it infects. This is the frightening combination of traits that we have feared might one day arise.

Then there is the effect of globalisation, and the huge growth in international travel. I wrote in my notes in 1996, when reviewing a book on new viruses, “If we persist in creating conditions in which viruses can be easily transmitted and amplified, then we will persist in experiencing waves of new viral epidemics. The problem lies in the ecology of our society, not destruction of the environment.” Human beings are just too tempting an ecosystem for an ambitious virus.

But we have indeed cried wolf over so many issues, that it has contributed to us being underprepared. We should have seen that globalisation would cause such a risk to grow ever larger and taken action to prevent a new virus appearing. We should have worried about things other than climate change.

A sizable fraction consistently took home products that bombed

Monday, March 9th, 2020

When Steve Sailer was in the marketing research business, his wife suggested that he start own product testing firm, because it would have the competitive advantage of needing just one single tester:

P&G and Frito-Lay could hire me to take home a case of their planned product. If I really liked their innovation, then they would immediately bury all existing samples in a landfill, burn the recipes, and fire the executives responsible.

It turns out he’s just one of many such harbingers of failure:

What do Crystal Pepsi, Watermelon Oreos, Frito-Lay Lemonade, Coors Rocky Mountain Sparkling Water, Colgate Kitchen Entrees and Cheetos Lip Balm all have in common?

The obvious answer is they are all failed products. What is less obvious is that they may also share a fan base — a quirky subgroup of consumers who are systemically drawn to flops and whose reliably contrarian tastes can be used to forecast bad bets in retail sales, real estate and even politics. These people are known as “harbingers of failure.”

The study of harbingers emerged from a 2015 analysis of purchasing patterns at a national convenience store chain. (In exchange for the data, the researchers agreed not to reveal the identity of the chain.) Drawing on six years’ worth of data from the chain’s loyalty card program, a team of marketing professors led by Eric Anderson of Northwestern University classified customers according to their affinity for buying new products that were later pulled from the shelves because of weak demand. Of the roughly 130,000 customers whose purchases were logged, a sizable fraction (about 25 percent) consistently took home products that bombed.