Late spring in the age of coronavirus

I haven’t posted on COVID-19 in a while. What’s there to say? The last month or so has been a great muddle. We soldier on, without purpose or direction. At least here in the United States of America. In regards to the pandemic, we’re in, all I can say is that I feel a sense of listless ennui. But perhaps I should say something, just for historical purposes of tracking where we’re at for this weblog?

On March 23th, T. A. Frank mentioned me in Vanity Fair as being a COVID-hawk. You can search this weblog and note I was relatively sanguine at the end of January, but we began to stockpile in early February. By the middle of February, I was alarmed. On February 19th news broke that Covid-19 was spreading Iran, and to be frank I flipped out.

Between February 20th and March 10th, there was a slow and gradual shift in thinking. But the real switch was flipped between March 10th and March 15th, as broad swaths of the culture moved into a high state of alarmism. It was curious seeing scientists who I followed who were fixated on Richard Dawkins in February joining the alarm about Covid-19. When they’d give a thought many (though not as many privately!) were reassuring.

They shouldn’t have been.

Some considerations and observations:

The COVID-doves: early in the pandemic there were critics who were accusing me of alarmism. This was March, so who knew? I asked for some numbers. One individual said that at most there would be 20,000 deaths. We are around 100,000 now. Over time the initial wave of skeptics faded away because the numbers were too high.

But, the second round of skeptics emerged. The interesting thing here though is that the second wave of skeptics was more focused on the opportunity costs of the lock-down. The key problem I have with this wave of COVID-doves is that I wish they would just admit that 250,000 miserable deaths may be the price we have to pay. Perhaps. We just need to put the numbers on the table and remember that the deaths seem quite unpleasant and protracted.

I am on friendly terms with many COVID-doves. I disagree with them, but I have friends and many who are liberals too, and I disagree with them. In fact, in an ideal world, I would be convinced by their arguments, and become a COVID-dove. I am not convinced by their arguments. Yet.

There is a broader class of COVID-skeptic which is, to be frank, unhinged, conspiratorial, and a promoter of misinformation. This is a serious problem.

The COVID-hysterics: another class of individuals are those who are hysterical about the impact of COVID. They want a two-year-long lockdown. They believe that the governor of Georgia has blood on his hands. They believe that COVID could kill anyone! Any skepticism or cost-vs.-benefit thinking is anathema to the COVID-hysteric.

The data is clear now that COVID-19 is particularly dangerous for older people. But the number of media profiles of young women who die of COVID-19 is quite high. There is, to my mind, a clear attempt by the media to make it seem like everyone is at risk. In fact, for people in their 20s and younger the seasonal flu seems to be more risk. The spate of stories about Kawasaki disease and children is, in my opinion, part of the issue. To convince COVID-skeptics those who wish people to take this pandemic seriously need to not exaggerate, or they’ll lose all credibility.

The IFR: I now believe that the infection fatality rate in the United States is around 0.75%. This is, as the above comment should make clear, not unconditional. For the young, it is quite low. For the aged, it is much higher. But when estimating how many Americans may die of COVID-19, this is the number that I think is reasonable. Perhaps higher. Perhaps lower. But this it the ballpark. If 50% of Americans become infected, that’s 1.2 million or so deaths. The IFR, like the R, is not a fixed parameter. Perhaps the virus will change. Perhaps our therapeutics will get better. But we go to war with the parameters we have, not the ones we want.

The uncertainty: There is still a great deal of uncertainty as we proceed forward. We know some things (e.g., no, children are not at high risk of death), but not enough. I have stopped paying attention to whether the weather impacts COVID-19. I think it does, but more in the range of 25-50% changes in the R, not an order of magnitude. There are lots of small things that are having impacts that we don’t know. And there are likely stochastic factors as well. We look through the mirror darkly.

Perhaps COVID-19 will fade away. Burn itself out. But that’s hope. A guess. We have no idea. We’re still not clear why the outbreak in New York City was so much worse on the West coast of the USA. Why Southeast Asia has been left relatively unscathed.

Pre-COVID-19 times

The quarantine: The major lacunae in the Western response has been quarantine-containment. The lockdown has, on the whole, not taken COVID-19 positive people, and put them in some sort of quarantine. It doesn’t look like it will happen.

That means COVID-19 is endemic. For now.

Where are we? It looks like as we move into fall the number of American deaths will be in the low 100,000s. This is a victory, after a fashion. My family is still self-quarantining. We have no date when we’re not going to keep doing this, at least for the foreseeable future. My children have grandparents that they want to see. What are we supposed to do? But the day will come when we go back out into the world…


33 thoughts on “Late spring in the age of coronavirus

  1. I’m worried about the potential for permanent lung damage, especially coupled with the possibility that immunity may not last long. A one-time ten percent decrease in lung function will barely inconvenience a healthy 20-year old*. If the same person gets the same disease every year, (s)he won’t live to 30.

    *unfortunately, it has been several decades since I was a healthy 20-year old.

  2. I’m sitting here in the goldfish bowl of Hong Kong – that is the way I think of it, because that is what it is like. Because no one is allowed in except for people from the Mainland, Macau and Taiwan, who are required to do 14 days quarantine, and HK returnees, who are also required to do quarantine. Everyone else is barred from entry, or even transiting through the international airport, not that anyone is currently flying anywhere.

    At no point have we had anything like a total lockdown – my wife has been going out shopping for food literally every single day, all the way through. Today I went back to the gym, for the first time in over a month because they closed all of the gyms and other public exercise facilities for a while before reopening, and it felt good to get my muscles pumped and my lungs gasping for oxygen again, and I didn’t feel like there was any risk because, well, the gym was empty. There was no one else there. And the gym staff are bored, so they keep endlessly disinfecting everything in the gym. Bad for them, good for me. Or maybe also good for them, because it reduces their chances of being infected if no one except me is turning up. They had a little celebration when I showed up and made a fuss about seeing me again, but hand shaking and hugging were obviously not on the menu.

    We have had no cases of local transmission, community transmission, for a long time now. The local disease experts keep telling us not to get cocky, that there is ‘silent’ transmission going on in the community from asymptomatic people, but there has been no antibody testing to demonstrate that is true, and if it were true, I would expect to see some symptomatic cases emerging, and I’m not. So, OK, they are experts, and I’m definitely not, but I don’t see any evidence to persuade me that they are right about the ‘silent’ transmission. I want them to start a program of random anti-body testing, but no one has even mentioned it. That feels like a pretty major omission.

    We are getting imported cases. HK has about 2,000 of its permanent residents currently stuck in Pakistan and 3,500 stuck in India, people who flew back to visit family or whatever and now they can’t get back to HK, so the government is chartering flights to bring them home, and a fair number of the people coming back from Pakistan so far have been found to be infected on arrival, but that’s not a problem – they are all tested on arrival, those found to be infected go straight into isolation in hospital (all of them, regardless of severity of symptoms or even no symptoms at all), and the rest go into quarantine, so that’s fine. They haven’t started bringing any Indians back yet, but I expect pretty much the same pattern – a small number of infected, but not huge, and it’s manageable.

    I keep having the same thought, and I could well be wrong about this (and people are welcome to tell me that I’m wrong), which is that it is not age so much that is the real determinant of how sick people get, it is co-morbidity, and it just happens that by the time people get to their 70s and 80s, almost everyone has one or more of the co-morbidities that are now familiar as big risk factors. HK still has only 4 deaths, out of a total of 1056 known cases, and they were all early on. Why? One thing is that HK has low levels of obesity, and people here are actually pretty active physically. Everyone walks a lot; they have to, it’s a function of the way the place has been laid out, you have to walk miles to get to anything, often up and down some steep hills. Out of 1056 total cases, we now have only 26 people still in hospital, and that is dropping every day as more of them are declared disease-free and released. The hospital system is definitely not under pressure, nowhere close, and it never really has been. A not often appreciated fact is that HK has the highest life expectancies in the world, and a lot of that is down to our excellent public health system.

    So, OK, lucky me, sitting in my goldfish bowl – but I keep wondering what the end-game to this will be. HK can’t remain a goldfish bowl forever, but how does it stop being that, and what happens when it does? At this point I have no idea, and no one is telling me. One thing is predictable – at some point there will be very cautious opening up of the borders to the Mainland, Macau and Taiwan, which just means they will drop the quarantine requirements, but beyond that, I can’t see HK opening its borders to anyone else for, well, a very long time.

    On weather, we are definitely now into early summer pattern, with daily maximum temperatures of 32C or higher, minima of 26C or higher, and high humidity, but I have no data I can observe to try to tell whether that is having any effect, because I see no evidence whatsoever of any local transmission. If it is happening, it’s invisible and it is not making anyone even mildly sick. Everyone who wants to get tested can get tested, and if these invisible infected people are there in the community, no one is detecting them. I could make some stupid joke about us having a phantom epidemic, but won’t. For people in other countries it is tough and very worrying, I know.

  3. John Massey commented: “On weather, we are definitely now into early summer pattern, with daily maximum temperatures of 32C or higher, minima of 26C or higher, and high humidity, but I have no data I can observe to try to tell whether that is having any effect, because I see no evidence whatsoever of any local transmission.”

    Interesting video below, at minutes 29:33 to ~ 35:00, a biomedical scientist talks about the various effects of insufficient Vitamin D levels on immune systems, and how simply ensuring a high level of Vitamin D might be a reasonably effective preventative measure against catching a serious case of COVID-19. Staying inside lowers levels of vitamin D, which may be why lots of cases in NYC were people who had been in lockdown. As well, reports in both the UK and the USA are that dark-skinned minorities are more likely to become seriously ill from the virus, which might be because they have trouble getting sufficient D in those climates, but the same populations in the tropics apparently do not have as many problems (climate, D or both?). It’s all correlational, as she says, but there seem to be a lot of studies pointing towards the same correlation.

    Btw, Elon Musk is a serious COVID-19 dove, still!

  4. My experience and perspective mirrors yours, Razib. Also, I am moderately at-risk due to some prior health issues.

    Combined with the “muddle” you describe, I am having a hard time formulating any reasonable criteria to determine when I would personally feel comfortable emerging from lockdown. I’m an extreme introvert and could probably do this forever, but my other household members…

    Any suggestions you could offer would be greatly appreciated.

  5. “Listless ennui” is a very apt description for my perspective, as well. At least I am thankful that my spouse and I are both still employed, that our kids are relatively self-entertaining (if not self-motivating), and that we have just enough space to get away from each other, when needed.

    I share Razib’s feeling on the tendency of COVID-doves to downplay what it would take to get to “herd immunity” without a vaccine (if it is possible to get there — seems from recent data that it likely is). A quick back-of-the-envelope calculation using an IFR of 0.75% and “herd immunity” threshold of 70% is sobering, and even that doesn’t take into consideration the health effects in survivors (lots of people with impaired lung function, impaired kidney function, etc.)

    On a related note, it’s interesting that the IFR rate of 0.75% that studies seem to be converging on is similar IIRC to what was observed for the cruise ship outbreak where 90+% of passengers and crew were tested, early on. I think that number was 0.8%.

    Here in Canada we are fortunate that the COVID response has not become highly politicized or extensively wrapped up in the culture wars. The federal and provincial leaders of all political orientations are doing a reasonable job, despite some early missteps. Community transmission is still a big factor, but the overriding issue now is long-term care facilities, which have been hit very hard (and in many cases have been found to be horribly mismanaged).

    My own take is that re-opening is going to take a combination of massively increased testing, a better understanding of the nature of community spread (currently very fuzzy), and better therapeutics. Possibly also a better understanding of susceptibility (beyond simply the old and obese) from genetic studies. The vaccine will come in time, but it’ll take a while.

    The “In The Pipeline” blog by Derek Lowe (at Science Translational Medicine) provides good updates on the biopharma side of COVID-19. Worth following for those interested.

  6. I appreciate Razib’s consistently informed and balanced observations.

    Here are a few highly anecdotal observations from NYC:

    I’ve been in Manhattan throughout the lock-down. With the quiet streets I’ve been taking a few 20-30 mile bike rides/week all over the city.

    In many neighborhoods people have appeared highly conscientious concerning social distancing. Masks are pervasive, and you rarely see more than a couple people or a family unit gathered outside together.

    In other neighborhoods there is zero evidence of any concern at all. South Bronx, SE Harlem, Brownsville. Zero masks, large gatherings, every day. Unfortunately, these are some of the neighborhoods hardest-hit.

    I mention this because I’m skeptical of the efficacy of many government plans. They end up being enforced and complied with only in the areas where they matter least.

    There are hundreds of thousands of people in this city who will ignore any lockdown/testing/quarantine orders, and the municipal government has neither the inclination nor the capacity to force them to do anything.

    With the streets mostly empty, people who are really down on their luck are more obvious. I can confidently assert that at this moment there are more than 5000 people in NYC laying on benches, subways, streets, stoned out of their minds, covered in their own excrement. They were there before the pandemic, and they are still there now.

    If you told me we would be living in a serious pandemic, I would not have expected to see so many people in these conditions – either they would pull themselves together, authorities would intervene in the interest of public health, or they would die.

    These are just my observations on the ground in NYC. Maybe our government (Federal, State, City) could have done something back in February to keep this from getting a toe hold. But once it got established in NYC I don’t think there was much to be done from a policy standpoint that wouldn’t be negated by cultural factors.

  7. First time, long time. Love the show!
    Do you acknowledge skeptics concerns around deaths w/ COVID and deaths of COVID? Given the affected sickly population — and diagnostic incentives — shouldn’t we be a little concerned about the death numbers? If it is highly virulent, we’re all going to get it and we’re all going die (with/of it).

  8. Michael Barone is, I think, the smartest and most knowledgeable political pundit now alive. He is 75.

    “COVID-19 shows we’re more risk averse than post-World War II Americans”
    by Michael Barone | May 20, 2020 |

    Do you remember the 1957-58 Asian flu? Or the 1968-69 Hong Kong flu? I do. …

    Yet these two influenza epidemics had death tolls roughly comparable to COVID-19. Between 70,000 and 116,000 people in the United States are estimated to have died from Asian flu. That’s between .04% and .07% of the nation’s population, somewhat more than the .03% COVID-19 death rate so far.

    The Asian flu, such as COVID-19, was rarely fatal for children and more deadly for the elderly — but it was also a special risk to pregnant women.

    The Hong Kong flu, the Centers for Disease Control and Prevention says, had a more precisely estimated U.S. death toll of 100,000 from 1968-70 (years that included the Woodstock festival), or .05% of the total population. Both flues had high death rates among the elderly, but apparently not as high in proportion as COVID-19 has had now.

    Once again, there were no nationwide school closings, no multi-month lockdowns, no daily presidential news conferences. Apparently, neither the nation’s leaders nor the vast bulk of its people felt that such drastic measures were called for. …

    Fundamental attitudes can change in a nation over half a century, and the very different responses to this year’s coronavirus epidemic and the influenzas of 50 and 60 years ago suggests that people today are much more risk averse, much more willing to undergo massive inconvenience and disruption to avoid marginal increases in fatal risk.

    At least some of this can be explained by different experiences. The Asian and Hong Kong flus arrived in an America amid and at the end of what I call the “Midcentury Moment.” That’s my name for the quarter-century after World War II when Americans enjoyed low-inflation economic growth and a degree of cultural uniformity and respect for institutions that some yearn for today.

    Midcentury Americans had living memories of World War II, with its 405,000 American military deaths. …

    Contrast this with the shrillness of outcries over orders of magnitude fewer military deaths in Iraq (4,497) and Afghanistan (2,216). … But today’s Americans, beneficiaries of a victory in the Cold War that was almost entirely bloodless, seem to blanch at paying any human price at all. …

    You can argue that Americans in the Midcentury Moment were too willing to accept pandemic or battlefield deaths …

    But there’s also a strong argument that they had a more realistic sense of the limits of the human condition and the efficacy of official action than Americans have today. Certainly more than the governors stubbornly enforcing lockdowns till the virus is stamped out, and deaths fall to zero.

    Behind that stance is the assumption there’s an instant and painless solutions for every problem, rather than a need to weigh conflicting goals and making tragic choices amid unavoidable uncertainty.

  9. To me the whole experience was quite interesting for another reason too, namely this was the closest thing to a societal Gleichschaltung/syncronisation in a near totalitarian manner – just for some weeks, but it was, nevertheless.
    At the beginning of the partial lockdown, all parties, most media and most influencers, celebrities were in full support of the measures.

    People which gave me a hairy eyeball when I talked about an pandemia of SARS-Cov 2 might become a real thing, in January, when the first reports came out from the international media and Chinese institutions, laughed about it and said its just like a harmless flu, became more frightened and fussy than I have ever been. It was like they got completely brainwashed and lost their own opinion within days, just when the propaganda started.
    Most people are really just sheeple and can’t thing for themselves it seems.

    What’s more, as bad as Covid19 is, there were always bad infectious diseases around. Again people which didn’t care about the most basic hygienic standards, refused to do medical checks, get vaccinated, have not too much of medical and scientific knowledge, completely freaked out with the synchronised propaganda. It was amazing to watch people around me getting more hypochondriac and neurotic than I ever was, people which never were like that before.

    I want to stress that there are and always were bad infectious diseases around us. I’m taking Covid-19 serious, I am even at greater risk than the average of my age cohort, and I’m concerned about a lot of people I care for, but some were or are just over the top with their fears and caution taking.

    When the majority of the political administration, parties and organisations, mass media, influencers and celebrities, the economic leaders and big companies, all went in the same direction, you see what this means. Most people will adapt, they just do, whether its reasonable or not what’s the “new normal behaviour” in society.

    About the future and the models around: I know some data from the past, diseases which many people think are quite harmless, just “childhood diseases” are or were quite nasty in the past. Many children and adults alike died from measles, varicella and pneumonia for example. What changed are the general hygienic and health standards, vaccines and actual medicines.

    If we are talking about a prolonged partial lockdown, or going back to it in case the numbers of Covid-19 increase again, the real question is what will be different in 1, in 3 in 6 months or a year? In 1 year or in 2 years?

    Because the real issue are treatment options and a possible vaccine, beside the capacities of intensive care beds and ventilators etc.

    Looking at it, how much better is the medical care for the average Covid-19 patient now in comparison to March? I’d say not too much better. Unlike with e.g. a regular bacterial pneumonia, the treatment options for more severe cases are still miserable.

    Whether you get a vaccine in 6 months or 3 years, nobody knows. As far as I can tell nobody can tell you how long you might be immune after infection or a vaccine anyway. Probably not at all, most likely between 6 months and 3 years, but very unlikely for longer than 5 years. So this disease will be around, will mutate, will cause illness and deaths for the years to come.

    And the longer the lockdown will last, the more severe the financial and economic, therefore social consequences will be.

    So the only relatively safe and easy way out would be good treatment options for severe cases and a low-risk, highly effective vaccine. If you tell people to wait for that, it would be ok if its there in the next fall, when the weather gets worse and the case numbers will rise again even higher, even faster, than they are now.

    But imagine there is no progress, no significantly better and safe treatment options, no effective vaccine, but the economic damage piling up for nothing, with the 50-60 percent of infected people being actually inevitable.

    That’s also the reason why all those politicians failed in February, all around the world. Because if the SARS-Cov-2 would have stayed first in China, or then in Italy, with no larger scale epidemic, who wanted to be responsible for a lockdown, for the damage to his people and economy by these political actions? Without the support by the mass media and society as a whole? It was a greater political risk to “act premature” than acting late, when most people would agree on “something has to be done quick” for doing damage control.

    With very moderate measures in February, most of the epidemic could have been prevented, probably even the plague eliminated. But that was no option for economical reasons then, now both the health AND economical damage is much bigger than it must have been.

    But that’s our short sighted Capitalist system in a nutshell: “We didn’t see it coming, nobody wanted to lose money…”

    Blabla, everybody with a functioning brain should have seen it coming, like many other negative trends in our current Western system too. But they just prefer to do business as usual, make profits as usual, as long as they can. And they act against that rule only if the damage piles up already, when its too late.
    Most people-sheeple agree with their politicians then, to get absolved from their own incompetence and cognitive failure, for being not able to think for themselves. “They didn’t know, nobody could know…”
    Crap, read the reports from China from January 2020 and you know everything. That’s like a central theme of the current Western society as a whole, don’t critices the status quo, don’t question where we are going, everything is ok unless our living room is afire already. Then its time to freak out and if your opinion leaders in policy and media tell you to freak out, then its time, then its ok, then you can turn off your own brain and rely on their expertise until the next bomb hits your building. But you can trust them, because they told you when your living room was in flames and you can’t trust your own eyes and brain. Most people are so lost without a good leadership.

  10. Still not able to get my head around this virus & its impact.

    If Hong Kong, & Australia could do it then why not New York?

    One major reason for New York suffering so much seems to be that they were preparing for the “wuhan/china” virus but got hit by the “Lombardi/french” virus. By the time New York realised what hit them they were 6 weeks late & 10000 cases in.

    Also clustering seems to play a major role due to the Dispersion Factor of this virus. Choirs, religious gatherings, wet markets (like the veg wholesale market in Chennai)

    It looks like this virus started out in November but got a boost only due to the clustering in the Wuhan wet market. Which probably implies that the wet market is not the real origin of this virus & it was circulating for 1 or 2 months prior

  11. @rw vitamin D makes lots of sense to me. Although there is no data/study to substantiate the same.

    Purely from personal instinct I would highly recommend including as much ginger as possible in the diet. In India all kinds of ginger are used in herbal remedies for various colds/allergies etc.

    Maybe have cream of chicken/mushroom/crab soup with ginger. French onion soup with ginger. Chicken tomato curry with ginger etc.

  12. 1. I am not surprised at all by the state (State) of New York.

    2. The broad outlines of my expectations have not changed.

    3. Met some Boomer today in the course of business, a nice guy, but he was full of things like “Trump profiting from hydroxychloroquine” “that malaria drug doesn’t work” and treating Trump as if he is in charge of New York. Also not surprised

  13. My children have grandparents that they want to see. What are we supposed to do?

    If they want to see the children, and you have taken precautions to minimize the risk that the children are infected, then you should get together.

  14. So, I just unsubscribed to the Insitome podcast. Really enjoyed it for a long time, but Spencer was pretty triggered in the last episode. Lost all respect I had for him…

    Still on board for Brown pundits and Patreon.

  15. Nick N, if you’re days are free, that’s a great way to spend one’s time if one is a Noo Yawka, especially if one wasn’t born there. I haven’t lived in the city for a long time, but that’s a great way to make lemons from lemonade as to learning one’s way around places like the Bronx and that NYC isn’t just Manhattan and I guess now, parts of Brooklyn. If I still did live in the city, I’d be doing that too, especially since the weather has turned so nice recently.

    I’ve been joking with my wife that the whole thing is our fault. Recently we’ve been grousing about just how much traffic there is (was) in NJ, as in it really was getting a lot worse, it wasn’t just us getting old and cranky. Be careful what you wish for!

    For a guy like that Frank guy to cop in public to reading Razib, who for some silly stupid reason isn’t enlightening NYT readers about cat genomics, is a bit surprising. I guess you’ve got lots of secret fans out there, who unlike Frank won’t admit they read you. Lest they be canceled. Weasels.

    Lastly, per what this virus actually does, I’ve read that what it specifically does is lower the efficiency that the lungs absorb oxygen, in that having it is the same as being on the top of Mount Everest, and that lung damage will occur since the ‘pain’ signal one gets about breathing problems is about exhaling CO2 not oxygen intake so one doesn’t know one is having trouble breathing until it’s really bad. Since I think an oxygen mask and tank would mitigate that, and I don’t hear about that being done in hospitals, I guess that is wrong. Is it wrong?

    Also, per children being largely immune, I’ve read that the DNA segment the virus latches onto is a gene that isn’t expressed in children, i.e. is plugged by a methyl, that eventually pops out later as one ages. Is that right?

    Generally, I’d have thought 2 months ago that we’d be farther along right now on what exactly the virus does to make one sick, though maybe I just don’t read widely enough, and would benefit from a pointer to some article explaining it all.

  16. I wanted to listen to more of your podcast on ancient Chinese DNA, but Spencer’s rant about how Trump should face a Nuremberg style war crimes trial for the Covid-19 response was so ill-informed, ridiculous and over the top I had to quit listening right there. And I’m by no means a Trump fan in any way.

    I had a lot of respect for Spencer, and am feeling a little disillusioned right now.

  17. I am in Israel where the crisis seems to be mostly over, at least that’s how the population sees it. Life went back to normal, almost everything is open (restaurants and cafes which were take away only go back full service wednesday), and there are still restrictions but not strictly applied.
    It appears that 70% of COVID cases in Israel came from the USA, and that 70% of COVID infected were ultra orthodox Jews, meaning in Israel proper there was almost no contamination of the non-ultra orthodox population. Which is weird, this is a country where people touch each others all the time.
    The fatality rate is 0.4% here apparently.

  18. Is it possible that the virus’s stochastic clustering is part of its evolutionary strategy? So it’s not humidity, vitamin D, or some other variable we wishfully think we can control. Rather maybe it’s programmed to just randomly morph between states of high and low virulence. Clearly such an approach has been very effective for its replication. Go big and expand while the humans are complacent, and then hunker down and bide your time.

  19. @Marees and all those here concerned about their health. Both SARs and the Wuhan virus bind to the Ace II receptor, which is important in preventing lung damage. In studies where lung damage occurs, or is induced in mice with a substance that caused the lung damage, vitamin D maintains normal levels of ACE II which appears to help minimize the damage. This info is in the same link I left above.

  20. But that’s our short sighted Capitalist system in a nutshell: “We didn’t see it coming, nobody wanted to lose money…”

    Oh, bullbleep. That’s humanity in a nutshell. “This new thing that we’ve never experienced. It won’t be so bad. We won’t have to screw up our lives because of it.”

    Blabla, everybody with a functioning brain should have seen it coming,

    Again, bullbleep. This was a new virus. SARS and MERS had been defeated relatively quickly and had been confined to a limited geographic area. People (especially people outside east Asia) generalized wrongly from that experience.

    It is certainly true that we WEIRD people think we are safer and more powerful than we really are. Though “think” may not be the right word. We just have no feel for the risk and uncertainty that most humans have lived with for most of our history.

  21. @Roger: “Oh, bullbleep. That’s humanity in a nutshell. “This new thing that we’ve never experienced. It won’t be so bad. We won’t have to screw up our lives because of it.””

    It is humanity in a nutshell, but a Liberal and Capitalist system makes it worse. You can see that in companies even, with those run as stock corporations, highly shareholder and profit-oriented, doing usually much worse making effective long term plans and decisions than those which have a decision making owner or at least a strong CEO. For making a cut, the problems need to pile up, for investing into something far in the future, the arguments must be too good to be real. Everything being short term-profit oriented, more corrupt and irresponsible. The response is rather slow, but on the other hand no big experiments being done, usually, which can be good or bad for the company, but most real innovations come from entrepreneurs or departmens under a chief.

    “Again, bullbleep. This was a new virus. SARS and MERS had been defeated relatively quickly and had been confined to a limited geographic area. People (especially people outside east Asia) generalized wrongly from that experience.”

    The virus was new in December, but in January you got good reports, data and experience from China. Everybody could see what the situation was, yet the Western leaders allowed airplanes full of tourists, workers and other travellers to come in directly from the centre of the epidemic. That was like a poker game of a bunch of morons, all having bad cards, but nobody wanted to blink first and question the Liberal, globalised order with free borders and travel.
    Just a small action, a limitation of the travels from Asia could, at this point, make a big difference. But no, we keep things as they are, no action needed.

    SARS and MERS were reasons for the lack or delay of response, agreed, but everybody with a functioning brain could see that this was different after the first weeks of the outbreak. Where is the Western leadership, where are the experts when you need them? They all talked crap, all of them, left and right, Europe and America. Are they unable to read? Are they unable to think? What’s wrong with them? There were never as many cases of SARS or MERS, they were never as widespread plagues, the reaction of the Chinese government was never the same. There were not just days, not even weeks, but months to evaluate the situation and take precautions, but nothing was done.

    And its not just this crisis, but its the whole path we are taking latest since the 1960’s which is wrong, in many ways. But they only react if the living room is in flames already, if at all. Which is the direct passage to this comment of yours:

    “It is certainly true that we WEIRD people think we are safer and more powerful than we really are. Though “think” may not be the right word. We just have no feel for the risk and uncertainty that most humans have lived with for most of our history.”

    I’m not into the WEIRD thing as much, I think its been overblown like the term Western in itself by American think tanks. But what’s true is that the Western Liberal societies had no major challenge or crisis since the 1960’s, and even that was largely fabricated by leading elements of the establishment, so no systemic crisis which was not under control at all.

    So people in the West are now living for generations in the same system, with the same basic rules, without any major crisis. They are now used to things getting not that bad, life going on the usual consumer oriented way and things don’t get really nasty for the majority of people anyway. That’s even more true for Americans, which had no major war or crisis since the Civil War at home. As bad as 9/11 was, its nothing in comparison to the 2nd World War for Europe, and that’s a long time ago, and it never hit America nearly as bad of course.

    So there is a system which is not build to resist, not build to persist even, its a short term profit and consumer oriented system with supply chains just in time and no reserves, even less in the overpriced and asocial health system of the USA.

    This is the first time all these weaknesses and systemic failures are showing themselves big time. And SARS-Cov-2 is no really big crisis at all, its a self-limiting challenge in any case. That tells you a lot about where the USA are right now. Its an “emperor’s new clothes” moment for the world. Europe has at least some rags to cover itself, its better functioning parts at least, but the USA is really naked.
    Even I myself had more trust into the CDC before the crisis started, I really thought “they can’t be that bad”. But as things proceeded, I changed my mind.
    And its not the Trump administration, not at all, because it goes far deeper than that, far, far deeper. Some just try to make him the scapegoat, which is cheap.

  22. For anyone interested in additional observations on NYC:

    Central Park is getting sort of crowded, but there are no large gatherings. Groups up to about 4 but people otherwise keeping their distance.

    They’ve closed the childrens’ playgrounds in Central Park. That has made them a good camping spot for homeless people, and that’s what they’ve become. There are police handing out masks at the entrances to the park, but none seem bothered by this development.

    Last week Mayor DiBlasio was in Prospect Park, Brooklyn, handing out masks for a PhotoOp. Prospect Park is a generally nice, gentrified area. I was biking down Norstrand Avenue about 1/2 mile East of there a few days later. Not gentrified, crowds everywhere, no masks.

    I think this is relevant because it shows the limits of policy. I think there’s an illusion of control, that the government could come up with some good policy and implement it and improve the situation. I contend there’s very little the government can do when it comes in conflict with personal and cultural habits. NYC isn’t Tokyo. There is no way comprehensive contact tracing would work here.

    If NYC wants to prepare for another pandemic, it needs to begin by adjusting cultural habits. To the extend the government can impact that, it needs to start enforcing laws against public urination/defecation.

  23. Obs, thank you for your gracious response to my throwing sh*t. However,

    SARS and MERS were reasons for the lack or delay of response, agreed, but everybody with a functioning brain could see that this was different after the first weeks of the outbreak.

    Different sure, but different in what ways was very much still up in the air. So, surprise!, most people believed what it was convenient to believe. Hindsight is 20-20. At the time, it’s “through a glass darkly”.

    You’re absolutely right “So people in the West are now living for generations in the same system, with the same basic rules, without any major crisis. They are now used to things getting not that bad, life going on the usual consumer oriented way and things don’t get really nasty for the majority of people anyway.” We have come to feel this is the way the world works. That’s a big part of the “R’ in WEIRD. The truly rich know they will never be worse off. Such an attitude tempts fate.

  24. @ John Massey

    Hate to ask you again but couldn’t resist due to current events happening in Hong Kong, so I’ll try and make my question very narrow and focused: How well do you think HK’s public health infrastructure could withstand, shall we say, “unpredictable” consequences from the recent security law passage and the likely “reactions” it’ll provoke?

    I understand this is a very sensitive issue for you, so will appreciate an answer strictly on public health and bureaucratic delivery grounds.


  25. Re; IFR, quick estimates from a UK / London perspective:

    – 17% reported serological prevalence in London based on PHE’s recent survey (taken from mid-April-May). With 8.96 million pop, that gives 1.52 million infected. With London the epidemic seems to have more or less “completed” (for now…), at least in excess death terms, hospitalization, so there is not much room for debating about people yet to die, prevalence yet to develop, etc, which cuts through a lot of issues.

    – ONS data ( gives deaths up to 10/05/2020, from Covid19 and all cause mortality.

    – Covid19 deaths begin on Week 12, so taking Week 12-19 total excess mortality gives 9220 excess deaths. That provides 0.61% IFR.

    – If we take just Covid19 declared deaths instead, then 7405 total, so 0.49% IFR.

    0.49% seems about where Swedish whole-country serological info and covid-19 death rate gets us as well. I believe UK and Sweden have also had care home outbreaks that have disproportionately high infection, which suggests that total population weighted IFR, accounting for both pre-existing conditions and age and mortality risk, could be lower.

    OTOH, on the other side of the case, London’s younger than whole UK by (at last measure) 3.8 years. Adjusting for London’s demography probably brings us back to 0.7% on the standard average European demography (0.85-1% on an Italian, German or Japanese one, or 0.2% on an Indian demography).

    Also OTOH, Bronx serological rate reported at 34% (half way to herd immunity) and total deaths recorded by NY as 0.3% of Bronx pop gives about 1% IFR (if they had London apparent IFR, at their deaths, they’d have close to herd immunity levels).

    It seems like overall things could possibly be lower than 1% or 0.7% when all is said and done, if we’ve all systematically done things so far that have resulted in sickest and oldest people being disproportionately exposed (shipping people back into care homes in New York! spread within hospitals via practitioners!) and if we’ve also over-zealously ascribed deaths from knock on effects. Though probably not by too much. But it doesn’t seem like it could be *much* higher than 1%.

  26. Some things have certainly improved. As a nurse who has many COVID patients, I see the trends in my hospital. One thing, we can now pretty easily distinguish between covid positive and negative patients well before the covid test results come back.

    There is now a well-recognized set of lab values that we use to differentiate covid from other resp diseases. D-dimer elevated (abnormal clotting), pro-calcitonin elevated, WBC normal or low (generally high in most bacterial resp ills), ferritin high, opacities on CT and X-rays of the lungs, CRP and CPK values elevated, lactic acid elevated, and liver enzymes elevated, etc. No one or a few of these is indicative, but the more we see the higher the suspicion.

    We can also now pretty easily spot which patients are trending worse and which are getting better, in advance of any crisis. Those first few weeks were pretty scary, but it’s much more calm now, as we can notify doctors and plan reactions.

    Treatments are also improving. Convalescent plasma seems to work pretty well, but we are only in the early stages of using this so not sure how it will pan out. We are better at supportive treatments.

    I expect to see death rates falling.

    As expected, many of the patients are residents at various old-folks homes and other facilities. Recently a fair number from homes for the mentally handicapped. Sad, as these folks rarely understand what is going on and are resistant to care from strangers. They are among the very few whom we allow visitors, family and their care staff who can convince them to eat and take meds. Surprisingly, no jail inmates.

    My take is that absent a good vaccine, we are stuck in the current mode until next spring at the earliest. No decline in cases in my region so far.

  27. @ Riordan – It’s not a sensitive issue for me; I just don’t want to get into any more pointless arguments with anyone, or get backed into any corners defending things that are not my problem to defend.

    The national security legislation has not been passed in Beijing yet. So far I am not seeing much reaction to it at all in Hong Kong, but we’ll see.

    I am worried that any large public protest activity could cause a major disease outbreak which could easily get out of control, to the extent that isolation, contact tracing and quarantine would become an impossible task, and which would overwhelm the hospitals. To state the obvious, HK has a very dense and ageing population, a lot of people are inadequately housed (which is an obscenity in such a wealthy place, but I digress), and a raging out-of-control epidemic would have awful consequences.

    But then, I am alert to the possibility that could happen anyway, for some other unknown/unexpected reason. So far we have done remarkably well, but we have been shielded by the control measures in the Mainland to some extent, and no one here should be relaxing and thinking the problem has gone away and won’t come back.

    I’ll say again, the local disease experts are telling us that silent transmission is already happening here, based on what I don’t know, it just seems like supposition on their part because they are seeing it happening in other countries – I am seeing zero evidence of that here, and there is no serological testing going on that I know of, which seems like a very strange omission, given how good HK has been right from the start with infection testing.

  28. @ Riordan – Sorry, I shouldn’t say that there is not much reaction to it in HK; the ‘democrats’ are going absolutely apeshit about it, as you can see from this news article, but that was entirely predictable – politicians politick about stuff:

    What I mean by not much reaction is that I am not seeing any public protests about it so far – not much public reaction. Maybe people are waiting to see what the legislation will entail, I dunno – we have yet to see any details.

    You can tell from the article what public concerns have been reflected to senior advisers so far, but that’s fine – people are reflecting their concerns and opinions to those senior people, and they are responding, so there is public consultation going on about that, and that is a good and proper process.

  29. Stating a raw IFR doesn’t promote clarity. I see two groups of people stating low IFRs that actually strongly disagree with each other.

    I claim that the NYC IFR is over 1%, probably 1.5%.
    We don’t have excess deaths from anywhere else, so I extrapolate from NYC to America.

    Do you disagree with me about NYC, or do you disagree with me about extrapolating?

  30. The latest Insight podcast seems to have had some serious editing issues. Lots of “transposition errors” as sections of audio bounced around (a discussion of the sweet potato in South America was interrupted by sudden switch back to the geography of northern China etc.)


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