Robin Hanson wrote,
it isn’t crazy to consider cutting pandemic deaths via more infection inequality, including via deliberate exposure.
Pointer from Bryan Caplan.
Consider the following strategy:
1. Separate the population into low-risk and high-risk groups, based on their conditional probability of death if they get the virus. For example, young people with healthy immune systems vs. older people and/or those with compromised immune systems. Separate them not only conceptually, but physically–don’t let anyone from one group get near someone from the other group.
2. Then, allow the low-risk group to become infected, while keeping them away from the high-risk group.
3. Once the low-risk group have recovered, let the two groups mix.
Two reasons to hesitate about doing this. One is that it is not certain that people who have had the virus are immune. There are anecdotes about people re-acquiring the disease. Perhaps there are multiple strains, rather than “the” virus.
A second reason to hesitate is the high rate of death among health care providers, many of whom are young with healthy immune systems. This suggests that there are some other factors that affect risk, and you want to know more about those other factors before you try this approach.
My own “out of the box” suggestion is a program to test a random sample of people who are asymptomatic. That would give us a better idea of the dynamics of virus spreading.
There are now, reportedly, immunoassays that can detect both IgM and IgG antibodies and give 15 minute readouts, all done in the familiar form similar to a pregnancy test device. I don’t how quickly this can be scaled up and produced in the millions needed, but it will help random testing of the population to find who has actually been exposed to the virus. The problem with using the RT-PCR test for the virus is that people who have recovered test negative with the PCR test- all you are getting is an idea of how many have active virus at that point in time, when what you are really looking for is how many have have had it
I think the anecdotes about reinfection are just that, anecdotes. People with compromised immune systems are always going to be a pool of people who don’t fight off infections- they already have to be protected vigilantly against the everyday viruses you and I fight off in a few days.
The gastro-intestinal (GI) subset of cases confuses things too. If I remember correctly, the epicenter of the original SARS epidemic in Asia was a building in which many of the plumbing floor traps dried out (the U-Shaped pipes that prevent sewer smells from escaping). One or more individuals with gastro-intestinal symptoms caused SARS-CoV-1 to spread in the building without direct contact. When there are sewer smells, pour water into the source drain. Apparently many people don’t know this.
The GI cases were problematic in Wuhan as well because they were not thought to be COVID-19 related and not properly isolated. I think the high rate of health worker infection is due to mishandling the GI cases. This misunderstanding and the over-dependance on complicated equipment/procedures was problematic for Toronto health workers during SARS-1 in 2003.
In newer apartment buildings built to modern codes, there are both control valves, vent stacks, and independent vent traps and even float refill valves for each unit or drain in the drain-waste-vent system, so that this very rarely happens. But there are a ton of legacy buildings even in developed countries that don’t have this, and plenty of new buildings in developing countries that don’t bother even today.
It also turns out that the floating apartment buildings didn’t bother, because according to reports the typical cruise ship waste drainage system, even on newer ships, is basically a common open pipe with a few pressure valves, but not good, isolating traps. So, you know, ideal disease spreading machines.
Handle Proposal #11 is “Everything Antimicrobial”. At least in facilities. The HVAC system should be filtering and killing, with ionization and trapping, UV, killer metals, irradiation, and so forth. Just like we should make new roads for dumb self-driving cars, we should make new living spaces for dumb sterilizer robots that are cleaning all the east-to-clean surfaces.
That’s related to Handle Proposal #4: “No Touch Lifestyle” If you see things that multiple people have to touch with their hands to make work, that’s a problem. That’s why airport bathrooms don’t have doors at all, just serpentine open entrances. But see all those door handles, see the elevator buttons, etc. Either put a strong UV light shining on all those things all the time, or get a hand-waving sensor, or something. Put a motor and sensor on the doors. But operation by public hand-touching should go away.
This “Herd Immunity and Exposure Policy” post is very timely, given my comment (rant?) to Handle earlier today about my mechanistic-mind being slapped hard with the reality that really high-IQ people who I respect are clueless when it comes to real-world technical analysis.
As a counter to Kling’s Petri Dish Test, here is my Malthusian Test: read “An Essay on the Principle of Population” by Thomas Malthus and if you can’t explain why his exponential model is completely wrong (HINT: r/K Selection Theory) then you have no business making applied math predictions.
Hanson’s Model would be a reasonable consideration if the Wuhan peak infection curve was one or two orders of magnitude higher, and that is a pure speculative estimate based on the relevant fact that no one, that I’m aware of, is discussing the Wuhan data relative to the original Susceptible population size. I need to self-isolate from non-mechanistic minds; I have no explanation for the widespread inability to grok what seems so obvious and straight-forward to me. Either I’m really flawed or some memes are just incredibly sticky.
Economists and Epidemiologists are riding this “Herd Immunity” straw man like their favorite hobby horse; rocking away while Rome starts to burn (too many metaphors I know).
The only thing journalists need to focus on is New Infections and publishing the relevant Contact Tracing history so we can stop Community spread. The only message officials need to focus on is Self-Isolation (14 days unless you are in UK then 7) immediately when first flu-like symptoms occur (then contact officials and start documenting your Contact History). Travel Cases and the associated Close Contact cases are important to watch as potential vectors but they are echoes of external Community Spread rather than the key signal of homegrown Community Spread.
When the cheap/easy immunoassays that Yancey Ward describes are widespread then we can refine our understanding of this pandemic but until then we need to treat ALL flu-like symptoms seriously and stop this ridiculous cos-play.
You are predicting that only a tiny % of the population will get infected? On what basis?
On the basis that the active cases form a Bell Curve as seen in the yellow bars of the Wuhan numbers. These numbers are horrifying and indicate that social/economic collapse occurs very quickly, well before any significant immunity occurs.
It is forced isolation due to panic and fear that breaks the transmission chain. Restarting an economy after such fast collapse is troubling and makes me worry about a series of shallow bell curves that last for months/years without ever gaining much immunity in the population.
Trusting official numbers from China is rarely wise, especially where issues of face are at stake. It is very likely that the health authorities were simply ordered to stop reporting new cases.
Jay, I think my comment from five days ago (one incubation period) applies here as well:
If your conspiracy theory about China faking its pandemic recovery is accurate, I will be truly humbled; that is an amazing feat.
that is an amazing feat.
Is it really, though? Totalitarian regimes aren’t exactly known for honesty. And China, for all of its 21st century glitz, is a Stalinist country.
On the other hand, I see that South Korea is reporting similar results. I consider them to be much more reliable.
I’m wondering if the leaders of China are accepting the reality of the superiority of “free democracies” with respect to a better meritocracy of lower level bureaucrats being truthful with their superiors.
So that the “benign dictators” of Chi-Com Politburo, mostly billionaires, really are interested in getting it right, now. So as to maintain their huge privileges.
The Diamond Princess “experiment” (more properly, “disaster”) indicates that only a tiny % of the population will be infected. The infection rate was “only” 17 percent in a situation which was far worse for virus transmission than than any country could possibly have (e.g. small cabins, people eating in common areas during the cruise, people being fed every meal by crew, even when the crew were infected, etc.).
Random testing is a good idea. Sure you’ll get some false positives (and negatives), but you’ll learn a lot. I shared this the other day, but reposting here, that shows that S Korea’s widespread testing shows many more 20-somethings infected than Italy’s symptom-based testing.
And they missed Patient 31. I’m pretty sure that once this pandemic is under control then most nation-states will adopt something like Canada’s Quarantine Act which was refined after SARS-1 in 2003. Patient 31 needed to be tested and constrained once it became clear that she was going to merrily go about her everyday business like she had a regular cold.
It is the Merrily Infected that undermine most/all reasonable efforts.
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Doesn’t this imply that most/all efforts are not reasonable?
No, they eventually figured out the Shincheonji Church of Jesus cluster that was the source of uncontrolled spreading. A full analysis will eventually be completed but I suspect that South Korea was on track to be another Singapore or Taiwan but Patient 31 threw a wrench into the works.
If anything it shows that perfect detection and tracking isn’t required. Mindless and terrible uncontrolled spreading (like Wuhan originally and Patient 31) can be brought under control. This disease is containable but it takes constant focus.
Here is a quick list of some of my out-of-the-box proposals to prevent this from happening again, I can explain further if anyone is interested.
1. Subsidized (or bailed out) Revenue Insurance, “AFLAC for businesses”: Better than mere forbearance or non-targeted monetary stimulus. Just like one can get supplemental insurance that include income-replacement in the event of disability, businesses should be able to buy cheap revenue insurance, which will replace lost revenues (maybe average over the previous 12 months), in the event of a major regional, national, or global emergency that causes all local sector revenue to drop a lot quickly, and which keeps filling the gaps for the duration of the crisis. Require that employees keep getting normal income too. Targeted stimulus, prevents loans and leases going bad, prevents unemployment, sends the money to those hit hardest, buffers and buys time.
2. Related to #1, Subsidized Refund (or Bailout) Insurance. So many people paid in advance for goods or services which are now impossible to obtain. Trip tickets, venue leases, etc. Yes, most contracts have force majeure clauses, cancellation policies, or even things like “travel insurance” available, but as usual, no one reads contracts or takes these terms seriously or pays attention until it’s too late. For true, big emergencies, those clauses should point to a fund filled by insurance premiums which make everyone whole.
3. An Emergency-capable administrative state and bureaucracy with a sliding scale of exigency. We don’t have one, it’s really bad. This one takes a while to explain, so I’ll defer until some other time.
4. No Public Touching Society: If you look at something that many members of the public regularly touch to operate, it’s wrong.
5. Kill All The Bats: We need to make the entire Order of Chiroptera extinct. Maybe we can preserve a few for posterity, but better just to eradicate them all forever. Sorry bats, but you are the enemies of mankind and at least partially responsible for nearly all the recent really bad new epidemics. There is a big cost to what it takes to kill all the bats, and to living in a world without bats, but those costs pale in comparison to the harm caused by bats. Kill All The Bats.
6. Oxygen Everywhere. We have “One Laptop Per Child”, or “A computer on every desk and in every home, and a device in every hand”. We have fire extinguishers and public-use automatic defribillators all over. A machine which can produce and deliver necessary and safe amounts of oxygen hygeinically would be very cheap (it can be done at tolerably low standards for under $100) and allow hundreds of thousands of people to ride out their symptoms at home without overloading the health care system. Another form of pneumonia pandemic insurance. There’s a reason lots of people bought oxygen generators and noninvasive ventilators and CPAP machines early in the crisis. They are not ideal and need care and some fixes, but better than nothing when the alternative is life or death.
7. Require beyond-reasonable-doubt level of justification of necessity to reestablish any rules which were waived during the crisis. For example, the ability to practice medicine in states in which one was not licensed was waived because, let’s be honest, the existing barriers are a corrupt joke, and no one actually thinks they have to worry if they need care from doctors licensed in other states. Once waived, stays waived.
8. Raise The Temperature and Humidity in all buildings. Best evidence we have so far is that the virus doesn’t spread as well in higher temps and higher levels of relative humidity. That’s probably why many colds are seasonal, and there was a big study about iatrogenic infections in hospitals due to dry air. There is little to lose and potentially much to gain. And with summer coming, it would probably save some energy, money, and emissions too.
9. Anti-Microbial Everything. Self-explanatory, but at the very least a lot more UV lights on stuff, and surfaces easy for clean-bots to regularly sterilize.
10. Tests on Prisoners. Tens of Thousands of them, at least. Voluntary tests on a captive audience, as it were, in exchange for clemency and commutation of sentences. The enormously beneficial Public Good is quick and accurate comprehensive knowledge about the new disease. End Mass Incarceration, Get Mass Inoculation!
11. Filter All The Air: Good, HEPA-quality, anti-microbial filters on all forced air flows in public spaces, with smart flow and pressure design to try and isolate proximate areas as much as possible.
Have you ever been to Singapore? SARS did quite well there. We need to wipe out influenza and influenza like illnesses and the self-isolate technique requires to battle COVID-19 might inadvertently do just that if executed well.
#4 You go do this in your charter city first and let me know how it goes, thanks very much.
7. Require beyond-reasonable-doubt level of justification of necessity to reestablish any rules which were waived during the crisis.
Yes, very much. I was just thinking that Trump could possibly give an executive order along those lines, requiring a LOT more gov’t bureaucratic justification for reestablishing rules.
Such “rules” should be changed to non-enforced “guidelines”.
We need far more guidelines, “best practices”, and fewer rules that enforced with gov’t coercion. (That’s a Liber killing word, coercion. Tho “entrepreneur” is worse. Failure to have a good word is a major failure of Libers; unlike feminists and trans folk.)
That’s a good list, although some of them I strongly question, e.g., “kill all the bats.” It’s not a good idea to wipe out species based on a few minutes (or hours, days, or weeks) of thought.
And I’d add one more:
11: Sufficient filter masks for the whole population, and sufficient washable gloves for the whole population. Then, when a government (federal, state, or local) advises, “It’s time to put on masks and gloves, folks,” there will be sufficient masks and gloves for everyone to do that.
Bats are one of the best ways to control mosquitoes, another serious disease vector. If the Chinese don’t crack down on wet markets after this pandemic then I think we should advocate strongly for them to do so but I’d be shocked if they didn’t do it on their own. Let’s start with avoiding getting up close and personal with bats before we decide to wipe them out. I like bats. I’m not fond of stupid people today.
Kill all the mosquitoes too, obviously. Also bedbugs. We’ll be fine without them.
Sorry, it’s not obvious that “killing the mosquitoes” is at all realistic.
Killing bats is far more technically feasible – they’re mammals, almost countable – their major habitats are. They have long periods of great vulnerability.
I would NOT kill all the bats until AFTER humans are successful at the much much harder job of killing all mosquitos.
I worked in mosquito control for 38 years. Bats do not consume many mosquitoes, not nearly enough to have any significant impact on mosquito populations.
Good to know, thanks.
Honestly, you don’t have to kill them, you just have to stop killing them in public places!
No, that won’t do anything. You have to kill them everywhere, all of them. Bats cause our plagues. Drain The (viral) Reservoir. And that requires eradication. See, e.g., “bats and viruses, a new frontier of emerging infectious diseases”.
Is this what Boris Johnson’s diktat to over-70s is intended to achieve?
Here is the plan: pay volunteers $1,000 each to be exposed and naturally inoculated to COVID-19. Pay the money as a helicopter drop. If 220 million Americans get inoculated, that will be a $220 billion helicopter drop and a pittance to the cost we face otherwise. At 60% inoculated, the virus retreats naturally, but is never eradicated. Evidently the virus is a permanent addition to our collection of maladies. Get over it.
With my plan, you kill two birds with one stone. You inoculate the population against COVID-19 and we can go back to normal, and you stimulate aggregate demand within the United States. It is Tyler Cowen’s “state libertarianism” in action.
For this one plan alone I should receive the Nobel Prize in the MacArthur prize, and Tyler Cowen’s rinky-dink little $50,000 prize.
It was my idea first. 🙂 But I might share.
I’ll name it Camp Covid, make it voluntary, and graduates get a diploma which will make them highly desirable in a health and disability insurance pool. Although not in a pension plan.
People will soon pay for the privilege.
Far far better than sending “everybody” a $1000 check, like Romney wants to do, and maybe Arnold too.
Even old folk should be eligible? But they’d have to pay for their own care? Who pays for health care is a HUGE issue in any such scheme.
I’ve been thinking the same, but we’d be mixing 2 unknowns into that one random sample testing experiment: the false positive rate of the test and the asymptomatic prevalence.