Friday, July 31, 2020

A Better Way To Solve The Mother Of All Fiscal Cliffs

With the extra $600 per week in unemployment benefits set to expire today, combined with the income tax deadline that just recently passed (July 15), the country faces the mother of all fiscal cliffs.  As a result, the money supply would shrink in August, and millions of Americans would have less money to spend right while the eviction moratorium expires and several months of their rent effectively becomes due all at once.  And the timing could not be worse, given the fact that the GDP apparently shrank by nearly a third (32.9%) in the second quarter of this year, the worst quarter in American history (and even worse than the European average now!), while any hope of recovery is currently sputtering now at best.

That is, the US economy literally shrank by a greater annualized percentage in just three months than in the entire four years (peak to trough) from 1929-1932, the worst of the Great Depression, when GDP shrank by 30.5%.  Let that sink in.  Meanwhile, the UK is currently experiencing their worst recession in at least 300 years.  Now that really says something!

Thus, a very, very big stimulus is necessary right now to prevent a long-term, full-blown depression of epic proportions.  Depressions are fundamentally caused by a shortage of money.  After all, GDP is literally just a spending measure, and most of that is consumer spending and government spending.  The caveat, of course, is that not even all the money in the world could fill (and can barely even briefly paper over) the inherently massive hole left in a shuttered-by-fiat economy until after the economy is fully reopened, at least not for very long.  Thus, the TSAP recommends the following steps be taken, yesterday:
  • Expand the $600 per week to ALL Americans period, not just those receiving unemployment benefits, no strings attached.  Anyone with an SSN or ITIN gets it.  Maintain such payments until at least December 2020.
  • Create a permanent UBI for all Americans, of $230 per week ($1000 per month) for adults and half that amount for children and young people under 18, for when the temporary extra $600 finally expires.  Again, no strings attached.
  • Pass the HEROES Act and all of its associated stimuli, not the cheap Republican knockoff version.  After all, without essential workers, civilization would have collapsed by now, so it is literally the LEAST we can do to thank them.
  • Extend the eviction moratorium until September 1 or until enough of the funds from the above are disbursed into the pockets of the people so they can pay enough to avoid eviction, whichever occurs later.  Consider also cancelling (and directly compensating with federal funds) landlords for all past due rent dating from March 1 until August 1.
  • More funding to shore up small businesses, which are the very bedrock of the economy.
  • Keep the US Postal Service running with whatever federal funds are necessary.
  • Increase aid to the states, and funding for hospitals as well.  And while we're at it, implement Medicare For All as well.
  • Three words:  Green New Deal.
  • And of course, DON'T shut down again!
As for the so-called National Debt, that is really a non-problem for a Monetarily Sovereign government like our federal government, since they can literally just print the money.  And right now we have far more to worry about from deflation than we would from inflation.  Even if inflation did occur, all the federal government would have to do is resolve the shortages in goods and services that caused it, by directly purchasing such goods and services at a premium and selling (or giving) them at a loss.  And failing that, the FERAL Reserve (which, we gotta say, has been doing the heaviest financial lifting in terms of shoring up the economy just enough to prevent a total collapse thus far) can always raise interest rates and/or the reserve ratio (both of which are at rock-bottom levels), sell bonds to shrink its massive balance sheet (Quantitative Tightening), and/or drain and sterilze excess bank reserves if and when the "inflation dragon" ever does rear its ugly head at some point.  Thus, it would really be a non-problem.

So what are we waiting for? 

Tuesday, July 28, 2020

The Only Way Out Of The Pandemic In One Piece

As time goes on and the endgame of the COVID-19 pandemic is now coming into focus, it is becoming increasingly apparent that not only do lockdowns not work very well and in fact do more harm than good, but that there is really only one realistic way out of this nightmare at this juncture.  And that way out will ultimately come about sooner or later, via a combination of three things:
  1. "Herd immunity", which simply means that a large enough percentage of the population has become at least relatively immune to the disease (either via natural infection and/or mass vaccination) so as to quash the epidemic and keep it from taking off again in the near future.  The former route is far more likely in the near term than the latter, and the herd immunity threshold (HIT) is most likely far lower than was originally believed, and many states and countries are likely already there by now.
  2. "Attenuation", which really is just a fancy way of saying that the virus becomes weaker over time, losing its "mojo".  There is some evidence that this process has already begun at least several weeks ago.  Especially if combined with herd immunity, the virus may eventually become the new common cold, if not phase out entirely.
  3. Better early treatment of patients with the disease.  This cannot be overstated, as we have learned a lot about how to treat such patients, and most importantly what NOT to do, through trial and error (sadly, mostly error).  Now if only the feds were use the Defense Production Act to force production of PPE for hospitals rather than focus on often counterproductive ventilators.
These three things are, of course, all a result of the widespread circulation of the virus, which of course came at a very heavy price in terms of human lives.  But once the proverbial horse is out of the barn, as it has already bolted long ago, such a thing is inevitable sooner or later.  Especially with the prospect of a safe and effective vaccine likely years away.

Sweden, as we know, understood this very well from the start.  It is really a shame how most other countries did not, and some still seem not to for whatever bizarre reason.  Instead, they mocked Sweden's moderate mitigation strategy and attempted to suppress the virus all the way to zero via lockdowns and mass quarantines, often belatedly.  Those that acted too late basically trashed their economies for nothing while inadvertently creating a Sweden-like herd immunity scenario anyway (albeit often with far more excess deaths), while those that acted early seemed to dodge a bullet, only to see a resurgence (or extra legs) of the virus later.  Basically, as the now-famous Swedish epidemiologist Anders Tegnell predicted, a year from now (if not earlier) we will see that practically all countries and states will end up the same way (within error bounds) regardless of what strategies they pursued, a few lucky (or unlucky) outliers notwithstanding.

In other words, the virus is in the wild and has been for a while now, so shutting down again will only delay the inevitable, and drag it out that much longer and more painfully.  So don't do it again!

That said, we should also note that the TSAP unequivocally does NOT support the practice of "corona parties" or any other deliberate or grossly negligent mass infection-inducing behavior.  This virus is, at best, extremely difficult to control.  Just because most people will inevitably be exposed to the virus at some point does NOT mean that anyone should willingly and unnecessarily tempt fate in any way.  And even though the virus is relatively harmless to most people, that clearly does NOT mean that it is for everyone, and there are of course documented cases of people dying or suffering irreversible damage from it at surprisingly young ages.  This is still a potentially dangerous and deadly virus, after all.  So seriously, live your life, "keep calm and carry on" as the old saying goes, but please do take precautions, avoid large crowds, and don't be stupid and reckless about it!  Young people, this means you too.

UPDATE:  Some pundits apparently still believe in a "Zero Covid" strategy in which no level of the virus is tolerated, assuming that it can actually be truly eliminated via suppression measures.  The problem with that quixotic, ivory-tower idea is twofold--first, even if possible, we missed our chance to do it many months ago, and secondly, any attempt to do so now will only drag it out and prolong the pain by further delaying herd immunity.  With plenty of collateral damage too.  And we would basically have to live like the unfortunate folks in Susan Cooper's Orwellian-style dystopian novel Mandrake for the foreseeable future, a truly disproportionate response to a disease whose deadliness is most likely in the range of seasonal flu to medium pandemic flu.  And with most likely zero lives saved as a result.  Fortunately, we will likely reach herd immunity and/or attenuation of the virus sooner than expected, if not already there, so it won't be long before this debate becomes academic.

And sorry, but moving the goalposts does NOT really furbish the "Zero Covid" strategy one bit, which is still just as ridiculous as a "Zero Flu" strategy.  After all, there was a reason we were able to (relatively) tame the flu over time without eradicating it, and that reason was via the three aforementioned factors:  herd immunity, attenuation, and improvements in treating patients.  We'd be wise to learn from history.

Thursday, July 23, 2020

Case Closed: Lockdowns Don't Work

A new study published in The Lancet examined the effects of various countermeasures and other country-level variables on COVID-19 cases, deaths, and related statistics in various countries.  And the results were rather underwhelming and disappointing for any lockdown enthusiast.  Behold the key takeaway, in the authors' own words:
Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people.
And that was after controlling for a whole host of variables in a multivariate analysis.  As the late, great William Farr (of Farr's Law fame) has famously noted, "the death rate is a fact; anything beyond this is an inference".  That is, if you know the death rate for a given disease, you can fairly accurately estimate the (lagged) infection rate from that.  And that is especially true of COVID-19, where cases are often counted differently in different times and places.

(The Occam's Razor is as sharp as ever here.)

And that is not even the most scathing study done on the matter to date.  Followers of our blog may recall others as well that were far less charitable than this one.  Worse, in some countries, lockdowns actually appear to have been deadlier than doing nothing or taking less extreme measures.  In many countries, deaths with COVID and from COVID are conflated, and even non-COVID deaths saw increases during at least the first few weeks of lockdown.  Excess all-cause mortality in so many countries shows a rather suspicious pattern that is strongly suggestive that the government response of lockdowns (along with closely related policies such as artificial restrictions of healthcare and monumentally screwing up with nursing homes) likely caused far more deaths than the virus itself.  In fact, despite the fact that the virus was already circulating much earlier, excess all-cause mortality did not exceed statistical norms in any country until after such lockdowns were imposed.

If that is the case, then that is nothing short of mass murder!  And those are just the short-term effects, with longer-term effects coming down the pike.

At best, then, such lockdowns were unnecessary infringements on civil rights and liberties, and at worst they were far worse (and deadlier) than useless.  All the more reason NOT to repeat such mistakes going forward.  Seriously, don't do it!

So what about those few supposed success stories of countries and states that locked down very early in their epidemic curves and seemed to have dodged a bullet?  Well, take a look at them now, or if not now, a few weeks or months from now.  Those are the ones who are or will be having the much dreaded "second wave" of the virus, since they still have quite a ways to go before reaching even partial herd immunity thanks to their early lockdowns.  Meanwhile, those hard-hit countries and states with belated lockdowns (or none at all, like Sweden) will most likely avoid a second wave, having built up enough immunity to keep the virus from taking off once again.  A very lucky few countries in the former group might still remain lucky, of course, but as Dr. Sunetra Gupta notes, that is really thanks to the rest of the world building up such immunity, a classic "free-rider" problem that really is nothing to be so smug about.

The thing about viruses is, you can run, but you can't hide.  At least not for very long.  Sooner or later, it has to run its course.  It really doesn't take a rocket scientist to see that playing hide-and-seek with an invisible enemy would be a lose-lose proposition.


JULY-NOVEMBER UPDATES:  Looks like yet another rug has been pulled out from under the strongest pro-lockdown argument recently, confirming the WHO's famous June 8th "gaffe" that truly asymptomatic transmission of the virus, while it exists, is indeed relatively rare and is thus not a particularly significant driver of the COVID-19 epidemic.  A new study in Annals of Internal Medicine in August simply confirmed what previous research has already found in that regard in countries that did very thorough and detailed contact tracing.  And of course, we now know that the decision to implement lockdowns was really due to countries simply copying each other and flying blind, not based on empirical evidence.  And the whole general concept has quite a checkered pedigree as well, while its original justification of "flattening the curve" was quickly and thoroughly supplanted by moving the proverbial goalposts practically 180 degrees.

(While presymptomatic transmission and subtly symptomatic transmission is apparently quite common, that is also true for the flu as well, a virus for which large-scale mass quarantines have been roundly discredited as useless and counterproductive for nearly a century.  The lockdown zealots can't have it both ways: either COVID-19 is as stealthy and practically unstoppable as the flu and common cold, and lockdowns are thus utterly useless, OR it is possible to contain it without lockdowns, and lockdowns are thus utterly unnecessary.)

And yet another study has recently found that the curve was in fact largely self-flattening from the start with or without lockdowns or other non-pharmaceutical interventions (NPIs) such as curfews, closures, quarantines, travel restrictions, event bans, or even the much-vaunted mask mandates.  That is, while the growth rate of the epidemic inherently started out very high, it had already begun decelerating after roughly the 25th cumulative death was recorded in practically every country studied regardless, with the daily curve peaking or plateauing within 20-30 days from then.  Even long before herd immunity was or will be reached, transmission rates were already slowing down dramatically due to the virus reaching "natural dead-ends and roundabouts" in human social networks.  Which is really not surprising for a virus that is primarily transmitted by a small "superspreading" sliver of the population, and that still in a highly heterogeneous population in terms of susceptibility as well.  And even if lockdowns and/or other NPIs were perhaps somewhat effective at first, any such effectiveness apparently rapidly decays over time to essentially nil by now.

And Lyman Stone, an early opponent of lockdowns, noted all the way back in April that Americans, much like Europeans, generally began voluntarily social distancing before, and often well before, lockdowns went into effect.  This was particularly true in Washington State, but true to an extent practically everywhere eventually.  Information and recommendations would thus appear far more effective than coercion, especially when done early.

Still not convinced yet?  Well, even more new evidence just keeps piling up, and none of it is particularly flattering to lockdowns.  Also, for the USA, it appears that the significant regional variations in the death curves are far more due to to climate and seasonality than to lockdowns and NPIs.  The Northeast was "early peak" much like Europe, the South and Southwest was "late peak" much like Latin America, and the Midwest and Northwest were essentially "no peak", just a long and low undulating plateau.  And a few borderline states were "mixed", not clearly fitting into any category.  All essentially independent of the timing and relative stringency of lockdown and reopening.  Thus, looking at the USA as a monolithic country, especially when comparing it to Europe, is highly misleading and disingenuous.

See also this video by the ever-insightful Ivor Cummins as well.  A real eye-opener indeed!

Thus, yet again we see that anti-lockdown Sweden (and Belarus, etc.) was not a special case at all, but rather the proper control group while the rest of the world essentially embarked on a crazy experiment whose theory behind it didn't really pan out.

Oh, and about that supposed "success" story of Peru?  There's a good reason why lockdown enthusiasts don't seem to want to talk much about them anymore.  Let's see:  world's longest lockdown (over six months), world's toughest lockdown (makes Melbourne look like a walk in the park), world's earliest lockdown (for their region), and--wait for it--world's worst death rate.  If that's "success", we'd really hate to see what failure looks like!  Now their fully-open neighbor Brazil doesn't really look so bad after all, do they?

(Pardon the pun, but don't cry for me, Argentina, either.  Another longest-lockdown country now getting the worst of both worlds, with the added insult of borderline hyperinflation (again!) as well.)

Later, Belgium of course became a bit worse than Peru once again despite going back to lockdown, as their second wave appears to rival their first one.  Neither their first nor their second lockdown seem to have done them a lick of good.  Supposedly they have quite a problem with Vitamin D deficiency, kinda like New York and the UK, so they might wanna start fortifying their food like the Nordic countries do.

Thus, in conclusion, the most fundamental flaw of lockdowns of all flavors is that it is applying a micro-level solution (quarantine of sick individuals and/or their contacts) to the macro level (mass quarantine of the healthy as well, over a wide area), which ultimately creates far worse macro-level problems.  The same can perhaps even be said about overbroad mask mandates as well, at least in the long run.  History will not judge such measures kindly at all.

And in case you think that the shiny new October study in The Lancet somehow overturns the aforementioned ever-growing mountain of evidence against lockdowns, well, we've got a shiny new bridge we'd like to sell you.  The ever-insightful Toby Young of the British site Lockdown Sceptics has an excellent takedown of this highly questionable study.  If only the UK Government (and indeed the rest of the world) would actually listen to him for once.

Meanwhile, yet another study finds that lockdowns still don't work in terms of reducing death rates, and another finds that the recent autumn outbreaks are (surprise!) strongly correlated with seasonality regardless of policy.  Case closed, full stop.

See also here, here, here, here, here, here, and here.  

Saturday, July 18, 2020

The Progressive Case For Reopening American Schools Sooner Than Later

NOTE:  This article is about K-12 schools only.  For the college question, please see this here.

Politics in the USA in 2020 has apparently gone from absurd to utterly horrifying to just plain silly.  The latest political football is whether America's schools should reopen in the fall, having been closed in all 50 states and territories since mid to late March.  Democrats are generally against it, while Republicans and especially Trump and his supporters are in favor of it.  Even Betsy DeVos, who has never been a friend of public education, suddenly pretends to support it (while surreptitiously trying to gut and ultimately privatize it, of course), while Democrats who are usually the the biggest champions of public education are more likely to oppose reopening.  Thus it seems to split rather evenly along party lines, as often happens in today's fraught and bizarre political climate.

But when you peel back the politics and see the issue for what it really is, then the only truly progressive position at this juncture is to reopen schools.  Because keeping them closed does more harm than good on balance, to both children and society at large.  And strictly and seriously "following the science" would in fact point strongly in favor of reopening schools.

School closures are a classic example of throwing out the proverbial baby with the bathwater.  While school closures are known to work very well in the short term in slowing the spread of influenza and infectious diseases in general, the longer-term effects are unknown, and children (and teens) seem to be at relatively low risk from this virus as well as not a particularly significant vector for spreading it to adults.  While some evidence strongly suggests that temporary school closures early in the epidemic curve have helped to flatten that curve (even if only indirectly to reduce the number of adults infecting each other), it remains unclear how long such benefits can last (likely not very long).  Many countries like Iceland, Denmark, Norway, Germany, and Taiwan (all fairly progressive countries) have already reopened schools with no evidence of any resurgence of the disease that could possibly be related to the reopenings, and Sweden never closed them at all for children under 16.  Belarus even kept colleges and universities open too, and yet they still have one the mildest outbreaks in the world.

Meanwhile, the collateral consequences of keeping schools closed keep on increasing the longer schools remain closed.  Virtual learning will never be as good as in-person instruction.  Students fall behind and find it harder and harder to catch up, and socioeconomic inequalities and inequities are widened that much more.  Children are denied the socialization experiences that are needed for healthy development.  And it also creates a heavy burden on parents, particularly working mothers, making work-life balance all but impossible.  There is clearly nothing "woke" or progressive denying such realities.

And the CDC guidance for reopening schools isn't really that much better than keeping them closed.  As famous Libertarian and Republican Senator Ron Paul himself noted back in May:
Last week, the Centers for Disease Control and Prevention (CDC) did its part to encourage homeschooling when it unveiled “guidelines” for schools to follow when they reopen. Among the CDC’s guidelines are that schools put tape on the hallways, directing children which direction to walk and how much distance to keep between themselves and their classmates. The CDC also recommends children do not share electronic devices or learning aids. The guidelines even say children should wear masks at school.The CDC’s guidelines instruct schools to close playgrounds and cafeterias, and to cancel all field trips and assemblies. Instead, students are to spend all day at their desks, not even leaving classrooms for lunch or recess.The CDC’s guidelines may not have the force of law, but it is likely most government schools will adopt them in order to ensure continued access to federal funding. Schools will do this even though children are at a very low risk of being seriously harmed by coronavirus. In fact, by forbidding children from going outside to play, exercise, and get sunshine, the guidelines actually endanger children’s health. The guidelines also harm children by limiting their ability to interact with their fellow students and develop social skills.
Now you KNOW things are bad in this country when Ron Paul (and/or his son Rand Paul) is anywhere even close to sounding like the voice of reason!  Keep in mind that in most of the countries that already reopened schools (or never closed them), none of these rigid and utterly dystopian protocols were employed in their schools, or at least not for very long.  Generally, the only notable departure from the status quo ante was a greater focus on hygiene, and that was basically it.  And the sky did not fall.

(The creators of South Park would surely have a field day with that!  Per Poe's Law, the satire writes itself.)

Yes, some precautions are certainly needed, particularly in schools that are located in communities where the virus is still spreading.  But we don't need to keep schools closed indefinitely or go full dystopia either.  The best advice the TSAP can recommend is that decisions be made as locally as possible, with all schools in this country planning on fully reopening by September 8 at the latest, and playing it by ear from then.  If there is a known outbreak (of three or more individuals) on school grounds/vehicles or otherwise linked to the school, a severe outbreak in the local community (i.e. a virus test positivity rate exceeding 10% for a 7 day rolling average) and/or excessive absenteeism for any reason, a brief precautionary closure not to exceed two consecutive weeks ought to be done without delay for that particular school or district only.  For excessive absenteeism specifically, the brief closures may be further extended as necessary for the duration of the bulk of the absences, kinda like was done locally with the 2009, 1968, and 1957 flu pandemics in some schools. But otherwise, schools should plan on being fully open by default.

Additionally, even after fully reopening for in-person classes, distance learning should also still remain as an option on the menu for any students with high-risk household members (or with serious underlying health conditions themselves), as well as for any teachers who believe themselves or their household members to be at high risk.  That way, even if the odd outbreak does happen to occur at school, it would really be a non-problem practically speaking.

As for masks and social distancing, and other restrictive protocols, that should be decided locally as well, and in our opinion only implemented as an alternative to closure when there is locally widespread community transmission but not (yet) seen among students, teachers, or staff.  Otherwise, a greater focus on hygiene, disinfection, and ventilation should be the only significant departure from the old normal, and perhaps also reasonably limit class sizes and the size of large assemblies.  And perhaps fever checks at the door as well.  That is, use common sense.

And parents/guardians, for the love of all that is good, please keep your kids home if they have any questionable symptoms, or if anyone else in the same household is under isolation or quarantine for known or suspected COVID-19 or any other contagion.  Honestly, that is just basic Public Health 101.

And yes, public schools should receive more funding going forward, and teachers should be paid more.  And if it is done by our Monetarily Sovereign federal government as as opposed to (our often already overtaxing and borderline bankrupt) state and local governments, it won't cost the taxpayers anything.

So what are we waiting for?

UPDATE:  It looks like a few states have already reopened schools with in-person classes as of early August, such as Indiana and even (gasp!) Georgia.  And apparently parts of Montana already did back in May, as did parts of Canada.  And by now, practically all of Europe too.  All with no evidence of any "parade of horribles" resulting from their decisions to do so.

OCTOBER UPDATE:  Many (though still not all) American schools have reopened, and it looks like it really was not a disaster after all.  Well fewer than 1% of both students and teachers have had confirmed or even suspected cases since the current school year began.  In fact, a recent analysis in 191 countries worldwide found no link between school reopenings and coronavirus infection rates.  But hey, we (and Sweden) could have told you that months ago, and in fact we literally did.  Now if only the remaining schools would finally open as well, yesterday.

Even The Atlantic now admits that the fears about schools reopening were grossly overblown.  Even in (gasp!) Georgia.  And the esteemed British Medical Journal (BMJ) now believes that closing schools had backfired and actually led to a net increase in COVID deaths compared to keeping them open.

NOVEMBER UPDATE:  A new study finds that closing schools likely costs children more life years than it saves in the long run.  That is, on balance, doing so actually kills more children than it saves.

Wednesday, July 15, 2020

Looks Like Sweden Won The Debate After All

Short version:  Sweden clearly won the lockdown debate, opting instead for a far more sustainable strategy that balanced the short-term goal of "flattening the curve" with the longer-term goal of "herd immunity", and the virus is now on the run and all but disappeared from their country as of July.

Longer and more nuanced version:  Sweden is one of those countries that, in our polarized world, you either love them or hate them.  Being the most famous of the non-lockdown countries, the anti-lockdown side loves them while the pro-lockdown side just loves to hate them.  Which makes sense, given how Sweden is one of the few and most well-known countries who chose not to do a lockdown at all.

In truth, however, they are neither a shining city on a hill, nor are they an unmitigated disaster in terms of how they handled the COVID-19 pandemic.  They are in fact...about average by European standards, at least in terms of per capita death rates for now.  Worse than their Nordic neighbors and Germany and Austria, but better than the UK, Belgium, Spain and Italy.  Worse than the USA as a whole, but better than the seven worst US states, especially New York.  Which is nothing to brag about, of course, but hardly a ringing endorsement for lockdowns either.  Especially since they avoided completely annihilating their economy (albeit still suffering) and inflicting other collateral damage that the lockdowns in other countries (especially the UK) did, while still being able to "flatten the curve" and thus keep hospitals from being overwhelmed and collapsing Lombardy-style.

The architect of the Swedish mitigation strategy of moderate social distancing, Anders Tegnell, admits that Sweden could and should have done more.  And yes, they did screw up in several major ways, at least in the beginning.  But he still does not endorse a full lockdown.  So what could they have done differently, short of a lockdown?

Here are the things that come to mind that they should have done but didn't, or should have done earlier but did too late:
  • They kept their borders wide open with no hard restrictions on international travel or even any health screenings at ports of entry.  Even Japan and Belarus didn't make that mistake.  In hindsight, that was really quite foolish.
  • They did not declare a state of emergency.  Even the Donald did that, albeit belatedly.
  • Their gatherings limit of 500 people, first imposed on March 11, should have been cut down to 50 people or some other double-digit threshold much sooner, ideally on that same day or the very next day, rather than waiting until early April to finally do so.
  • They should have made virus testing available much sooner.  Instead, until very recently, you literally had to be sick enough to go to the hospital in order to get a test as per their test rationing policy that began in March.
  • They made a reasonable stab at contact tracing at first, but gave up when the numbers grew too overwhelming.  (Though even with very little testing, they could still have done it the Japanese way had they started earlier than they did.)
  • Like most countries, they should have done a better job protecting nursing homes. In Sweden's case, they should have banned or severely restricted visits to nursing homes much, much sooner, instead of being loosey-goosey about it until finally doing so on March 31.  And they should have made sure early on that the staff had (and used) adequate masks and PPE, which they failed to do.  Even Florida did better than they did, though New York and New Jersey were far worse, as was the UK.
  • Their triage protocols for nursing home patients being (not) sent to the hospital turned out to be wholly unnecessary and counterproductive.  Ditto for any other artificial restrictions on health care.  (Other countries did this too, so this was not unique to Sweden.)
  • And like most countries also failed at, they should have kept colleges open even if they canceled classes temporarily.  Sending students home to infect their parents and grandparents was probably not the wisest idea in the world.
  • And last but not least, they advised against face masks (and apparently still do) on the mistaken belief that they create a false sense of security and lead to less social distancing.  And that stance does not appear to be accurate.  (Though admittedly, the book has still not been 100% written on the question of net effects just yet.)
Aside from those flaws, there is still much to admire about Sweden and their strategy.  But ultimately they are paying a rather heavy price for their earlier errors, even after belatedly correcting such mistakes.  They likely will reach the holy grail of "herd immunity" sooner or later, if they are not already there, but unfortunately due their missteps, the journey turned out to be much more dangerous than the destination.  Thus, we give Sweden a gentleman's C for effort.  Still far better than several lockdown countries did.

As for population density, in case someone uses that argument, it is misleading to compare average densities across nations, given the large variations in density and distribution within each country.  And even so, higher densities do NOT necessarily imply higher per capita death rates, in fact the opposite may very well be true as a result of at least somewhat better healthcare provision in denser areas.

It looks like not only is Sweden's COVID epidemic all but oven now as per Worldometer death rates, and their death curve did turn out to be much more bell-shaped after all, but that Sweden is now quite vindicated indeed compared to even some of their neighbors in terms of cumulative all-cause mortality through the first 24 weeks (roughly the first half) of 2020.  Though worse than Norway, Sweden nevertheless fell very close to and just between Denmark and Finland, and fared far better than Scotland.  So it looks like the lockdown zealot vultures will need to find a new punching bag now--take a guess which country? 

(Hint: it's the one that is still not only debating on whether to reopen schools in the fall, but actually has the GALL to crassly turn the issue into a silly political football because it is an election year.  Really. Meanwhile, most other countries have successfully reopened K-12 schools with essentially no problems, and Sweden never closed them at all.)

Additionally, it looks like the Swedish city of Malmo is in fact doing a particularly good job overall.  After watching and learning what not to do from the early hotspot of Stockholm, they followed essentially the same Swedish strategy minus the nursing home screwups, basically, and as we can see now, it's really paying off.  Their per capita death rate is lower than even Copenhagen, Denmark across the Oresund strait.  That is, they are achieving herd immunity AND protecting the most vulnerable members of society at the same time, while maintaining individual freedom and avoiding an economic depression.  Now THAT is really a shining city on a hill!

(Lest anyone claim that somehow America is too diverse and multicultural for the Swedish model to work here, keep in mind that Malmo is also a very diverse and multicultural city as well.)

In other words, we can certainly learn a lot from Sweden--both what to do as well as what not to do.  But all things considered, Sweden clearly wins the debate hands-down.

Sunday, July 5, 2020

Seriously, Don't Shut Down Again!

(NOTE:  This post has been updated several times, see the updates at the end of the post.)

It looks like several states are seeing spikes in COVID-19 in recent weeks following reopening.  While probably most of it is due to increased testing, the very large spikes (and increases in positivity rates) in Texas, Arizona, Florida, California, and some other states also show increases in hospitalization rates, so at least some states are likely seeing real increases.  And those are generally the ones who reopened before even reaching their peaks, while California's early flattening of their curve seems to have merely delayed the bulk of their infection burden.  And interestingly, Georgia had not seen any real spikes until very recently, despite being the first state to reopen.  Meanwhile many states, most notably New York and New Jersey, have not seen any spikes at all despite increased testing and massive protest rallies in recent weeks.  Both were among the first states to have mandatory mask requirements, and were also the earliest and hardest-hit states.

Even the increase in hospitalization numbers may be less than meets the eye.  Given how now they tend to test every patient that darkens their doors regardless of what they initially went in for, that alone will push the numbers up, especially since many new patients are from the backlog of patients when non-urgent and elective procedures were restricted during the shutdown and many people had a fear of going to hospitals due to COVID-19.

Thus, it may not even be due to the timing and pace of reopening at all, but rather due to how many people are wearing masks, and simply that states that were hit harder earlier, the epidemic has largely run its course, while the states that started with milder outbreaks simply still have a ways to go yet.  And overcrowded bars and nightclubs seems to be the biggest culprits in the new hotspots lately.

It is notable that death rates are still dropping nationwide despite the apparent surge in daily cases to new record highs.  Even in the new hotspot states, deaths are generally low and flat or declining, and even Arizona's death rates are still following the same old slow-burn pattern they had before reopening despite being the fastest-growing state in terms of positive test results lately.  Most new cases are coming from younger people (under age 35), a possible reason for the apparent decoupling of infection rates from death rates, and suggesting herd immunity likely occurring sooner rather than later.  Or perhaps we have learned (often the hard way) better ways to treat the disease, thus saving more lives.  Or the virus itself could simply be getting tired and losing its "mojo" after circulating so much for so long.

So even if there is a surge in cases, resist the impulse to lock down ever again.  Doing so once is already one too many times.  Simply require masks to be worn in public, particularly indoors, and tighten limits on building occupancy and large gatherings.  That's it.  Add some temperature checks and you're golden.  Maintain such policies until case numbers drop to a statistically and practically negligible level, then repeat as necessary.  As for a vaccine or cure, don't hold your breath, since a vaccine is likely years away, while anything resembling a (belated) cure would most likely not be much of a game-changer compared to existing treatments (remdesivir, steroids, etc.).

And of course, there is already a certain alternative treatment protocol that has gotten such a bad rap in the mainstream due to grossly improper use (and its infamous guilt by association with certain politicians who promoted it) that some countries have even banned it despite its rather promising effectiveness in saving lives when used early, properly, and under the advice of a qualified physician.  Switzerland briefly banned it and subsequently lifted the ban, effectively creating a natural experiment, and the results speak for themselves in terms of death rates. (The TSAP cautions the reader to always consult a physician before beginning any sort of treatment or prophylactic regimen, especially this one.)

(Also, enter lab-created antibodies, which are of course certainly worth a try in the meantime.)

As for contact tracing, they really need to step it up.  And any supposed shortage of testing capacity (even after having many months to prepare!) is no excuse not to do it, as Japan was able to do retrospective contact tracing successfully with very little testing (2000 tests per day, equivalent to about 5000 per day in the USA), focusing on the larger clusters and thus the "superspreaders" that account for the vast, vast majority of virus transmission in the community.

And perhaps COVID-sniffing dogs will soon become a thing as well.  Apparently they exist. Regardless, all of these aforementioned alternatives are far better than a return to lockdown.  So what are we waiting for?

JULY UPDATE:  It looks like daily death rates finally did begin modestly rising again for the USA, driven by a handful of hotspot states, several weeks after apparent cases had begun rising.  That said, the death rates nevertheless still remain far lower than what they were in April and May, and the case-fatality rate continues to fall.  In other words, the curve has been flattened.  And apparently a good chunk of these supposedly "new" COVID deaths are a simply a result of delayed reporting of deaths that occured back in June, May, or even April, and/or were not even necessarily caused by the virus (e.g. motor vehicle fatalities in which the deceased happened to test positive).  Thus, our argument still stands.

AUGUST UPDATE:  As the ever-insightful J.B. Handley recently noted, there is yet another crucial nuance to this pandemic that has been overlooked.  That is, much like with other seasonal viruses, in the more southern latitudes, the epidemic burns slower and the peak simply arrives later and is smaller (at least in terms of deaths) compared with the more northern latitudes.  And since even in the north (Europe and the northern US states) it arrived about three months later than a typical flu season, it would be even more delayed still in the southern US states as well as Latin America and the rest of the global south, lockdown or no lockdown.  Divide the USA by the 35th parallel and in fact you see two distinct death curves.  This is exactly what the famous epidemiologist Dr. Edgar Hope Simpson would have predicted.  Combine that with Dr. William Farr's famous Farr's Law, and one can predict that the pandemic is almost over.  So yes, much of the surge in cases and deaths in the southern states is all too real,  but even there it will be largely over (that is, no longer at epidemic proportions) in a few weeks from now.  Based on excess weekly all-cause mortality, Handley notes that the predicted end date for the USA overall is August 25, 2020, when such figures return to baseline and there is no longer any signal in the noise (even if there are still some reported cases and deaths from or with COVID-19).

(Same thing happened with its cousin SARS back in 2003, by the way.  It simply arrived and peaked later in the lower latitudes, then eventually disappeared.)

And let's not forget the problem of false positives on the PCR tests as well, which will become increasingly salient as the actual epidemic/pandemic wanes.

SEPTEMBER UPDATE:  Looks like all-cause deaths in the USA by date of death are still elevated (significant excess deaths) as of late August and early September, but declining.   Thus, the prediction by Michael Levitt was simply off by a few weeks due to reporting lags.  The lag for designated COVID deaths specifically is even longer still, with a good chunk of the deaths reported today having occurred weeks or even months ago.  And given all of the increased testing and false positives for cases, what we have now seems to be more of a "casedemic", while the actual pandemic is waning if not already technically over in most places.  A true second wave is thus unlikely.