Giuliani's Contact Tracing

Fox News aired a segment last week in which Rudy Giuliani scoffed at contact tracing: "We should trace everyone for cancer, and heart disease, and obesity and — I mean, a lot of things kill you more than COVID-19. So we should be traced for all those things". Here's an idea. Perhaps we should do contact tracing for stupidity. I confidently predict that when you graph the results, there will be a dense clique around Fox News. 

New Zealand beats the pandemic

Just for the record, New Zealand is beginning to reopen its economy. It now has "no widespread undetected community transmission", according the Jacinda Ardern, the country's PM. New Zealand has had 19 deaths from covid-19, a country with a population of 4.88 million.  Had the US kept the infection under control same degree, we would be reopening with only 1244 deaths. But we are getting almost that many every day. And the US tally is over 57 thousand, 45 times as high a mortality rate as New Zealand's. Can the two countries be compared? Clearly there are big differences, so direct parallels are difficult. But perhaps it's one reference point worth remembering...

Yes, he really did say that, and yes, he really meant it

Yesterday I had a head-spinning conversation with someone I know fairly well. It was about Trump's astonishing suggestion to his pandemic response gurus that they should "look into that", 'that' being a suggestion to inject disinfectant into covid-19 patients.  She began by saying that it was fake news from the lying left-wing media. I then pointed out that he had indeed asked that his team look into his suggestion. Her comeback was "he never said that". Then I played the clip. Twice. First she claimed it was out of context so I wound the tape back so that the context was there. When she could no longer argue that he didn't say what he said, or that he was taken out of context, her position became, "that may be what he said but it's not what he meant". And while it's beyond normal people's comprehension as to what in the world anyone might have "meant" by such an insanely irresponsible remark, that completely misses the point; people, and particularly Fox viewers apparently, do take him seriously, and that's a problem. Speech, I vainly pointed out, was designed to convey information, not mislead [although that's not always the case, but the principle should apply here], and as the president, it was his job to speak in a way that at a minimum did no harm.

Although there have not yet been any reports of people being daft enough to take him at his word, some may, and there have been floods of calls to state heath advisory bodies asking whether this was a good idea or not. As Nicole Wallace pointed out, this is yet another example of quackery (think hydroxychloraquine, and "what have you got to loose?") from the commander in chief. Trump's ridiculous excuse that was so transparently a lie that no one who watched the exchange would ever believe it, was that he was giving a "sarcastic answer to a reporter's question".

First there was no question. He walks to the podium, begins extemporizing immediately about the effect of UV light and then goes straight into his deranged musing about disinfectant. So no, it was not in response to a question, and for the record he wasn't looking at any of the reporters, but he turns repeatedly to Dr. Deborah Birx (who sits completely immobile, one can only imagine astonished and trying to digest the impact of the presidents 'poor choice of words'). Fox viewers should by now be asking themselves if this is really what they want, a sarcastic practical joker in the Oval Office.

Speed Power and Politics

I sometimes teach a case based on a Bloomberg article about Speed's Power Equipment, a Stihl dealership in Sale Lake City. The crux of the case, at least as I teach it, is that Sam Wilson, Speed's Power Equipment's owner, decided to move his store closer to Home depot when it opened, rather than move further away. That was in inspired decision, since Speed's Power Equipment was a in essence complimenter, not a competitor. Since it offered a differentiated product, the Stihl line of power tools, and one that Home Depot did not (and could not) carry, it didn't compete head to head; and by locating near Home depot it benefit from geographic proximity enabling it to pick up customers where was already visiting Home Depot and who weren't able to find the quality of power tool they wanted.    

Biden has done something analogous by offering interviews to TV stations in battleground states that air while the station is waiting for Trump to hold his daily corona virus campaign events. In offering  a contrasting message, he is able to benefit from the "foot-traffic" coming to watch the Trump show and who may not find the message they are looking for.       

Spinning wheel

I'm not a macro-economist and I confess I struggled with my macro econ course 30 years ago. So I rely on a mental mode that may be a little off. The way I think of the economy is a as a circular flow of money; and if that were water it would have considerable momentum, but if stop it circulating, it takes a great deal of energy to start it rotating again. ( Of course the metaphor is problematic; where does the energy go when you top the wheel suddenly, as we have just done ). But setting that difficulty aside, pumping water into the system as a way of keeping the flow circulating when the normal flow is being siphoned off  by-shelter-in place is important, because starting the flow again if it stops would be far more difficult that keeping it going and siphoning off some in higher taxes to replenish (repay) the loans.   

Biden's VP

Joe Biden has a dilemma now that Bernie (Sanders) has ended his campaign.  How to get Bernie Bros to the polls in November without alienating the marginal voters in swing states, and conversely, how to get marginal voters into his column without Bernie supporters crying "sell-out".

Alexandria Ocasio-Cortez, while the far left's darling and Latina, will be easy meat for Trump and would likely jeopardize the election. 

Amy Klobuchar would bring in Mid-West marginal voters but wouldn't energize the left.

Kamala Harris would be a good choice in general; she's smart and, as an ex-litigator, would be sharp in a debate against Pense, assuming he's re-upped. She's energetic and engaging, and ticks two litmus-test ethnicity boxes. 

Elizabeth Warren might be a good pick; she's relatively down to earth, so good for the swing states. She's progressive, so acceptable to ex-Bernie supporters. She has done her homework and has a plan for almost everything, or so I hear.

Who knows, he could even pick he daughter-in-law.  Oh. No, that's the other guy's MO.

More on escalating commitment (the social component)

I have written before about this administration's escalating commitment to a failing course of action (Ross and Staw, 1993;  "Fear and self-loathing";  "Republicans, what did you expect?";).  Trump's ill-considered encouragement of the use of the unproven anti-malarial drug hydroxychloroquine offers another illustration.

After hearing a rumor that hydroxychloroquine might mitigate covid-19's symptoms, he rushed to publicly tout its possible efficacy; "Try it! What have you got to loose?".  But once he'd publicly encouraged the use of the drug, he was no longer able to back away, even when it was pointed out that 1) there was as yet no evidence for its efficacy, 2) there was evidence that it had harmful side-effects and 3) the ensuing rush to get the drug was making it harder to find for those for whom it had been appropriately prescribed.

Ross, J. and B. M. Staw (1993). "Organizational Escalation and Exit: Lessons from the Shoreham Nuclear Power Plant." Academy of Management Journal 36(4): 701-732.

Power and responsibility

With great power comes great responsibility; so goes the old aphorism. For over three years Trump has enjoyed the former while shirking the latter. Covid-19 is therefore a bigger problem for him than any he has faced yet, since there will be consequences for his actions (or lack of) that will be hard to dismiss with alternative facts. His poodle-like supporters in the Senate and the House cannot protect him from a pandemic as they did during his impeachment.  Of course that will not prevent him and Fox from trying to rewrite history as they have already begun doing, by making that very accusation against the voices of reason. 

Until yesterday, Trump was happy to let the governors make their own decisions so that he could avoid taking blame; that was until they started publicly contradicting him. Until early April, even Democratic governors knew that if they wanted help from his administration they need to fawn over him and massage his fragile, narcissistic ego. That seems to have come to an end when it became clear to many of them that the administration was so incompetent that sycophantic compliments were not getting the job done; they began to be more assertive with regards the timing of re-opening their states' economies.

Trump appears to have seen this as a challenge to his authority, authority he had been hesitant to wield lest he get blamed for the ramifications, and (incorrectly) asserted that he was the only decision maker who could say when the mitigation measures were to be lifted. States rights, apparently, only matter when Trump and the GOP say they do.

More on the trust deficit

I have written elsewhere on the problems that arise as trust is eroded. Another example reared its ugly head in recent days. Trump's distrust of what he calls the "deep state" (and reasonable people call the civil service) meant that he didn't trust the advice they were giving him.

On February 23rd asymptomatic contagion was picked up by Dr. Robert Kadlec, the top disaster response official at the Health and Human Services Department from earlier work by a researcher at the Georgia Institute of Technology. This, above all, should have set alarm bells ringing, since it meant that covid-19's propagation could not be tracked through the identification and isolation of those who had been taken sick; by that time many others would already have been infected.

But Kadlec's attempts and those of others to convince the Trump administration that there was a serious problem fell of deaf ears. Trump's distrust of "experts" (which may be a reflection of his self-image as "a very stable genius" who knows better than everyone else, or simply that he only trusts those who he perceives are Trump loyalists - or both, of course) ultimately led to at least three weeks of delay before the administrating changed course and recommended serious social distancing mitigation recommendations. And that delay cost lives, as these simple models illustrate.

The delay could have caused the initial peak to be almost five times larger than it would have been had the administration acted in a timely fashion. Using a simple assumption of a constant ratio of death to infections, prompt action would have saved, to this point, over six thousand lives in New York alone, and fifteen thousand for the country. And that's before the virus's spread has been contained; there will be more fatalities in the seeks to come, most of which could have been avoided with prompt action.

Moreover, this estimate of lives that could have been saved could be conservative; it assumes that fatalities rise in proportion to the number of cases, but when the health care system is overloaded as arguably it may well have been in New York, at the margin the mortality rate is higher. So, a trust deficit has real consequences other than imposing search cost. Not paying attention to experts can be fatal, as Trump appears to so ably demonstrated.   

The end is in sight - but not for everyone

There seem to be signs, according to knowledgeable officials, that the exponential growth of covid cases is slowing and may soon peak if it has not already done so. Since we are using deaths and hospital admissions as the metric and both are lagged indicators, it is possible that new cases are already on the way down. There is light at the end of the tunnel.

But that light isn't as bright for everyone. Anyone who is in the high risk category (those with respiratory ailments or the over 60s) is unlikely to have contracted the disease and will have no immunity. And while those now circulating freely will probably be immune and non-contagious, it's by no means a certainty, so at-riskers interacting with them run still the risk of infection with the serious consequences that entails.

The only good news is that by that time, the health case system will have the capacity to hospitalize them without triageing admissions.

Exit ramp

Social distancing, albeit unevenly applied (Georgia's governor Brian Porter Kemp claims he had no idea it could be spread by people not exhibiting symptoms; and then exempted churches and beaches  - unbelievable), has applied the brakes to covid-19's spread. That may prevent the tragedy of millions of unnecessary deaths from an overwhelmed health care system. But what next? Models suggest that unless the virus is completely eliminated (as New Zealand seems to have done by acting swiftly and aggressively), going back to "normal" will simply allow the virus to propagate again. Since we have not crushed the infection, we need an off-ramp from the lock-down that doesn't put lives at risk again.

Long term a vaccine will help as will herd immunity, but what about the next 9 months?   

One possibility is that a cure for the most severe cases be found that will reduce the mortality rate. People will get sick but their chances of surviving will increase significantly. But that's not here yet.

So before we have a vaccine and if no cure is found, what then?

The first is to get more data, in real time rather than lagged by three weeks, on who has the infection. That will involve massive amounts of testing and hopefully 'instant' results. That data should also be aggregated into a database to understand where hot-spots may be emerging.

While not perfect one could require people get tested weekly and provide proof on demand that they are covid-free that; without that they should not be allowed to circulate in public.

Finally, a method of back- and forward contact tracing is needed. Once an case of infection is identified, those that person has been in contact with need to be identified and tested; and those they have been in contact be identified and tested too (like a snowball social network data collection effort).

Technology could help here; an app if widely adopted that recorded all other apps in Bluetooth range proximity could help in that contact tracing effort, but like all apps with network effects, widespread adoption is needed to make it effective. Once such an app is developed, adoption might be accelerated if localities (towns, counties) required all restaurants to require the app be installed and active for all their patrons.

Another possibility is to require Fit-bit and similar health monitoring app companies to share data; this could be aggregated and annonymized giving a broad picture of small regions that may be heating up, triggering localized lock-downs; or it could be shared with personal data sent to the CDC (and the local authorities) to ensure that infected people are prevented from circulating freely in the community.   

None of these fit comfortably with American individualism; and they need not be federally mandated. states or counties could implemented these requirements more locally (although, as The Economist noted, there may be legal challenges to such measures). But if we are to avoid the two extremes, an enormous number of deaths or an economic depression, such seemingly unthinkable measures may be needed.     

A social distancing model

The model used here is small (2,000) people but I believe the results are generalizable to larger networks. Social distancing is modeled as a reduction in network degree from 15 to 5. The results are from 15 iterations of each model.

The two lines represent two social distancing (SD) duration periods, one of 30 days and one for 60; both were implemented at 45 days after the initial outbreak. With the caveat that the 45 day start point may be later than is the case and noting too, that the model assumes a uniform implementation of SD (which is clearly not the case), three interesting observations may be made.

First, SD does appear to significantly reduce infection density. Second, when SD ends, infection density climbs again; and finally the second peak is much more severe when SD is short (30 days) than is the case for a 60 day period of SD (which is also lower than the initial peak.

At the end of the simulation (which was run for 18 virtual months), in the shorted SD scenario 68% of the population in the model had been infected while in the longer SD case, only 31% had; while that leaves a significant proportion of the population at risk, the hope is that within 18 months, a vaccine will have been developed.

The model should be considered as illustrative, not predictive, since it makes a number of assumptions that are clearly violated in practice. Nevertheless I think it is strongly suggestive of the efficacy of SD, though questions regarding the model's scalability have not thoroughly investigated.

True to form

About a week ago I was about to post this:

"President Trump appears to have finally understood the gravity not only of the situation but of the office he holds. His press briefing today was the first in his tenure that might be deemed (by reasonable folk, anyway) as "presidential". Perhaps it was the realization that unless he took his job seriously, and more importantly the advice of experts seriously rather than relying on his own intuition, things could go sideways very quickly (some would argue they already have and now anything is too little too late).  But better late than never".   

But I didn't' because I wasn't sure that he had really changed. And boy was I right! Trump is back to his old self, trying to be the star in his own alternate universe reality show. As most sane observers expected, you can't teach this old dog new tricks.

We are at war

I often wonder what life was like for my parents who lived in London during the Blitz. I've lived long enough to have seen several: Vietnam (not my country), The Falklands War (very far away), the wars in Afghanistan and Iraq (nearer, but still...).  Unlike my parents, all were wars I experienced as a dispassionate observer through the medium of television. They were wars that went on "out there" somewhere, but daily life for me, as for so many, didn't change.

Covid-19 is different. Yes, it's not a conventional war, but defeating it it requires a war-time like response.  And while we're not there yet, largely because Republicans seem more concerned about their and their donors' wallets than the health of the country, but we are moving slowly and fitfully towards getting things if not under control, at least less terrible than they could have been.

Life has changed with "shelter in place", in ways perhaps analogous to what Londoner's went through in the war. Of course we're not huddled in tube stations, sleeping on the platform (but my parents didn't either, they were living with my grandmother in Highgate.

And there is now a change in risk. Even with the rise in terrorism, Islamic or domestic, there was little chance I'd be impacted. But with covid-19 the risk is significant.  The enemy isn't human, but it feels like more like we are at war than any of the armed conflicts I have lived through.

Clown show at a funeral

Trump has turned what should be a deadly serious business into a farce. His daily press briefings are just another piece of reality TV to make sure he's seen as being front and center, "the leader" in the crisis. Since he can't hold his pep rallies, he's using the crisis as a political platform instead.

But it's clear that he's less fearless and more clueless. He contradicts the experts, he whines about how it's not his fault (his usual grievance), lies repeatedly (for example how he always took the threat seriously when only two weeks ago he was saying that it was an "impeachment hoax").

If he is reelected in the fall it will prove definitively that there is 1) no god, 2) no justice in the world, and 3) an epidemic of ignorance.