Since I missed my usual Friday Covid-landmark blog, I thought I'd do a second blog. I think my streak of Friday blogs go all the way back to our self-isolation in February, so it is a shame to have broken it.
What has this seven day period brought? The world's daily increase in the numbers of cases and deaths seem to have stabilised, but it isn't dropping. It is rather incredible and it would be interesting to know how this is possible. The majority of the affected world being locked down shouldn't really allow it to keep going with 90,000 cases a day. With almost all social and commercial interactions suppressed, there shouldn't be a way for cases to sustain what is essentially the same rate as before the lock down, but yet there are very few countries on the path to elimination, and fortunately New Zealand, Australia and South Korea are all pretty close to it.
There are some articles recognising the patchwork inconsistent strategy of Australia, which looked messy at first, has reigned in the outbreak while preserving normality by a degree. Doing a "black and white" analysis, they might have stumbled on a better degree of social distancing than the strict lock-down in New Zealand. That is not to say the foolish pundits criticising the New Zealand approach have any merit to say that we have been too heavy-handed. When we went into lock-down, there were few successful suppressions of the outbreak to reference and it is a good thing that different countries try different things, even if there might be some failures. But there is room for individual characteristics in each experiment. Covid-19 might spread in any weather, but warmer, drier, more outdoors-inclined countries may have a greater advantage. There is every chance that the Australian strategy might have failed in New Zealand as the cooler, moister climate would keep people indoors earlier and windows shut. Australia might end with lower cases per capita and deaths per capita, but then our deaths are blighted by the failure in Rosewood Resthome, which makes up over half of our fatalities.
How the real satire that are the United States of America has not yet descended into chaos deserves some consideration. They are racking up the cases and the deaths. And even before cases have consistently gone down, they're loosening restrictions in some states. It would be too easy to say that this will permit the outbreak to continue and burn on - but it is still an experiment of sorts. If Australia could drag its numbers down with more moderate controls in a hot, dry climate, perhaps Texas might enjoy the same success. Either way, their hopes of keeping it under 60,000 deaths is out the window. Their cases increased a third and their deaths by 70% in the week. 2,000 to 3,000 deaths are reported each day. As New York's blaze runs out of wood, the other states are manning up the bodybags.
Fingers crossed for all concerned.
Saturday, April 25, 2020
Corona killed the ESOL star
I've realised that I might have not mused in this blog about a trend I often speak to my colleagues about: the end of the ESOL teaching industry (ESOL = English for Speakers of Other Language). I shared it to encourage people to take broader training and professional development seriously. This predicted trend was, going back to 2009, one of the reasons that I made my decision to get into education management instead of teaching, which was the motivation for going to China where there are big organisations with lots of opportunities.
The main factor in the prediction was technology, which, even back then, before I even had a smartphone was already indicating the increasing substitution of the need to either learn a language, or facilitate the learning of language without the vagaries of brute human-to-human impartation of knowledge and skill. Some primordial translation software such as Babblefish was coming on the scene. I'd already learned language with podcasts and Youtube videos; Skype was king back then and it seemed that the cost-benefit for students would be to learn as remotely as possible. When the sharing economy started to disrupt long-standing industries, it seemed even more like the writing was on the wall. Even in 2013 when we visited China, the adult English teaching market had shrunk. If we had stayed in China, we would have been teaching a smaller number of students with a diminishing group of colleagues.
Of course, prediction is not a science. We returned to New Zealand in 2015 and although I did apply for non-ESOL related positions, both of us are in our fifth year of having our lives supported within the English teaching sphere. And our school hasn't been especially technological till recently. The way my teachers have been teaching is very similar to how I would have been teaching in 2001 when I began. It's been successful. Low cost yet personal, rapport-based teaching. But just like the asteroid strike that killed off the dinosaurs, Covid-19 will either force evolution upon you or render you extinct.
Within a week, a former colleague at another school went from informing me that an ESOL school in Napier had closed becoming ESOL's first casualty in NZ due to Covid, to telling me on Thursday that his own school, a boutique premium provider, was closing. Our school is intent on evolution and there is a good chance that I'm going to have a heavy responsibility to get things moving. But we're going to be getting leaner and meaner. Staff have gone. Staff will go.
Of course, this is far from just an ESOL situation. The whole world might be turned upside-down yet. Manning the process of preparation for a pandemic has felt like something that I have the skills to do. Manning the process of change for the post-pandemic world I think gives me a chance to get experience with whole-organisation change, broad technological mastery, methods of incorporating technology into pedagogy (teaching methods) to enhance learning. If I can do this well, pretty much I could make myself quite the commodity. It might be my main way to avoid extinction.
The main factor in the prediction was technology, which, even back then, before I even had a smartphone was already indicating the increasing substitution of the need to either learn a language, or facilitate the learning of language without the vagaries of brute human-to-human impartation of knowledge and skill. Some primordial translation software such as Babblefish was coming on the scene. I'd already learned language with podcasts and Youtube videos; Skype was king back then and it seemed that the cost-benefit for students would be to learn as remotely as possible. When the sharing economy started to disrupt long-standing industries, it seemed even more like the writing was on the wall. Even in 2013 when we visited China, the adult English teaching market had shrunk. If we had stayed in China, we would have been teaching a smaller number of students with a diminishing group of colleagues.
Of course, prediction is not a science. We returned to New Zealand in 2015 and although I did apply for non-ESOL related positions, both of us are in our fifth year of having our lives supported within the English teaching sphere. And our school hasn't been especially technological till recently. The way my teachers have been teaching is very similar to how I would have been teaching in 2001 when I began. It's been successful. Low cost yet personal, rapport-based teaching. But just like the asteroid strike that killed off the dinosaurs, Covid-19 will either force evolution upon you or render you extinct.
Within a week, a former colleague at another school went from informing me that an ESOL school in Napier had closed becoming ESOL's first casualty in NZ due to Covid, to telling me on Thursday that his own school, a boutique premium provider, was closing. Our school is intent on evolution and there is a good chance that I'm going to have a heavy responsibility to get things moving. But we're going to be getting leaner and meaner. Staff have gone. Staff will go.
Of course, this is far from just an ESOL situation. The whole world might be turned upside-down yet. Manning the process of preparation for a pandemic has felt like something that I have the skills to do. Manning the process of change for the post-pandemic world I think gives me a chance to get experience with whole-organisation change, broad technological mastery, methods of incorporating technology into pedagogy (teaching methods) to enhance learning. If I can do this well, pretty much I could make myself quite the commodity. It might be my main way to avoid extinction.
Sunday, April 19, 2020
Anecdotes
"3% of Dutch blood donors have antibodies to Covid-19" was the headline. I picked it up from a pleasant vlogger by the name of Dr John Campbell. He is another vlogger, along with Dr Chris Martenson (Peak Prosperity), who has been following and interpreting reports about Covid-19 from a very early stage. He is overall very concerned about the pandemic but also does quite neutral interpretations, i.e., he qualifies comments well and raises not just depressing but also optimistic news that Covid-19 might not be as bad.
This particular result can cause many conclusions depending on the angle you're thinking about at any one time. The Netherlands who apparently have been fairly transparent and complete with their numbers has the eighth most deaths per million, not far behind the UK. Herd immunity, if it exists for this, is at the 80% mark for this kind of thing so it indicates that this crisis is a long way from finishing.
But it was interpreted for another key metric. The heart of a lot of the controversy is to know how many people have had Covid-19, whether confirmed or not, because if you only county confirmed cases, then the current fatality rate in that country, ignoring the lag between diagnosis and death, is an unlikely 11.4% (3601 death divided by 31,589 cases after testing 0.9% of the population). But if 3% of the population have already had it, actually deaths should be divided by 514,046 cases instead, and the case fatality rate drops to 0.7%, which would make it really bad, but not as bad as feared from the official numbers.
Should we breathe a sigh of relief? Well, perhaps it's my innate catastrophism but I'd say no. In any snapshot of any complex situation or phenomenon, you can see it one way from one angle that makes it all look black and white, when reality is prone to being grey. Where is the grey here?
1. Blood donors might be a cross section of the population. On the positive side, it would tend to be the healthier portion, too. (You are questioned before donations and rejected if you've had symptoms of an infectious disease or been to an affected country.) So it could be thought that the prevalence in the Netherlands could be higher.
2. If it was known that blood donors were to be tested for antibodies, it may have biased the group though for those who thought they may have been exposed.
3. There is some interesting fine print: "Preliminary results show that the presence of antibodies differs per age group. 3.6 percent of young blood donors between 18 and 20 years old (688 individuals) have Covid-19 antibodies. That percentage decreases as donors get older. No antibodies were found among donors between the ages of 71 and 80, though the number of donors in that age group is also much lower - only 10 individuals." This could mean quite a few things, from the older group not travelling as much and not being exposed, to the existed of a repository of vulnerable but safe unimmune groups, perhaps through the measures put in place.
4. Maybe more significant though is the accuracy of tests. Any test has two metrics, sensitivity (the ability to signal the existence of the antibody) and specificity (only signalling the exist of one antibody and not others, or other substances). It sounds good to have a test that is, say, 99% accurate, but if it comes up with false positives 1% of the time and false negatives 1% of the time, then it can lead to wrong conclusions at different levels of prevalence:
Note how at a low actual prevalence, 0.1%, the test might give a 1.1% prevalence. If this were the parameters of the 3% test, then it is possible that the actual prevalence could be more like 2% and then the case fatality rate becomes 1%.
For amusement, here is the case of a 98% reliable test, where a 3% test prevalence actually corresponds to a 1% actual prevalence. (And the corresponding case fatality rate would be 2%...):
It is unlikely that the sensitivity and specificity are the same percentage, and ideally for the purposes of a non-diagnostic test, specificity should be as high as possible at the cost of some sensitivity. (And a diagnostic test, for the purposes of isolation, not treatment, should be high in sensitivity at the cost of specificity.)
And you will find even 98% is not a realistic number: The government’s “game changer” antibody tests are inaccurate. What next?
So what does the Netherlands news mean? Well, it is just a data point. Neither a black or white, but a shade of grey that you need to accept till other anecdotes and cases bring more definition in. People who rely on a single case, article or anecdote and interpret it for their purpose, perspective or politics.
Another similar case, also picked up by the vloggers was: Pregnant women without symptoms are testing positive for coronavirus, study says. This article described some research described the situation for women who came to deliver their babies at one medical centre in New York, 4 of whom were symptomatic for Covid-19 which was confirmed by test. But 23 of the other 210 pregnant women were also tested as positive by the PCR test for Covid-19. The hopeful conclusion reached by some from this was that the vast majority of the infected were asymptomatic (or at worst, pre-symptomatic).
The latter point is a cry for optimism. If over 80% of the infected are asymptomatic or have very mild symptoms that would not cause them to be voluntarily tested, then the actual case counts in any country that tests only symptomatic cases would be underestimating by 80% the actual rate that the population has been infected.
There is well-documented asymptomatic cases and asymptomatic spread of this virus, which is not in doubt. The numbers seem quite powerful again in this case, but it is once again prone to the wrong extrapolations. But the virus is more dangerous, and presumably symptom-causing, as you get older, and the more male you are. Pregnant women tend to be younger, and some communities in New York might have even younger average ages of pregnancy too. They also tend not to be male. In this case it is not the cross section you'd use to base conclusions on the whole population. The other conclusion that should have been made from this article was that that, if they were representation of the current infection rate for the population of New York City at the time of the research, late March/early April, over 10% of the city population was positive with the virus and shedding virus particles. Disturbing.
In the so-called Plan B camp (the people who advocate letting the virus do its thing in the population), there is often the desire to find the true infection number, which they surmise is significantly higher than the confirmed case number. This is a way to minimise the case fatality rate and to demonstrate the scale of the overreaction from lockdowns. Anyone who is biased the other way will likely indicate that the confirmed death number isn't accurate either, as deaths at home, care homes and the pre-testing covid-related deaths are also not being taken into account.
People used to raise the Diamond Princess cruise ship as the perfect case study because everyone on board was tested. There were 712 cases and 14 deaths (almost 2% CFR), but again the meaning of this is qualified because the clientele of cruise ships are older and all the fatalities were over 60. (And even at this age, over half of cases were asymptomatic.) And even though this case seems an age ago, there are still many passengers still in hospital. It is possible that the CFR may grow pass 2.5%. There is also a possibility that though the quarantining at Yokohama might have reduced the impact. There was no further exposure to the previously exposed and many of the early symptomatic cases may have been discovered early.
Then South Korea was said to be a good case study as they were the reigning testing champions. Early on the Plan B people were optimistically crowing that there was a 0.6% CFR for a time forgetting the lag in deaths. Now, based on official numbers only from PCR testing, their PCR has slowly grown to almost 2.2%. But again the explosive outbreak that happened may have meant many people got it without knowing it.
Taiwan is also another case study who has managed to be scrupulous with screening and testing to the point that they were barely affected and are harder to judge because of their lower numbers, just six deaths out of 398 cases (1.5% CFR). But an undue number of those are young travellers and tourists. It has never really broken out in the population to get a better cross-section.
Each situation that you could singularly quote has its own parameters, history, idiosyncrasies and quirks. Using any single one is not enough to mean anything for the whole. They need to be all taken in to make any definitive calls.
This particular result can cause many conclusions depending on the angle you're thinking about at any one time. The Netherlands who apparently have been fairly transparent and complete with their numbers has the eighth most deaths per million, not far behind the UK. Herd immunity, if it exists for this, is at the 80% mark for this kind of thing so it indicates that this crisis is a long way from finishing.
But it was interpreted for another key metric. The heart of a lot of the controversy is to know how many people have had Covid-19, whether confirmed or not, because if you only county confirmed cases, then the current fatality rate in that country, ignoring the lag between diagnosis and death, is an unlikely 11.4% (3601 death divided by 31,589 cases after testing 0.9% of the population). But if 3% of the population have already had it, actually deaths should be divided by 514,046 cases instead, and the case fatality rate drops to 0.7%, which would make it really bad, but not as bad as feared from the official numbers.
Should we breathe a sigh of relief? Well, perhaps it's my innate catastrophism but I'd say no. In any snapshot of any complex situation or phenomenon, you can see it one way from one angle that makes it all look black and white, when reality is prone to being grey. Where is the grey here?
1. Blood donors might be a cross section of the population. On the positive side, it would tend to be the healthier portion, too. (You are questioned before donations and rejected if you've had symptoms of an infectious disease or been to an affected country.) So it could be thought that the prevalence in the Netherlands could be higher.
2. If it was known that blood donors were to be tested for antibodies, it may have biased the group though for those who thought they may have been exposed.
3. There is some interesting fine print: "Preliminary results show that the presence of antibodies differs per age group. 3.6 percent of young blood donors between 18 and 20 years old (688 individuals) have Covid-19 antibodies. That percentage decreases as donors get older. No antibodies were found among donors between the ages of 71 and 80, though the number of donors in that age group is also much lower - only 10 individuals." This could mean quite a few things, from the older group not travelling as much and not being exposed, to the existed of a repository of vulnerable but safe unimmune groups, perhaps through the measures put in place.
Note how at a low actual prevalence, 0.1%, the test might give a 1.1% prevalence. If this were the parameters of the 3% test, then it is possible that the actual prevalence could be more like 2% and then the case fatality rate becomes 1%.For amusement, here is the case of a 98% reliable test, where a 3% test prevalence actually corresponds to a 1% actual prevalence. (And the corresponding case fatality rate would be 2%...):
It is unlikely that the sensitivity and specificity are the same percentage, and ideally for the purposes of a non-diagnostic test, specificity should be as high as possible at the cost of some sensitivity. (And a diagnostic test, for the purposes of isolation, not treatment, should be high in sensitivity at the cost of specificity.)
And you will find even 98% is not a realistic number: The government’s “game changer” antibody tests are inaccurate. What next?
So what does the Netherlands news mean? Well, it is just a data point. Neither a black or white, but a shade of grey that you need to accept till other anecdotes and cases bring more definition in. People who rely on a single case, article or anecdote and interpret it for their purpose, perspective or politics.
Another similar case, also picked up by the vloggers was: Pregnant women without symptoms are testing positive for coronavirus, study says. This article described some research described the situation for women who came to deliver their babies at one medical centre in New York, 4 of whom were symptomatic for Covid-19 which was confirmed by test. But 23 of the other 210 pregnant women were also tested as positive by the PCR test for Covid-19. The hopeful conclusion reached by some from this was that the vast majority of the infected were asymptomatic (or at worst, pre-symptomatic).
The latter point is a cry for optimism. If over 80% of the infected are asymptomatic or have very mild symptoms that would not cause them to be voluntarily tested, then the actual case counts in any country that tests only symptomatic cases would be underestimating by 80% the actual rate that the population has been infected.
There is well-documented asymptomatic cases and asymptomatic spread of this virus, which is not in doubt. The numbers seem quite powerful again in this case, but it is once again prone to the wrong extrapolations. But the virus is more dangerous, and presumably symptom-causing, as you get older, and the more male you are. Pregnant women tend to be younger, and some communities in New York might have even younger average ages of pregnancy too. They also tend not to be male. In this case it is not the cross section you'd use to base conclusions on the whole population. The other conclusion that should have been made from this article was that that, if they were representation of the current infection rate for the population of New York City at the time of the research, late March/early April, over 10% of the city population was positive with the virus and shedding virus particles. Disturbing.
In the so-called Plan B camp (the people who advocate letting the virus do its thing in the population), there is often the desire to find the true infection number, which they surmise is significantly higher than the confirmed case number. This is a way to minimise the case fatality rate and to demonstrate the scale of the overreaction from lockdowns. Anyone who is biased the other way will likely indicate that the confirmed death number isn't accurate either, as deaths at home, care homes and the pre-testing covid-related deaths are also not being taken into account.
People used to raise the Diamond Princess cruise ship as the perfect case study because everyone on board was tested. There were 712 cases and 14 deaths (almost 2% CFR), but again the meaning of this is qualified because the clientele of cruise ships are older and all the fatalities were over 60. (And even at this age, over half of cases were asymptomatic.) And even though this case seems an age ago, there are still many passengers still in hospital. It is possible that the CFR may grow pass 2.5%. There is also a possibility that though the quarantining at Yokohama might have reduced the impact. There was no further exposure to the previously exposed and many of the early symptomatic cases may have been discovered early.
Then South Korea was said to be a good case study as they were the reigning testing champions. Early on the Plan B people were optimistically crowing that there was a 0.6% CFR for a time forgetting the lag in deaths. Now, based on official numbers only from PCR testing, their PCR has slowly grown to almost 2.2%. But again the explosive outbreak that happened may have meant many people got it without knowing it.
Taiwan is also another case study who has managed to be scrupulous with screening and testing to the point that they were barely affected and are harder to judge because of their lower numbers, just six deaths out of 398 cases (1.5% CFR). But an undue number of those are young travellers and tourists. It has never really broken out in the population to get a better cross-section.
Each situation that you could singularly quote has its own parameters, history, idiosyncrasies and quirks. Using any single one is not enough to mean anything for the whole. They need to be all taken in to make any definitive calls.
Friday, April 17, 2020
Downhill
All over the world it's extraordinary the amount of verbiage and criticism spent to say that the lockdowns are an overreaction, and that more moderate plans of mitigation are more appropriate. Setting aside the precautionary principle, goldfish-forgetting those salutary early examples of Italy and Iran, innumerately forgetting that there is a lag in numbers and that the final figure, thus fatality rate, is long away, or medically naïve what long-term impacts a novel virus might have on the survivors, let's just say that almost all the comments come from people without "skin in the game".
"Skin in the game" was a phrase or concept I take from Nicholas Naseem Taleb, whose books I adore. One of his heuristics is that you never trust a pundit who doesn't have skin in the game. What is "skin in the game"? It means some exposure to loss if you are wrong. One of the reasons the markets are a metric for confidence is that shareholders have a stake. (Although there is a certain gamification for short-term gain embedded.) Mike Hosking does not have any skin in the game because he is not held accountable for his words. He can contradict his previous stances or actions he has advocated simply because apart from a momentary blush in a rare moment of reflection, there isn't a loss to him. There isn't even the eating of one's own hat. The man at the bar, the armchair general or the TV pundit can find reasoning or a number, or some doubt in a number, or a perspective, to advocate for anything. Ask them to put money on it and the confidence may wash away, at least by the second round. Decision-makers have both responsibility and accountability, which means that they will always have sticks and stones thrown at them. Idle lips don't.
The classic line of the year is "Hindsight is so 2020". At what point is a reaction deemed an overreaction or an underreaction? It's very difficult to know at the time of decision and that's the unfairness of the criticism. Now that the NZ curve is incontrovertibly flattening, there is a huge temptation to open up and at least get our domestic "show back on the road". The astonishing thing in all this - the most effectively locked down country, China, still has issues with the asymptomatic spread of this virus in their population and are still doing local sealing of towns and cities. The near global lockdown has seemingly halted the growth in infection rates, but not infection. There are still 80,000 new confirmed infection each day and between 6,000 to 7,000 deaths each day. I say again: that, with most countries locked down.
In some ways the granular view of the global infection is the surge in one large area, followed by a plateauing in one area followed by a surge elsewhere. So where China was the first, once the dip came for them, Iran and Italy filled the vacuum. Once they faded, Spain, then New York, filled the vacuum; Spain and New York possibly tending downwards, we have Belgium, Canada, Sweden, the rest of the US, Brazil and Russia charging up. It looks like there is going to a second wind over the next week to push cases up another notch and the death rate too. Sweden is going to be the most horrifically interest to watch. They are avowedly going the moderate view of controlling the virus through mild measures with an emphasis on personal responsibility. Depending if they follow through, they are the ultimate "control" group. They are still early days, and without large scale testing, but their deaths increased by a third in two days.
There is an argument in favour of moderate control, but it is plagued by more assumptions than in favour of the lock down. The assumptions are:
- long term immunity can be gained from exposure to Covid-19
- the health system can sustain the sharp rise in sickness and still address the needs of other medical needs
- prevalent infection in the community doesn't cause greater death to other groups
- the elderly or immuno-compromised can be truly insulated from the virus (asymptomatic spreaders seem to get them in the end...)
- survivors do not have persisting health effects
- the overall economic benefits of a long term moderate shutdown exceed that of a sharp short lockdown ("overall" being a key word as it might take years to really know)
and more.
There tends to be a Faustian deal in it, too, where the "marginal" years of the elderly are being traded in for economic sustainability. The potential economic and social unsustainability of lock-downs are real but again, stamping it out and controlling it is probably a better bet.
The numbers? Well, if I said that New York wasn't Wuhan, after a new reckoning of the numbers, it is now not even the UK, who now lags behind the Big Apple in terms of deaths. It might not have enough gas to overhaul France, Spain and Italy but it is quite a stat... New Jersey's numbers cruised passed China's official numbers.
It has been a week where the lockdown has lead to a slowdown in global cases, which moved from 1.6 million to almost 2.2 million official cases (roughly a third increase). Deaths always lag though, from over 95,000 to over 145,000 official deaths. That's over a 50% increase, a faster rise than the previous 7 day period. This all goes to show the nature of this beast.
"Skin in the game" was a phrase or concept I take from Nicholas Naseem Taleb, whose books I adore. One of his heuristics is that you never trust a pundit who doesn't have skin in the game. What is "skin in the game"? It means some exposure to loss if you are wrong. One of the reasons the markets are a metric for confidence is that shareholders have a stake. (Although there is a certain gamification for short-term gain embedded.) Mike Hosking does not have any skin in the game because he is not held accountable for his words. He can contradict his previous stances or actions he has advocated simply because apart from a momentary blush in a rare moment of reflection, there isn't a loss to him. There isn't even the eating of one's own hat. The man at the bar, the armchair general or the TV pundit can find reasoning or a number, or some doubt in a number, or a perspective, to advocate for anything. Ask them to put money on it and the confidence may wash away, at least by the second round. Decision-makers have both responsibility and accountability, which means that they will always have sticks and stones thrown at them. Idle lips don't.
The classic line of the year is "Hindsight is so 2020". At what point is a reaction deemed an overreaction or an underreaction? It's very difficult to know at the time of decision and that's the unfairness of the criticism. Now that the NZ curve is incontrovertibly flattening, there is a huge temptation to open up and at least get our domestic "show back on the road". The astonishing thing in all this - the most effectively locked down country, China, still has issues with the asymptomatic spread of this virus in their population and are still doing local sealing of towns and cities. The near global lockdown has seemingly halted the growth in infection rates, but not infection. There are still 80,000 new confirmed infection each day and between 6,000 to 7,000 deaths each day. I say again: that, with most countries locked down.
In some ways the granular view of the global infection is the surge in one large area, followed by a plateauing in one area followed by a surge elsewhere. So where China was the first, once the dip came for them, Iran and Italy filled the vacuum. Once they faded, Spain, then New York, filled the vacuum; Spain and New York possibly tending downwards, we have Belgium, Canada, Sweden, the rest of the US, Brazil and Russia charging up. It looks like there is going to a second wind over the next week to push cases up another notch and the death rate too. Sweden is going to be the most horrifically interest to watch. They are avowedly going the moderate view of controlling the virus through mild measures with an emphasis on personal responsibility. Depending if they follow through, they are the ultimate "control" group. They are still early days, and without large scale testing, but their deaths increased by a third in two days.
There is an argument in favour of moderate control, but it is plagued by more assumptions than in favour of the lock down. The assumptions are:
- long term immunity can be gained from exposure to Covid-19
- the health system can sustain the sharp rise in sickness and still address the needs of other medical needs
- prevalent infection in the community doesn't cause greater death to other groups
- the elderly or immuno-compromised can be truly insulated from the virus (asymptomatic spreaders seem to get them in the end...)
- survivors do not have persisting health effects
- the overall economic benefits of a long term moderate shutdown exceed that of a sharp short lockdown ("overall" being a key word as it might take years to really know)
and more.
There tends to be a Faustian deal in it, too, where the "marginal" years of the elderly are being traded in for economic sustainability. The potential economic and social unsustainability of lock-downs are real but again, stamping it out and controlling it is probably a better bet.
The numbers? Well, if I said that New York wasn't Wuhan, after a new reckoning of the numbers, it is now not even the UK, who now lags behind the Big Apple in terms of deaths. It might not have enough gas to overhaul France, Spain and Italy but it is quite a stat... New Jersey's numbers cruised passed China's official numbers.
It has been a week where the lockdown has lead to a slowdown in global cases, which moved from 1.6 million to almost 2.2 million official cases (roughly a third increase). Deaths always lag though, from over 95,000 to over 145,000 official deaths. That's over a 50% increase, a faster rise than the previous 7 day period. This all goes to show the nature of this beast.
Sunday, April 12, 2020
My China
The virus might be a scourge but it has been the catalyst for horrendous racism. It was first the prompt for base reactions in fear and mockery of people with vaguely Oriental features by the hoi polloi. It was double-standard reporting by the media. It was "dog whistle" naming of it as the Chinese virus.
Now in China, with the global flow of the virus reversing, it's the shoe on the other foot. I have a friend who got removed from his apartment and dragged down to the police station for testing; Africans and Afro-Americans are now being targeted explicitly: Africans who make up many of the permanent residents have been evicted and even a McDonalds in Guangzhou has banned black people from entering. Why? Because foreign countries have Covid-19, so foreign people are a risk, even if they arrived well before the outbreak even began in Wuhan.
Both are atrocious an incomparably unfair. The politicisation of the virus might be a side-show but it's the thing that leaves me more disgusted than ever. I'm thankful to not be living in China right now. My best hopes for the civility of cosmopolitan Guangzhou is shattered.
There is a lot of blaming still going on against the state of the Peoples Republic of China whether it be for the original sin of having wet markets with exotic animals where the first fateful animal-to-human infection occurred or their tardiness revealing the extent and data on the outbreak.
The complaints of the cover-up by China annoy me a little bit, because it takes China as a monolith. From my limited view of the slowness to go public, it was actually the authorities in Wuhan who tried to deal with the outbreak without it going public, even keeping it from the central government. The mayor of Wuhan was sacked during the crisis for his handling. It is also easy to point fingers early on - to be clear, even with several months of international collaboration Covid-19 is still a relative unknown and statements made at one time are overturned with new evidence. Now we are much more aware of asymptomatic cases and methods for transmission, but even once public about it, there was still a lot to learn. I still think the audacious decision to lock down cities was a good one. The moves since were good, too. As I often mention, as soon as they sealed Wuhan and other cities in Hubei, I knew it must be even worse than it was actually shown to be. And it was presented as a monster virus.
There was also a few articles recently expressing shock that "controversial" wet markets had re-opened. From a Chinese perspective, the controversy hasn't been on wet markets per se, but what was sold in wet markets. There was widespread condemnation at the time for the selling, use or consumption of exotic animals. Wet markets might take some time to disappear. They're still a key part of food distribution system in China and it'd take rather huge reform and structural change to move away from these. Is there still exotica available? Probably, and probably at a higher price and a much lower supply than before. Expecting it to disappear completely is as simple as ridding a country of illicit drugs from a country. When there is demand, there will be a market.
The blame put on China by commentators and American political figure for the current situation in the States is ridiculous, however. Even if you don't trust China's words, you can trust their actions. They shut down the country for an outbreak largely centred on a single city. The Trump administration was the first to move to block Chinese travellers to the US, but effectively blocked one kind of passport coming into their country and did not implement much in the way of safety checks or isolation to their own returned people.(Compare that with New Zealand which implemented self-isolation.)
Wuhan was finally unsealed in the last week but huge protection measures persist, which must be costly still to implement and have a slowing effect on the economy. Personally I was shocked how long the quarantine lasted for Hubei and especially Wuhan. The official numbers showed that it was just the long-term critically ill who were expiring with little sign of new infection. The official numbers might be a lie but you can take a lesson in reading the actions: take their slowness to open as a sign that it is very difficult to safely open even with an apparent lack of infection. I hadn't followed the province-by-province reports for a while since the international news had gone wild, but recent announcements make it clear that the asymptomatic transmission seems to be the main problem, that the unaware can carry it on, perhaps to another unaware until it lands in some fertile ground. Tomorrow I might translate a few as a general notice what's "officially" happening in China.
Four
It didn't take long for our one death (29 March) to become two (10 April) to become four (11 April). And for all the tracking of cases, recoveries and intensive care, three of them were essentially cases that were barely recorded before they were moved column from cases to fatalities. The first fatality showed how freakish the virus is with its contagiousness. an elderly woman on the relatively remote and unexposed West Coast who caught and died of Covid-19 in a flash. It seemed that the diagnosis was almost an afterthought. There is no path determined how she acquired this virus. She is the clear-cut case of community transmission and was our first death. Two of the others were at the same resthome as Covid-19 like a determined ferret to get into the henhouse finds any weakness to find the defenseless.
Some people are caught with the bittersweet of the burst in deaths and the drop in new cases. This may be just a result of the expected delay between infection and testing, testing to diagnosis, diagnosis till official release, and infection, to critical case, to death. Each update is like the light from stars, Alpha Centauri's light is four years old by the time it arrives. A distant supernova that suddenly appears in the sky is long after the violence of the explosion. It reminds me of one of the definitions of "report" being the sound of gunshot or explosion, which is slower than the sight of the action.
I have dabbled a little in the world of the Corona-denier recently. There is a hodgepodge out there which doesn't necessarily internally agree but is uniform in its suspicion and its attack of every part of the reporting or the response to the pandemic, or the term that they use: plan-demic. It is interesting to see what counter-evidence they use to sustain their fervour. So far:
1 - doubt about one vlogging nurse at a New York hospital (there is the lamentable use of the term "crisis actors", which is someone who is not a true victim but acts as one for the news).
2 - "empty hospitals" or rather the contrast between the visuals on the news, and those when a correspondent in the area videos the same hospitals at another time
3 - suspicion of the numbers, which seems to focus on the doubt for numbers that support the overestimation, and ignore doubt around numbers that underestimate the damage.
4 - suspicion about the criteria for dying with covid-19, if it is the prime cause of death, or that it is just killing the people who were going to die anyway.
5 - beliefs that the number of asymptomatic or naturally immune people is higher than thought.
6 - quotes from experts qualifying statements taken out of context. (For example, quoting a statistician to say the "case counts" as meaningless; when the pragmatic methods of PCR testing can only lead to an indicative count, and to identify risk and isolate. Random antibody testing that will come on stream soon would be the only ones that should yield statistically meaningful results.)
(The contradiction in some of the messaging is whether Covid-19 is a true health crisis or whether it's overblown, and whether it's natural or a designed weapon. Above I've taken arguments from those who think it's a true, natural but moderately harmless virus. Some of the analysis below would be different if it is thought to be a Chinese weapon, or a true pandemic virus that is being exploited in the spirit of "Never let a good disaster go to waste.")
Anyone of the points above is an interesting rabbit-hole to waste away an afternoon. And if I were to meet someone who was really possessed by this evidence and argumentation, it'd be an interesting but probably fruitless interaction. These points are just the scaffolding to support one plank of a greater belief system that is generally suspicious of the mainstream media, government and science. And the belief system is often a sustaining pillar in their intellectual self-esteem. The above are the reeds of the discussion but it's interesting not to get caught in there but better to contemplate the swamp.
The points above are all parts of the "plan-demic", so it pays to look at the swamp, that is, what "plan" is being enacted by creating a multi-country conspiracy with agents in every level of each society to execute with great loss to almost every level of society. And it is that which I think makes it an easy conspiracy theory to dispel. There must be a pay-off for executing a plan, and the pay-off needs to cover the cost of the plan.
So first, what is the pay-off of this plan? A summary of possible answers to this is: to get control of everyone's information and limit their freedoms, reset the world, wipe out debt, end democracy and implement martial law. It is hard to imagine who exactly would be the dark, shadowy figures who benefit from this, and for the investment they must be sure that this is the result. In most countries the established elite already have huge benefits.
What are the costs of all this? Almost all economic entities have had a loss of wealth and value in the last three months. Even after the smoke clears, it would seem that a whole lot of value has been lost and compared to the salad days of last December, profits will not be flowing with the recovery. A huge portion of the citizenry have lost their jobs and their ability to be the kind of consumers who can reflate the economic cycling of money. If the string-pulling entities had wealth, it's likely their wealth will be diminished, and will not recover for some time. But that's just the bodyblow of the lockdown. To execute the plan, you would need to persuade a huge number of people to act against their own interests. There would need to be bribery or subterfuge to make them think they would be better off in the end. But on top of that, you would have to have enough threats to prevent any one of the actors and agents in the conspiracy from speaking out, blowing the whistle and exposing it. But the only people speaking out are the conspiracy theorists and not any of the doctors, the not-so-dead victims, the testing organisations, the health officials in a myriad of districts in a multitude of countries.
The result you get is an unlikely benefit to a nebulous group at an unimaginable cost to a group who can create unbelievable discipline across an innumerable group of individuals to do their bidding, suffer a loss and not say word. If I were to meet that hobbyist conspiracist it would be these bigger questions that I'd discuss.
All the reeds are an insult to the dead and dying. The term "crisis actor" came to real prominence, at least for me, when victims of the Sandy Hook gun massacre who went public and was met with accusations, death threats and criticism. Sandy Hook was somehow contrived into a false flag operation to take away gun rights. So the victims were not really victims. So the victims were attacked.
For all the intellectualism that can be poorly applied to a tragedy it would be that.
Some people are caught with the bittersweet of the burst in deaths and the drop in new cases. This may be just a result of the expected delay between infection and testing, testing to diagnosis, diagnosis till official release, and infection, to critical case, to death. Each update is like the light from stars, Alpha Centauri's light is four years old by the time it arrives. A distant supernova that suddenly appears in the sky is long after the violence of the explosion. It reminds me of one of the definitions of "report" being the sound of gunshot or explosion, which is slower than the sight of the action.
I have dabbled a little in the world of the Corona-denier recently. There is a hodgepodge out there which doesn't necessarily internally agree but is uniform in its suspicion and its attack of every part of the reporting or the response to the pandemic, or the term that they use: plan-demic. It is interesting to see what counter-evidence they use to sustain their fervour. So far:
1 - doubt about one vlogging nurse at a New York hospital (there is the lamentable use of the term "crisis actors", which is someone who is not a true victim but acts as one for the news).
2 - "empty hospitals" or rather the contrast between the visuals on the news, and those when a correspondent in the area videos the same hospitals at another time
3 - suspicion of the numbers, which seems to focus on the doubt for numbers that support the overestimation, and ignore doubt around numbers that underestimate the damage.
4 - suspicion about the criteria for dying with covid-19, if it is the prime cause of death, or that it is just killing the people who were going to die anyway.
5 - beliefs that the number of asymptomatic or naturally immune people is higher than thought.
6 - quotes from experts qualifying statements taken out of context. (For example, quoting a statistician to say the "case counts" as meaningless; when the pragmatic methods of PCR testing can only lead to an indicative count, and to identify risk and isolate. Random antibody testing that will come on stream soon would be the only ones that should yield statistically meaningful results.)
(The contradiction in some of the messaging is whether Covid-19 is a true health crisis or whether it's overblown, and whether it's natural or a designed weapon. Above I've taken arguments from those who think it's a true, natural but moderately harmless virus. Some of the analysis below would be different if it is thought to be a Chinese weapon, or a true pandemic virus that is being exploited in the spirit of "Never let a good disaster go to waste.")
Anyone of the points above is an interesting rabbit-hole to waste away an afternoon. And if I were to meet someone who was really possessed by this evidence and argumentation, it'd be an interesting but probably fruitless interaction. These points are just the scaffolding to support one plank of a greater belief system that is generally suspicious of the mainstream media, government and science. And the belief system is often a sustaining pillar in their intellectual self-esteem. The above are the reeds of the discussion but it's interesting not to get caught in there but better to contemplate the swamp.
The points above are all parts of the "plan-demic", so it pays to look at the swamp, that is, what "plan" is being enacted by creating a multi-country conspiracy with agents in every level of each society to execute with great loss to almost every level of society. And it is that which I think makes it an easy conspiracy theory to dispel. There must be a pay-off for executing a plan, and the pay-off needs to cover the cost of the plan.
So first, what is the pay-off of this plan? A summary of possible answers to this is: to get control of everyone's information and limit their freedoms, reset the world, wipe out debt, end democracy and implement martial law. It is hard to imagine who exactly would be the dark, shadowy figures who benefit from this, and for the investment they must be sure that this is the result. In most countries the established elite already have huge benefits.
What are the costs of all this? Almost all economic entities have had a loss of wealth and value in the last three months. Even after the smoke clears, it would seem that a whole lot of value has been lost and compared to the salad days of last December, profits will not be flowing with the recovery. A huge portion of the citizenry have lost their jobs and their ability to be the kind of consumers who can reflate the economic cycling of money. If the string-pulling entities had wealth, it's likely their wealth will be diminished, and will not recover for some time. But that's just the bodyblow of the lockdown. To execute the plan, you would need to persuade a huge number of people to act against their own interests. There would need to be bribery or subterfuge to make them think they would be better off in the end. But on top of that, you would have to have enough threats to prevent any one of the actors and agents in the conspiracy from speaking out, blowing the whistle and exposing it. But the only people speaking out are the conspiracy theorists and not any of the doctors, the not-so-dead victims, the testing organisations, the health officials in a myriad of districts in a multitude of countries.
The result you get is an unlikely benefit to a nebulous group at an unimaginable cost to a group who can create unbelievable discipline across an innumerable group of individuals to do their bidding, suffer a loss and not say word. If I were to meet that hobbyist conspiracist it would be these bigger questions that I'd discuss.
All the reeds are an insult to the dead and dying. The term "crisis actor" came to real prominence, at least for me, when victims of the Sandy Hook gun massacre who went public and was met with accusations, death threats and criticism. Sandy Hook was somehow contrived into a false flag operation to take away gun rights. So the victims were not really victims. So the victims were attacked.
For all the intellectualism that can be poorly applied to a tragedy it would be that.
Friday, April 10, 2020
The heuristics of the mystics
Sheep. They're stupid animals, aren't they. They are individually timid toward kind, friendly people that approach. And as a flock, even the safest ewe on the farthest side moves away from the approach of people whom for their whole lives have never done them any harm. A thousand people pass them harmlessly in Cornwall Park and they flee. Of course, the sheep are also equally as wary of that thousand and first person who will succeed in penning, capturing them and taking them to the abattoir or, if they're lucky, the shearing shed.
Of course, even if sheep aren't doing actual decisions to weigh up risk and reward to logically treat different people in a different way, evolutionarily they're applying what is a fairly successful cognitive formula. Approaching humans are an absolutely unnecessary risk because the thousand and first one, if not one before, will do you harm. It is effectively a heuristic, a tool used "to quickly form judgments, make decisions, and find solutions to complex problems" (Wikipedia). You might think they are being unfair and have a bias against humans. But if at the end of the day, it's an effective bias that ensures their lives, what's wrong with it? This heuristic had to precede their domestication, and probably was lessened during the process but still remains and probably still ensures their safety on a lesser extent from rustlers and predators.
A heuristic and a bias seem two sides of a coin, both are quick ways to make decisions and judgements, as there is a limit to what we can know or be sure of. There is connotation to both: a heuristic sounds like a smart, shorthand guide, or a rule of thumb; whereas a bias sounds like it is an overgeneralisation that leads you to error or a lack of equity. Profiling at the airport is probably an effective way to find the majority of illicitly brought it contraband; but there will be those of the non-targetted groups who bring it in with an unfair lack of scrutiny; and there will be a lot of innocent, rule-following members in the targetted groups that will cry foul. To cross the street because of the presence of a young Polynesian in a hoodie coming the other way would be racist; but like the sheep might actually be a heuristic to avoid risk. Murky, huh.
Pretty much any item of controversy is a clash between the heuristics/biases that people use. The easiest one to look at is political labelling, in New Zealand it often goes to the National / Labour brands or the left / right polarity (often at the expense of any awareness of the continuum underneath). Not much of the electorate of any country has the luxury to be completely aware of the exact distinctions between political options; but might know that people similar to them are more likely to vote one way, or benefit from one particular party, without knowing exactly how. When a judgement has to be made, it's easier to go with that party. It works in reverse, too, when your party or a political figure you support comes out with a policy, that is difficult to exactly understand whether it is allowing in migrants, "supporting medicare for all" (a US example) or shutting the borders. You're more likely to support it using your informal affiliations as a guide, that if you had agreed with them before, you probably should agree with this policy, too, even if it sets you up for all sorts of contradictions between this and your private self. Even if you were to think that you had reasons for your support for the policy, it might be because you've heard the arguments in favour that "made sense" and, as a bias, discrediting or underestimating the worth of those from the other side which might also make some sense.
There is a lot of talk about tribalism in politics but by extension in the way that the tribal evokes the primitive, it's the primal heuristics that are worryingly still present. The fear of strangers is a heuristic, but one that we learn to overcome in most circumstances. There seems to be a heuristic where people are ethically contaminated by association with those who do some sort of wrong, or have some sort of beliefs, no matter how intellectually clear in an civilised society that you should be able to have relationships, and that the fallen should be able to be redeemed. It's a simple heuristic to sort people: Person A does bad things. Person B has been his friend. Person B is thus also bad. Person A likes Person C. Thus Person C is not a reputable person. Person D dislikes person B, so they must be a good person. It's all black and white and not much grey. Heuristics and biases are indeed fast ways to generate a black and white certain answer, judgement or decision, in times when you are information-impoverished, or not inclined towards the effort that accuracy might demand.
At the end of the day, one person's heuristic is another person's bias. In this world of memes (which I'm using in the original sense of the word as transmissible ideas that spreads like genes), there will eventually be some culling of the poor heuristics that turn out to be self-defeating biases. And they must be self-defeating in some sense to be eliminated. Racism doesn't disappear because it is an unfair belief. It disappears when it doesn't confer an advantage. In New Zealand, in this "PC world" overt racism has already been made to be disadvantageous to your social and professional life, for example. In the metaphorical Black Swan event, those who have a collection of attitudes that, "rightly or wrongly" ensure survival are those that will prevail. Survival hasn't really been a big issue in the last 70 years because the human race hasn't been stress-tested for some time. It might be that you could do a regression of memes in societies that prospered (when there is an explosion of ideas, heuristics and beliefs) and then when the crunch came which ones lasted, not just because of fashion but brutal life and death distinctions. Ancient Greece, Rome and China all had periods of intellectual prosperity before circumstances caused their decline and also the culling of a whole bunch of ideas. Many of the ideas might have been idealist, but when the pressure is on the judgements they made in unique situations did not work. During the flourishing "anything can go" but in the eventual and certain unexpected adversity, the beliefs that work not just for the present but also for extraordinary times are the ones that suddenly become key and will survive.
Anyway. It's a Friday. A Good Friday for another landmark week. I quoted New York Governor Andrew Cuomo saying "New York is not Wuhan" and his words are become more and more true. New York City alone will double, perhaps even triple, the death rate of Wuhan. New York State has more infected than either Spain or Italy. The USA as a whole went from over six thousand dead to sixteen thousand officially dead in the space of 7 days. There was a bit of news about Sweden's alternative way where they try to use self-responsibility as the main principle in social distancing but otherwise keep things "normal". The rest of Europe, including the similar country Norway, did the now standard lock-down. Result: Norway has 108 dead since the beginning. Sweden had 106 dead yesterday.
New Zealand might be on the cusp of pulling off the perfect turn, if the perfect turn was to allow some spread and then pull it back in. Even with two regrettable deaths and possible a few other potential fatalities in the ICU's we might have played our cards relatively well. There is a "what next"-ness about the next step. And what of the world? And what of the border? It's extraordinary to think that here we are with barely any new cases, and countries where there are literally hundreds dying each day are saying that they have reached the peak and looking to allow people release from the lock-down.
The incredible thing to think about is that there are just 50 official deaths per million in the USA. For most people stuck at home, they will feel that the situation is overblown, a hoax, a conspiracy or a power grab to seize the freedom back from the citizenry. There is probably even a sense of that here too, with people feeling the cost of the lock-down outweighs the barely apparent epidemic. With 12 more days of Level 4, at least, to go, it will be an interesting time.
Sunday, April 05, 2020
EpidemEconomics
Economics is an inextricable part of pretty much every part of life. Epidemics are no different. Most of the focus of it so far has been the dilemma all countries have gone through, that is, the initial weighing up of suppression of the virus versus a temporary loss of economic activity, that has now morphed into the dilemma between mitigating the damage and a world recession. Now, almost all countries have accepted that the disease is worth the damage of the cure and have done steps to hobble themselves to flatten the curve. Just like China did. So we're all in for an interesting time.
The more interesting thing for me is the smaller, more soluble economic issues. Probably the most interesting is that of testing, which any follower of any of this pandemic will know is one of those key parameters which has differentiated countries. The United Kingdom, after not reacting fast enough to the arrival of the virus, decided that there was not much purpose for testing beyond diagnosis in the hospital. The United States decided to refuse the WHO test and develop their own faulty test which delayed them. On the flip side, South Korea and Germany are now the "stars" of testing, pretty much confirming that the secret to good containment is not a secret; it's exactly what the WHO has suggested: test, isolate, contact trace.
But in almost every country there is the cry of people not being tested who should have, and it's fair enough to feel outraged when knowing or not knowing could affect the lives of your loved ones and your professional life. But my administrator brain does not think it is reasonable to expect that any one who wants a test should get a test and the answer is economics.
I'm no expert but testing as it is done to diagnose people for their infection with the virus has several components. One is the test kit, which has swabs for the nose and throat. The next step is exposing that sample to a PCR process, a polymerase chain reaction. This is when the sample is treated with the enzyme, polymerase, which reacts to any RNA in the sample and multiplies it to a huge amount. Then the final stage is when a reagent is added. The reagent is a chemical that is reactive to the RNA to Covid-19. And voila, you should have a result. What's so difficult about that?
Firstly, you need the test kits, which need to be sent to the testing centres in sufficient supply for the need, and to general practices. Then you need to have the capacity and expertise to do the clinical work with the enzyme and the reagent, and you need to have sufficient amounts of these two chemicals.
The smoke and mirrors of this is that testing is not the same as processing a result. In the US, ashamed by their slowness, they ramped up testing, claiming to send a million test kits out in a week. "Anyone who wants a test can get a test," Trump famously said. But that did not make much difference to the situation because there wasn't the capacity to do the clinical tests on the samples. They used private labs but many of these struggled to scale up their services to the scale that a pandemic required. Once samples are sent to a private lab, sometimes there are too many samples for their daily capacity and the backlog of people waiting for results went into days, where presumably people are out of action and isolated, perhaps needlessly.
To ramp up testing you need to have not just the kits but also the laboratory resources, and an administrator thus will be careful to have measures in place to prevent wastage and overuse. Where there are scarce resources there must be management of them and the moderation of the case definition seems to have been the tool for controlling the number of tests.
The ideal of "testing everyone" is unrealistic, but also dangerous. Certain tests are famous for their "false positives". The process above is one that can result in "false negatives". If you test too soon, you might clear someone who is just a day short of having detectable virus in the sample. New Zealand's terminology of "probable" cases I haven't seen elsewhere. I presume this is the apparent case of Covid-19 but with a currently negative result.
The more interesting thing for me is the smaller, more soluble economic issues. Probably the most interesting is that of testing, which any follower of any of this pandemic will know is one of those key parameters which has differentiated countries. The United Kingdom, after not reacting fast enough to the arrival of the virus, decided that there was not much purpose for testing beyond diagnosis in the hospital. The United States decided to refuse the WHO test and develop their own faulty test which delayed them. On the flip side, South Korea and Germany are now the "stars" of testing, pretty much confirming that the secret to good containment is not a secret; it's exactly what the WHO has suggested: test, isolate, contact trace.
But in almost every country there is the cry of people not being tested who should have, and it's fair enough to feel outraged when knowing or not knowing could affect the lives of your loved ones and your professional life. But my administrator brain does not think it is reasonable to expect that any one who wants a test should get a test and the answer is economics.
I'm no expert but testing as it is done to diagnose people for their infection with the virus has several components. One is the test kit, which has swabs for the nose and throat. The next step is exposing that sample to a PCR process, a polymerase chain reaction. This is when the sample is treated with the enzyme, polymerase, which reacts to any RNA in the sample and multiplies it to a huge amount. Then the final stage is when a reagent is added. The reagent is a chemical that is reactive to the RNA to Covid-19. And voila, you should have a result. What's so difficult about that?
Firstly, you need the test kits, which need to be sent to the testing centres in sufficient supply for the need, and to general practices. Then you need to have the capacity and expertise to do the clinical work with the enzyme and the reagent, and you need to have sufficient amounts of these two chemicals.
The smoke and mirrors of this is that testing is not the same as processing a result. In the US, ashamed by their slowness, they ramped up testing, claiming to send a million test kits out in a week. "Anyone who wants a test can get a test," Trump famously said. But that did not make much difference to the situation because there wasn't the capacity to do the clinical tests on the samples. They used private labs but many of these struggled to scale up their services to the scale that a pandemic required. Once samples are sent to a private lab, sometimes there are too many samples for their daily capacity and the backlog of people waiting for results went into days, where presumably people are out of action and isolated, perhaps needlessly.
To ramp up testing you need to have not just the kits but also the laboratory resources, and an administrator thus will be careful to have measures in place to prevent wastage and overuse. Where there are scarce resources there must be management of them and the moderation of the case definition seems to have been the tool for controlling the number of tests.
The ideal of "testing everyone" is unrealistic, but also dangerous. Certain tests are famous for their "false positives". The process above is one that can result in "false negatives". If you test too soon, you might clear someone who is just a day short of having detectable virus in the sample. New Zealand's terminology of "probable" cases I haven't seen elsewhere. I presume this is the apparent case of Covid-19 but with a currently negative result.
Friday, April 03, 2020
Strolling the world
It's been a seemingly unprecedented run of fine weather since December. It has barely rained. When it has rained, it's been barely at inconvenient times. It would be a shame to spend it at work. It would be worse to just spend it at home not going out. During our self-isolation, we had walks and driving lessons. Based on the principle that under lock-down, you should avoid risks that might put us in situations requiring help, we are left with just walks. Walking during a lockdown in a major suburban area is a continuous state of awkwardness as everyone else is desperate to be outside, yet distant, in unusually crowded streets.
Many people though do not self-contain and don't like to be contained. It is not surprising in a country of five million that there are those that either think the danger is overstated, or are complacent about the risks, or feel that the rules do not apply to them. And they stick out like a sore thumb. And are eyesores to boot. And there is the eternal doubt you have for the conduct of others. Three kids playing basketball in a school court. Are they brothers from a same bubble? They're unsupervised. Did they touch a gate on the way in? That one's leaning against a wall. Has anyone else touched it? An adult should really be there if they were brothers. But what can you do?
Of course any one transgressive act have very little chance of random transmission; but in a country even as small as New Zealand it's going to happen to someone. My initial confidence of the strategy has been dampened by the sheer number of infected. It's astonishing to go from 39 cases two weeks ago, just before the level system was introduced, to 868 now, with a death. But it means the timing was right. We can only hope that this lock-down is well-timed.
Friday is a comparison day. In just the last 7 days, the cases in the US have tripled to almost a quarter of a million; deaths quadrupled to over 6000. How's that for a reality check? The biggest reality check was the American people hearing that even with best mitigation practices at least 100,000 people are expected to perish, probably more. Fortunately most states have done what is essential: shelter-in-place orders are in effect.
Compare that with a country less fortunate than us but at least better than the US: Australia. In the same period their cases haven't quite doubled; but deaths have. Even if their method has looked mad, they have seemingly done "relatively" well.
An "interesting" addition in the numbers today was that that the French decided to do something that really exposes the weakness of the numbers. They added 884 deaths to their death toll for yesterday. They thought the deaths that had happened in rest homes up to this point presumably due to Covid-19 should be added even though they hadn't happened in hospitals. The common man screams that this goes without saying, that a death is a death regardless of where it happens. Chinese numbers are suspect not from deliberate obfuscation but the same art of qualifying numbers.
The plain-sight UK version of this is that when their Department of Health and Social Services announce those grim statistics daily with the same explicit qualifier, they say: "As of 5pm on 1 April, of those hospitalised in the UK who tested positive for coronavirus, 2,921 have sadly died." This has been noticed and the common man yet again pounds his fist about the lying technocratic elite. But then again some qualification of the fact is imperative, because there will always be some grey and something has to be stated about the criteria to be counted has to be said for figures to mean anything at all. Numbers must be qualified. And it is only with an announcement like France's that suddenly there are indeed apples and the oranges counted together to give a 53,000 death toll at this moment, reveals itself as a bottom bedrock number on which the real has to be much greater.
Deaths in rest homes would be a feature of any overrun city or country by covid-19. America's early numbers were marred by a king-hit for the virus, which like a ferret seeking out chicks in a birds nest, wiped out a third of the residents of a rest home in Washington State. It was a precision strike, which if it had triggered a national response at the time might have saved at least 100,000 more lives.
When the fog of this is dispelled, the estimates will be scary. It won't be just the undercount of rest homes deaths, but home deaths, homeless deaths, pre-outbreak deaths (in hospitals before countries realised they had it) and post-breakdown deaths when there is no testing available for the already dead, being saved for the still alive. If you don't mind me repeating the analogy, like a ferret hunting and slaughtering chicks in a nest, this virus tests and probes every country and it will ransack the weak and disorganised. My favourite vlogger on the topic calls covid-19 the honey badger virus. I'd call it a ferret and I wish it could just be exterminated.
Many people though do not self-contain and don't like to be contained. It is not surprising in a country of five million that there are those that either think the danger is overstated, or are complacent about the risks, or feel that the rules do not apply to them. And they stick out like a sore thumb. And are eyesores to boot. And there is the eternal doubt you have for the conduct of others. Three kids playing basketball in a school court. Are they brothers from a same bubble? They're unsupervised. Did they touch a gate on the way in? That one's leaning against a wall. Has anyone else touched it? An adult should really be there if they were brothers. But what can you do?
Of course any one transgressive act have very little chance of random transmission; but in a country even as small as New Zealand it's going to happen to someone. My initial confidence of the strategy has been dampened by the sheer number of infected. It's astonishing to go from 39 cases two weeks ago, just before the level system was introduced, to 868 now, with a death. But it means the timing was right. We can only hope that this lock-down is well-timed.
Friday is a comparison day. In just the last 7 days, the cases in the US have tripled to almost a quarter of a million; deaths quadrupled to over 6000. How's that for a reality check? The biggest reality check was the American people hearing that even with best mitigation practices at least 100,000 people are expected to perish, probably more. Fortunately most states have done what is essential: shelter-in-place orders are in effect.
Compare that with a country less fortunate than us but at least better than the US: Australia. In the same period their cases haven't quite doubled; but deaths have. Even if their method has looked mad, they have seemingly done "relatively" well.
An "interesting" addition in the numbers today was that that the French decided to do something that really exposes the weakness of the numbers. They added 884 deaths to their death toll for yesterday. They thought the deaths that had happened in rest homes up to this point presumably due to Covid-19 should be added even though they hadn't happened in hospitals. The common man screams that this goes without saying, that a death is a death regardless of where it happens. Chinese numbers are suspect not from deliberate obfuscation but the same art of qualifying numbers.
The plain-sight UK version of this is that when their Department of Health and Social Services announce those grim statistics daily with the same explicit qualifier, they say: "As of 5pm on 1 April, of those hospitalised in the UK who tested positive for coronavirus, 2,921 have sadly died." This has been noticed and the common man yet again pounds his fist about the lying technocratic elite. But then again some qualification of the fact is imperative, because there will always be some grey and something has to be stated about the criteria to be counted has to be said for figures to mean anything at all. Numbers must be qualified. And it is only with an announcement like France's that suddenly there are indeed apples and the oranges counted together to give a 53,000 death toll at this moment, reveals itself as a bottom bedrock number on which the real has to be much greater.
Deaths in rest homes would be a feature of any overrun city or country by covid-19. America's early numbers were marred by a king-hit for the virus, which like a ferret seeking out chicks in a birds nest, wiped out a third of the residents of a rest home in Washington State. It was a precision strike, which if it had triggered a national response at the time might have saved at least 100,000 more lives.
When the fog of this is dispelled, the estimates will be scary. It won't be just the undercount of rest homes deaths, but home deaths, homeless deaths, pre-outbreak deaths (in hospitals before countries realised they had it) and post-breakdown deaths when there is no testing available for the already dead, being saved for the still alive. If you don't mind me repeating the analogy, like a ferret hunting and slaughtering chicks in a nest, this virus tests and probes every country and it will ransack the weak and disorganised. My favourite vlogger on the topic calls covid-19 the honey badger virus. I'd call it a ferret and I wish it could just be exterminated.
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