Friday , October 23 2020

Jacobin pandemic

Casey Mulligan tweeted an interesting report on the coronavirus from Jacobin online magazine as "makes the most sense." Given that the Jacobins were "the most radical and ruthless of the political groups formed in the wake of the French Revolution, and in association with Robespierre they instituted the Terror of 1793–4."(google dictionary) the link attracted my ...

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Casey Mulligan tweeted an interesting report on the coronavirus from Jacobin online magazine as "makes the most sense." Given that the Jacobins were 

"the most radical and ruthless of the political groups formed in the wake of the French Revolution, and in association with Robespierre they instituted the Terror of 1793–4."

(google dictionary) the link attracted my eye. (Do these people know history? Or is this intentional? And they're all upset about Trump and "authoritarianism?")  

Indeed, after the predictable throat-clearing editorializing about "disparate impact" and inequality, and despite idiotic question preambles like this one

"Under capitalism, we have become a species that increasingly exploits other creatures and their habitats, and moves in large numbers and with great speed around the globe, making us ripe for a pandemic like this one."

(China is.. capitalist? The plague, cholera, yellow fever, smallpox were... what?) Jacobin editorial board member Nicole Aschoff spurs Harvard professors Katherine Yih  and Martin Kulldorff to interesting, sensible and useful answers. The extreme source of this commonsense gives me some hope. However, read though or skip to my critical comments, as it's not as totally wise as Casey suggests. 

KY: ... I don’t think it’s wise or warranted to keep society locked down until vaccines become available. ..Instead of a medically oriented approach that focuses on the individual patient and seeks (unrealistically) to prevent new infections across the board, we need a public health–oriented approach that focuses on the population  and seeks to use patterns, or epidemiologic features, of the disease to minimize the number of cases of severe disease and death over the long run, as herd immunity builds up.

NA: Like Dr Yih, I am very concerned about the collateral damage of lockdowns. In public health policy, we cannot just consider the present consequences of one single disease. We must think more broadly, considering all short- and long-term health outcomes.

...Another example is school closings. Good education is not only important for academic achievement and financial well-being; it is also critical for the mental and physical health of children and into their subsequent adulthood. Kids have minimal risk from this virus, and it is sad that we are sacrificing our children instead of properly protecting the elderly and other high-risk groups.

(I hate to break it to modern-day Jacobins, but the Trump Administration is basically following this approach. And the disparate impact is precisely brought on by economic lockdown.  ) 

Read on for much common sense. 

However, I don't think this is totally right, and "damn the torpedoes, protect the old folks and let's sail on to herd immunity" is not, I think the right or at least complete answer.  

1) Herd immunity, on its own, is a meaningless concept.  Most people think herd immunity happens when everyone has gotten it, which is false.  A virus stops spreading when the reproduction rate is below one. The reproduction rate combines frequency of contact and fraction of immune in the population. Only that combination matters.

If each infected person meets 3 people and 67% of the population has immunity, the virus stops.  If each infected person meets two people and 51% the population has immunity, the virus stops. If each infected person meets 0.99 people and nobody is immune, the virus stops.  The fraction with immunity on its own is meaningless.

So we need to work on both parts of the equation -- reduce the contact rate and minimum economic and social cost, as well as wait for greater numbers to become immune. 

2) Long term consequences.  The article acknowledges these and moves on. This strikes me as a great unknown. The view that it’s like the flu, just let people get it until immunity rises, while keeping old and sick people safe, is predicated on the idea that there are few long term consequences other than death. 

 If 20% are getting long term important debilitation, that skews the treadeoff to less contact.  If this were the plague or cholera, with 50% death, we would not be talking about herd immunity.

3) Testing. The article is missing the one great opportunity we have to reduce the spread and reduce the social and economic cost of the disease, until a vaccine becomes available. "Test" only appears in the article in the section on protecting the elderly and nursing homes. This is the great unexploited opportunity. We can cheaply reduce the contact rate with next to no business or social cost.

Why in the world are we not embarking on widespread public-health testing? Why is the FDA still regulating tests, saying they may only be performed in a medical setting?  By what possible right or common sense can the FDA tell me that I cannot send samples of my body to a lab, and the lab cannot tell me what’s in them? Read Alex Tabarrok "our antigens, ourselves" to get really grumpy about this. You have to be astoundingly paternalistic about the stupid deplorable to believe that people need to be protected from simple information about what is in their body. There is zero medical danger from a saliva test. 

This thing could be over in  weeks if the FDA allowed cheap, fast, relatively inaccurate, cash-and-carry, completely unregulated tests. Go to CVS, get the test kit, find out if you have it. No referral, no doctor visit, no prescription, no insurance, no faxed paperwork. Let private decisions figure out what to do with the results. Businesses, restaurants, schools could all demand it. With a cheap test, the contact rate can go below one and we need no immunity. Of course, the government has every interest in paying for and subsidizing tests too. 

Frankly I do not understand this Administration. If President Trump simply tweeted, "FDA: Free the tests!" and "CDC: tell people to get tested" this thing could be over in weeks. We could reach herd immunity with a low contact rate alone, and reastaurants, schools, universities, airlines, could require test results and reopen quickly. Trump could go into the election with the number of cases and deaths crashing. He could campaign in empty hospitals. 

John H. Cochrane
In real life I'm a Senior Fellow of the Hoover Institution at Stanford. I was formerly a professor at the University of Chicago Booth School of Business. I'm also an adjunct scholar of the Cato Institute. I'm not really grumpy by the way!

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