I wanted to commend this article at STAT by Helen Branswell to your attention. It reviews the process of rolling out inoculations for COVID-19:

Vaccines that prevent symptomatic Covid infection in roughly 95% of people vaccinated — as the data from clinical trials of the Pfizer-BioNTech and Moderna vaccines suggest — should, over time, help the country and the world return to a life where we can travel without quarantining; where sporting events can be played before live audiences, not cardboard cutouts; and where snowstorms are the only reasons school gets canceled.

But if we’re not careful, we could fail to take full advantage of the opportunity scientists and governments, pharmaceutical companies and philanthropic foundations have created for us.

And there’s a possibility that the pandemic off-ramp doesn’t merge with a straight road back to Normalville, but instead becomes a meandering country lane with the occasional detour. We may need to choose the right turns and avoid the potholes as we make our way to our destination. It will require patience.

It goes on to describe some of those potholes including speedy “roll-out”, acceptance, strategization, vaccinating the pregnant, vaccinating children. This passage, for example, is pretty interesting:

A recent survey of 2,000 doctors and nurses in New Jersey found that 60% of doctors planned to take a Covid vaccine, but only 40% of nurses intended to, Health Commissioner Judith Persichilli said in a recent “60 Minutes” segment about Operation Warp Speed.

That jibes with the experience during the 2009 H1N1 flu pandemic, when many health workers eschewed the new flu vaccine when it became available.

That’s interesting since studies have shown that front-line health care workers have experienced a higher incidence of COVID-19 than the general public. That would seem to suggest that the most important mitigation strategy might well be avoidance, i.e. those who intrinsically can’t avoid are at higher risk regardless of other mitigations.

My takeway from this article is that even with an efficient roll-out of a safe and effective vaccine returning to normal may take a lot longer than many people seem to think. Certainly not weeks. Possibly months but just as possibly years.

IMO it’s vitally important that we know whether the vaccine prevents transmission as well as symptomatic COVID-19 if we are to strategize those who will be the first to be inoculated appropriately.

At Bloomberg science writer Faye Flam offers some good advice:

Harvard’s William Hanage, who studies infectious disease dynamics, told me that people don’t need more rules. They need more information about how the virus is transmitted so they can take steps to avoid it. “When you phrase things in terms of rules, it leads people to try to come up with ways to get around those rules,” he says.

Rules can become a form of misinformation. The rules in many states seem to suggest that walking outside is dangerous and eating in a restaurant is safe, but Hanage says the truth is the other way around.

Baker has justified his outdoor mask mandate by saying it sends a message. The message I heard was that that the rules are not chosen for our health and welfare but to make our political leaders look like they are doing something.

Rules should only be decreed along with evidence for their benefit, argued statistician and risk communication expert David Spiegelhalter in a piece for The Guardian: “Too often, the message is shaped by communication professionals working to ensure the greatest number of people ‘get the message’ rather than thinking about how to present the evidence so the greatest number of people can understand it, trust it, and then decide for themselves.”

In my view rather than imposing mandatory mask requirements in the out-of-doors where it is practically useless and clearly arbitrary, more than anything a way for policymakers to signal that they’re doing something, we would be much better off encapsulating things into a few clear principles. Avoid the three C’s: close contact, closed spaces, and crowds. Stay away from those situations as best as you are able.

Spurred by comments, I decided to dig into the reasons that COVID-19 tests aren’t as plentiful as we might like. The reasons are actually pretty simple: the reagents are niche products, supplied by a handful of small to medium-sized companies. According to Thomas the suppliers are:

• Integrated DNA Technologies
• Qiagen
• Biosearch Technologies
• BEI Resources

The largest of these is a medium-sized company. The rest are small. Just to remind you of how I use the terms a small company has revenues up to about $200 million annually; a medium-sized company has annual revenues from $200 million to $1 billion; above that is a big company.

Contrary to the impression you might have received in economics classes the difference between a small company and a big company isn’t just revenue. Said another way small companies can’t expand their production rapidly even if you give them more money. The small company that can do that is rare, indeed. They just don’t have the management time.

Given enough time and persistent demand major players will get into the business but they’ll wait and see—they won’t gamble on it. The most likely major player is Baxter due to its present relationship with one of the top suppliers (disclaimer: although Baxter is an old client of mine I haven’t had anything to do with them for years). Intellectual property is probably a barrier to entry as well.

I believe that I disagree with David von Drehle’s assessment in his Washington Post column of the Chinese government’s recent behavior. He thinks Beijing has lost its confidence:

Yes, confidence. A confident government doesn’t lock up a million or more ethnic Muslims for months, even years, of brainwashing, as China continues to do in Xinjiang. A confident Beijing would no sooner throttle the intellectual vibrancy of Hong Kong than Canada would crack down on Montreal, or the United States would stifle San Jose. Repression is — always and everywhere — the mark of a government afraid of its own people. In the modern world, where human capital is the indispensable resource, repression is, therefore, fatal to development.

Lost its confidence or overly confident? I think more the latter—the Chinese authorities believe they have more to lose from looking weak to the Han Chinese population than they do by exterminating the Uighurs, whether literally or culturally, or from stifling Hong Kong. He comes closer here:

Making matters worse is China’s proud self-image as the world’s most patient country. China thinks in decades, in centuries, in millennia, whereas the West flits from month to month and quarter to quarter. But strategic patience is not a virtue in itself. It serves only when the underlying strategy is sound. A strategy of repression is doomed to fail no matter how long or how brutally it is pursued.

Let’s leave aside whether China’s strategic patience is overrated. One thing I will hand the regime: they write a heckuva press release. But he’s right that strategic patience is just a means to an end and the end is the continued rule of the Chinese Communist Party. Other interests will be subordinated to that.

I think he’s right about this:

First, the West holds a winning hand in our commitment to individual rights. We can lose only by folding. The fact that we haven’t always lived up to our ideals in no way repudiates the ideals themselves. Diversity of thought, freedom to question and create, equality before the law, and individual human dignity have always tended to foster prosperity and strength — and always will.

The Chinese authorities cannot repress their way to a creative, vibrant economy. That’s why they’ve relied so heavily on theft. He goes a little overboard here:

Some nations are further along in this journey than others. Where there is no rule of law, there can be no equality before the law. Where there is no education, there can be little intellectual diversity. Where there is extreme want, dignity is a luxury. But no matter where a nation finds itself on the path of development, the next best step is one that points toward human fulfillment. The West prevails by believing in this idea, nurturing it and holding it up as a beacon.

China has no practical rule of law for the reason mentioned above but it’s ahead of us in education. They have ten times the recent STEM graduates we do. We do beat them in journalism, psychology, and interest studies majors, however.

And China has eliminated more “extreme want” over the last 20 years than the rest of the world has extreme want. They deserve credit for that.

To the extent that it has prevailed at all it has not prevailed through promoting human fulfillment but through having a vibrant economy. Free people produce more than slaves. No matter how smart their creators are five year plans inevitably result in the misallocation of resources.

In Chicago at least contact-tracing to limit the spread of COVID-19 is a flop, as this article by Brett Chase in the Chicago Sun-Times points out:

Contact tracing begins with trying to locate and interview anyone who recently tested positive. Its success depends on those people opening up about others they recently have been in close contact with. And, beyond that: convincing people who possibly were exposed to the virus to quarantine themselves to keep from spreading it, even when they haven’t experienced any symptoms.

Touted early in the pandemic as a critical tool to help slow the spread of COVID-19 by interviewing people who might have been exposed, the effort in Chicago is falling far short of expectations.

There’s the city’s low rate of success even reaching COVID-positive people.

Beyond that, those who do get interviewed aren’t giving up the names of their friends and family, health officials say. City officials hoped they would get names from the COVID-positive Chicagoans contact tracers reach of five to 10 people each who potentially had been exposed. But city officials say that so far they are getting little more than one contact, on average, for each COVID-positive person interviewed.

The reasons given for why it’s a flop include:

• There aren’t enough people doing the tracing
• The city’s program can’t respond to changes in the number of cases fast enough
• Even when contacts are identified they don’t know how to reach them
• People don’t answer their phones or doorbells
• Even when they reach them people won’t talk

Based on experience I would add that any contact-tracing program will inevitably become a method of channeling money to political activists. Maybe it’s different elsewhere but that’s the way it is in Chicago.

The United States is different from Germany or Japan. People don’t trust the government. That isn’t new—with the exception of a brief honeymoon following World War II, the most successful government program in U. S. history, Americans have never trusted the government. Trust is hard to build and easy to lose.

I rather like the infographic above, sampled from this article by Siobhan Roberts in the New York Times:

Lately, in the ongoing conversation about how to defeat the coronavirus, experts have made reference to the “Swiss cheese model” of pandemic defense.

The metaphor is easy enough to grasp: Multiple layers of protection, imagined as cheese slices, block the spread of the new coronavirus, SARS-CoV-2, the virus that causes Covid-19. No one layer is perfect; each has holes, and when the holes align, the risk of infection increases. But several layers combined — social distancing, plus masks, plus hand-washing, plus testing and tracing, plus ventilation, plus government messaging — significantly reduce the overall risk. Vaccination will add one more protective layer.

or, rather, I like it with a couple of exceptions. My first quibble occurs in the very next paragraph:

“Pretty soon you’ve created an impenetrable barrier, and you really can quench the transmission of the virus,” said Dr. Julie Gerberding, executive vice president and chief patient officer at Merck, who recently referenced the Swiss cheese model when speaking at a virtual gala fund-raiser for MoMath, the National Museum of Mathematics in Manhattan.

“But it requires all of those things, not just one of those things,” she added. “I think that’s what our population is having trouble getting their head around. We want to believe that there is going to come this magic day when suddenly 300 million doses of vaccine will be available and we can go back to work and things will return to normal. That is absolutely not going to happen fast.”

Uh, no. A safe, effective vaccine will reduce the risk. It will not reduce it to zero which is implied by “impenetrable barrier”. The model originated in industrial safety and even the bloke who devised it in that arena recognizes its limitations. Accidents can be reduced but not reduced to zero. It should also be pointed out that the most successful vaccination program in U. S. history included mandatory vaccination and quarantines. If you believe we will implement mandatory vaccination and quarantines for COVID-19, please explain how you think that’s politically possible. I don’t see it. We can’t even manage to get everybody vaccinated against measles.

My second quibble has to do with the slice labeled “fast, sensitive testing & tracing”. I don’t believe that we presently have fast, sensitive, and accurate testing and will not have such a thing for the foreseeable future. There’s generally trade-offs among speed, sensitivity, and accuracy and I expect that to remain true. I’ll have more about tracing in a later post.

Nonetheless I think the infographic is good and largely good advice with the distinction between personal responsibilities and shared responsibilities being useful.

Speaking of fools and knaves, does anyone seriously believe that Rahm Emanuel didn’t know about the Laquan McDonald tape or that Richie Daley didn’t know about the torture being carried on by Jon Burge and his minions? Now the same people who voted for them are complaining. IMO there’s a simple solution: stop voting for them!

In a post at The Week Joel Mathis makes a pretty good point:

Hypocrisy by men and women in high places is galling enough on its own. But the real risk is that double standards will melt into no standards at all. If my city’s mayor decides to sidestep the rules — or even good sense — by having an indoor restaurant meal, or taking an out-of-town trip to see family, why shouldn’t I do the same? Every person who decides to follow suit takes the chance of spreading the virus, and its accompanying misery, to a wider group of people.

in which you might see echoes of a point I’ve made myself. Let me ask a question. Which is the worst?

1. People in high places who don’t make the right rules and model bad conduct?
2. People in high places who make rules and openly exempt themselves from them?
3. People in high places who make rules but don’t live up to them themselves?

I think they’re all pretty bad. The fool or knave that wears a title lies.

There’s a paper on educational loan forgiveness from a pair of University of Chicago economists (PDF) that arrives at the same conclusion I did in examining the subject:

We find that universal and capped forgiveness policies are highly regressive, with the vast majority of benefits accruing to high-income individuals. On the other hand, enrolling more borrowers in IDR plans linking repayment to earnings leads to forgiveness for borrowers in the middle of the income-istribution.

Let’s put this very clearly. If you’re interested in welfare for the rich, you’ll support educational loan forgiveness programs. If you’re concerned about middle income people and income inequality and the drag on the economy provided by educational debt overhang you’ll support an income driven repayment program.