Yves here. Ilargi deserves kudos for explicating Nassim Nicolas Taleb’s work on the coronacrisis, particularly his paper with on pandemic risks with Yaneer Bar-Yam and Joseph Norman on pandemic risks. Guess what? They have really fat tails.
It says something not good at all about the state of medicine, public health, and the leadership of Western societies generally that it’s Taleb who has been speaking relentlessly, and largely alone, about the importance of the precautionary principle. It may be that Taleb, in his usual iconoclastic fashion, brought it up in the context of GMOs, where supposedly only cranks worry about safety. Perhaps my sample is skewed, but the one person I know who is ex the NIH (later went to Big Pharma and then to FDA/intellectual property law) thought that GMOs were an appalling abuse: a mass experiment conducted with no controls and no consent. And even though she wasn’t at all a health nut (she relished the occasional burger and fries and would eat junk food from the snack machine if she was stuck late at the office), she avoided GMOs until she gave up, saying it was too hard.
There are many important takeaways from this discussion, but one stood out for me: Taleb and his fellow risk analysts argue that contact tracing is of little use once a disease has hit the pandemic stage.
By Raúl Ilargi Meijer. Originally published at Automatic Earth
Today, I’m going to try to show you how and why we know that in the case of a pandemic like the one we’re in, surrounded by doubts and uncertainties, there are still a series of measures that we can and, more importantly, must take. But also, how these measures are hardly ever taken, and if they are, not in the correct fashion. This has to date led us into a ton of preventable misery and death. If only we would listen. And there’s still more we can do to prevent more mayhem, there is at every step of the process.
It took me a while to get this together. But in the end I wound up with the only COVID19 analysis that makes sense. It doesn’t leave much room for discussion, at least not in the steps needed to be taken in order to tame the virus (I despise the war analogies everyone uses, taming sounds much better). How to fill in those steps once they have -kind of- been taken is another matter.
I’ve been reading up on this for a while, adding -much- more stuff as I went along (this will be a long essay), and at some point realized that the coronavirus is an issue you can’t leave to epidemiologists and virologists, because there are far too many unknowns for them to create a working model, and without such a model they are lost. These fine people are not good at 10-dimensional chess, even if they like you to think otherwise.
These people are useful for the knowledge they possess of past epidemics, not for predicting what will happen in the next one, certainly not if it’s caused by a virus which they -and we- simply don’t know enough about to build a reliable model. In that case, you need to step back and apply more basic principles. Lucky for us, those exist.
If you can’t know what will happen next because you can’t oversee the multitude of variables involved, and there are no models that can do so either, the best -only- thing you can do is to halt the growing complexity as soon as you are able to, in order to create a situation, an environment, which the epidemiologists and virologists DO recognize, and can work with.
That is the point where they come in, not before. At present, they are asked to do things beyond their knowledge. And, typical human trait, they don’t tend to acknowledge that. Well, there’s a second reason: some actually think they do understand. The outcome is the same: we- and they- are led astray, away from science and into “scientism” (more on that in a moment).
Which would be fine if this concerned just a hobby, or even if it was only an academic paper left to discuss in classrooms and web forums. But we are talking about 10s of 1000s of deaths, 100s of 1000s of gravely ill people, and in the wake of that an economy as much in need of assisted breathing as the human patients involved.
Lucky for us, we have people who DO understand these things. Unlucky for us, our “leadership” doesn’t listen to them. They think that an epidemiologist or two, three, should be enough. But neither the “leaders” nor the epidemiologists understand the limits every single scientific field has. They don’t understand what happens when scientists venture out of their chosen field. And most of all, they don’t understand what complex systems are.
Please note that the above also means that any and all virus modeling going forward should be taken with an ocean full of salt. We get new examples every day of “qualities” of the virus that are not in any models. Where the virus originated, asymptomatic patients, re-infection, huge discrepancies in ‘modeled’ numbers predicted vs factual ones, Asians vs whites, blacks vs whites, men vs women, smokers vs non-smokers, chloroquine (non-)effectiveness, contagiousness, the list goes on for miles.
There is a way to leave those discussions, based on, we must admit, far too little verifiable information, leaving us groping in the pitchblack, behind for now.
Most people who read a site like the Automatic Earth, where finance is a main topic, will know who Nassim Nicholas Taleb is, for instance because he wrote The Black Swan before the 2008 financial crisis. Or because a hedge fund he advises recently announced a 6,000%+ gain in “virustime”. But Taleb is also, and more interesting for this essay, “distinguished professor of risk engineering at New York University’s Tandon School of Engineering”.
For much of his coverage of COVID19, Taleb has been co-operating with Yaneer Bar-Yam, president of the New England Complex System Institute, and Joseph Norman, a postdoctoral researcher at the same New England Complex System Institute. That means “real scientists”, just not from where you might expect. Which in turn means they can help the other guys get out of the ditch they’re in.
I’ll refer to “Taleb” here, nice and short, but that often means his co-operators too. Key terminology you’ll find, and need, is “asymmetry”, “precautionary principle” (“first do no harm”, which is close to the Hippocratic Oath’s “to abstain from doing harm”), and perhaps also “convexity” (a term from the finance world that depicts a relation between interest rates and bond duration).
First, here are a few bits from a piece the three wrote on January 26, to get you familiar with some of the ideas. These are ground rules for approaching a pandemic such as this one, but they are also ground rules for -any- other problems with too many unknown variables.
This is crucial because it denotes that if you have a disease that is both contagious and deadly, you don’t -have to- first wait and (build a model to) see how deadly and contagious it is, as an epidemiologist is wont to do, you can act right off the bat. Of course the scientists at the WHO and various government know this basic stuff, but they still haven’t acted accordingly. On January 26 and after, the ground rules were ignored.
So then you’re forced into the next basic steps. Still -mostly- not an epic disaster, but surely an unnecessary -and potentially deadly- risk. Taleb doesn’t take prisoners, and labels the WHO “criminally incompetent”. And I fully agree: they get paid billions a year to be the world’s ears and eyes in case a new disease pops up somewhere, and they have still let it happen. Here’s that first bit:
Systemic Risk Of Pandemic Via Novel Pathogens – Coronavirus: A note
General Precautionary Principle : The general (non-naive) precautionary principle  delineates conditions where actions must be taken to reduce risk of ruin, and traditional cost-benefit analyses must not be used. These are ruin problems where, over time, exposure to tail events leads to a certain eventual extinction. While there is a very high probability for humanity surviving a single such event, over time, there is eventually zero probability of surviving repeated exposures to such events. While repeated risks can be taken by individuals with a limited life expectancy, ruin exposures must never be taken at the systemic and collective level. In technical terms, the precautionary principle applies when traditional statistical averages are invalid because risks are not ergodic.
Spreading rate : Historically based estimates of spreading rates for pandemics in general, and for the current one in particular, underestimate the rate of spread because of the rapid increases in transportation connectivity over recent years. This means that expectations of the extent of harm are underestimates both because events are inherently fat tailed, and because the tail is becoming fatter as connectivity increases. Global connectivity is at an all-time high, with China one of the most globally connected societies. Fundamentally, viral contagion events depend on the interaction of agents in physical space, and with the forward-looking uncertainty that novel outbreaks necessarily carry, reducing connectivity temporarily to slow flows of potentially contagious individuals is the only approach that is robustagainst misestimations in the properties of a virus or other pathogen.
Asymmetric Uncertainty : Properties of the virus that are uncertain will have substantial impact on whether policies implemented are effective. For instance, whether contagious asymptomatic carriers exist. These uncertainties make it unclear whether measures such as temperature screening at major ports will have the desired impact. Practically all the uncertainty tends to make the problem potentially worse, not better, as these processes are convex to uncertainty.
Conclusion : Standard individual-scale policy approaches such as isolation, contact tracing and monitoring are rapidly (computationally) overwhelmed in the face of mass infection, and thus also cannot be relied upon to stop a pandemic. Multiscale population approaches including drastically pruning contact networks using collective boundaries and social behavior change, and community self-monitoring, are essential. Together, these observations lead to the necessity of a precautionary approach to current and potential pandemic outbreaks that must include constraining mobility patterns in the early stages of an outbreak, especially when little is known about the true parameters of the pathogen.
It will cost something to reduce mobility in the short term, but to fail do so will eventually cost everything—if not from this event, then one in the future. Outbreaks are inevitable, but an appropriately precautionary response can mitigate systemic risk to the globe at large. But policy- and decision-makers must act swiftly and avoid the fallacy that to have an appropriate respect for uncertainty in the face of possible irreversible catastrophe amounts to “paranoia,” or the converse a belief that nothing can be done.
As you can see, that already contains the next steps in case the initial response is warped (it has been). An expensive failure, but not necessarily an all too fatal one yet. Missing the next steps as well, though, turns this into a whole other story, and one that must be familiar to you, because you’re living it.
Yaneer Bar-Yam on March 23 gave it another try when he wrote in USA Today that “We Need An Immediate Five-Week National Lockdown To Defeat Coronavirus In America”. We know how that went (I don’t really have space to include that piece). According to this little graph I picked up last week, the US is barely 50% locked down. And that’s not going to cut it.
The last thing the “science crowd” want is for a bunch of complex systems guys, who they don’t understand anyway, to upstage them. And granted, the headline alone is ample threat to the UK government’s scientific advisers. But that attitude leads to more entirely preventable deaths; as I said above, the epidemiology etc. crowd simply lack the knowledge that the risk engineers do have, and which could help them prevent those deaths.
Something related, before I forget: I’ve been following Nassim Taleb’s opinions on genetically modified organisms (GMO) for a long time, because in that field, too, he applies the same ground rules that he does vis-a-vis the virus. First, precautionary principle (do no harm), and in the wake of that, asymmetry (asymmetric risk). In “Monsanto’s GMO field”, just like with deadly viruses, the risks when something goes wrong are devastating. If you get that wrong, you’re literally talking potential extinction.
And that makes any “normal” cost/benefit analysis obsolete. If you get the preliminary risk assessment wrong, the consequences are so far-reaching that your only realistic option is extreme carefulness (precautionary principle). Ergo: you don’t allow GMO crops until you’re 100% sure they have zero negative impacts on human health. What Monsanto does is use “scientists” who declare that no negative effect has been found so far, so it must be okay.
Taleb asserts that that is not science, but “scientism”. It is obvious that the negative effects can take decades to show, but if they do, things have probably become irreversible (all corn contains GMO traces). In other words, the burden of proof MUST lie with Monsanto; you can’t demand that everybody else proves their GMO crops are harmful. On the one hand, Monsanto gets to make a profit, while on the other billions of human lives can get lost. That’s the asymmetry Taleb is talking about.
Labeling any such deliberation, any such cost-benefit analysis, scientific, is an affront to any- and everybody’s intelligence. There are things that you cannot afford to take risks with. Mankind, the animal kingdom, the planet, are some of these things. You can’t argue that a lockdown might cost jobs if and when a non-lockdown will cost lives; you can’t argue for measures that kill people.
The only thing we can really do is to apply those measures that best mitigate job losses, not the ones that keep jobs but mitigate loss of life. It’s not even an actual choice; it’s a false dichotomy, because the risk of consciously allowing people to continue to infect others who may then die, which you could have prevented from happening, is so much greater than the loss of a job. The risk is asymmetric. A job is not a life.
It’s nuts to argue that we should allow someone to die because his/her neighbor might lose their job or because his/her neighbor beats his wife. In case someone loses their job, a government can issue a bailout or even a UBI. That they don’t do that and/or not properly, is another matter. But not one that justifies murder.
And you can’t take the conscious risk of letting people die because someone married an abusive person either. Yaneer Bar-Yam wrote some good stuff on community efforts with regards to COVID19, to be found at the New England Complex System Institute site, which might help in that regard. But you can’t aim for letting a deadly virus spread in order to prevent joblessness, loneliness or poor -life- choices.
Back to Taleb and Bar-Yam’s March 25 piece in the Guardian. I have a hard time selecting only some of it, a general problem with well-written essays.
The UK’s Coronavirus Policy May Sound Scientific. It Isn’t
When, along with applied systems scientist Dr Joe Norman, we first reacted to coronavirus on 25 January with the publication of an academic note urging caution, the virus had reportedly infected fewer than 2,000 people worldwide and fewer than 60 people were dead. That number need not have been so high [..] Our research did not use any complicated model with a vast number of variables, no more than someone watching an avalanche heading in their direction calls for complicated statistical models to see if they need to get out of the way.
We called for a simple exercise of the precautionary principle in a domain where it mattered: interconnected complex systems have some attributes that allow some things to cascade out of control, delivering extreme outcomes. Enact robust measures that would have been, at the time, of small cost: constrain mobility. Immediately. Later, we invoked a rapid investment in preparedness: tests, hospital capacity, means to treat patients. Just in case, you know. Things can happen. The error in the UK is on two levels. Modelling and policymaking.
First, at the modelling level, the government relied at all stages on epidemiological models that were designed to show us roughly what happens when a preselected set of actions are made, and not what we should make happen, and how. The modellers use hypotheses/assumptions, which they then feed into models, and use to draw conclusions and make policy recommendations.
Critically, they do not produce an error rate. What if these assumptions are wrong? Have they been tested? The answer is often no. [..] Risk management – like wisdom – requires robustness in models. But if we base our pandemic response plans on flawed academic models, people die. And they will.
This was the case with the disastrous “herd immunity” thesis. The idea behind herd immunity was that the outbreak would stop if enough people got sick and gained immunity. Once a critical mass of young people gained immunity, so the epidemiological modellers told us, vulnerable populations (old and sick people) would be protected. Of course, this idea was nothing more than a dressed-up version of the “just do nothing” approach.
Individuals and scientists around the world immediately pointed out the obvious flaws: there’s no way to ensure only young people get infected; you need 60-70% of the population to be infected and recover to have a shot at herd immunity, and there aren’t that many young and healthy people in the UK, or anywhere. Moreover, many young people have severe cases of the disease, overloading healthcare systems, and a not-so-small number of them die. It is not a free ride.
This doesn’t even include the possibility, already suspected in some cases, of recurrence of the disease. Immunity may not even be reliable for this virus. Worse, it did not take into account that the duration of hospitalisation can be lengthier than they think, or that one can incur a shortage of hospital beds.
[..] No 10 appears to be enamoured with “scientism” – things that have the cosmetic attributes of science but without its rigour. [..] Social science is in a “replication crisis”, where less than half the results replicate (under exact same conditions), less than a tenth can be taken seriously, and less than a hundredth translate into the real world. So what is called “evidence-based” methods have a dire track record and are pretty much evidence-free.
[..] when one deals with deep uncertainty, both governance and precaution require us to hedge for the worst. While risk-taking is a business that is left to individuals, collective safety and systemic risk are the business of the state. Failing that mandate of prudence by gambling with the lives of citizens is a professional wrongdoing that extends beyond academic mistake; it is a violation of the ethics of governing. The obvious policy left now is a lockdown, with overactive testing and contact tracing: follow the evidence from China and South Korea rather than thousands of error-prone computer codes.
If that’s not sufficient, here’s Taleb in a March 31 Bloomberg interview. Please watch:
And just in case it’s still not clear, I have collected a series of Taleb tweets that should make his position that much clearer. That is, after we failed to halt the virus while we could, thanks to China, the WHO and your own government, in that order, mass mask wearing is inevitable -because not doing so involves an asymmetric risk: even the worst mask reduces infection rates by 30%, and if both people involved in an interaction wear one, that may be 90%.
In that same vein, you need mass testing. And reliable testing, which is still not a given. These are things that people like to question, but those people are in the wrong time capsule. The proper time for that was December in China, and perhaps January in Europe and the US. Not now. Now you can only save what you can save, and that inevitably means taking measures that appear drastic. But which will look walk-in-the-park-ish compared to what follows if you don’t take them.
Tweets first; please do read them all. Note: Fat Tony is Taleb’s best friend and alter ego, and there’s controversy about whether he actually exists. For what it’s worth, I agree with Fat Tony that we don’t need a conspiray theory to explain COVID19, we have a virus that is deadly and highly contagious, and 1000s of scientists and politicians who have no idea what they do.
Those are all the basic ingredients you need for absolute mayhem. Not that all theories, whether it’s glyphosate or 5G, China lab or US lab, intential release or not, are necessarily wrong or baseless, but because in the face of a virus that doesn’t need any of these things to replicate the way COVID19 has, you need to come up with very solid proof. And I have seen none, just plenty theories.
Fat Tony don't believe much in conspiracy theories.
The "geniuses" at the top have proven time and time again they're too stupid to pull anyting that elaborate off… https://t.co/q9DllGX7IJ
— Fat Tony (@FattestFatTony) March 27, 2020
This is the strongest statistical association I've seen w/ respect to the virus. Wear a mask, mandate others to wear masks, & remember that @WHO is criminally incompetent. To repeat:@WHO is criminally incompetent.
PS-Don't get into elevators, buses, etc. unless your mask in N95 https://t.co/ZCkl3hql9K
— Nassim Nicholas Taleb (@nntaleb) March 31, 2020
Rightwing sociopathic quacks like @BjornLomborg: are ALWAYS on the wrong side of things precautionary, (including climate).
Saying "no worse than the flu" was ignorant 3 months ago; saying it after data from the past few weeks is outright malfeasance.@Twitter blocks fakenews. https://t.co/ENVjCWG00P
— Nassim Nicholas Taleb (@nntaleb) April 10, 2020
and… the NYT and science journos and ignorant "evidence based" epidemiologists who can't read absence of evidence got us here.
Don't blame mayors who shut down cities, blame misinformation about masks and mobility. Blame the New York Times.
— Nassim Nicholas Taleb (@nntaleb) April 12, 2020
One comment about masks and nonlinearities that these imbeciles are not getting.
Reducing exposure to viruses by 30% thanks to an "imperfect" mask does not mean reducing risk of contracting the disease by just 30%. By convexity, it must be more than 30%, can even be 95%.
— Nassim Nicholas Taleb (@nntaleb) April 12, 2020
We have a hint: @dzviovich just sent me something useful: comparison of US vs CZ w/a single sign. difference: edict to wear maks.
We know masks work (from other combined statistical signals). Now let's back up the convexity of probability of infection to particle concentration. pic.twitter.com/H2KNgiptX5
— Nassim Nicholas Taleb (@nntaleb) April 13, 2020
The proof is in https://t.co/EzrlOG4M1J pic.twitter.com/I7ibmge5EY
— Nassim Nicholas Taleb (@nntaleb) April 12, 2020
I don’t know about you, but where I am right now, Holland, there are no masks available on a grand scale. There is so little testing going on in large parts of the West that even medical personnel often go without testing. I would love to be tested, if only so I know I either can or can’t infect people, but who am I to take away a test from a nurse, even if I could?
And this happens 3+ months after all our governments should have made testing and masks for everyone their no. 1 priority. And that was onnly after they failed to crush the curve when they could have.
Donald Trump was talking over the weekend about the “biggest decision of his life”, referring to the moment the US economy could be re-opened. Trump, as well as all the other “leaders”, even if their science advisers don’t like it one bit, or maybe because of it, should contact Nassim Taleb and the risks scientists he works with, within the next 5 minutes.
What is happening right now is not because all the epidemiologists and virologists around the world are wrong, but because they’re asked to make decisons and construct models about something they don’t know nearly enough about.
Call Taleb, Donald, Emmanuel, Shinzo, Angela et al. If you care enough about the lives of your people. I see a lot of rational-looking measures today, in all the lockdown variations, but I also see many countries and states clamoring for peaks to be called, and subsequent calls galore for less stringent lockdown measures. Decisions prone to be taken by politicians and epidemiologists who are -way- out of their league.
Please be careful. Call Taleb. You have nothing -more- to lose.
I’ve been saying this for some time, but the reaction to Covid has been a very clear example of scientific policy failure, primarily because of a deep epistemological weakness within the public policy field. Quite simply, its not enough to ‘follow the science’. You must dive deeper into what the evidence says and what it means in terms of real policy implications. Perhaps because I come from a more systems and ecology background this seem obvious to me (the precautionary principle after all comes from taking an ecological perspective on public policy), but its shocking to me that so many of the hard sciences often simply pretend there is no issue with this.
We’ve seen this for some time in the area of public health. Its (relatively) easy to decide if a new drug or surgical technique passes certain criteria to regard it as suitable for general use. But when it comes to lifestyle and diet recommendations, public health advice in most countries is an absolute mess. Much of this comes down to a failure by the scientists themselves to understand what ‘evidence’ or ‘proof’ really means in complex systems.
On the subject of WHO – I think the situation is a bit more nuanced than their supporters and detractors will allow for. There are undoubtedly some very good scientists working within WHO and many of their papers are exemplary. But it does seem they were badly damaged by a percieved over reaction to Bird Flu and they may have been guilty of simply being too scared to be seen to over react to Covid, especially when it came to angering a key ‘player’ – China. They have often hidden behind some very ambiguous science to come to politically correct recommendations – the obvious example being their opposition to shutting down air travel early in the pandemic. Yes, there are models and some studies that support this conclusion, but given how counter intuitive this is, they should have demanded more evidence and – yes – taken the precautionary principle seriously, even if it meant looking a little foolish if it turned out that Covid was another Bird flu (i.e. bad, but not as bad as it could have been, and ultimately controllable).
I have a very similar perception on WHO actions. By some accounts it has failed, probably because political pressures, but in some others has been very well pointed.
Taleb’s notion of scientism may be generalized to economism and politism. Practitioners of those disciplines, and their fellow travelers, pundits and such, cannot escape the fundamental truth that they are all part of the polity.
By definition, they, and we, are all subject to fat tails, Black Swans and randomness, much as they may try to persuade otherwise. There has been too much whistling past the lab.
Policy must be informed by Scientism and Economism, the Nanny State writ as large as possible will not defeat Death though (speaking generously) that is what they try to do with ever-increasing measures on everything from helmet laws and now to mandatory house arrest for nearly all of the world’s citizens.
The globalized economy is (was?) a highly-interdependent and in the end very fragile latticework, and removing great swathes of it at a stroke engenders multiple “Black Swan” risks Taleb is supposed to be the expert on. You simply cannot turn it off and then expect it to turn back on to anything like the previous chaotic but functional organized form.
Turning the world economy off may be a global suicide pact where I believe the adverse health, death/suicide rate, economic, political, and misery consequences will far outweigh the marginal additional flu season deaths. Maybe we should have a another think about the consequences in their totality:
(Gail Tverberg’s analysis is sobering. Reminds me of the 3-in-one-million chance that we would ignite the Earth’s atmosphere that the Los Alamos scientists decided to take when they lit the fuse on the first A-bomb)
Again a terrible irony. The same people who are now throttling the WHO financially are likely the very same ones who directed it initially not to raise alarms until way past the point conditions warranted – no doubt with considerable threats and pressure. I’m thinking of Trump of course, but likely Trump at the insistence of others.
The WHO might try to direct any eventual vaccines to where it deems them most necessary, which could be why the US is effectively tell it to sod off in advance.
Yup. And Trump also needs a scapegoat to explain away the time in which his administration did nothing. The kerfuffle about when the WHO decided call it a “pandemic” is just a red herring. The word is simply a scientific term to describe a situation in which the virus is basically present in all countries. In the run-up to the decision to use the word, the daily messaging from the head of WHO was extremely clear. The language was strong: governments were urged to take action immediately, and a key element of the required response was widespread testing and isolation of positive cases. (I followed things closely from the time it became clear that the world had a problem: New Zealand TV reporting and a number of international news channels. I wasn’t watching US networks, so don’t know whether they were relaying this messaging.)
Tracing, in the sense of controlling a single cluster, i think is useless as you say but massive tracing (for instance, with fever maps) may help to detect clusters and determine, for instance, new local lock-downs if seen necessary. Apps for this are being developed all around the world and this will be useful. What is key is to decide the distancing measures needed. One of Taleb’s remarks that I have internalized is that there is not “enough paranoid” measure to be avoided. The risk of being too easy is too high, not from a personal point of view but from the general point of view. In this sense the remark on masks by Taleb is well pointed. I now recognize that I have made lots of comments on masks here that were wrong. Might be right from an individual POV, but quite mistaken from the POV of epidemic management.
One thing that Taleb does not address is possible unforeseen outcomes of precautionary actions. As an example, its not clear to me that the use of disposable gloves by untrained people (in shops, for example) could not make things worse by spreading infection on the gloves, and then transferring it to the staff themselves when they remove the gloves. In a hospital setting, these gloves are meant to be disposed of and replaced when moving from patient to patient.
I have heard it argued that masks can also cause unintended risks – by, for example, encouraging risky behaviour, or that reused masks could themselves become vectors for the virus. However, this does seem unlikely if people are properly informed.
Having said that, I live in an area with several hostels for the homeless and drug addicts – they’ve obviously been given gloves and masks for their own protection (as they are nearly all wearing them), but they are being badly misused. I even saw one street drunk wearing his mask as a hat. They are also just discarding them on the street and in my local park, becoming a serious worry for people with children and pets. I can certainly see that what seemed like a humane service could backfire badly.
But this, IMO points to two other problems: absence of education or training (an effort is badly needed and so far absent IMO) and a more general problem which comprises the margins of our societies.
Illustrated by the scene I observed just now while waiting in line to get into a supermarket (they are operating a “one in, one out” policy here at the moment).
Few people are wearing masks in the U.K. I’ll leave aside the shortage of PPE the world over and assume, blandly, there are an infinite number of masks. And they’re effective ones like N-95. But the woman in front of me was (it looked kind-of homemade with a thin single piece of fabric and two loops of elastic, stitched either side, which went round her ears).
The mask was obviously uncomfortable for her. We were waiting outside the store in a glazed atrium section of the mall and it was midday so it was getting warm (the store’s A/C didn’t extend much beyond the entrance). We were waiting an average of about 10 minutes. During that time, I observed her adjust the mask four times (it looked fairly tight on her nose and mouth) by hand. Her hair, which was shoulder length, wasn’t tied back so it kept falling forward when she looked down and got entrained in the mask or the elastic fastener so she had to keep brushing it back.
I saw more hands-to-face contact in her than I did anyone else. Even if the mask had been N-95, I suspect she would still most likely have been better off without it lacking the prerequisite training.
And I’m not blaming anyone here. As I’ve had eye surgery and a compromised mucus membrane (through a corneal transplant) I am perhaps understandably absolutely neurotic about touching my eyes or even my face with my hands outside. But it has taken me nearly 10 years (and constant reinforcement of the importance of eye hygiene practices in a clinical setting from ophthalmologists and contact lens fitters) for it to become second-nature.
As a friend quipped to me the other day, even the most authoritarian government of the most pliant cooperative population can’t stop people from picking their noses. I doubt scientists telling them stuff will have much more impact.
But your mention of n95 seems to reflect confusion about the purpose of masks in a public health context.
They are NOT to protect the wearer. They are to protect everyone else. So as much as her fiddling did unnecessarily endanger herself, it didn’t undermine the primary purpose of wearing her mask.
And there are tons of online guides to making masks…..
Yes, I don’t like the surgical masks precisely due to the elastic. I find I fiddle with them and wind up touching my face, but no where near as much as that woman.
The authorities have recommended wearing scarves as an alternative. I’ve repeatedly shown the video from Venezuela showing how to make a mask from baby wipes. They cover the full face below the eyes and are comfortable. I don’t fiddle with it, I don’t touch my face.
There are plenty of options that are adequate. But people need to find something that works for them and that might take a bit of doing.
I do get that the aim isn’t to protect the wearer, it’s to protect those around the wearer.
The Japanese are well used to this mask protocol (it’s for others’ benefits).
But the woman still ended up touching the supermarket trolley handle then touching her mouth. So assuming she wasn’t infected, she was increasing her chances of becoming infected. Without a strong (and adhered to) public heath message accompanying masks or mask-like protection, I’m not sure how you limit the damage potential to people from breaching the no-face-touching protocols.
What really bothered me was the woman was in her early seventies — not someone who can easily risk COVID-19 exposure. I think that at the base of it, I’m just a tad guilt-wracked because I wanted to tell the woman that, I know it’s hard until you get used to it, but it’s important not to ignore the advice about touching your face — and I didn’t. But we just don’t do that sort of thing here.
The plural of anecdote is not data. In China everyone was made to wear a mask, no exceptions. And it’s hardly a settled matter whether people can be infected by “aerosols,” which are small enough to get past surgeon’s masks, or whether the real threat is those large droplets which surgeon’s masks block. Which means they are possibly useful to protect you as well as prevent the infected from infecting others.
And finally unlike the N95 which needs some expertise to wear properly scarves and surgeon’s masks are easy to put on and wear. The government should be issuing these things by the millions because a big reason people still aren’t using them is that they don’t have any. You can order from Amazon for delivery in May.
You can’t get to China from here (the UK).
Here (and this is pre-COVID-19 so not tainted by confirmation bias or priors being defended) is where the UK is (or was) in terms of infectious disease countermeasures and public attitudes https://www.nhs.uk/news/heart-and-lungs/dirty-brits-are-worlds-worst-flu-spreaders/
And you’re seriously telling me that, on the word of Boris Johnson (and/or “experts”, or Donald Trump, for that matter) this could have been changed inside of two or three weeks? And when set against a backdrop of unclear (or disputed) scientific evidence https://www.bbc.co.uk/news/health-51205344 which, even if I am convinced, and I am persuaded, you’ve got 60-odd million others to similarly convince when you’ve spent years telling them otherwise? Oh, and the irony of being told, as Taleb told me just now, that I should be guided by the science but then ignoring (or picking and choosing which versions of the “science” he holds to be the truth) wasn’t lost on me, either.
And against a hostile press? Even if, say, Trump was willing to face them down (and he’s got no problem at all with going in, guns blazing, against the media) he’d have been (and yes, this is been, past-tense, because this had to have happened early February to implement a crush the curve strategy) taken seriously?
And, even for public health measures which were implemented, these were not at all easy to actually deliver on. Did you miss (and apologies if it wasn’t the situation in the US, it most certainly was in the UK) that when the government made a big publicity push about the importance of hand hygiene (especially “wash you hands when you come home, handle food, have met others” etc.) literally, within a day or two, the shelves were cleared. And I mean cleared. I had a small stockpile of bars of soap because I have to be anally retentive about eye hygiene and hand hygiene for contact lens medical appliance insertion but I did not want to run low, when I checked my supermarket after a few days of this public health messaging you simply could not get any liquid or bar soaps. This situation lasted at least 10 days.
I’ll mention here as an aside, that, as we’ve not mentioned unintended consequences of mass communications campaigning, I rely on a hydrogen peroxide contact lens cleaner. It comes in a 500ml bottle that last about a month. Again, I keep about 3-6 months’ supply usually. I used to think I was being overly-cautious. My mistake. When the cleaning product panic buying set in, this became completely unavailable. None of the people buying it were doing so for medical need, they’d simply read somewhere on the internet that hydrogen peroxide was effective in killing the virus and off they went. merrily hoarding away with little or no thought of those who genuinely need access to this product.
I won’t even go there on the subject of mass public non-compliance (there’s another very insightful and pertinent post on that here on NC today https://www.nakedcapitalism.com/2020/04/lockdown-rebelliousness-denying-that-coronavirus-is-in-charge.html) but I will merely leave you with the thought of the amount of ridicule which Trump would have had heaped upon him at such notions of telling people that, since they can’t be supplied with manufactured masks (oh, I’m sure the media would have not made a meal of that, no, not at all) they could make their own. I can see the headlines now “Donald Trump Calls for Nationwide Mask Sewing Bee”.
Yes, if we were more like China where you can — no kidding — get sent to a labour camp for disobeying the government (or shot), Trump’s (theoretical) words may have had a little more oomph behind them. But since we don’t, we’d be relying on mass communications and public acceptance and uptake.
All I can say is, good luck with that, given the givens.
I love hydrogen peroxide….use if for all my cuts and scrapes. I haven’t checked whether it is back on the shelves here. But we too had a huge run on the stores once it became obvious that restrictions were going to be applied. First they came for the toilet paper….
And down here in the Southland where people are polite there’s been fairly good compliance with the social distancing etc. Our huge BMW plant closed down until the end of the month but that also had to do with collapse in car sales. People are wearing masks in grocery stores (including me) but only half or a third of the customers by my estimate. I really do think stores should have mask dispensers at the entrance so everyone could wear one of those ten cent paper filter surgeon’s masks. The employees should wear them too.
You picked up on at least one of my queries about this article Clive. Do you blog yourself? I’m looking for trustworthy sources to follow as this develops.
Another query I have is assuming that death is the worst outcome (the ‘there are worse things than death’ argument.) I have heard from vulnerable people that they’d prefer to catch the virus and die doing the things and seeing the people that make them happy rather than being alone and stuck at home. I also know at least two others who’ve had suicidal ideations stemming from loneliness and stress.
How can we be sure there will be more lives saved by lockdown, social distancing and masks? What about secondary effects like suicides, elderly people ‘giving up’, the ones you mentioned Clive from people touching their faces more because of masks etc, touch deprivation etc?
And at what point does quality of life come into the equation, if at all? If an elderly person who’s near death and is ready to die catches the virus and dies, surely that’s better than a young, healthy person developing severe mental health issues from these anti-infection measures?
For myself I’m not afraid of death. If it’s my time then it’s my time. And if my day to day is spent in a lonely, fearful hell then I’d rather kick the bucket!
I’d love to hear yours or the author’s thoughts on this.
Where I am, baby wipes are no more available than N95 masks or disposable gloves. None of these things can be found. People are making fabric masks and we have purchased several to wear whenever we have to be in a store, or must wait in line to get into a store. I totally get the fact that “my mask protects you and your mask protects me,” but the number of people who are not “protecting me,” including many store employees, is somewhat concerning.
One of the hardest parts of adjusting to masked living is not being able to see people smile.
Masks with smiles? Not quite as spontaneous, but the intent is there.
Yes! Not being able to share smiles is strange.
Smile with the “eyes”. The message gets across with eye contact.
this has been revised: masks DO also protect the wearer. The graphic in Taleb’s tweet above shows two-way protection.
Going on with your anecdote (I will add mine) I would say that it is hardly avoidable to see a few or some people doing things incorrectly as the lady you mentioned. At least she did the effort, and this is good signal, to make her own mask. By the way, I have more confidence in my washable, home made, double layer cotton masks than on the disposable POS masks I bought online. I have observed in the spmkt queue (same pattern, one out, one in) different behaviours. For instance some people kept 2 mts distance with the previous person while others kept 5-10 mts. Women were typically more prone to keeping longer distances while men were generally keeping shorter distances and more probably not wearing masks (some kind of fearless macho-man?).
But this is a world were anecdotes are more or less useless. It is the average behaviour what matters now.
Unfortunately that (average behaviour) is not perfect and can never be made perfect. Even in a healthcare setting and even in the most basic and obvious preventive measure (hand hygiene) even healthcare professionals do not easily maintain consistency in compliance.
It is this which I am questioning — not the merits of the crush the curve policy measures, but the ability, or otherwise, to instigate these in the real world with real-world people in a short period of time. This was Taleb’s implicit assumption.
I’m certainly not saying we (or governments) shouldn’t try. And you’ve got to start somewhere. But in cultures where mask adoption is new and unaccustomed, I’m very dubious it can (or could have) made a real difference in the four to six week window Taleb refers to. And at the heart of it, this is my disquiet. I’m generally very skeptical of any methodology which goes something like “all you (or Donald Trump) have to do is…” followed by some not-entirely plausible set of criteria.
I will refer you to a famous George Carlin take on the state of the American people.
Nothing like some self-righteous dumping on the deplorables for being fat, huh?
Absolutely wonderful…..What made Carlin so compelling was his insightfulness: our recognition of the truth forces us to laugh because it was all so obvious once said out loud.
This whole video needs to be watched, because his observations about fat, stupid people in malls, is really just winding-up for his real target, starting at about 8:00, which ties in very nicely to this post.
Kudos to you for admitting you were wrong about something. It’s a rare quality these days. You certainly don’t see it in politics or finance.
Me too. And I’ve been a bit sceptical about masks for everyone before, so me too again.
Yes. It’s a rara avis.
“Tracing” and “identifying clusters“ won’t likely be a lot of help because people carrying the virus in a “cluster” area are going to be moving into other areas and spreading the virus there. Seems to me that a prolonged lockdown everywhere, plus masks and the hope that the virus won’t mutate to shed and transmit in other ways (see, e.g., fecal viral levels now) is about the.only “policy choice” that leads to anything other than an enormous tail. And given the complexity of the systems that globalism has created, food and fuel and medicines and medical equipment have to move into and out of “clusters,” implying virtual impossibility of restraining spread. It’s already clear that many individuals will, out of nonchalance, ignorance or necessity, break quarantine and blow off the use of masks and hand washing and other public health measures.
Grim payback for the churchgoers who “pass the peace” with loving hugs in a densely packed church, then share the virus with their families and community and maybe get ventilated with slim chance of recovery.
Maybe the “good news,” For our species at least, is that some of us are either immune to this virus or are genetically predisposed in our immune system responses to survive our individual infections. The obvious bad news is what is presented in the post.
I’ve whined here over the years about the necessity to elevate the precautionary principle to the top of the chart in any kind of policy-making. There are lots of other people who have been making the same ignored observation. But alongside and in opposition to the precautionary principle are the “Cassandra myth” and the profit motive. Obvious which side wins, though Monsanto, ExxonMobil and the rest have had their innings, of course as we see, “Gaia bats last.”
Thank you! You reminded me of one of my thoughts about this post.
I heard that a lot of us may already have immunity (can’t remember the reasoning exactly), which would make sense to me as I was sick with (what I’m almost certain was) Covid and went around hugging my friends and family as usual for a month or two and barely any of them had symptoms. Which was why some said we may only need 20% of the population or something for herd immunity.
Obviously could be bollocks, but it seemed like the author dismissed herd immunity pretty hastily.
It seems to me that at almost any point in this pandemic, massive testing, contact tracing, and quarantine, would have a positive result that more than justified the effort, particularly if constraint of movement was simultaneously applied until daylight appeared at which point contact tracing et al would continue. China did both of these things after an initial failure which reached numbers often considered “too late” and yet which worked to bring the disease under control and allow lifting of some restrictions. Some things would have to change to meet particular or local conditions, but technology could help with that.
Short of effective workable medicines, I don’t see another approach than “all of the above” that would provide any exit duration of sufficient quality to allow commerce of some sort to co-exist.
TTQ: test Trace Quarantine.
it is working. look at HK, look at Taiwan, look at Korea.
Tracing works, but you have to CRUSH first. This is how China got the virus under control.
First, they started early enough they only had serious outbreaks in one region.
Second, they CRUSHED. Total shutdown. Including factories and public transportation. They trucked in supplies from other regions. Everyone doing deliveries had PPE. No exceptions. People under quarantine were locked in their homes if necessary. People weren’t allowed to leave home unless they were going to a grocery store, clinic, or pharmacy (most people had everything delivered) and they had to scan in and out of the building with a temperature check. And they kept these measures in place for 5-8 weeks, which was enough time for the infected to spread the virus to whoever else was in their household, and for those infections to resolve at R0. While draconian, this is how they succeeded in stamping out infections.
Third, once the virus was no longer spreading rampantly, they were able to return to classical epidemiological techniques like contact tracing and testing. Testing infrastructure and supplies must be in place to do this. PPE must be in place. The Chinese had a first mover advantage — they were able to import billions of PPE items from the rest of the world at rock bottom prices.
The US has already failed at item 1, has no political leadership or will to do item 2, and no capability or will to do item 3.
We’re [family blogged].
This assumes the CCP was / is honest about their numbers.
I agree they did do the “crush” phase, but I would argue it was long after it was already too late or as useful (hence the extreme measures they employed).
I doubt we will ever know how many were really infected or died.
As many different societies around the world are now going into the prison equivalent of lockdown, it matters not what the actual death rate was elsewhere (in China),but the home death rate or final tally (presuming there is an end to CoviD19)
China being the world’s factory means the machinery and people exist to make PPE. Incomplete stories about the US waylaying a german order of PPE on a Thai airport tarmac, or Trump asking states to “compete” for ventilators, suggest the hollowing out of manufacturing of PPE States-side a problem only evident in times of stress. Stories of UK NHS advising paramedic teams of two to only use one mask, or hospital staff resorting to trash bags as PPE, suggest that the political will to be prepared even whilst China doing a CRUSH in January was already lacking.
Without the political will to CRUSH as described above, nothing will improve in terms off a society dealing successfully with CoViD19.
The replication crisis isn’t limited to the social sciences.
>These fine people are not good at 10-dimensional chess, even if they like you to think otherwise.
I like doctors, so take the below with that in mind:
The weakness (and strength) of doctors is the selection process picks for the ultimate “book-learners”. They are genetically built to absorb information to the detriment of being able to make logical leaps or think along different paths.
And what ability they may have to think creatively is squashed by the mysterious requirement of a frontal-lobe numbing work schedule that they are subjected to just when their brains are at their peak, late 20s to early 40s. Sleep deprivation has been proven over and over again to be a great negative, by researchers in the medical profession itself, yet somehow this is still the culture.
There’s also a bit of the authoritarian streak in the culture, a lot of kicking down and kissing upwards. They don’t see it because authoritarians are convinced status derives purely from merit.
The problem I have with this can best be summarised in an Onion-headline-like comment: “Shrieking Demented Mentally-Unstable Media Prone to Psychotic Paranoid Episodes Demands Meeting With Government to Calmly and Rationally Discuss Complex Society-Wide Policy Measures”.
To which the next day, you might see: “Government Tells Media It Might Be Best Having a Nice Sit Down Quietly With a Cup of Tea And Maybe Think About Taking a Holiday When All This is Over”.
To unpack a little, its no use anyone in the media singly (such as this appeal to “hey, guys, listen to Taleb”) expecting to be listened to or taken seriously by either the general public at large or politicians as a group if collectively trust in the media is low-to-non-existent.
For example, I am just trying to conjure up what a lot of the now wise heads would have said if, say for the sake of argument, Trump had locked down every major US population centre and cut off all international travel in or around mid-January. It stretches credulity (and makes the media seem even more taciturn and venal) for it now to be saying that, yeah, sure, we’d be fine with that. Like Hell they would. And, of course, since that action might well have produced a COVID-19 nothingburger, it would have been even worse — Trump would have looked like he was, at best, over-reacting and, at worst, like he was exploiting a situation to his advantage.
And even Ilargi, who is sane and credible, ends up a little hectoring and preachy in this piece. Although the reaction is entirely understandable, I have to say it, as a piece of writing intended to inform and influence, wouldn’t pass the “what would my mother-in-law make of it?” test. Perhaps she’s not the target audience. But then, who is aiming at my mother-in-law?
And there’s the obvious inconsistency which even Ilargi can’t run away from: okay, we’re supposed to trust experts (or “scientists”), but only, apparently, the “good” ones. It is not, unfortunately always simple to tell.
Thank you for these comments. I think they are crucial in trying to understand the reaction/confusion, obedience/resistance, of the general public — including the “educated” public. If Trump would have called for an immediate lock-down, I have no doubt he would have been pilloried as a “dictator” by the liberal punditocracy. And as we all know, we can find “scientists” to back up whatever we want to believe (that’s what “think-tanks” are for, after all). It is nearly impossible to find information anywhere these days that is not affected by partisan ideology. And while this is a very helpful article here, Illargi is certainly not immune to this tendency.
“Ergodic” and “convexity” are not very accessible terms. Trump and Pence would not get much out of this. Or Boris, either.
Funny! I was about to post that those two words sent me to the dictionary.
In retirement, out of the lab and IT fields, I rarely talk with people who are aware of probability, fat tails, long tails, Pascal’s wager etc. So, yes, but my mother-in-law would have understood a simple comparison such as: don’t pull out in front of that car; even though the risk is small, the consequences are huge.
IOW, Strunk and White had it right: eliminate unnecessary words, use Anglo Saxon ones, keep it simple if you want to be heard. Oh, and repeat often.
Taleb does not always make it easy to follow his work!
His UK essay was well written and made simple arguments. He writes well for the lay reader when he has reached a conclusion to sell you. He is a master of one-liners.
The problem is he undersells the power of his approach to get there. He makes it sound like mumbo jumbo. His paper (linked in the final tweet) delights in its own “mathiness” – the irony being that this may be mathematical scientism! It is written in mathematical notation but some of the statements rely on a lot of priors: perhaps these are obvious if you work in his narrow field (Which is the intersection of logic, functional analysis and statistics) but not to me, despite a willingness to be converted. For a prophet, this may be why he lacks followers….
The prose explanation of his paper would be that he is applying pure reason to (i) about the higher order general properties of mathematical functions that would describe things like a dose-response curve, in the context of (ii) different distributions of dose. If certain parts of the response curve have a certain general shape, they will ineluctably and predictably have certain behaviours as the scale (variance) of the distribution changes. We should assess clinical trial results and formulate policy in the context of these behaviours. Unfortunately, working scientists especially in biology and medicine are lousy pure mathematicians and do not interpret their findings against such higher order properties. And no member of any scientific priesthood is going to take criticism seriously when the examples he draws on deliberately range over such disparate domains of expertise (because he is too delighted with the generality of his insights and not thinking about piercing the carapace of expertise of current practitioners).
You could say that his own dose response curve is fragile, given his one liners are better than his papers!
(Having seen him perform the Taleb act for years on the public intellectual circuit, I am now intrigued enough by his paper to go and buy his book).
“Nassim the dream…”
I was in the pit with him 30 years ago… he’s smart, but not as smart as he thinks. And he’s a d**k. Really enjoyed communicating to cause max pain to the recipient. Has contempt for almost everyone
But some insights are valuable so I follow.
The Jan 26 note in particular got me to hedge when it was cheap so that pays for all the books right there…
I see what you are saying, but Trump didn’t need to shut everything down. Things entirely in the executive branch’s purview like: having working tests, a less restrictive case definition (including people who had not been to Wuhan), contact tracing, and proper screening at airports, would have made an improvement in the number of people identified and isolated before they spread it. Nipped in the bud early, things would be very different today.
That sort of tinkering at the edges is not what the article is saying. The label on the chart “Crushingly the Curve” gives four bullet points to do that. I’m assuming these are all required and they are all draconian. The healthcare theatre of waving the medicine cabinet thermometers at people going through airports (and the like) is not sufficient to crush the curve.
The US government actively prevented the testing of thousands of samples in the early months, simply because the sick person had not been in Wuhan. CDC rules made it illegal to test a sample for the virus, if it did not meet the case definitions.
If those people had been identified and isolated, instead of ignored, they wouldn’t have gone around seeding the rapidly multiplying infectious chains that grew to what we see today.
If they nipped it in the bud, there would be no need for these heavy handed reactions today.
You must be reading a different article above than the one I’m reading. It says to crush the curve you need four policy responses. It doesn’t say “do the easy, fairly un-intrusive one first, then see what happens, then do the hard stuff later if you find you have to”. It doesn’t assign differing weights to the four and offer the opportunity to pick-and-mix.
The article doesn’t support a notion that you can, as you put it, “nip it in the bud” by only doing testing. It does say that you need all four policy legs.
In posing a question which I’ll paraphrase as “why didn’t Trump do this particular easy thing?” but all the while ignoring how hard the hard things would have been (and what the inevitable media reaction would have been, had he implemented them) you kind-a prove the point. No-one wants to face up to the implications and the ease (or not) of implementing hard policy requirements.
I wasn’t talking about the article. I was responding to what you were saying. I may have misunderstood it, but it seemed like you were suggesting Trump had a choice between shutting everything down too early, or too late. He would have been damned either way by the “Shrieking Demented Mentally-Unstable Media Prone to Psychotic Paranoid Episodes” :-)
In simulations, the best way to beat epidemics was shown to be by surgically removing the sick from the general population, so they cant spread it. You do that by testing anyone who might have it early on. You isolate the sick until they don’t have it anymore. You then try to test everyone they spent time with, and isolate them if they have it.
Making it impossible to test people, as the US did, is the exact opposite of the best approach. Now its everywhere, and logistically very challenging to test and trace. All they can do now is try to enforce is these very blunt lock downs and hope for the best.
I understand what you are saying. However, Singapore were a long way ahead of the game on this – I was watching it closely from the start as I have reports working there. They have very strong testing and contract tracing regimes. But it has really started to come back there;
> the best way to beat epidemics was shown to be by surgically removing the sick from the general population
That’s like the economist who says “assume a can opener”. Tests are not accurate enough for such an approach to work, lockdowns are needed too. Of course the US approach (“no test no problem”) was criminally incompetent. It blinded decision-makers at a critical point.
It is still difficult to get tested in many parts of the US.
Wow Clive that was a really good post.
This is the nut. Even Taleb is (and I think he is one of the great thinkers of our time) fails to see that this is not a solvable problem. He, perhaps – I’m not smart enough to say – has the technical/scientific solution. But the devil is in the details. His solution lies outside of what is possible in the real world – this is a common occurrence when the super bright are talking about what should be done. As they commonly have little understanding of the human race and human interactions – they are not logical as my genius brother used to say – they cannot figure out how to interact with human reality. Just logical reality – which no one pays much attention to nor has much interest in. A long winded way of saying this situation is not a problem it is a dilemma.
There is simply no easy way out now nor was there one in Jan. That is just a big misunderstanding on Taleb’s part. We are going to take a big hit and we were always going to take a big hit. Taleb may be right in a technical sense on our way of dealing with crises eventually leading to extinction. But then again the Sun has a life span too. His approach is not viable within the realm of what we are capable of executing. So we have to go with what we actually can do and do our best to live with the consequences. Best of luck to everyone btw.
“There is simply no easy way out now nor was there one in Jan. That is just a big misunderstanding on Taleb’s part. We are going to take a big hit and we were always going to take a big hit.”
Counterpoint: South Korea did a bang-up job
But they had a population who had experienced getting it wrong before and knew what that meant. The only reason South Korea (to give one example) knew what to do right was because they knew what they’d done wrong before.
And they didn’t have a media which would have reacted like ours. I can guarantee you, if Trump had demanded the four policy responses to crush the curve, Twitter and the mainstream media would have erupted and in 24 hours the number one hashtag would be #NoWayWeWillWearTrumpsMasks (or some such).
I think this lies hovering in the subconsciousness of many pundits from all walks of the media and even the rest of the population. They may even be consciously repressing it. They know or they suspect that, if Trump had proposed the four policy responses deemed necessary to suppress the curve, they would have been right there, in the thick of it, chiding him for all they were worth. Now, they want to semi-appease their consciences.
I’m certainly not immune to holding grudges and I definitely know how hard it is that, when you think you’ve been wronged, slighted, ignored or people haven’t done what you think they should have done over something or did what you thought they shouldn’t, how easy it is to use any excuse that comes along to refight an old (lost) battle). To suggest that the Trump shutdown (that never was) would not have been picked apart — especially in regards to things like masks where the prevailing advice wouldn’t have supported it at the time (and a lot of “science” still reports otherwise) — by people who had heavy baggage they were carrying and old fights to pick with Trump is not part of any reality I recognise.
Yes, but South Korea implemented and demonstrated the effectiveness of it’s policies well before the US had sniffed danger. Underlying social, cultural, and political differences notwithstanding, not only did the US government not even try South Korea’s method, the lockdown methods in the US are drastically different from the ones that have been working well in South Korea.
All excuses to the contrary simply proclaim that our leadership lacks wisdom and courage. Do the right thing isn’t even on the table, nor is try. Not one political “leader” in the United States has demonstrated wisdom or courage in the face of COVID-19.
No I think you have this misstated.
It is not our leadership that lacks wisdom and courage. Leadership always reflects its population. Leaders are the leaders because they are in the right place at the right time to jump in front of the crowd when it is going somewhere. Gandhi even said this about himself.
The American people have a culture and way of behaving/believing things. It is deep and ingrained. It would take deep trauma to change it (and I point out here that the 1918 epidemic did not result in significant change). It may be foolish in some respects but in others it has worked out to help put the country in dominant position.
Acting like South Korea did is simply not in our DNA. It was not possible. Period. Thus the US was always going to go down some version of the herd immunity approach.
I’ll add a hopefully revealing anecdote about these cultural norms.
My dad was an electrical engineer and after a stint as an expat, did the HV distribution design and builds for some Japanese-made heavy machinery. One such contract was for a crane at a port (it did shipping containers, or bulk cargo or similar if I recall rightly).
The Japanese manufacturer supplied and installed the lifting gear and my dad did the final checks and signed off the installation. The crane (or whatever the exact description was) had huge electric motors and power was run to a control panel in the operator’s cab. There was a master isolation contactor / emergency stop panel. This was “protected” by a flimsy plastic flip-up cover.
When my dad did the testing, he saw that the contactor was an exposed busbar with 11kV running across it. That’s 11,000v (and it probably draw several hundred amps) and a pull switch. It was all beautifully built and impeccably manufactured (well exceeding the required line set size and switch ratings). But it was, of course, absolutely lethal. You (or the crane operator) could easily push up the plastic panel and there, right at your finger tips, was more-or-less instant death.
My dad condemned the installation of the lifting gear and spoke to the manufacturer, who had Japanese staff on site supervising the correct placing and commissioning of this hugely expensive piece of kit. He was, once he’d calmed down, aghast and asked what the heck did they think they were doing putting something like that in, where it could kill an operator. They’d have to, he insisted, fit a strong, lockable switchgear supply housing to get it passed to UK standards for electrical installation and plant health and safety.
The Japanese staff (they were very highly trained engineers themselves) looked rather pained and didn’t really understand my dad’s reaction — being Japanese, they didn’t say anything, especially as he was the customer, or represented them. But they couldn’t really hide their mild surprise and, to a degree, amusement. And a lack of understanding as to what, really, was the fuss all about? This was the same equipment they’d been supplying and installing in Japan for decades.
My dad reiterated that the operator risk was completely unacceptable. Even if the plant operator hadn’t intentionally opened the (unsecured) panel cover, they might nudge it open, thinking it was another control cover in the cabin (there were several).
The Japanese engineer replied that this would simply be quite impossible. It wasn’t even a conceivable situation. For the HV control panel cover was clearly marked (in Japanese) with the words “Do Not Open”. And that, for a Japanese equipment operator, was that. If they saw “Do Not Open”, written on something, it would stay shut until, presumably, the hot springs froze over.
A quote from Terry P comes to mind, although I’ll paraphrase:
If you wanted something to be pressed, make it a large red button and write on it in large letters “DO NOT PRESS UNDER ANY SITUATION!”.
As my dad put it at the time in his own inimitable way “as soon as the average hairy arsed British crane operator got in the cab, he’d be saying to himself “I wonder what’s in here?” and poking it with a screwdriver.”
The US has a problem with NIH, not invented here. Can’t adopt anything from any other country because we’ve number one.
I wouldn’t underestimate the issues facing the Koreans to implement their control measures. There is a very active crazy far right religious political movement which did its best at the beginning to oppose any control by the Moon administration, which they hate with every fibre of their Christian beings. They are, as it happens, particularly powerful in Daegu, where the main outbreak occurred (the Conservative power base in Korea is mostly in the mid sized industrial cities). Korea was probably quite fortunate that the outbreak occurred precisely when the conservative right was at its weakest. In other circumstances, things could have been different.
Likewise in Taiwan, I suspect that had the government been of the more pro-Chinese KMT variety (which it has had for most of its history), it would not have been able to react so quickly.
There are all sorts of reasons why some countries reacted better than others, some just have to do with random timing and the right people in the right position in the right time, not necessarily deep cultural or other causes.
Well, it probably amused Taleb to write this.
And, admit it, it’s not going to do us any actual harm to know exactly what it is we’re not going to do to save ourselves.
To my mind, Clive wins the day on this one, and Wyoming articulates why. But kudos also to Yves, for posting Illargi’s piece, and letting the commentariat have it. THIS is what keeps me coming back to NC every day, many times each day. Thank you ALL.
Uhm, I meant to say “letting the commentariat have AT it.”
After the initial infatuation with Taleb, I now believe that that’s massive weakness and a blind spot. He’s pretty good at identifying the problem, but his solutions just aren’t from the real world, populated by real people.
TBH, it’s a blind spot he shares with a lot of people..
I’m not really sure thats a fault of Talebs – he is not a public health manager he’s a risk analyst. His point I think holds – that we have very seriously underestimated the costs of certain types of risk. His ‘solution’ I would imagine is far more resources put into identifying these risks and to put in place independant structures capable of enforcing rapid emergency responses (such as shutting down transport in and out of risk areas) without having to go through the normal political/legal routes.
We can never know for sure, but I don’t think it can be argued that there is nothing that could have been done about Covid. There was a window when it could have been isolated within Wuhan. Its also possible that if it escaped Wuhan it could have been isolated in China. Disease outbreaks have been isolated and prevented before, albeit not one as infectious as this one.
This line sort of leapt out at me: “You can’t argue that a lockdown might cost jobs if and when a non-lockdown will cost lives; you can’t argue for measures that kill people.” There are many Americans, not just Charles Koch, who are actually are making this argument.
The best reply thus far. Taleb is smart but there are different kinds of smart and moving people requires different kind of smart (for example as Trump has). Moving people requires time – even in totalitarian China it took time – it must have taken more in a free country like the USA. That’s the cost of doing business and the trick is how to make mistakes, learn from them, correct and learn to live with our imperfect world.
I loved your post Wyoming. One of the most sensible things I’ve ever read about Covid.
This has been my favourite place on the internet for discussing all this! Where have all of you been hiding?? The next best thing has been Reddit’s ‘LockdownSkepticism’ subreddit but it’s a bit too one-sided. So much in this comment section has been so well balanced and perceptive.
I have a lot of time for Taleb, and I think I read most if not all of these pieces at the time. But Taleb’s problem is that he doesn’t have a clue about government and politics and indeed is contemptuous of both. His thinking is based entirely around what he knows – private sector risk management. But these issues are fundamentally political ones.
Consider the case of poor Roselyne Bachelot, Health Minister under Sarkozy. After the Bird Flu episode she set up massive stock piles of masks and vaccines, which was the right thing, as Taleb would no doubt agree. She was hauled before Parliament, accused of wasting public money and even having corrupt links with the health industry. She was driven from public life as a result, something which all French politicians are very conscious of. Now, of course, the story has changed completely.
The point is that the rules of politics, which are almost as inflexible as those of engineering, simply don’t allow governments to invoke the precautionary principle as often as they would like. You can only pull a stunt like lockdown once in a while, and if you get it wrong – say by overreacting to Ebola, where exactly the same warnings were offered – then the public will never believe anything you say again.
Or you can destroy people’s understanding of the precautionary principle with fifty years of propaganda that labels taking precautions as ‘stunts‘ and dangerous to the ‘economy’.
The rules of politics have been ‘engineered’ to be inflexible by a relatively tiny bunch of psychopaths, they are not immutable laws of nature, the rules of politics are synthetic, and we are finding the current ones have resulted in disaster.
It’s time to change them.
Well, we have indeed had fifty years of conspiracy theorizing about evil governments coming to take your rights away, with the result that sensible things that would have been possible then aren’t possible now, and people will die as a result. That’s what I mean about the rules of politics: it’s forces acting upon a body, and the endless propaganda about governments setting up concentration camps, conspiring with aliens, or (in the US I believe) taking peoples’ guns away, has created a situation where the precautionary principle is more and more difficult to implement when it’s needed.
Well, we have indeed had fifty years of conspiracy theorizing about evil governments coming to take your rights away
Are they really “conspiracy theories” is they are true? Can you show me one increase in individual rights over the last half-century?
Well, it may or may not be important to you personally, but Roe v. Wade (1973) fundamentally expanded individual rights for more than half the U.S. population.
It also removed the rights of about the same number?
It depends where you live, but certainly in Europe I don’t think the EHR has been wasting its time. But that’s not the point is it? The point is that people have become so conditioned to horror stories of governments laying dastardly plans to introduce a police state the they now can’t tell fantasy from reality.
We’re still mostly at the intelligence and surveillance stage on the one side, and the propaganda and disinformation stage on the other. You may well get an attempt at a police state soon enough; the tools are certainly there. It probably depends on how bad things get. I thought most people knew about that who wanted to know. It’s not a conspiracy, it’s pretty much out in the open. A recent, perhaps trivial, example was the information given out about masks: first they were useless, then they weren’t. I guess Snowden and Assange have suffered in vain.
Department of res ipsa loquitur:
So you err on the side of caution, except the covid-19 pandemic, when viewed against the the past near-misses you mention, makes deciding what a cautious response is a rather tricky affair for a politician. If you under-react and a full blown epidemic ensues, you have blood on your hands and are nailed to the stake, if you over-react then you’re driven out of political life (hopefully with a nice pension to cushion your fall from grace). I know which one i’d choose.
Well, over-reacting has the disadvantage that nobody will believe you next time, so basically you only have one chance over a reasonably long period of time to get it right. This is Taleb’s problem, that he doesn’t understand that uses of the precautionary principle in real life are iterative and interrelated. You can make prudent financial moves against unforeseeable but very extreme dangers as often as you like, but you can’t do the same thing in real life. No government can say,” OK, we were wrong last time, and the time before, and the time before that, but trust us this time, you can’t be too careful.” In that sense, what Taleb, is suggesting, for all that I have sympathy for his approach, is like a mirror image of the Herd Immunity nonsense: interesting intellectually, but not actually useable in the real world.
Yes, and as a here’s-one-we-made-earlier example is the U.K. government being given a good stiff talking to by the National Audit Office over its previous pandemic planning measure of stockpiling Tamiflu https://www.nao.org.uk/wp-content/uploads/2013/05/10155-001_Access-to-clinical-trial-info-and-the-stockpiling-ofTamiflu-Executive-Summary.pdf
I suspect the Tamiflu debacle coloured, to some degree, the U.K. government’s response to COVID-19.
“Well, over-reacting has the disadvantage that nobody will believe you next time…”
I wonder if this pandemic hasn’t exposed the chink in democracy’s armour during times of existential crises (in so far as the constraints placed on leaders to respond to a crisis of this nature can be recast as encroachments on civil liberties, democratic rights etc by activists and people tired of the government telling them to sit at home). Leaving aside the potential ills nested in authoritarianism as a governing system, governments that are authoritarian don’t have this crippling handicap of having to convince the populace to “believe them this time”, they go full draconian if they believe that’s what a crisis calls for without worrying much about whether people/citizens will say “but you said it was serious the last time round and it turned out not to be”. Western style liberal democracies don’t have this latitude to go all-in, constrained as they are by too many competing interests to balance (including the need to avoid being consigned to the fringes of political life for making the wrong/over-cautious choices).
Perhaps your disagreement with Taleb on the unworkable nature of his recommendations should be seen within this socio/cultural-political context. It’s entirely workable in China but perhaps less so in liberal democracies (that’s until people start dying in such great numbers that politicians are left with little choice but to impose full, strict lockdowns with the enforcement apparatus to match, the sanctity of their political futures be damned).
Yes, I’d agree that political systems make a difference, but perhaps there’s another dimension: rather than a simple democracy/authoritarian distinction. I think it has a lot to do with how far political power is concentrated or distributed, and in what way. Many so-called “authoritarian” states have complex power structures where forces balance each other (Algeria for example) whereas some democracies (like South Korea, which has made a lot of progress in thirty years) are capable of swift decisions, and also have an impressive degree of popular consensus. The US system, for example, is so famously divided and complex that it’s almost impossible to get anything done, and often hard, at least for outsiders, to understand who’s in charge of what. In general, you can say that liberal political systems, since they are based on competition and conflict, find it harder to take quick and fundamental decisions than other systems – not necessarily authoritarian ones.
The other thing, I think, is that most western governments at the moment are weak and unpopular, and are heirs to a tradition since Blair and Clinton of navigating by opinion poll and buying off various pressure groups (IdPol, human rights, the media, Silicon Valley etc. etc) rather than actually standing up for anything. Not the best preparation for confronting the biggest crisis since 1945.
I believe it’s more about how much the population believes its governmnet or not.
Different point, I think. There are functioning and non-functioning governments irrespective of public belief in them.
I don’t entirely agree.
China’s extreme lockdown of 70% of its economy was a Defcon Level One warning that what they were seeing required incredibly aggressive action. We chose to ignore what it meant.
And the US in particular refused to send much in the way of doctors or public health officials to China then. Dunno what the UK did. But if we’d had people from outside China sounding alarms based on what they saw themselves, it would have gone a long way towards softening up public opinion.
You’re right, of course, that the Chinese took extreme measures early and were right to do so. It’s also true that the West as a whole didn’t pay enough attention to what was going on there. And action could certainly have been taken sooner in most countries. But I really doubt whether it would have been politically feasible to take “incredibly aggressive action” at that point, or even soon afterwards. Between the human rights lobby, the conspiracy theorists, the anti-communist lobby, the anti-China lobby, the Russia3 lunatics, the courts, a demented media and political opponents (wasn’t there something about impeachment in the US?) I just don’t think it would have worked. In a number of European countries, there would have been legal challenges to the Constitutional Court, and they might well have been upheld (there have been a few in France but they were batted away). Coincidentally, your Democracy Watch article demonstrates the breadth of this sort of opposition and suspicion even when the lockdown requirement is blindingly obvious: a couple of months before, the opposition would have been infinitely stronger.
Even now it seems rather tricky
I suspect the level of communication required is actually impossible, sadly.
A chilling observation, political un-feasibility being societies ACE-2 receptor.
This reminds me of the “4 Stage Strategy” clip that went around early in March.
Yes Prime Minister – Corona Virus strategy
Things seem to be playing out, just as predicted.
The so-called liberal democracies can always seem to generate near unanimity when they start wars, that is, real wars when the call is to murder “furriners”, not the ones on drugs, or crime, or poverty.
Sorry. No edit available on the above.
Was referring to Yves comment about Western so-called democracies just not paying attention. Why pay attention? It’s waaay over there.
And further, re Michigan and Paul O’s link: The people protesting are the authoritarians pulling the usual stunt, and they brought their gunz to prove it.
I cannot totally agree, yes, politics have their rules but in this special case they should also bend to precautionary practices. I think a good example is the proposal now being considered in Germany made by Leopoldina National Acad of Sciences, that Merkel is said to pay close attention to.
Scientific Experts Release Proposals for Loosening the Lockdown See the detailed roadmap for back to school which in my opinion is carefully and sensibly planned. This is precautionary and at the same time politically wise.
I don’t think Taleb means the same as you by using the word “precautionary.” Remember, he says that
“The general (non-naive) precautionary principle delineates conditions where actions must be taken to reduce risk of ruin, and traditional cost-benefit analyses must not be used.”
What that means (and the PP means generally), is that if there is any possibility of things going catastrophically wrong, then you should not do what you were thinking of. The normal cost-benefit analyses are specifically excluded, because there is a chance, even infinitesimal, of catastrophe. The German example you quote could be said to be “taking precautions” but it actually seems to me to be precisely a cost-benefit exercise.
Of course, Taleb’s proposal, if taken literally, would completely stop everything dead. You would not re-open schools, for example, because there would be a possibility, however remote and unquantifiable, of a catastrophe resulting.
Exactly. taleb’s precautionary principle sounds sensible but is actually naive and foolish in practise. Because one is either precautionary about everything and therefore does nothing, or one arbitrarily applies the precautionary principle to some problems but not others, or accepts that one frequently applies or doesn’t apply the precautionary principle to the right problems because of imperfect information.
I’m not happy with Taleb’s piece either – seems to me he’s a bit like the boy who cried wolf who was accidentally proven right and can now gloat about it. I’ve even a suspicion his little team has probably been right about six of the last three pandemics.
He seems to be guided by the maxim “Do no harm, or even risk harm.” No problem with that, but what about the inevitable harm arising from a total nation lock-down in response to a possible pandemic? People losing income they can’t afford. Businesses going under? Governments having to divert resources away from urgent real-time needs? He and his little team might be able to ignore these realities but politicians and governments can’t.
He also writes – and this was where I gave up on him – “In that same vein, you need mass testing. And reliable testing, which is still not a given.” Yup. So his whole strategy rests on something he admits he can’t do.
And something I would regard as a fifth essential to the four he lists is to close your borders, which unless you’re an island is very hard to do successfully.
So yes, in his ivory tower of academia he’s absolutely spot on. In the real world he’s just another “This is what you should have done,” voice.
I think the answer to the question of how to deal with over reaction is that politicians are supposed to be good at what they do – and one of those things is framing political decisions. Its up to scientists and advisors to lay out the facts as they see it, and lay out a range of actions, its up to politicians to work out how to make these things work. A lot of the success I think in countries like Taiwan and Singapore was based on the politicians being able to frame this as an example of domestic scientific superiority battling a foe from deepest darkest China. The reaction became part of a national struggle, not an imposition from above. This is one reason I think why face masks are important – its as much a symbol as anything else of people wanting to ‘do their part’. Its a little like people in WWII donating their cast iron railings for the war effort. The iron was useless and was thrown away – the significance was in the act.
As one example I think of where both scientists and politicians got it wrong was on travel. Whatever the scientific arguments, it should have been recognised that immediately shutting down air travel to China and implementing strict airport protocols was an important ‘signal’ to the public that something was up, and that action needed to be taken. Of course airlines and business flyers would scream and shout, but they are a small minority. Ironically, Trump, with his usual uber populist instincts, got this right, while his science advisors got it badly wrong.
There also seems to have been a failure to recognise the value of slowly ratcheting up restrictions, rather than waiting and waiting and then declaring an emergency. As much through luck as anything else, Ireland got this right – there was no sudden declaration of an emergency, there was instead a slow build up of restrictions which got people used to the idea that something serious was happening. By the time a shut down was declared, people were ready for it, in contrast I think to the UK, where it caused a lot of confusion and became heavily politicised.
Scientific advisors contributed to this muddle because so far as I can see, many mixed political judgements (there is no point telling the public to do this, they won’t listen) with objective scientific advice. The result is that they got into a horrible mix up on subjects like face masks and airport controls. This of course has a lot to do with a lack of preparedness…. I’m still quite amazed that few countries seemed to have a well prepared and well structured plan that included public communication. I remember when this first broke out in January I googled ‘Irish pandemic emergency plan’. I found one dating from 2007. It took me five minutes to read it and I ended up head down on my desk thinking… ‘oh we are so F***d’.
New Zealand is about the same population as Ireland although we have no land border with anyone else. We have been under strict lock-down for the past month. Jacinda Ardern our Prime Minister has explained our government’s strategy to go fast and go hard. It was not a slow ratcheting up of expectations – once she saw the data we got two days’ notice. She used a frame that we are in this together, the health of our people is paramount, and that we should be kind to each other. Her approval raings are high.
It is explicitly an elimination strategy. We are currently waiting to see if we will move from Level 4 to Level 3 lock down next week. People are generally cautious although some in business are clamouring for release. We currently have 1,086 cases confirmed and 11 deaths; I see Ireland has 13,271 cases and 486 deaths. Early days, but so far so good.
I think Taleb is right, and that political leadership is far more important than political followership.
New Zealand has done outstanding work here and after the virus has been eradicated, then kiwis can go wherever they want internally. Might be that one island is cleared before the other but I just had a terrible thought. Can you imagine what would have happened if John Key was still Prime Minister?
I wonder how what must be one of the largest housing bubbles in the world, will play out in NZ?
And one thing about their property bubble that was different from other countries, is damn near every tom, dick & harry town and city played along, and prices look to plummet across the board.
You have to trust your governmnet – but that’s a necessary, not a sufficient condition.
I can’t see how any of the continental European states could impose lockdown ala NZ – because they would have to patrol the border extensively, which they most certainly could not handle in two days. It’s just physically impossible.
Here’s the full timeline for New Zealand – I should have said the two days notice was from announcement to implementation. https://shorthand.radionz.co.nz/coronavirus-timeline/
Yes, but NZ’s announcement was very late, at least by the standards of most countries. It was dressed up politically as ‘decisive’, when in reality, it was just very late. NZ is fortunate to be perhaps the least interconnected (at least to any major Covid hotspots) major country so it had a lot more time to prepare than others.
If draconian measures had been quickly implemented and had stopped the pandemic, then because there would have been no pandemic, there would have been an outcry that the draconian measures had been completely unnecessary.
We have ‘leaders‘ who can’t lead, even if they wanted to because they are kept on a short leash by those who fund the process that puts them in office.
We have an electorate that has been marinated in neoliberal propaganda for their whole lives and as a result cannot be convinced of the danger, and the necessity of taking the precaution of not allowing the rule of money.
And we have now been brought to the precipice and are about to be pushed over the edge by a surging wave of ignorance and significant number of us feel it is an entirely rational to stockpile ammunition so as to be able to shoot each other on the way down.
We long ago abandoned belief in taking precautions of any kind other than arming ourselves to the teeth.
Taleb’s phone ain’t gonna ring.
We can thank Sebastian Junger for that occasionally overused meme, “the perfect storm.’ Which it seems to me from all discussed here is what us humans are facing, the way the incentives and feedback loops in the political economy of the planet operate.
The best we collectively can do is I guess the best we can do. Query whether it’s good enough.
As Ghana president Nana Akufo-Addo said recently: “We know how to restart the economy, what we don’t know is how to bring the dead back to life”.
All policy making in response to the covid-19 pandemic must flow from this “biological life as a prime value” heuristic. But alas, the “we need to reopen the economy” brigade is gaining the upper hand in shaping the crisis response narrative, aided by the chattering voices of individuals suffering from lockdown cabin fever saturating online platforms, citing all sorts of personal inconveniences as the reason why the “draconian state” needs to release its grip and enact “risk adapted strategies” to allow a return to something resembling normal life. I continue to assert that a balanced approach to arresting the spread of the virus and reopening economies is a fantasy-laden aphrodisiac that is seducing many a leader because it sounds all so politically attractive and pragmatic. As a consequence, leaders are rushing headlong into wrapping politically expedient yet potentially disastrous decisions with “scientism” to grant them a measure of legitimacy. As the post so unequivocally hammers home: the cost of under-reacting is many orders of magnitude higher than the cost of over-reacting. Stated differently, it means the time for half-measures is well and truly over.
On the contrary. Over-reacting (clamping down as Taleb advocated) would have resulted in just a different kind of half measure, not a solution. In the culture and world we live in in the West, and especially in the US, the hard clamp down would have resulted in disaster. Just like the ‘under-reaction’. Just a different kind of disaster. If we had tried to do that we would be sitting here today discussing the on going breakup of the US into a new set of countries. The economy would be in an equal mess and there would be blood in the streets.
There was never a time in this crisis where we really had any feasible option to do anything but a chaotic version of ‘herd’ immunity. And that is certainly what we are going to do. An early clampdown of the economy would have encountered vast resistance and there would have been very little cooperation. And significant areas of the country would have just refused to cooperate. And they would have refused violently if they were opposed by authorities – and that possibility is going to grow not fade away. So be very careful what you do now. And as anyone can see what we are actually doing is just another version of getting to ‘herd’ immunity. And we are almost certainly going to ease off on restrictions currently in place. So things will likely take at least a temporary turn for the worse. We are going to deal with this situation mostly the old fashioned way.
I have said it before of course, but the world we knew last Dec does not exist anymore. We are on our way to a new place and we will go on from there. The old place was not all that great anyway so don’t mourn for it.
Some states might have gone along with it after which, success might have bred success? I realize that’s pretty iffy, particularly controlling interstate movement.
It seems to me clampdowns come in two varieties: pro-actively chosen or reactively imposed and each exact their own penalties. I suspect the cost of a proactively chosen clampdown will be significantly lower than that of a TINA clampdown imposed by circumstance (I.e. the unfolding of a full scale pandemic). I agree, as can be evidenced by my response to David above, that western style political systems make it exceedingly hard to enact a hard clampdown when there are various lobbies on both sides of the political spectrum ready to pushback against it on grounds ranging from spurious to credible (especially during the early stages when a pandemic is still a phenomenon happening in foreign lands). This for me means that democratic political systems are vulnerable, given how the power dynamics nested within such systems paralyze decision making, to slow responses during times of existential crises (please see my exchanges with David above for more on this line of reasoning).
Why was the only other possibility a massive early lock down? What about just trying to find the people who might have been infected back in January and February, when there was just a handful to find. Then they might not have needed to do a lock down at all.
If people knew how the risk was evolving, they could make informed decisions for themselves. Instead the CDC actually banned testing of anyone who had not come from Wuhan, and pretended there were only 15 cases, all under careful observation. Meanwhile, the hysterical media, if they mentioned it at all, were telling everyone its just a flu, and masks are pointless.
There were no reliable tests early on, at least this is my recollection.
Because the CDC effed up. They wouldn’t use the tests everyone else was successfully using for some reason. Probably because some crony got a sweet no bid contract to make their own. Hopefully one day the details will become clear.
“There was never a time in this crisis where we really had any feasible option to do anything but a chaotic version of ‘herd’ immunity.”
I read a comment in the Guardian recently that really made an impact: it was from someone who grew up in the developing world (I’m not remembering the country) in the 60’s. They talked about how he and his sibling got the Polio “spoonful of sugar” vaccine and was spared, whereas his mother did not get the vaccine. She survived when she contracted it, but faced health and pain issues for the rest of her life. The reason he told this story was to point out that without the vaccine, there would be no herd immunity, at least not in time scales that are acceptable to most people.
In other words, without a vaccine, herd immunity is a deadly option, unless you’re willing to wait multiple generations and tolerate a massive number of dead.
The Black Death comes to mind.
“There was never a time in this crisis where we really had any feasible option to do anything but a chaotic version of ‘herd’ immunity. And that is certainly what we are going to do.”
I have read a great deal on covid and this is, in my opinion, the most mature, succinct sentence I have found. Perhaps in 5 years, we will finally be able to understand what we would have needed to know to optimize the response to covid. But we don’t enough now; the scientific and political aspects of this pandemic are too complex to make optimal decisions in a timely manner. Talebs approach is simply not feasible, except in hindsight. His approach would require that we too often over-react to threats that would rarely happen. There is no way to maintain political support with Taleb’s approach.
Without the inspired leadership of Joe Biden, Nancy Pelosi and the Democratic Party we would be well and truly fucked.
The Democrats are good running the government into the ground. Calling that crowd ‘leadership’ must be a new definition of the word. Steny Hoyer won’t call back the House unless it an emergency. Does he have a clue what’s happening in the country
Separate from the needed divining rod for locating the true well spring, I keep coming back to the irony of face masks in a neoliberal world. It is neigh on impossible for such to ferret out the notion before hand that protecting others is they way to save oneself.
Even though, perhaps because, it is hidden in plain sight via the golden rule.
And please, I am not talking here about individuals – such as Ignacio who exibits concern for others in almost every comment he makes. I’m talking about the way Western culture approaches concepts and the remarkable way in this instance it is encapsulated in a mundane physical object.
I think you are absolutely right. Liberal political theory is simply conceptually incapable of responding intelligently to this situation. It’s like asking a horse to play the violin.
I’m skeptical that imposing extreme lockdowns to “crush the curve” will succeed. They sound great in theory, but the entire approach presumes that re-infection from an outside source (like visitors from other countries or regions that haven’t “crushed the curve” yet) or long-term carriers will never happen. This clearly isn’t true.
Indeed, look at South Korea’s numbers: https://pbs.twimg.com/media/EVcyO2rWkAMLkOf?format=jpg. Their efforts at social distancing were quite effective at squelching the initial exponential rise, but the tail of the curve has remained stubbornly long. It will likely be many months before they get it to zero. If ever.
Interestingly, though, the South Koreans haven’t implemented much of a lockdown. They’re at the far right of the “lockdown effectiveness” chart, and yet their new case rate continues to slowly fall.
There were voluntary lock-downs, particularly in Daegu. The difference? The tail is not as fat as in Italy or Spain for instance.
As I understood it, the general explanation of S Korea’s success with minimal initial lockdowns is that – due to past experience with SARS-CoV-1 – they were prepared and started (relatively) extensive testing combined with contact tracing and quarantine of all involved in each and every contact and, more importantly, did so immediately before they had wide spread contagion.
Once that window passes but before medical intervention can help at scale, I don’t see any other way than lockdowns imposed from above while at the same time using extensive testing and contact tracing et al to chip away at enclaves from below.
Strict control of all movement has to be lifted at some point and to assume one has eliminated all instances of a such a virus (asymptomatic, long lasting in cold, etc.) thus needing no other measures to lift restrictions seems unreasonable . that is – if I’ve understood correctly that that is the proposal.
One recent history case of a potential world wide problem that may have been nipped in the bud was the concern about software based systems manifesting the Y2K bug at the Jan 1, 2000 rollover of internal software clocks.
At the time, my job required me to change some embedded firmware in an electronic instrument to fix a minor Y2K concern.
I suspect a multitude of similar repair efforts happened quietly all around the world.
As far as I know, when 2000 rolled around, nothing happened of note.
In this case, perhaps anticipation of the problem DID prevent some big problems, but we can’t know with any certainty.
I believe the world came to see the Y2K bug, in NC terms, as a “nothingburger”, while ignoring Y2K might have had some severe consequences.
This suggests that successfully selling the USA political leadership on a precautionary 5 week lockdown and having it successfully work to defeat the virus may have simply caused people to claim the lockdown was an unjustified overreaction.
But, if the next pandemic occurs in a few years, the response to the new pandemic might be far better as the politicians will have political cover for a rapid response.
This is the “silver lining” of the Covid-19 cloud.
1998 and 1999 had an massive amount of my work in fixing unintended Y2K problems, sometimes needing to update code last touched in 1985. I have actually seen references to the Corona response, as exactly the Y2K non-event it successfully was. This is the problem of success. However it is still the right thing to do.
Well this is another fatuous essay, isn’t it?
Raúl Ilargi Meijer
Or to rephrase this, I just got my diploma from Google U. in epidemiology Of course I’ve never met an epidemiologist in the wild yet but I do know much better how to practice epidemiology then somebody spent 20 or 30 years learning about it.
Raúl Ilargi Meijer
That insight is so amazing that epidemiologist are working in the must be a deterministic physics model from the 1910s. Of course they would never think that there could be more than what are two variables to deal with. B*******.
Well this must be correct. I’m sure that epidemiologist never noticed the transmission speeds for the 1918 flu epidemic depended on trains and ships and failed to realize airplanes airplanes are faster. I suppose we’re lucky that they aren’t still working on models from the 1300s Plague when transmission speed was determined by ox carts and sailing ships.
There are any number of good suggestion was that they made in that paper; of course if you look closely China seems to have done most of those, even without this valuable advice. China may not have done them in time and they may not have been able to given the nature of the SARS-CoV-2 virus but they did them.
It’s just a very minor point but how do you think China was able to build two quarantine hospitals in days at Wuhan? Those were prefabs that came out of a strategic reserve. How did they manage to send 40,000 medical staff to Wuhan. That shows a lot of preparation and planning.
It is unfortunate that a paper that clearly headlines a number of a critical steps that should be taken to contain a pandemic had to start out by trashing those very people that seem to supplied the Chinese government with the advice on how to deal with SARS-CoV-2 .
Too much of this paper reeks of ignorance of the field epidemiology and practical politics, plus pure, unadulterated, arrogance. It certainly not as bad as this essay by Tyler Cowen What does this economist think of epidemiologists? but I would have much happier if it had stressed the very good points it was making, and avoided thrashing the discipline that they don’t seem to know anything about.
The arrogance is anchored by the “extinction level” possibility of a pandemic. Chronologically we are past that point now with Coronavirus. It is not an extinction level pandemic, it is something less, therefore the “avoid risk at all cost” argument is not just expired, but also unhelpful in determining the proper policy response to balance lives worth living vs lives lost.
Taleb works from the premise that saving human lives is paramount. The transnational global elite doesn’t. In fact, I’d venture that amongst themselves in Davos, they regarded the virus as potential cleansing balm. And they will never ever care about human extinction: IBGYBG.
To be fair, I think Taleb is really arguing that saving lives which are at risk from the narrow consequences of the epidemic is paramount. He’s not interested in lives which might be lost as a result of adopting the policies he recommends. This is, in fact, essentially the Trolley Problem with knobs on.
Thank you David- very succinctly put (and brought me back to my Philosophy 101 ethics days). If we truly had leadership who would and could do the needful and the necessary to completely take care of the victims of the proposed adopted policies, I think a good majority of people would definitely be onboard. But, alas, what are we left with? Even with the limited measures and lockdowns we have now, people are already rebelling (Yves has post up about this today). It will probably get a lot worse for a lot of people- eviction, bankruptcy, suicides, homelessness. These are problems that could actually be solved but we are left with half-measures or no-measures for the lot of us, while we kick 5 trillion$ upstairs.
re chloroquine compounds and covid19 — please spend a few minutes studying this summary of past and future trials. There is anecdotal evidence to support the claim that one or more of the chloroquine drugs used in conjunction with zPak and/or zinc supplements has been effective as an early Rx intervention. OrangeManBad (OMB) does not have the credentials to make comments in support of any Rx intervention, and he has been called to account for that mistake. But in our collective zeal to signal that we are part of the “smart kids group”, let’s not conflate dislike/hatred/dismissal of OMB for hatred/dislike/dismissal of this class of drugs when used to help covid19 patients improve.
1 paper from France (read) found it to be helpful in such a limited range and set of conditions, with extreme side effects such that I’d never use it on a patient. A note of caution, whatever we learned yesterday is probably been modified to reflect more data.
1061 patients. 91% cure rate?
there was an earlier small n study from this group, and it was deeply flawed relative to the claims made
for completeness, summary table from the n=1061 study in France
and then there’s this — brand new
I have a friend who claims chloroquine saved his life. He was on “death’s door” until he took the drugs and had a nice recovery. Anecdote doesn’t equal data, and who knows, he might have recovered anyway, but I don’t see how we can contemplate double-blind testing given the current circumstances (so sorry, your loved one was in the control group).
many anecdotes equal clinical data, but I do not know who is the arbiter of that issue
there are credible stories of doctors giving remdesivir and reporting great results, and the local hospital near here stopped using it in the icu because of lousy outcomes.
Last Friday, the NEJM published an article that included a mildly positive report on remdesivir on a small n group (link below); in addition, please see the http://www.statnews.com link I provided above.
It does appear that hydroxychloroquine/zpak/zinc works as an inexpensive and early rx intervention, but those doctors and patients reporting success with it might be lying, and it might be useless.
In any case, OrangeManBad spoke optimistically of it, so half of the country wouldn’t consider taking it on ideological grounds.
Was looking for the part that said ‘lockdowns’ kill people in other ways (people fail to go to the doc with other conditions which then kill them, suicide etc, people starve). It’s not just Virus Death VS The Economy… there are incremental deaths on the both sides.
Don’t get me wrong, I believe in lockdown!
Interesting to see foreign commentary about us here in the UK – implicit disappointment to realise we have incompetent government and indeed institutions, civil servants etc. Just start from the assumption that we are a sort of bongo-bongo failed state ruled jointly by Putin and Trump OK? Then you will only see upside as you watch us stumble forward. Sit back and get ready for the no deal Brexit at end of 2020.
Well Richard North is arguing that the U.K. needed to do the China thing of 1800 x 3 people teams to find 7 track everyone. If in fact that’s what they did. Every country no matter what they do is having exactly the same problems regardless of the competence of any Gvt including the U.K. Gvt. The mindset required to have stopped this carnage is in one way of framing of it, consider: that nuclear missiles were being launched at you, but add the ability to protect everyone by fast and through actions – hardcore as in lockdown. This is too much like the Jackpot, those that knew did nothing, those who could act did nothing, those who could report on it (except @NC) did nothing. Sadly, this is the pattern in the West Civilization- we do nothing (useful, helpful, better)
The dates 29 March 5 April dates do not agree iwith the footnote.
When was the study done?
I keep hearing discussions about reopening the economy and all I can think is are these people insane?!?! We are nowhere near a position of being able to “manage” the viruses spread right now. If we re-open for business we will most assuredly just restart the contagion with little promise of not replicating the NYC situation. Just yesterday I was listening to a covid-19 update by Dr. Campbell where he was reviewing some data from Italy. It appears that in one remote village in Italy they tested everyone… all 3,000 residents. Anyone who tested positive (symptomatic or asymptomatic) was quarantined. In 10 days their new cases dropped by 90%. There are 300 Million people in the US and we’re not even able to test 200,000 a day. Given everything we know from hard data about this virus (not the dumb model data) says we won’t be able to contain it given our current testing capabilities and I’m not hearing anything that says that will change anytime soon – at least not to the real levels we’ll need. Again, these people are insane.
If I was facing eviction and wasn’t able to feed my family, I would not see re-opening the economy as insane.
I would place the blame where it belongs: with my landlord (or his bank) for evicting me, and with the government for not compensating me for the consequences of their actions (even if justified).
Imagine the joy of finally being free to go out into the world and bring back coronavirus to your family.
Blaming people or institutions doesn’t feed my hypothetical family. Also, if they’re young and healthy, they will most likely survive the virus. If I’m concerned, I will do my best to distance myself from my family. I still see this as a better option than being homeless and relying on food banks and charity to eat – which quite likely also exposes us to the virus, and given the lack of safety nets, many other undesirable things.
If we can put GE on respirators, why not Boeing on face masks or would that be too obvious an insurmountable challenge for them? Could they make kites at least that we could cuit up and make into masks?
Seriously, why do we still not have abundant gloves, face masks and tests?
Raw materials are in short supply. Spinning mask fabric requires equipment we don’t have or make, and gloves require latex from Malaysia. (I think, anyway)
Autarchy. What’s that?
With regard to latex gloves not so much many prople are allergic to wearing them and break out in hives if touched by them.
I completely agree! Pearl Harbor was bombed on December 7 1941. Within 2 weeks the FDR administration was diverting people and resources to make the Doolittle Raid possible. All I hear today is a lot of talk and not so much action. This is not a situation the market is going to fix so waiting for the market to fix it is a futile activity. The establishment (Trump or Democratic) is not capable of actually getting us where we need to go, that will require doing too many taboo (to them) things.
Last I heard, USG had put Boeing on a respirator. :-)
Re this dispute among theorists–in my opinion it doesn’t matter what Trump decides because the public is only going to put up with lock down for so long and so we will have the new social experiment when that happens whether the “experts” approve or not. Meanwhile we might want to worry about other things beside covid–no not stocks and bonds but whether we will all have enough to eat.
Yes, if we can prevent the people working on our food supply from getting sick, we have got a better chance of getting enough food. Perhaps they could be designated as an essential industry or something?
That’s an interesting side effect of the well-finance opposition of the Kochs to “collectivism” (their word).
The truth is that the limit for most humans’ sphere of acquaintance is about 150 others. Society, however, requires literally thousands of people to provide the quality of goods and services we have come to take for granted. The big question: How do you manage such an enormous entity?
We have several experiments in governance going on around the planet, and so far Korea and Germany have the lowest death rates from coronavirus. Both governments get lots of trust from their citizens…but in the U.S., the likes of Trump and Republican sabotage (cf. Thomas Frank’s The Wrecking Crew) make citizen trust in government low, and conscious pursuit of healthy policies far less likely.
Whether the current adoption of large, MMT-style bailouts will make people wake up to the power of that larger entity, and the profit in making sure its “eyes and ears” are wide open, at least an open question.
I’m not all that clear on what “fat tail” means, and evidently it’s very important. I THINK it means that the “tails” of the bell curve are thicker than usual – that is, the extremes are more likely, relative to the middle. But a better definition would be helpful, especially since I’m trying to put together a glossary of NC, well, jargon.
It has a few different meanings, depending on the context. The sense in which Taleb often uses it is model error – for example, getting a one-in-a-thousand-years flood (or whatever) two years in a row. This is often framed b the media as extreme bad luck, but Taleb argues that a more sensible interpretation is that the underlying model is wrong (perhaps it used to be right but isn’t any more due to changing circumstances) and what you thought was a one-in-a-thousand-year event is actually nothing of the kind.
In general it refers to supposedly rare/impossible scenarios that are in fact far more likely than we think they are.
Thank you for asking as I assumed the same, and you are basically correct. Your comment made me look on WikiPedia, but the math does not cut & paste well. From Wiki, without jargon it says: Pr[X>x] ~ x (to the power of a [negative] alpha). The distribution is said to have a fat tail if alpha is small. For instance, if alpha is less than 3. Note: here the tilde notation “~” refers to the asymptotic equivalence of functions (?). Fat-tailed distributions also include other slowly-decaying distributions.” I hope you understand it because I don’t. This is why I said this piece is relatively jargon free on links this morning. Talib’s books are marginally understandable for me, as I never took calculus. There are several graph on the right side at this Wiki location that vary the value of alpha:
Fat tailed distribution
If you think of a normal distribution or bell curve, it’s typically drawn as a line that is high in the middle near the mean, and tailing off to zero at the ends (hence the ‘bell’ part, since the middle looks somewhat like a bell silhouette).
The ‘tails’ are the bits at the ends that approach zero. One of the properties of the normal distribution is that while you can theoretically get any result, the probability of getting a result a long way away from the mean drops off very fast after a certain distance. For example, the chance of a result that is more than 5 standard deviations away from the mean is less than 1 in a million, while a result that is 7+ standard deviations away happens barely more than once in a trillion.
‘Fat tails’ are essentially tails that don’t do this kind of rapid drop-off. In probability, it’s a distribution in which outliers (results a long way from the mean) are much more common than you would expect in a normal distribution. There are a great many of these in nature. The problem is that if they are unimodal (one ‘hump’ rather than multiple) and symmetric, they all tend to look very much like the bell curve when you plot them. This is because the meaningful differences are all squashed down into tiny areas of the graph in the tails, and the human eye is not good at spotting the distinction.
Pundits, non-scientists and even some scientists famously assume normal distributions in all kinds of situations where it may or may not be justified for them to do so. This is partly because every unimodal distribution looks similar to the normal distribution visually, and partly because the mathematics are tractable for normal distributions (the streetlight effect). A side effect of this is that they then end up massively underestimating the chance of outliers or unusual events, because of the thin tails of the normal distribution.
Thank You. A very good description.
This is a good summary statement, and describes what New Zealand (for example) is trying to do. You need to reduce the transmission/reinfection rate below 1, even in cases where the infection hasn’t yet been detected (the exception is if you can realistically hope to catch close to 100% of cases, which is only possible when the total number of infections is small, and is never possible in the early stages before the nature of the virus is fully understood). The only feasible way to do that is to identify how the infection is transmitted, then change the architecture of society to eliminate opportunities for transmission, or at least reduce them as much as humanly possible.
The other thing I’ve realized is that no community is going to continue operating as normal in the face of a pandemic that is likely to sicken and/or kill a significant percentage of the population. It’s just not in our nature. This means that this is not a policy option available to Trump, whatever he may think. The governors will override him, or the mayors. Even in the rare cases where they are all in agreement, community groups, neighborhoods and even individual households will make their own decisions, and eventually political pressure will force leaders into line. This has already happened once to Trump (remember it was going to be business as usual by Easter?) and will again. So the whole ‘herd immunity’ theory, as seductive as it may be to economists who are used to measuring success by GDP growth and discounting human lives, is, and always will be, a mirage. It’s not actionable in a meaningful sense in any Western democracy, and possibly not in any human society of any kind.
The circle is complete!
@nntaleb retweets this post.
There are some obvious flaws in parts of the above argument:
(1) We make trade offs between economics and human life all the time. Certain medical treatments are rationed, especially for older people. We do not go on and on spending to make transport 100% safe. We do not demand endless spending to make every home 100% fire proof.
(2) Governments know masks work. They just can’t buy any, or make any, quickly enough. So they pretend they don’t work instead. We would need billions of N95 masks in the UK alone to satisfy demand over the next few months if everyone had to wear one.
(3) It’s very easy to say “just build testing capacity and provide means to treat patients” in February 2020. It was far, far too late by then. It ignores that governments and private organisations globally were scrambling for every last scrap of such things by then. And there are no known effective treatments at this point. It also ignores the great, incompetent, slow-moving monolith that is government bureaucracy – doing anything with that monster must be like pushing on a string. It ignores the reality of dealing with people, bureaucrats, incompetence, corruption.
(4) It’s daft to say that “nobody listened” to the article that Taleb published on 25 March. The UK was already in its strictest lockdown in history by that point and still is. What on earth is the point of Taleb publishing such things as late as 25 March? Useless by that point.
(5) Regarding “herd immunity” what happens if we never find a vaccine or effective treatment? Do we stay locked down for ever? Herd immunity may be forced upon us at some point. Taleb skips over this problem.
(6) Of course, what SHOULD have happened is that (a) all governments should have prepared seriously years ago in the way South Korea and Taiwan did and (b) the moment a dangerous new pathogen appeared all global travel should have been suspended and the curve crushed by lockdowns and testing/isolation. That needed to be done with days of the original spotting of the new virus. Governments of course should NOT have been relying on China or the WHO to tell them – it was obvious to any fool that both organisation would either lie or be hopelessly slow and corrupt.
The problem with precautionary principle is that most people will agree with you only with hindsight.
In addition to the problem David mentions above, of “if you use it and turn out to be wrong..”, there’s also the problem “if you use it and turn out to be right”.
I.e. the problem of counterfactuals (which IMO is where Taleb just doesn’t get the man in the street is not interested in counterfactuals..). I.e. if they come in hard for two weeks, and nothing happened, well would be be because they came in hard, or would it be because nothing would have happened anyways? And there is NO answer to that.
See Y2K bug. I regularly meet people who say how much money was wasted on Y2K bug, and how it was all scare to create contracts for IT companies etc. etc. because _nothing happened_.
There’s no way I can persuade them that nothing happened _because_ the money were spent (and I believe that on the basis that I know how many were deployed to deal with it, and a lot of them are coming to roost these days), cos you know, nothing happened and that’s the proof.
That said, with covid there are counterfactuals – different countries. I’m sure there will be a lot of PhDs done in years to come showing how one country’s response was better than other (while ignoring a lot of idiosyncratic issues, because they can’t be controlled for).
There have been massive floods in California every 200 to 400 years, the last one coming in 1861-62 which turned the Central Valley into a rather large lake. There weren’t 500 million fruit & nut trees, so no damage done there, and most of the land was hardly occupied, the state being less than a dozen years old.
These happen all the time from a historic standpoint, but i’ll assure you, nothing is really being done to address the probability of it happening until it has already occurred, not so dissimilar from Covid-19, albeit more of a flash in the pandemic time-wise.
The 1861-62 flood epoch lasted a few months, not so dissimilar from our ‘shutdown’ in terms of length of people being inconvenienced, and back then most people were farmers, and you didn’t plant in Dec-Jan, so losses there weren’t bad, but livestock was a different story altogether, with huge losses incurred.
A rather large fat tail in the guise of atmospheric rivers soaking the state repeatedly in a short time is a given, but what we worry?
The article should have been titled “Casandra meets Chicken Little”. So much pseudo intellectualising that basically comes down to “think of the worst possible scenario and act accordingly”. Really? To the paranoids go the spoils!
Maybe Monte Carlo simulation may predict the rate of spread, mortality. In reality,I think no risk engineering and stat modelling work. We cannot reduce the importance of observation even casually. And casual observation shows this is not a killer at the rates this article and other experts have projected and especially as temperatures rise. Extinction level kind of talk as the article alludes has no stance in reality. Just ask Hillary how well modelling worked out. WHO Pandemic play book needs to be followed and not the words of some risk engineer.