Coronavirus Magical Thinking, US Style: Contact Tracing Versus Masks

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Since the US is a federal system with an Administration that refused to take coronavirus seriously early enough, and now seems determined to validate its original decision by doubling down on it, it is a bit simplistic to speak of a “coronavirus response,” since cities and states have been taking the lead and they’ve gone down different paths.

Nevertheless, due to the decision by many governments, particularly in the South, to start relaxing restrictions, I’m coming across way too many rationalizations. And one of them is that officials can make things safe enough with approaches like contact tracing. Mind you, as you will see, the point is that contact tracing, or any information gathering, practiced on an insufficient scale and without programs to take disease containment steps using that data, is at best misguided, and at worst, intended to build false confidence.

Put it another way: the enthusiasm for a gee-whiz, tech based approach with no real world back end doesn’t merely reflect a lack of operational capacity, a key point Lambert made yesterday. It reflects a grave decline in basic problem-solving and planning skills, as in how do you get from A to B. And there bizarrely is limited interest in the one thing that could be done easily and cheaply, which is getting tough about mask-wearing.

On top of that, one measure that really could make a difference, mandatory mask wearing, isn’t required many places, and even in those locales, not in a sufficiently bloody-minded manner.

The first biggie is that it had to be this way. No, it didn’t. Note that Slovenia, which borders Italy, has the disease pretty well contained. From EndCoronavirus.org:

Countries beating Covid-19

Even countries that had very bad outbreaks like Italy and Iran have considerably reduced infection levels:

Countries that are nearly there

Countries that need to Do Something

The US is not in good company. Note how Singapore is now sitting at the “bad performance” table due to outbreaks among its migrant worker community…which is now quarantined in housing that makes social distancing pretty much impossible.

It turns out that big contagion vector was air travel. Epidemiologist Ignacio had this intuition a few weeks ago. Via e-mail:

Prompted by discussions on epidemics management (or lack thereoff) and cummulative casualties in various countries I have compared the “air connectivity” of various European countries with cummulative casualties with a lag corresponding to the clinical lag between contagions and casualties. Air connectivity is measured by daily flight departures for each country the week ending the 13th of March. And cummulative casualties up to April 7th.

When I plot both variables using logarithmic scale for both, I obtain a fine visual correlation:

The correlation coef. between both variables is about 0,84 though I have not checked if the distribution of both is normal.

Reader David sent along this pre-print (as in not-yet-peer-reviewed) article at MedRxiv that comes to similar conclusions. Its abstract:

The pandemic state of COVID-19 caused by the SARS CoV-2 put the world in quarantine, led to hundreds of thousands of deaths and is causing an unprecedented economic crisis. However, COVID-19 is spreading in different rates at different countries. Here, we tested the effect of three classes of predictors, i.e., socioeconomic, climatic and transport, on the rate of daily increase of COVID-19. We found that global connections, represented by countries importance in the global air transportation network, is the main explanation for the growth rate of COVID-19 in different countries. Climate, geographic distance and socioeconomics had a milder effect in this big picture analysis. Geographic distance and climate were significant barriers in the past but were surpassed by the human engine that allowed us to colonize most of our planet land surface. Our results indicate that the current claims that the growth rate of COVID-19 may be lower in warmer and humid tropical countries should be taken very carefully, at risk to disturb well-established and effective policy of social isolation that may help to avoid higher mortality rates due to the collapse of national health systems.

I know a cool network chart does not make the authors right, but nevertheless:

As PlutoniumKun added:

I still scratch my head at the insistence of WHO (and other authorities) at the beginning of this that airline travel was not a particular problem. I scanned the studies they used to support this conclusion and none seemed very convincing to me. I think its hard to avoid the conclusion that WHO simply shied away from the implications. The thing is, a lot of public authorities were relying on WHO’s recommendations on this – it took a brave politician/official to shut down airports in the face of this.

You can go back to 1895 and the Russian flu to see this – it was clearly (and rapidly) spread across the northern hemisphere along the main railway routes.

Additional support for the airport thesis comes from the fact that New York was the main source of coronavirus for the US.

Back to the main plot: what should the US (and other pretty badly afflicted countries) do, given where they are now?

The Contact Tracing Delusion

The depressing thing about the contact tracing plans in the US is that they demonstrate how incompetent we’ve become as a people. We were able to send a man to the moon 50 years ago. Now all we seem able to do is build apps when they won’t solve anything.

Way too late for contract tracing to work. Joseph Norman, Yaneer Bar-Yam, and Nassim Nicholas Taleb pointed out in a January paper that contact tracing was ineffective once a disease reached pandemic scale:

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 robust against misestimations in the properties of a virus or other pathogen….

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.

In keeping, China tamed its outbreak not with contact tracing but with a combination of aggressive testing for fever and confinement of anyone exhibiting one, required mask-wearing, and social distancing. Interestingly, other reports indicated that Beijing, and one assumes other major cities outside Hubei, did not have all non-essential businesses closed. About 1/3 of the restaurants and bars were open, seating customers, but only well spaced out. From an Agence France-Presse account:

Every time I enter a building nowadays, I say a little silent prayer before a little plastic gun is pointed at my head. After all, the contraption literally holds the key to whether I get in or not…

The little plastic gun is an electric thermometer and it has become ubiquitous in China and in the battle against the virus and the COVID-19 disease that it causes. A fever is one of the first symptoms and so the right temperature is essential in entering your office building, the supermarket, restaurant, public transport or your apartment building….

The taking of temperature has become a daily ritual for everyone living in the Chinese capital…

At the office building housing the AFP bureau in Beijing, the hunt for infectees does not end with the temperature taking. First I have to produce a brand new “entry and exit” card that building management made for this epidemic and that allows people to come and go from the 31-story structure. Then I walk in front of an infrared camera that stands ready to catch the fevers the thermometer may have missed….

In the elevator, there is a box of tissues, so that you don’t have to press the buttons with your bare hands. And at our office, the keypad where I have to press the entry code is covered in plastic (easier to disinfect and replace)….

A sign on our door reminds us that there can be no more than 12 people in the bureau at once (half of our staff normally) and security guards check in occasionally to make sure we’re complying. “You have to wear a mask, even when you’re working,” one of them says during one such inspection…

Outside, wearing a mask has become mandatory pretty much everywhere, even in the parks…

So the approach in China, which worked pretty well given the scale of the outbreak, was the use of temperature as a real-time test, with immediate quarantining, social distancing, and mandated mask-wearning. Notice the manpower was devoted to testing (the many temperature-scanners) and enforcement (the AFP story described several policeman coming into a restaurant, screaming it was too full, and forcing everyone to leave).

What About South Korea?

Yes, what about South Korea? On the one hand, Seoul, with a population bigger than that of New York City, has had two coronavirus deaths. Two. Even if they are off by a factor of 100, it’s still two orders of magnitude less than the 20,000 and counting deaths in the five boroughs.

And the country is so fixated on coronavirus that the discovery of a mere 34 new cases led the government to shut all bars and nightclubs until they tracked down all the people who’d been at the venues. That was an estimated 7,200. Numbers like that are manageable, but look at the draconian additional steps the officialdom is taking to make sure it doesn’t propagate beyond that.

The other central measure in South Korea is widespread, no-wait, fast turnaround testing. And the techs are in full hazmat attire.

Lambert featured this tweetstorm yesterday. I suggest you read it if you didn’t have time:

In the replies, there were a lot of comments about “No way would I give up my freedom like that” (ahem, the airport in Seoul was full of soldiers in combat gear carrying machine guns even before coronavirus) but some got the tradeoff:

Contact Tracing US Style: Potemkin Public Health

Let’s start with the basics. For contact tracing to be effective, you need to identify a decently high percentage of the infected and then get them to quarantine and be treated as needed.

The big and obvious fail in the US is no one is willing to forcibly quarantine people. And even if it were ordered, how would compliance be enforced? With ankle bracelets? Anything else is subject to cheating, and plenty of Americans would cheat.

Plus many individuals are in households where they can’t isolate. The sick person needs his own bathroom, at a minimum. So absent that, the entire household needs to be quarantined too.

On top of that, testing needs to be sufficiently widespread to catch a high percentage of the infected before or very shortly after they become symptomatic, and identify who might have been nearby during the high viral load shedding period. Given that this extends over several days, that’s not necessarily easy. Add to that that only about 80% of Americans own smartphones, and some don’t carry them all the time.

So when I read about the state plans to start contract tracing, it sounds like a 21st century version of Keynes’ proposal to stimulate demand by hiring people to dig ditches and fill them back up as opposed to a serious program to combat disease. From The Hill:

State governments are building armies of contact tracers in a new phase of the battle against the coronavirus pandemic, returning to a fundamental practice in public health that can at once wrestle the virus under control and put hundreds of thousands of newly jobless people back to work.

California is already conducting contact tracing in 22 counties, and it eventually plans to field a force of 10,000 state employees, who will be given basic training by University of California health experts.

Massachusetts and Ohio have partnered with Partners in Health, a global health nonprofit originally established to support programs in Haiti, to field teams of contact tracers. Maryland will partner with the University of Chicago and NORC, formerly the National Opinion Research Center, to quadruple its contact tracing capacity.

Washington, West Virginia, Iowa, North Dakota and Rhode Island are using their National Guards to trace contacts of those who have been infected with the coronavirus….

If those contacts then come down with the virus, they can be quickly isolated so they do not spread it further. They can also be treated, making it less likely they develop the most severe symptoms.

“They can be quickly isolated.” This is the DC version of the economist’s “Assume a can opener”. How, exactly? Will they be thrown in the back of an ambulance and hauled away to a medical lockdown? About 41% of American adults have kids under 18 in the household. How can they be “quickly isolated” when childcare is an issue? Pray tell, where is the model statue to go about doing this? And who bears the costs? Or is the hope that a South Korea-style $10,000 per infraction fine will do the trick? In reality, that won’t phase Hamptons or Silicon Valley denizens.

On top of that, the reverse-transcription polymerase chain reaction test, used to test if people currently have coronavirus suffers from a high false negative rate, estimated at anywhere from 15% to 30% (usually due to faulty administration). And they apparently still do not know what the false positive rate is in the field, which could make any effort to quarantine someone who was not symptomatic against their will subject to legal challenge.

Even The Hill acknowledges some problems well down into the article:

But contact tracing can work only if the number of new cases the United States confirms every day begins to bend down to a manageable number. The number of cases confirmed in the United States has grown by at least 25,000 on all but two of the first eight days of May.

And tracing will become an effective tool only when those who are conducting the tracing have the ability to test people broadly and to get the results of those tests back quickly. The Food and Drug Administration said Friday it had approved both the first diagnostic test that could be conducted using home-collected saliva samples and the first antigen test, a type of test that delivers results much faster than others on the market.

The lack of available tests at the earliest stages of the coronavirus outbreak has hidden the true extent of the virus’s spread around the United States. While some countries have the capacity to test huge percentages of their population on a given day, the United States is still testing only about 250,000 people per day, a level far short of the capacity necessary to conduct widespread contact tracing.

Why Are We Ignoring Masks?

Getting people to mask up is way easier and faster, although it doesn’t give people in the Beltway the opportunity to strut and take credit. And by “mask” we don’t mean a surgical mask; a bandit-style cloth bandana will cover the nose and mouth and does an even better job of preventing face touching.

A new study confirms our priors. From Vanity Fair:

But a compelling new study and computer model provide fresh evidence for a simple solution to help us emerge from this nightmarish lockdown. The formula? Always social distance in public and, most importantly, wear a mask.

The day before yesterday, 21 people died of COVID-19 in Japan. In the United States, 2,129 died. Comparing overall death rates for the two countries offers an even starker point of comparison with total U.S. deaths now at a staggering 76,032 and Japan’s fatalities at 577. Japan’s population is about 38% of the U.S., but even adjusting for population, the Japanese death rate is a mere 2% of America’s.

This comes despite Japan having no lockdown, still-active subways, and many businesses that have remained open—reportedly including karaoke bars, although Japanese citizens and industries are practicing social distancing where they can. Nor have the Japanese broadly embraced contact tracing, a practice by which health authorities identify someone who has been infected and then attempt to identify everyone that person might have interacted with—and potentially infected. So how does Japan do it?

“One reason is that nearly everyone there is wearing a mask,” said De Kai, an American computer scientist with joint appointments at UC Berkeley’s International Computer Science Institute and at the Hong Kong University of Science and Technology.

Now the Japanese are also clean freaks, but the flip side is despite riding on sardine-packed subways in Tokyo, they aren’t big on hand-shaking or backslapping. They tend to maintain distance when they can. Nevertheless, masks look to be the big explanatory variable.

In the US, the state-level mask-wearing laws are wimpy. This CNN article lists only Connecticut, Hawaii, Maryland, New Jersey, New York, Pennsylvania, and Rhode Island.

New York’s is the toughest, yet you can still drive a truck through the loophole:

All residents over age 2 must wear masks or face coverings when they’re in public and social distancing isn’t possible (though maintaining at least six feet of distance is always preferred).

So if you go to a store at off hours and give other customers a berth, or hop into a cab and stay on the right side of the back seat, you are complying

By contrast, Rhode Island’s covers only employees of essential businesses.

So what is America’s excuse? Of all places, Birmingham, Alabama is doing a better job, As they are unlocking in phases, they have implemented a serious mask law, passed at a city council meeting where all the council members were wearing masks and well spread out in their chambers:

Masks or face coverings are required in all public places in Birmingham effective May 1.

The Birmingham City Council on Tuesday morning approved the ordinance requiring face coverings for all 2 and older….

The ordinance defines a mask as “A device to cover the nose and mouth of a person to impede the spread of saliva or other fluids during speaking, coughing, sneezing or other intentional or involuntary action.” It doesn’t require the masks be medical-grade, just that they cover the wearer’s nose and mouth.

The masks must be worn in all public places, which the ordinance defines as anywhere outside the person’s vehicle or home…

Business owners will also be required to make employees wear masks while at work. However, the ordinance says “this shall not be interpreted as requiring businesses to provide face coverings or masks to employees.”

Failure to comply with this ordinance is punishable by a fine of up to $500 and/or up to 30 days in the municipal jail. Woodfin says a violation of the ordinance should be treated like a curfew violation. Violators will be allowed to either pay a fine or appear in court.

That means churches too. Only exercising outdoors is exempt.

And not only has the city set meaningful fines, it is collecting them. I overheard a woman who is in a high risk category and therefore very grateful for the law, tell a cashier at the local drugstore that the police were ticketing scofflaws at the Lowes (a home supply store) the very first weekend.

Now this situation is still not ideal. The law applies only in Birmingham proper, not even in all of Jefferson County, so in my little suburb, masklessness is still the norm.

Another important part of the Birmingham move is that city officials are now always wearing masks. A big impediment to getting Americans to take mask-wearing seriously is the lack of modeling. If Democrats really wanted to get Trump’s guff as well as make a point, why aren’t Governors Newsom, Cuomo, Inslee, and all their staffs masked up, particularly for photo ops? Why aren’t Pelosi, Schumer, and all their fellow party officials sporting face wear, particularly when they get the opportunity to stand next to Republicans?

For instance, vlade says in the Czech Republic, the government mandated mask-wearing and social distancing and made a point of leading by example, which included having TV hosts wear masks. (Czech officials went over the top by making a show of wearing masks while being photographed for a lunch; advances like these Italian face shields not being on the market yet).

China was also conscious about the need to walk the talk, although it was tripping over its feet in the beginning From Agence France-Presse:

Take the first presser organized by the health ministry three days after Wuhan and its 11 million residents was placed in quarantine. Before the start, journalists wearing face masks were ordered to take them off so as not to appear on camera with them.

But “when the presser started the de-masked journalists listened as an official emphasized the importance of building a ‘face mask culture’ to prevent the virus from spreading,” Matthew Knight, our video journalist, told me.

Needless to say, it didn’t take long for reporters to be told to wear masks and to be seated a bit apart from each other too.

By contrast, here the press has if anything been playing up mask defiance, not just in covering shootings of store personnel by mask refusniks, but in the spin. The press has been dwelling on the horror, playing up the fear factor. That has the effect of discouraging other businesses from enforcing mask policies. The media should be clear about the cowardice as well as criminality of these shootings, by showing law enforcement officials describing the sentences if the suspects are tried and found guilty, and focus on the damage by presenting the victims’ families.

I wish I could be more hopeful. On the one hand, it’s great news that have a simple remedy that could get large swathes of the economy back to normal. On the other, the US seems so unable to get out of our own underwear that it’s not clear we are wiling to do something simple that works because no opportunities for corporate grift can be found. Can’t let those Gilead stockholders down, now can we?

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164 comments

  1. fresno dan

    https://kmph.com/news/local/man-arrested-outside-of-restaurant-defying-fresnos-stay-at-home-order

    Note the lack of a mask. Bear in mind there is a public order for wearing masks if one enters a business.
    When one notes how long it took to get people to use seat belts, stop smoking, and how many unhealthful activities such as over eating and over drinking people engage in, I guess I shouldn’t be surprised.
    I ordered a real cloth facemask, instead of my homemade handkerchief, and that is so much better – practically no condensation on my glasses and much more comfortable.

    Reply
  2. Lambert Strether

    Wait. I’m not seeing how requiring masks would generate massive IT consulting contracts, or provide the rationale for new and onerous surveillance mechanisms, or generate a steady revenue stream of tests for Big Pharma. Anyhow, it might work. So isn’t it rather utopian? What do our people at McKinsey think?

    Reply
    1. vlade

      Wearing a mask would require reprogramming all those face-recognition algos, so there’s your massive do-nothing IT contract.

      But that one in particular could be actually one of the few the govt does want to work, so maybe the reason not to wear the masks is elsewhere?

      Reply
  3. Eustache de Saint Pierre

    Doesn’t bode well for future collective or even individual action from countries in combating the effects of climate change, which will likely include the same factor in relation to Mr. Market’s perhaps predictable response of the show must go on no matter the possible consequences – maybe there will be an app to sort out CC too

    The 1st three charts could be given the names ” The Good, the Bad & the Ugly ” with the UK & the US seemingly dancing a deadly duet of death, while IMO shooting themselves in the feet.

    Reply
  4. nycTerrierist

    Much-needed post to share, thx!

    typo (in caps), should read:

    “If Democrats really wanted to get Trump’s guff as well as make a point, why areN’T Governors Newsom, Cuomo, Inslee, and all their staffs masked up, particularly for photo ops?…

    Reply
  5. Louis Fyne

    to correct one of those tweets: “… we don’t get fined for non-essential travel—as long as we’re not breaking quarantine…..”

    this is not right and the statement contradicts itself

    While Seoul never went under lockdown, like most of the US—-if you’re under Korean quarantine (say for testing positive or you just entered the country and are under a mandatory 14-day isolation) one can be fined $9,000 or deported if you’re caught outside of your home via tracing app or in-person check.

    Local news has multiple stores of locals and foreigners who have been fined or deported for breaking quarantine.

    That said, Korea never entered into a lock down like NYC or California. Seoul’s public transport was never shut down and never became a disease vector.

    Life has a semblance of normalcy—but discretionary spending is way down and people have hunkered down and self-isolated after going to work. Presumably the Korean behavior is what the Swedes were aiming for when Sweden chose the herd immunity-route.

    Reply
    1. Yves Smith Post author

      No, the statement is correct as written.

      Quarantine is ONLY for those who have just entered Korea or have tested positive or have been traced to someone who tested positive. It applies only to particular individuals. So everyone else can go about more or less as normal.

      Reply
  6. actionmasten

    Obviously, bumbling through without a cohesive plan won’t stop the pandemic anytime soon, with or without masks and tracing. But, after listening to an interview with smallpox slayer, Larry Brilliant on Al Franken’s podcast yesterday I learned a serious plan was submitted to Congress 2 weeks ago by Andy Slavitt, Brilliant and others. A Medium article by Slavitt, from April 28, which includes the letter

    https://medium.com/@ASlavitt/to-open-the-us-economy-we-need-a-contact-tracing-workforce-of-180-000-82ebad460a2a

    “The major pieces:
    A national 180,000 person contact tracing workforce
    $4.5 billion to allow people to voluntarily isolate at a hotel if there’s no room at home
    $30 billion to replace income for people who had to isolate
    Engaging primary care physicians”

    Reply
    1. Yves Smith Post author

      Huh? This shows it’s unserious Even of the only 82% who have cell phones (and my guesstimate is only <80% carry them all the time), fewer than half would install an app that will trace them. So you are down to 40% of the population unless you provide for sanctions, which I see nowhere. They admit that and then talk past if as if they've solved it when they haven't:

      It was clear that these apps would have to be opt-in, not opt-out — the tech firms were clearly sensitive to privacy concerned. 40% of people opting-in felt optimistic. And if the infected person and their contact both needed to opt-in, that could make the effectiveness only 16%.

      Reply
      1. xkeyscored

        The way I read it, that’s exactly why Slavitt was recommending a 180,000 person contact tracing workforce, rather than relying on phone apps.

        Reply
        1. Yves Smith Post author

          With all due respect, you are acting as if intoning “contact tracing” and hiring people produces results how, by magic?

          How does this contact tracing force find people who have been sick in the first place? Testing is too late and sparse.

          And if it’s not via cell phone GPS location, how do you think this works? You seriously expect the infected person to remember when and where they were for the first two days they exhibited symptoms, and the four days before that, down to times of day and who they interacted with? And then actually have their names and contact information too AND be willing to provide that?

          And what happens when people contacted say “Nope, your information is wrong, never near the place/person that day?”

          In China, they apparently had 180,000 teams of five, and that was using China’s total surveillance tech. Even so, you can see they effectively abandoned that and went instead for intensive temperature checks and forced confinement (as in not letting people out).

          And how do you get people to isolate? This is a total fail even if the fantasy contract tracing part worked. Contact tracing is pointless if you can’t get people to quarantine, which really means force people to quarantine. They were forced even in supposedly cooperative Confucian China and South Korea.

          Why do people who are normally smarter than this go all fuzzy headed when they hear “contact tracing”? Has none of you ever managed a project of any complexity? Everyone seems to think this all works by itself or pretty close to that.

          Reply
          1. Conal

            I agree that contact tracing can’t be scaled up to meet the requirements of the mass outbreak in the US today, but if blunt and broad measures (including mask-wearing, social distancing, curfews and lockdowns, etc) can reduce the scale of the epidemic massively, then contact tracing can still make an effective contribution to dealing with the tail of the epidemic.

            Mask wearing is not mandatory anywhere here in Australia. You do often see bus drivers and some shop-workers wearing them in public, and it’s true there’s been a big jump in the number of people wearing masks in public, but from what I’ve seen it’s almost entirely among Asian communities, still.

            In general, any measure which can reduce the viral transmission rate, even a little, is helpful, and the benefits of all such measures are compounded. For contact tracing in particular, every additional contact who is traced is one fewer potential spreader, so every source of contact data is useful. Even if a person has an imperfect memory of their whereabouts over the last few weeks, they are likely to remember at least some of it, and often these would be the most epidemiologically significant parts (“I had lunch with my friend X at Cafe Y that Thursday”, “I caught the bus / train / riverboat from point A to point B to go to my hairdressers”…). These memories can be supplemented by bank-card transaction details, public transit electronic records, personal diary/calendar entries, and yes, even those contact-tracing apps using Bluetooth Low Energy handshakes can be helpful, though they would have to have some significant uptake.

            Here in Australia, the federal government has pushed a BTLE app called CovidSafe (it’s a locally branded version of the Singaporean TraceTogether app), and as is par for the course they’ve done an appalling job.

            A key requirement is to maximize uptake, and hence public trust is super-important. The public already and justifiably has little trust in the feds’ information technology efforts or for their respect for privacy (for a number of reasons: the official census website which famously crashed under massive load on census day, the crappified National Broadband Network, the awful “RoboDebt” scandal, the metadata retention law which gives all manner of public agencies the right to access details of Aussies’ phone calls and internet usage, the attempt to force everyone to consent to centralization of their health records in MyHealthRecord … the list of stuff-ups, incompetence, and indifference to privacy is practically endless). In this context they published the app while failing to immediately publish its source code, allowing for all kinds of wild speculation to flourish, about how it was a front for government spying. Many people believe the app is hoovering up everyone’s contacts into a centralized database (in fact, the central DB would only contain the contact logs of just those people who uploaded their own data, themselves, which would only be after they had been tested positive for Covid19, at which point their local health authorities would provide them with a security code which would allow them to upload).

            The government seemed not to really care about the critical need to ensure people understood how it actually worked; the idiot PM even stood up in a presser to tell people it would keep them safe like a “sunscreen”. Now some people think that carrying the app around on their phone will somehow ward the virus off or give them some kind of real-time alert, and this false confidence is positively harmful.

            Despite this, though, the apps have had millions of downloads, and would probably prove at least marginally useful if there were a major outbreak again, though thankfully we seem to have brought it under control here now.

            Apart from the poor PR around the app, there are some real technical defects, too.

            The iOS version of the app (i.e. about half the potential user base in Australia) has serious usability defects due to limitations in iOS on using BT in background apps; you have to keep the app in the foreground or it stops working. The Android app doesn’t have that problem, at least. Apple and Google are hurriedly collaborating on a technical standard to support such apps in both iOS and Android, so this particular issue will eventually be resolved.

            The information security and privacy preservation aspects of the design aren’t ideal either (though it’s nowhere near as bad as many people presume). If an infected person uploads a contacts log which includes your BT identifier, the contact tracers will get in touch with you by a phone call, for which purpose they require you to have registered your phone number in their central database. They could instead have contact people through the app itself, and not needed to record a phone number. They also keep a name in the central DB, entirely unnecessarily (though they are happy for you to use a pseudonym), and a post code. In the event of a breach of the central database’s contents, those details (especially the phone numbers) would be personally identifying information.

            The EU is pushing a new and standard protocol for these apps, which is better for preserving privacy; I expect that a second-generation of apps will get better uptake and ultimately prove more useful than the ones we have now.

            So I suspect that there may be more of a role for BTLE contact-tracing apps in future, though they are not particularly useful at the moment.

            Reply
            1. norm de plume

              Good summary.
              The potential privacy and security issues are a deal-breaker on their own, and the storage contract not going to an Aussie concern is a worry too.
              But the fact that the contract went to Amazon killed it stone dead for me.

              Reply
          2. xkeyscored

            I wasn’t trying to say Slavitt’s idea of contact tracing is magically wonderful or that it would vanquish this virus, though it does sound to me, for similar reasons to Conal above, like it would help. Just that it doesn’t seem to particularly involve cell phones or apps. There’s no mention of them in the letter they sent to Congress.

            Reply
  7. Michael Hudson

    What struck me as a lacuna in yesterday’s links was the role of SUBWAYS and public transportation — especially here in New York.
    I’m afraid to take the subway, esp. with the homeless population in the cars — and the tightly packed cars. (I’m out in Forest Hills.)
    The dream is limiting the number of people in cars. That can’t be done here, because it would require more frequent trains — and the switches haven’t been upgraded to prevent crashes. So I’m stuck at home, unable to get safely into Manhattan; and my wife too. So my point is that contact tracing is impossible.

    Reply
    1. msmolly

      I have been watching Cuomo’s briefings every day, and several days ago he announced with some fanfare that all subways would be closed and sanitized daily (between 1:00 and 5:00 a.m. I think) and that the homeless who encamped there would be moved off to some sheltering location and kept off.

      Is this not happening?

      Reply
      1. xkeyscored

        Sanitised daily? That’ll help loads. How many people will be in and out of each carriage in the other twenty hours?

        Reply
        1. JBird4049

          It always comes to the money. Who has it and who doesn’t. Who controls, it and therefore the system, and who is denied that freedom.

          Some of the reasons why some people don’t take mass transit is because of the expense, the amount of time it takes to use because of a lack of routes and/or scheduled runs, and often, shall we say, the sensory experience.

          Also, every single time that there is a budget shortfall somewhere, sometimes for the lack of fares, they cut service and maintenance, which reduces fares and makes the traffic worse for those who need to drive. Which often means that they cut even more.

          Planes, trains, buses, and even auto all need slack, maintenance, and regular expansions, but our overlords insists on running all forms of transportation, public and private, like a barebones, just-in-in-time retail business.

          And of course the homeless live in the stations, trains, and normally in the libraries, because that’s an affordable housing for them. Even in California it can really get unpleasant outside.

          Oh, is Cuomo and company going to push through the necessary upgrades to the subway or is it going to like BART (Bay Area Rapid Transit)? Always behind and never enough?

          Reply
    2. Joe Well

      But almost every large metro area on earth has a subway and the pandemic has played out very differently from one to the next.

      Reply
      1. Sacred Ground

        If by “on Earth” you don’t include North America. Very few cities in the US have any sort of rail transit at all and those that do are generations behind the rest of the world.

        Reply
        1. Joe Well

          That is so wildly untrue, I don’t know where to begin. How can people make statements like this?

          As of the 1990s, even Los Angeles has some kind of metro. Outside of The South, only a few major metros don’t, even though US metros are badly underfunded and not extensive enough. In Canada, Toronto, Montreal and Vancouver, the only true major metro areas, each have some kind of metro, and the one in Montreal is broadly comparable to those in other world cities.

          Reply
  8. JacobiteInTraining

    About 30 minutes ago, before reading this article, I got the text I have been dreading – the first one since the pandemic from the grandparents of the kids I’ve semi-sorta adopted – these are the US-traveling grandparents in the evangelical, Trump voting, Fox news viewing, potentially conspiracy-theory consuming demographic.

    It was just a link to a youtube video whose title is referring to LA hiring thousands of contact tracers. I’m kinda scared to watch it in full, because I have the suspicion based on the name of the youtube poster – and the gist of other vids that come up in the feed – that it will be something that either directly or indirectly goes down the ‘bill gates is manipulating this for moloch sacrifice’ rabbit hole.

    In the past (before the virus) I have (ahem) religiously changed the subject, avoided politics, and/or done my best to abstract out my criticisms of the magical thinking they have often come down on the side of…taking a neutral position ala Switzerland in the hopes that I can put out a vibe that does not immediately hack on their ideas and turns them off but nevertheless throws out some aspect of gentle persuasion.

    Absent their political ‘beliefs’ – mostly spoon fed propaganda from Fox & Evangelical mega pastors – they are both salt of the earth hard working people. 90% of my time with them has been great.

    But oh, what to do. What to do. Guess i better go watch the vid and…..text back something completely innocuous asking how they are doing I suppose.

    At some point though, these are the times where I may not be able to keep my cool….and if they toss out an ill-timed reference to something about their sky-father sending a plague to deal with the enemies of Jesus, and how much Trump is doing to rectify this…..I might just burn up the phone line…and burn down that familial relationship for good and always.

    I…must….keeep….coool……

    Reply
  9. Clive

    If we strip out the specifics of what is being proposed here as a public health measure (mask wearing) and return to a more fundamental evaluation of what is in play, we find an age-old interplay of societal structures, strata and standards. When I say “age-old”, I mean age-old. You can trace the lineage back centuries, for example, here’s a public health moral panic we made earlier.

    So in the framing of “why don’t you just wear a mask”, we have to look at where we are in our current act of this latter-day Gin Lane drama. And what character are we playing in it? Belonging to what social, credentialed or entitlement class? Playing to what audience?

    Are we the prurient largely (but not exclusively) middle-class or expert-class (or wanna-be expert) onlooker of our envisaged scene of moral and social dissipation where not only are our lower orders not heeding our good intentions and implied demands, but also the authority figures (yes, they are present in William Hogarth’s imagery) are not Doing Anything About It either; thus, both are the targets of our ire.

    Are we the commissioners or creators of such works or criticism about our prevailing societies and what we find abhorrent about them (their refusal to Do — as we see it — What Is good For Them)? But what is our muse for such creations? Altruism (we want to “help”)? Admonishment (we want to “punish”)? Atonement (we know we err, too, in not Doing What We Should Be Doing, in some way at least, so we want “forgiveness” for ourselves and to or from others — because ‘everyone is doing it’ or not doing it, too, ‘it’ being failing to comply with some public heath advice or other)?

    Are we seeking to understand and exonerate those who don’t follow the “obviously” good advice — but risking romanticising and excusing that which isn’t really romantic or excusable because there’s an element of assigned heedlessness whenever people don’t do what we think they should do.

    Or are we just incorrigible finger-waggers who like bossing people around and looking to justify our actions because Won’t Someone Think Of The Children (or the old people)?

    We’re all in there somewhere. Or, if not in one of those precise descriptions, playing some other defined role.

    But this isn’t how public health messaging works. When it comes to changing compliance with public health recommendations or orders, the only thing that works in the long term is persuasion. Moralising doesn’t work. Demonising doesn’t work. Coercion or legislating only works for a while, until people think they are “safe” or can “get away with it” when they’re not at risk of being subjected to the forces of coercion or falling foul of the legislation. It, rather, necessitates cultural change, to put it another way.

    Cultural change requires time, patience and a collegiate approach. You can’t screech or hector people into submission. This, I’ll postulate, is the nub of the disquiet in some quarters about the adoption, or otherwise, of mask wearing. There’s nothing at all wrong with personally, oneself, wanting this- or that- public health related behavioural outcome. But it can’t, if it is to be successful, be imposed. It can’t even be guaranteed to receive widespread adoption. There is always the possibility that people simply won’t do what you want them to do.

    Our societies are not, I don’t think, easily able cope with this dynamic. We’ve totally lost the art of gentle, constructive, persuasion. We want and expect instant results. We want what we want and we want people to do it now. When they don’t, there is the all-too-easy temptation to start shouting at them, or calling them stupid, or marginalising or otherwise disenfranchising them in some way. Suffice to say, that is not going to be any more successful in converting the dubious.

    The art of persuasion is going to have to be re-learned. That, too, requires patience. A commodity which is in short supply, so it seems.

    Reply
    1. Yves Smith Post author

      I have to disagree. I’ve read the literature on propaganda pretty extensively. The record shows that public opinion can be changed on a mass basis in six weeks. The problem is that the Republicans are keen to pander to the libertarians, and the media is keen to play up social divisions. And even if the Democrats were in charge, they’d probably be too chickenshit to pull out the MIghty Wurlitzer. I’m just surprised that big business isn’t demanding it, but they are currently high on their bailout supply. They don’t get that we are on course for a depression and their stimulus just means they fall off the cliff a bit later than little people.

      And the word on masks (ex Taleb) is pretty new. The needs of everyone ex Big Pharma grifters may prevail, but even so, that fight will take a few months. Some officials and business leaders in red states getting sick might also produce some conversions.

      Unlike Texas, I don’t see opposition to mask wearing here in Alabama. I just see inertia. A lot of people regard it as too much bother to go procure or make masks, as opposed to an offense to their precious liberties.

      Reply
      1. vlade

        Maybe the Texans and all those against masks should be told about the large govt tracing programme using face recognition. And wearing a good mask/bandana as a way to stick it to the state?

        Reply
      2. PlutoniumKun

        Its a long time ago since I’ve read it, but there is also an extensive literature on social changes. As you say with propaganda, what the research indicates is that social changes, contrary to popular opinion, are rarely slow, gradual things. They often happen very rapidly, when a tipping point is reached. Good social policy uses carrots and sticks to drag public opinion over that tipping point (I hate to use that term, since its become so favoured by a certain type of behavioural economist, but I don’t know any other useful one). In many cases, rapid and decisive changes can be made when there are certain preconditions (usually, an underlying disenchantment among the public with the way things are).

        A good example is the Irish public smoking ban, the first in the world. It was met with widespread scepticism, but it altered behaviour remarkably quickly. While other countries tried to implement smoking controls in an incremental manner, Ireland went for a big bang approach, which proved far more successful. I remember the general surprise that it was so popular, even with hard core smokers. The key point in its success was I think good communication and prep work, along with very firm and unambiguous enforcement.

        It should be said though that a badly thought through policy can make things much worse – in Japan, Abe’s horribly misconstrued ‘2 free masks per household’ offer led to mockery and (by Japanese standards) widespread disobedience. I’m not sure how you’d do it in the US, since pretty much any attempt to bring in masks will be politicised by one side or the other. I can’t help feeling that if Trump went all in on ‘everyone should wear a mask’, suddenly liberal Dems would find an excuse not to wear one.

        Reply
      3. Clive

        The US may well be different, but in the UK I don’t see any agent or agents with any credibility at all at the moment who could move the dial for any particular policy position. Conversely, the level of public scepticism across all estates (politicians, media — be it mainstream, alt or alt-alt, “experts”, the punditry, you name it) is breath-taking. A more contrarian society would be difficult to imagine.

        Plus many propaganda models now seem hopelessly — almost comically — out-of-date. You show someone Thatcher-era — or even Blair-era — messaging and you can’t believe anyone was ever taken in by it.

        And reduced barriers to entry have sent propaganda costs plummeting. There is huge oversupply into a fully saturated market for opinion making. The population is not only over-solicited with a cacophony of messaging (so cut-throughs are pretty much random, no matter how carefully constructed they may be) but it is also savvy in a way which couldn’t be imagined even 10 years ago. Some apparently (or so it’s creators hoped) sophisticated and subtle planted — or even overt — opinion leading attempt gets spotted and trashed on Twitter in a couple of hours.

        The Sardines movement, for example was obviously a funded, managed, manufactured, curated but ultimately (for these reasons) inorganic attempt to turn back populism. It lacked critical mass and authenticity so never reached a point where it could become self-sustaining. So it fizzled away. Of course, it’s possible that new attempts could be made to do a similar kick-starter initiative on COVID-19 public health policy — but very difficult to predict when, or if, it would succeed. More likely than not it wouldn’t. So both deep pockets and persistence would be needed. Your Bill Gates’ and George Soros’ of this world don’t lack for money, but they don’t have the required patience to see these things through. Plus, in six months or a year’s time, there’ll be a different set of issues to fix anyway. And reliance on propaganda in the absence of any other vectors is also somewhat magical thinking, too.

        This is all good in terms of furthering individualism, but as we’re finding, when you need to instil change or social reform for a broader societal benefit, it’s like herding cats.

        Reply
        1. Fíréan

          The interest amongst some parties is not masks yet vaccines .

          ” The most influential members of the UK Government advisory team have demonstrated a blatant conflict of interest through their connections to the Bill Gates empire, but the British Government itself has invested heavily in the global immunisation concept that Gates is engineering through all manner of public and private sector initiatives. ”
          Quoted from the article.

          https://off-guardian.org/2020/05/10/covid19-the-big-pharma-players-behind-uk-government-lockdown/

          And , seperate quote , ref Gates.
          ” One of the questions I get asked the most these days is when the world will be able to go back to the way things were in December before the coronavirus pandemic. My answer is always the same: when we have an almost perfect drug to treat COVID–19, or when almost every person on the planet has been vaccinated against coronavirus.

          – Bill Gates — Gates Notes

          This linked article is part two of a very comprehensive two part article.

          Reply
      4. Oso

        Yves, i’ve observed something on a small scale in Cali urban areas regarding mask-wearing, appeals to the general public by public figures who are closely intertwined with hip-hop culture and activism makes an impression upon the youth. basically you’re a badass to mask up. young people everywhere thru music and media are strongly influenced by black/brown culture. use it to promote masking and social distancing. would even appeal to the young folks in the red states whose parents are at anti-lockdown protests. plenty of artists and athletes would be happy to join in. if nothing else would boost their street cred.

        Reply
      5. Susan the other

        About inertia. On the positive side, on NPR a few days ago there were instructions for making masks. One of the suggestions that was interesting was to use nylon or some other synthetic fabric sandwiched between the cotton layers of the bandana. Because synthetics have an electrostatic effect which better captures both moisture droplets and tiny particles. Easy to make – all you need is a pair of scissors – as synthetics usually don’t fray and can be cut and worn like the Venezuelan nurse demo or a bandana. So a short tangent: it is dawning on me that “inertia” might be what we substitute for freedom. Like a negative freedom when positive options have been eliminated from the system – the propaganda still works. When it comes to congress I’m certain that is true. Land of the free; home of the inert.

        Reply
        1. Travis Bickle

          It’s also been found that a piece of nylon legging can be trimmed-down and used to flatten and hold a simple cloth mask more securely, enhancing its effectiveness dramatically. This can create an a tight seal on even an improvised cloth mask.

          What is needed is not a full-head armed robber presentation (although that would also work), but just a section of the nylon, flattened and tied around a multi-layer clothe piece, and even a folded bandana will do.

          The problem with all these masks, including a N95 that isn’t properly mounted, is the seal.

          What you’re saying about complacency, even in the face of what is happening, is a huge problem

          Reply
      6. curlydan

        I agree that mask wearing could be accomplished quickly here. If we had a leader and uniter (aka President) who could make the case that wearing a mask is “patriotic” or even essential to the good of the country, people would rally behind it.

        The media show all the time that opinions on countries and policies can be flipped on a dime so to speak. We can demonize any country in a matter of weeks. We could do the opposite as well.

        We also have the “power” (just not the current will) to make people wear masks. We just don’t have the leader to do it. He’s a petulant little brat. I’m not saying the other side are angels, but it’s Trump who needs to pull the trigger on this.

        If I were in charge, I’d say mandatory mask policy until the 7-day moving average of new cases per day falls below 1,000.

        Reply
    2. ScottW

      You make good points and my response is more of an inquiry for discussion, rather than an argument against what you say.

      How did we get to the point in which the “No shirt, No Shoes, No enter,” mantra was universally accepted? We never hear of fights or shootings by a customer who refuses to put on a shirt or shoes before entering a store. Likewise with being told you can’t bring your dog into the store. What is the response of mask-wearing objectors to having it pointed out to them they already comply with these public health requirements and wearing a mask is actually more important at this point than wearing a shirt, shoes, or leaving dogs outside?

      Traffic laws are a form of public health and no one argues we should not enforce them punitively. Likewise with food safety, environmental regulations, restaurant inspections, etc. We banned smoking in buildings when many predicted doom for businesses by doing so.

      It seems your arguments apply more to getting someone to quit smoking, or drinking, which does not directly affect my health (unless you live with them) than requiring another to wear a mask which directly affects my health.

      Time is of the essence and patient persuasion may never work for a good portion of the public.

      Reply
      1. xkeyscored

        Traffic laws are a form of public health and no one argues we should not enforce them punitively.

        I don’t know where you’re thinking of, but that is not my experience at all. Many people argue they should not be enforced strictly or punitively, and indeed they often aren’t. Last time I was in the UK I got the firm impression the 70mph motorway speed limits were being neither obeyed nor enforced, with most cars doing more like 90, and I’ve read of some self-driving car firms in the US having to alter their algorithms so as not to follow the law, as doing so would put them in conflict with the majority of drivers who regularly flout it.

        Reply
        1. Dirk77

          I was taught that going with the flow should also be considered, which seems to be about 5 mph over the speed limit where I’ve lived in the US, outliers depending on how well the local police ticket. Perhaps flow in the UK is higher, or the usual norms bring cultural.

          Reply
          1. xkeyscored

            I’m quite sure the many 90mph drivers would argue loudly that the laws should not be punitively enforced.
            And UK traffic wardens, who mostly enforce parking regulations, are routinely pleaded with to be lax.

            I expect many of those who do argue for lax enforcement of traffic laws also argue against compulsory and enforced mask wearing.

            Reply
            1. Dirk77

              Ha. The UK is missing out on a good funding source then. Perhaps in the UK the authorities know their people, and 70 really means 90 bc if they said 90 people would go 110.

              Reply
              1. xkeyscored

                When I was a kid there, 70 meant 70, occasionally 75, for the great majority of drivers. The move to 90 took place in the 80s, coincidentally or not the Thatcher years of “F*** society.”

                Reply
                1. Dirk77

                  Interesting. I wonder if driving behavior also changed in the US, but I’ve been living in heavily congested places so getting to the speed limit has become a rarity.

                  Reply
                2. Tom Bradford

                  When I was a kid in the UK 75mph was pretty much foot-to-the-floor for most drivers in their Austin 10s and Morris Minors. It was in the ’80’s that Japanese engineering in cars able to cruise at 90mph began to penetrate the market, so I don’t agree you can blame Thatcher for that.

                  Reply
      2. Dirk77

        Good points. Reading this article reminded me that the local cannabis show on the county public channel, which I sometimes watch at dinner time, has everyone wearing masks. I thought that was over the top, but the arguments about setting an example and social conditioning seem persuasive.

        Reply
      3. False Solace

        “No shirt, no shoes, no service” was enforced against dirty hippies by conservative shop owners. Thanks to Trump and other members of the billionaire class, we now have a political division where boozhie conservatives are lined up to protest protection orders. The establishment always views conservative complaints as legitimate and leftist complaints as illegitimate. (I’m specifically using the term leftist, not liberal. Liberals, as corporatists, are sometimes considered legitimate.) So we’re not in the same situation as the 60s. The media is going to treat these monied, armed, conservative germ-spraying mask refusers with kid gloves and sympathy.

        Reply
    3. mpalomar

      We’ve totally lost the art of gentle, constructive, persuasion. We want and expect instant results.
      This is a telling assessment contextualized within what is perhaps the end game of the neoliberal era.

      Cultural change requires time, patience and a collegiate approach. You can’t screech or hector people into submission. Benevolent culture change requires patience and a collegiate approach.

      There is the ‘at the point of a gun’ approach and its variations that produces more immediate change, eventually that change becomes ingrained and may be called cultural; it is also likely to manifest as subliminal and overt sociopathy or dystopian, eg. armed citizens in statehouses, mask resistance, age cohorts pitted against one another .

      We may be in that sociopathic range now given the coercive societal changes wrought by the neo liberals over the last half century. Their underlying premise, often summed up by Thatcher’s turn of phrase ‘there is no society…” was to atomize the herd for exploitative culling by the predator class. Now that we confront the imperative of functioning societies we are left with this conundrum.

      Reply
    4. SteveW

      Respectfully disagree. Effective pandemic responses and their adherence required people to be in “scare mode”, perhaps even a bit panicky. Or to be socially responsible. Or to be submissive to authorities. This virus is not scary to many people. If it were Ebola, everyone would be in masks and deep isolation now. Also, much of the U.S. population would look at pandemic as being transient, so how do you persuade an essentially selfish population that seeks instant gratification?

      Reply
      1. Clive

        As prohibition clearly demonstrated as a matter of historical fact, there are limits to public tolerance for public health measures to be enforced where there is — not even a majority, a substantial minority will do — antipathy towards it.

        Reply
        1. vlade

          No-one died of a single beer (well, not many, anyways), and most people have direct experience with that.

          Based on polls, majority of the UK disagrees with the government on relaxing the lockdown, so agrees – right now – with a public health measure. Of course, that will evaporate as the body count drops.

          There was a large upheaval before the UK banned smoking in pubs and restaurants. Yet it went over pretty well, and I don’t remember any visible movement to reinstate it.

          Reply
          1. Clive

            The U.K. ban on smoking in enclosed spaces would be my go-to evidence to support my point. It took ten years from instigation (assuming the real starting point was in 1997 for the voluntary ban or informal code) to, finally, legislation and adoption.

            And this was for about a no-brain’er public health policy as it is possible to think of.

            Could the eventual outcome have been accelerated by moving directly to a legislative (or prohibition) approach? Possibly. But equally possibly, public appetite and tolerance for this starchiest of pinafores Nanny State disciplining would not have been strong enough for the legislation to have been as far-reaching as it was eventually enacted. It’s conceivable that a rush to brandish the statute book would have resulted in watered-down curtailment which had to be baby steps to gain public acceptance.

            And, of course, the tobacco companies, the pub trade and, predictably, smokers did not simply roll over and let their tummies get tickled by the anti-smoking lobby. Far from it.

            Key takeaways for a successful public health policy campaign from the link above:

            The campaign strategy was to build a broad coalition and to lever political action by government through coalition pressure; and also through

            promoting evidence‐based arguments

            proactive and reactive media coverage

            building positive public opinion

            developing local action by working with local authorities

            sectoral action working with employers and lawyers; and

            political support in both Houses of Parliament.

            Mask adoption has barely got started on even some of these, let alone all. And yet, going back to my “wanting instant results” comment, the stamina, commitment and being willing to stay in the game for the long haul ethos is not exactly being highlighted there.

            Reply
          2. Yves Smith Post author

            To your point, 93% of the people in the US think the lockdowns are being lifted too early. That high a level of agreement almost never occurs in polling.

            Reply
            1. xkeyscored

              That may be the result of one poll, but not all seem to agree.

              “As some states have begun to slowly ease restrictions on businesses and individuals, the poll finds that 71% of Americans favor requiring people to stay in their homes except for essential errands. Support for such measures is down slightly from 80% two weeks earlier.

              Similarly, 67% of Americans now say they favor requiring bars and restaurants to close, down from 76% in the earlier poll. The poll also suggested dipping support for requiring Americans to limit gatherings to 10 people or fewer (from 82% to 75%) and requiring postponement of nonessential medical care (from 68% to 57%).”

              https://www.csmonitor.com/USA/Politics/2020/0511/Poll-Most-Americans-disapprove-of-anti-lockdown-protests
              “The AP-NORC poll of 1,002 adults was conducted April 30-May 4”

              Reply
              1. Yves Smith Post author

                Survey results are extremely sensitive to how the question is phrased. Remember I did survey research early on.

                “….requiring people to stay in their homes” emphasizes the coerciveness and is assured to get less approval than a more neutral phrasing.

                And no one has required restaurants to close. They are allowed to do takeout/curbside everywhere. This is a rank fabrication.

                Reply
                1. xkeyscored

                  Exactly what I was getting at. “93% of the people in the US think the lockdowns are being lifted too early” depends very much on how the question was phrased and what questions or cues came before, as well as a host of other factors.

                  Reply
        2. xkeyscored

          Was prohibition even intended purely as a public health measure? I always thought moral disapproval was a large part of it, and that’s certainly how many perceived it, whatever the intentions.

          Reply
          1. pricklyone

            This is the way I understand it, as well. Churches. Temperance Leagues, etc were on the forefront, and did some fine lobbying.

            Reply
  10. PlutoniumKun

    At the very beginning of this, the writer of the Ask a Korean Blog semi-jokingly predicted that the virus would expose every countries worst trait – Chinese authoritarianism, South Korean religious nut jobs, Japanese sclerotic bureaucracy. He didn’t expect, as he said, to find that all three combined in the US.

    The virus is a very efficient stress test for all countries, and we are seeing surprising results. Who would have thought that the Greeks would turn out to be among the best performers? Mostly it seemed because after years of hardship they were willing to act very decisively to prevent yet another disaster. The smaller Eastern European countries have also impressed a lot. Canada and Sweden seem victims of their own smugness and a refusal to admit that poorer less developed countries could teach them something. The US and UK have predictably discovered that decades of ignoring or undermining the public sector has resulted in an inability to react when the public sector is needed most.

    Its still early days – a seemingly inevitable second wave may undermine supposed successes (as it seems to have already with Singapore), and maybe herd immunity really does exist, and will save the embarrassment of the Swedes and English (I say the English, because Scotland and NI have desperately been trying to do a better job than London).

    But so far I would say there is only one thing that is reasonably clear – countries that took quick, decisive action did better than those who took a ‘wait and see’ approach. And also, that assuming the WHO was too cautious was a very good and safe assumption to make. Thats all we really know for sure.

    Reply
    1. vlade

      The thing is that a decisive approach in Feb (where “all” it really needed was travel clampdown + SK like test & Trace) would have saved a lot.

      That said, if it was adopted, by now we’d be hearing the screams on how unnecessary it was, as it would become a victim of its own sucess and the lack of counterfactual.

      Reply
      1. PlutoniumKun

        Yes, that’s the paradox – its been argued that one reason WHO was so slow off the mark is that it got a lot of pressure over its supposed over-reaction to Bird Flu and Ebola – yet all indications are that neither became a serious problem precisely because rapid reaction worked.

        But fortunately, there is always a Trump (or Boris) to provide a good counterfactual. I’m surprised the Swedes are taking on that role too, but I guess they like to be a bit different.

        Reply
    2. td

      The situation in Canada is actually more complex than the graph indicates. For starters, if you actually look at scale, Canada flattened the curve at half the death rate currently occurring in the US. Then, we have Montreal, where half of the national cases have occurred and where the curve has not flattened. All the other provinces than Quebec either prevented serious outbreaks or are in strong downward trends. To be fair, that just started in Ontario.

      The explanation has three parts:

      1. Care Homes for the elderly and disabled, where more than half of the deaths have occurred. Sweden also suffered from excessive optimism about how ready such places were.

      2. March Break. Around the middle of March, there was a wave of young and old heading for a week or two in warmer climes. This was especially true of Montreal. This was a failure on the part of all levels of government to tell or force people to stay home, which they did the week after. I gather lots of Swedes went south for vacations and brought the bug back with them.

      3. Large scale food processing plants. Any work environment where people work closely together was an outbreak ready to happen and food was regarded as essential, again with excessive optimism about readiness. Half of the cases in Alberta came from meatpacking.

      British Columbia had cases early, like Washington state, and handled the outbreak especially well. Some of the smaller places like New Brunswick and Nunavut blocked inward travel and are essentially virus free at this point.

      There is much to be learned from many countries by examining the details.

      Reply
      1. ObjectiveFunction

        Agreed! In Singapore, the “circuit breaker” stay home orders definitely canceled out the spike in cases brought in by returnees (mostly students). Transmission among residents is in single digits per day now.

        But the foreign worker dormitories, with their close quarters conditions, have proven to be plague ships, especially under lockdown. They drive the vast bulk of the caseload here; hospitalization rates are about 10%.
        In case any further proof were needed that crowding needs to be the primary focus, in addition to better universal PPE and new behaviors. Hence the robot dogs!

        Reply
        1. ObjectiveFunction

          …Here’s my Singapore source data. Seeking truth from facts.

          The Erin Bromage piece (an immunologist at UMass) posted by Lambert in Links yesterday is definitely a must-read!

          1 line summary: to ‘solve the biology’, we must start with PPE, but also avoid crowds and poor ventilation.

          So disperse to your homes, citizens, before we send in the m̶e̶n̶ ̶w̶i̶t̶h̶ ̶s̶t̶i̶c̶k̶s̶ s̶c̶o̶o̶p̶s̶ robot dogs!

          Reply
    3. SteveW

      You are right. Canadian here. We did “wait and see”. Smugness — public official in February til early March kept saying that the risk is very low and they knew what they were doing and that they were “prepared” because of the SARS experience. There was very little border (airports) epidemic actions. The Premier told people to go and have a good time for March break. Pandemic requires early responses by definition to deal with the exponential growth characteristics. But then if we took decisive action and the virus is controlled, people would consider it much ado about nothing.

      Reply
    4. Carolinian

      I think we should make clear that the US is not a monolithic entity and that the impact of the disease within the country varies greatly. In my county of 300,000 people there are 300 or so known to be positive for covid and around a dozen deaths. An adjacent less urbanized county only has a couple of dozen cases and zero deaths. There is no place in the US that even comes close to NYC and environs even though that’s where most of the coverage originates. Here’s suggesting that the great impact of the epidemic is less about our dysfunction as a society and more about specific practical failings of a crowded city with lots of international air travel. If you subtract New York metro you’d lose about a third of our cases and while that would still leave quite a lot it would be spread over 300 million people.

      I say let’s quit worrying about who’s to blame and move forward with practical ideas as suggested in the above headline. Certainly anyone over 60 should be wearing a mask to go to stores and probably stay away from restaurants or bars–at least if they don’t want to get sick. But the degree to which the disease is a threat to younger people is very much up in the air despite anecdotal accounts to the contrary. If we want to be “practical” then evidence based must be the rule.

      Reply
      1. curlydan

        Here is a list of the top infected counties. You’ll see Trousdale, TN listed #1 with 14,175 confirmed cases per 100K residents. In other words, 14% of the population of that county has a confirmed case of COVID.

        https://www.statista.com/statistics/1109053/coronavirus-covid19-cases-rates-us-americans-most-impacted-counties/

        In fact, most of the top 10 are rural counties. Until we get the national confirmed cases down, COVID will continue to pop up in wave after wave of large and small communities alike.

        I’m reminded of the Blondie song, “One Way or Another”. Unless we push the national cases down, the virus will find you and get you.

        Reply
        1. Carolinian

          Reply pending but the deaths per 100k for Tennessee is 4 and for NY state it is 138 as of today. For SC it is 6.

          Reply
        2. BobW

          Trousdale county is the site of Turner prison in Hartsville. Prisons, like retirement homes, are known foci of infections. Worse than NYC subways.

          Reply
      2. xkeyscored

        Whether the purpose of wearing a mask is to protect others or to promote general awareness of COVID, why should over-60s be wearing them any more than everyone else in stores?

        Reply
        1. Carolinian

          On the assumption that it spreads via droplets and that simple masks therefore protect from infection as well as prevent spreading. Yesterday’s how does it spread link seemed to support this.

          Reply
          1. Yves Smith Post author

            No, surgical masks do not protect someone FROM getting coronavirus. It reduces spread. Fer Chrissakes, look at how front line medical professionals are getting sick and freaked out about getting sick.

            We’ve had this discussion in nauseating detail in comments and I’m appalled you are making me debunk your disinformation. Only a n95 mask could prevent you from contracting coronavirus. They require training to wear properly. Because they are so hard to breathe through that they reduce air exchange, most people can’t wear them for more than a half hour to an hour at a clip. As a result. they may not be all that much more effective than a surgical mask in real life due to not being fitted to the face properly.

            https://academic.oup.com/annweh/article/55/8/917/265317

            Reply
            1. Carolinian

              I didn’t say they would provide absolute protection as is needed by a medical professional dealing with verifiably sick people all day in small enclosed spaces.

              Medical-grade masks include disposable surgical face masks and N95 respirators. Surgical face masks are used to block large particles and respiratory droplets (which are sent into the air when someone coughs or sneezes) from entering [emphasis mine] or exiting your mouth. Tight-fitting N95 respirator masks are designed to filter smoke, small particles and airborne viruses.

              http://www.cnet.com/how-to/which-face-masks-protect-against-coronavirus/

              Since it now seems to be widely believed that droplets rather than aerosols are the main danger and that surgical masks can block droplets from exiting your mouth into the atmosphere it’s only logical that they can also block droplets from entering your mouth to at least some degree and perhaps to a great degree if you also maintain social distancing and avoid crowds….i.e. a grocery store situation. To be sure those droplets may go around the poorly sealed edges and I’ve seen an article–can dig it up if needed–that suggested simple masks only block droplets 80 percent or so of the time and block virus particles 50 percent of the time.

              I don’t think my statement is unreasonable although perhaps I should have been clearer and more explicit. Which is to say simple masks are likely to provide some protection in both directions and the vulnerable should wear them.

              Reply
              1. Yves Smith Post author

                Your surmise does not cut it. Please provide links. I have yet to see research or an expert support your claim. They usually go to great lengths to take the opposite position, that masks protect others, and not the user much, unless a properly fitted and deployed n95.

                Reply
              2. xkeyscored

                Carolinian – If under-60s are in stores without masks, wouldn’t that result in more virus in the air and on things?

                And if the over-60s are there, with or without masks, wouldn’t the virus have more chance of getting onto their hair, clothes, shoes and wherever, as well as onto stuff they touch or buy, and thence to their mouth, nose or eyes? They may be able to go home, strip naked and sanitise everything, including themselves, before touching their faces etc, but wouldn’t exposing them to less virus in the first place, eg by everyone in stores wearing masks, not just the most vulnerable, be a better idea?

                Reply
                1. Carolinian

                  I’m not posing as a medical authority here and get my info from the internet like everyone else. And yes in an ideal world everyone in stores would be wearing masks (store employees now do). I’m just asserting that it is much more important that older and vulnerable people wear them because it’s likely they do offer some protection–not absolute protection–against breathing virus droplets.

                  What I do very much believe is that it is up to older people to protect themselves as much as possible and not blame young people for doing what young people do which is be young.

                  Reply
  11. Edward

    This is not a new problem. Like all the other problems in this country, Americans have had many opportunities to correct the situation, but the elites refuse to change the status quo. The failed federal response to Superstorm Sandy, which was put to shame by Occupy Wallstreet, may have been due to the fact that the FEMA director was a political appointee without expertise. We saw a similar situation in the aftermath of Katrina; “Heck of a job Brownie” had a background with horse racing, as I recall. The Flint, MI crisis drags on, and given the EPA’s removal of environmental protections, will probably be replicated elsewhere, not eliminated. Puerto Rico is still burdened with both a fiscal crisis and a failed hurricane recovery.

    The problems with Wall Street were foreshadowed by the Orange County financial meltdown. After the Enron electricity blackout in CA the public should have revolted. Americans have had warning after warning about Global Warming, overuse of antibiotics, risks with the dollar reserve currency status, and on and on. We have a culture, at least at the elite level, of irresponsibility, negligence, and that is not “reality based”. I have a hard time imagining the Puritans behaving this way, but this is where we are.

    Reply
    1. juno mas

      Puritans, or Pilgrims? The Puritans were originally a reformist religious group in England. Some migrated to North America in the middle 1600’s, and those who stayed multiplied in numbers greater than the original couple thousand. Their religious culture led to a population growth that impacted the native “owners” of the landscape adversely. Like folks today, they didn’t seem to understand the impact they were having.

      Reply
      1. Edward

        Fair enough– I probably should have written Pilgrims. I am just guessing about how they would behave, but they had a culture of austerity, as I understand it; they had prohibitions against a variety of behaviors. The world was a dangerous place, inviting Pilgrims to engage in dangerous behavior/sin. They had to struggle against their own weaknesses to resist these invitations. This is a mindset that I think would support social distancing and other preventative measures.

        Reply
  12. Spring Texan

    The “study” cited in the Vanity Fair article is not an actual study, but a computer simulation (which like the studies projecting infections and deaths is very subject to what assumptions are made, and is likely not particularly accurate). The evidence from actual studies is not particularly strong. And, there are real downsides to masks. A nephew who has to wear them to work has trouble breathing at the end of his shift. A friend gets a runny nose almost immediately she puts on a mask. The paper I include a link to below mentions: “existing research also provides little information on potential harms, such as “discomfort, dehydration, facial dermatitis, distress, headaches, exhaustion.” I am very disappointed by this post; cloth masks are NOT some magic answer; at best they are likely marginally effective. https://www.dora.dmu.ac.uk/bitstream/handle/2086/19526/Face%20masks%20caution%20in%20policy_v1_2020-04-22%20%28with%20disclaimers%29.pdf

    First, the very weak evidence for face masks should be reiterated. Although some important studies followed the outbreak of SARS-Cov-1 in the 2000s, by and large the quality and clarity of the evidence base for face masks as a means of reducing transmission is disappointing. Few studies examine use of face masks in community settings; those that do find no evidence of reduced transmission compared with no face masks.

    Cloth masks will retain moisture, with indeterminate consequences for their efficacyand for the creation of a microbiological environment favourable to other bacterial or viral organisms.

    Notwithstanding the weak evidence base for face masks as a standalone measure, businesses or states might see widespread or mandatory mask-wearing as a warrant for a premature return to ‘business as usual’, justifying unsafe workplaces or crowded commuting conditions in terms of the protection offered by masks.

    Reply
    1. SteveW

      There is no magic bullet. Each piece only needs to be marginally effective so as to contribute to bringing the infection rate to below 1. There is certainly more scientific studies with respect to masks than coughing/sneezing onto the elbow.

      Reply
    2. Yves Smith Post author

      The evidence is that Covid-19 is overwhelmingly transmitted by droplets, not by aerosols or surfaces. Masks most definitely will impede transmission.

      And whoever wrote that bit about masks lost all cred with the comment about masks creating an environment favorable to viruses. Viruses do not grow outside a host. This is just Making Shit Up.

      SARS is most viable at 22-25 degrees Celsius and low humidity. Warm and next to the face is less, not more favorable to it not lasting.

      https://www.hindawi.com/journals/av/2011/734690/

      Reply
    1. xkeyscored

      This, from the first link, seems a trifle hyperbolic:
      “COVID-9 would end in 2 weeks if everyone wore a face mask whenever out of the home or car.”

      Reply
      1. Rodger Mitchell

        It is virtually impossible for two mask-wearing people to communicate COVID-19 to one another.

        The incubation period is 2-14 days. Each person’s mask protects both people — i.e. double protection.

        Therefore if everyone wore a face mask, there would be no communication after 14 days. Needn’t even be an N-95. Any fabric will do.

        Not at all hyperbolic. No vaccine or cure would be necessary, because the virus would not be transmitted after 14 days. It simply would die. The corollary is “herd immunity.:

        Reply
        1. JTMcPhee

          Except, of course, for the people who have the disease and manage to leave som virus deposits on door handles, working surfaces, touch screens and the like. And masks, particularly cloth masks, leak virus particles. So nice thought, but it’s not a lay-down end to the virus. And of course it’s wishful thinking to expect that us fractious humans are going to uniformly and constantly observing mask discipline. Let alone washing their hands, touching their faces, and never spitting or sneezing when unmasked. https://www.livescience.com/are-face-masks-effective-reducing-coronavirus-spread.html

          Reply
          1. Yves Smith Post author

            Don’t making shit up:

            We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.

            https://www.nature.com/articles/s41591-020-0843-2

            Due to the state of Google, I can’t find a study I saw in the last 10 days, but it found that there were just about no cases of transmission while outdoors, and it strongly suggested that transmission was mainly by droplets, which a mask will block, and not aerosols, which a mask is not as good at impeding.

            Reply
        2. xkeyscored

          It is virtually impossible for two mask-wearing people to communicate COVID-19 to one another.

          Do you have a link for that?

          Reply
          1. SyKrass

            I believe the number is 98.5% effective when two people wear masks, Would have to google it, I’ve seen it in two separate articles, couldn’t tell you where.

            Reply
    2. juno mas

      RE: The False comparison: Lockdown vs. sickness

      I’m tired of seeing this:

      Sweden has been as successful in controlling the virus as most other nations, though its businesses remain open; its death rate is lower than those of the most hard-hit U.S. states that locked down relatively early.

      Sweden has taken a “voluntary” approach to “controlling” coronavirus, yes. And most of the population has essentially locked down. Sweden also has a national healthcare system, national housing program, and a nation paycheck protection program. Unlike, say, the U.S.

      Sweden’s population is younger and it has only one major city, Stockholm (~1.5M pop.) It is mostly a nation of small towns (<50K). Their elderly population was hammered because the virus was circulating in the younger demographic (unrestricted to lockdown) and found its way to the vulnerable aged population. Sweden did not recognize the lessons to be learned from Italy.

      Sweden's death rate is similar to the US; per million population. And the US is moving to the top of the list. For a relatively rural, isolated nation, Sweden is a train wreck.

      Reply
      1. Yves Smith Post author

        Yes, the charts above confirm your point. Sweden is in the “failure” category like the US on containing the disease. And it didn’t save the economy either:

        Sweden’s laid back approach to thecoronavirus takes a heavy death toll yet it isn’t shielding its economy.

        Despite recent warm weather, streets are quieter and business is slower because many Swedes, like Ms. Sandblom, take government guidelines seriously and even go beyond them to avoid catching the highly contagious pathogen.

        All of that is contributing to what Sweden’s government estimates will be a 6% contraction in domestic consumption this year. Combined with a forecast 10% drop in exports, Swedish authorities predict, the result will be a 7% decline in overall 2020 economic output. The eurozone economy as a whole is projected to contract by about 8% this year, according to a European Commission estimate.

        https://www.wsj.com/articles/sweden-has-avoided-a-coronavirus-lockdown-its-economy-is-hurting-anyway-11588870062

        Reply
  13. FFA

    I think that, in the future, literature studies degrees will include at least one module on the Corona Modelling ‘Pre-Print’ Paper. You create a model that gives the result you want, write about how the model shows that your proposed course of action fixes everything, upload the pdf to arxiv.org or medrxiv.org and presto: you’ve saved the world!

    I quote the arxiv pre-print [0] linked to in the Vanity Fair article:
    “Mask wearing. A gradual increase in mask wearing was modeled using a linear increase in the proportion of individuals randomly allocated with a reduced rate of transmission. The factor by which β was reduced was conservatively set to 2…”

    This paper assumes that wearing a mask has a substantial effect on the individual transmission rates and then models the result of that across a population. This paper is not begging the question [1] but it doesn’t show that fabric masks reduce transmission rates, it assumes that they do.

    I’m not surprised that we have 10,000 models for each ‘on the ground’ study. Collecting actual evidence – in a rigorous way – is slow and hard compared to writing and running a model; and we have an abundance of data scientists, economists, professional forecasters, consultants and behavioural experts with too much time on their hands.

    FWIW my personal view is that universal masking is worth doing if you do it right: South Korea distributed professionally made masks [2] and I am sure that the majority of Koreans then used them well. I think it only makes a small difference either way. I do think that contact tracing and testing (done right) is an essential part of any plan to deal with Covid-19 even if Yves criticises contact tracing done wrong. I would say more but this comment is already huge and I need to go back to work.

    [0] arxiv.org/pdf/2004.13553.pdf

    [1] The step of modelling whether a locally effective intervention will affect the overall outcome is necessary to making decisions about implementing that intervention, once you form an opinion on whether that intervention has any effect.

    [2] There was no libertarian, free market, everyone grab what they can nonsense to distributing the masks. South Korea also had the advantage of still having a manufacturing industry.

    Reply
  14. Burritonomics

    Watching the resistance to masks has been one of the most frustrating parts of this disaster. It’s even worse than it should have been, considering authorities and experts spent a good deal of March and April telling everyone that masks do nothing.

    Reply
    1. Clive

      Which is why it’s so interesting and important to evaluate the reason (or reasons) for this.

      If it is, as I am tempted to theorise, because of concerted attempts by actors — actors who were discredited in the eyes of some of their needed audiences whose cooperation was required and essential for the success of this public health policy initiative — to totemicise and make mask adoption symbolic of other, wider and not-directly-related incendiarising which they were also attempting to advance, then this is a crucial facet of our societies which everyone who would seek to emulate them must be aware of.

      Frankly, if it (mask adoption) fails to become embedded as a public health norm and this failure can reasonably be attributed to a societal Mutually Assured Discreditization (whereby every actor, be they government, opposition, agitators, media and Uncle Tom Cobbly & All seeks to delegitimise everyone else on the political stage apart from themselves and others with their same views) then this is salutary lesson which our cultures will need to learn from. Our body politic and our shared public discourse is a “commons“. And just like any commons, it is potentially despoiled by the casual, careless actions of any one member (or group or groups) who share this space.

      We all have a responsibility to protect and preserve the ability to make society-wide decisions and choices. But if, having found they’ve lost an argument, one section of society simply decides, oh, to Hell with it, if I can’t win then no-one can win (or else they refuse to play by any sort of rules and everything and everyone is fair game for snubbing out) then those sorts of protagonists deserve nothing less than to be thrown out into the wilderness.

      Reply
    2. juno mas

      I don’t recall hearing a “masks do nothing” message. I recall hearing a “don’t use N95 masks, they’re needed for healthcare workers (doctors,nurses, 1st responder). Then when the N95’s became in shorter supply and less protective surgical masks (F2100) were being instituted as a stop-gap, the message became make your own mask. Now, with greater understanding of the failure of “social distancing” the message is everyone should where a mask in close quarters.

      I just returned from the PO where masks are required for entry. Once inside, the line to the counter is marked with floor tape at eight foot separation. A woman. without a mask, walked into the small PO to look for mail while brushing up against me and several other patrons in line. No sheepish look appeared on her face. Minutes later another woman wearing a mask walked past these same patrons and stood directly behind me. After glancing at the expression of the other patrons I turned to her and said, “the end of the line starts about 16′ behind me and 8′ behind these folks who were here before you.” She was bothered and dumbfounded by the “social distance” rules.

      Reply
  15. Frank Little

    Thank you for this post. Did not realize how many fewer deaths Seoul had relative to NYC. I wonder if other places where the policing of mask use and adequate distance between people have different relationships to the police than in the US? A recent story pointed out that 35 of the 40 or so people arrested for violating social distance in NYC were black despite the many photographs of white people crammed into parks.

    I definitely agree that leaving everything on a purely voluntary basis will not be adequate to slow the rate of infection in the US, but I also think the state of law enforcement in America is such that even the most well-intentioned efforts that rely on existing police and sheriff’s departments will not only not be adequate but will cause additional suffering. You mention things like ankle monitors, but those are often faulty and have before led people to be re-arrested for supposedly violating house arrest when really their monitor was just broken.

    I don’t mention any of this because I have an alternative or to disagree with the content of this post. This is just yet another example of an already long-simmering crisis in America (housing, health care, corroded welfare state, massive prison population) that is now hindering our ability to curb the rate of infection and deal with the social and economic fallout.

    Reply
  16. The Rev Kev

    This is actually sad reading this. The reason is that when you look at the responses of different countries, they can be divided up into those that took this virus seriously and those that did not. No, more than that. You had countries out there who had sat down and drew up detailed plans on how to deal with a pandemic and thought it all out right to a local level. I mean South Korea’s plan as revealed in Michael Kim’s tweets is simply a revelation.

    And simple things like, for example, having plastic over keyboards is a simple hack that every business can so. But too often we saw so many countries that seemed to have no plans prepared and were trying to wing it. And now a price is being paid for that negligence. Trillions are being spent because for the sake of the pocket change of a few million that were not spent on planning. This is not the world’s first pandemic and won’t be the last so I hope that lessons will be draw up for the next time this happens.

    Reply
    1. SteveW

      You are right. Taiwan is the best example. Prepare and execute. They are next to mainland China with major crowded metropolitan areas, population 24M, yet only have a few hundred cases and a few deaths. Then I found out that their VP, who is in charge of the epidemic, is a well known epidermologist, a John Hopkins alumni. Also helps if he population is socially responsible.

      Reply
    2. wilroncanada

      In Canada, it was parts of the country that took the virus seriously versus parts that didn’t. In Canada, it was the provinces with the largest populations which did not: Ontario and Quebec. Both have what you might call populist or faux-populist governments. There were, of course, other factors as well: lack of attention to seniors’ care, people forced to work in close proximity without personal protection, people who are incarcerated.

      Reply
      1. Math is Your Friend

        I suspect trying to predict or explain success and failure by party in power or type of government is distinctly incomplete.

        The hardest hit provinces – Ontario and Quebec – have a number of differences from the others that may be significant.

        They have the largest cities with the largest contiguous urban areas.

        They almost certainly have the highest level of international travel.

        They are both highlyl connected by air and road to the US east coast, and they are close to New York. Analysis of imported cases indicates that a substantial majority came from the US.

        They almost certainly have the highest mass transit rider-km per capita, as well as in absolute terms.

        Roughly 40% of the country’s population is in Ontario, and most of that is in a relatively small portion of the province. The GTA (Greater Toronto Area) has 20% of the national population, and two of the busiest airports in the top 10 nationally.

        Given all these factors, Ontario seems to be handling the situation responsibly and well, the major error being early optimism… shared by a majority of jusisdictions around the world, it seems, but this was brought to realistic levels quite early. That may be part of the reason that deaths have generally been tracking about 2.5 to 3 times higher, per capita, in Quebec, but there are probably other factors in play as well. Quebec also seemed more resistant to instituting a ‘lockdown’ than other provinces.

        The worst failure would seem to be the response of the federal government which was very slow to limit international travel, and which did not limit travel from the US for a time after it was essentially banned from all other countries.

        Reply
  17. Steve

    Two months, 80k dead, you’s think if we had any hope of coming together as a society it would at least have started by now. We lack the basic capacity to get people to wear masks. We can’t even stop people from shooting people who are asking others to wear a mask. If you assume that the decision makers in charge, the 1%, have better information and better professionals advising them, how can we be where we are? How can we be at this point without the top business leaders being able to muster enough political and corporate power to change our course. Where are the supposed real adults in the room, going to in mass, to tell the Trump Administration you must resign now!

    Reply
  18. Hayek's Heelbiter

    For once in his life, Thomas Friedman is right. The world is INDEED flat.

    Or is it “flattened”?

    Reply
  19. Mikerw0

    There are broader issues at play too. How long will Americans even tolerate the necessary changes. My neighbor asked me “how long this goes on?”, I responded 2-3 years in the most likely case. She has two primary school sons and asked what does she do. She won’t accept a vaccine that isn’t tested to be safe. I said exactly.

    Our physical plant was not designed for the kind of changes required. Just look at the jerry-rigged post 9/11 security in airports and NY office buildings. Will we readily send people back to cubicle-land? Saw a report on Disney Shanghai and the changes they made to reopen. I know enough to know there is no way their economics work with the distancing and extra cleaning.

    Too many companies have margins that are too low and debt too high to change operating practices to make a safe working environment. They will fail.

    Reply
  20. Bsoder

    To be sure, it should be realized that any hunan being on earth can get infected and infect others. No one escapes this disease. Yes, indeed there are differences in everyone’s dna, but all the data to date shows that those differences change the presentation of the disease, not likely hood of infection. Some get sicker in different ways. The process of infection is a function the amount of virus one is exposed to x the amount of time one is exposed to it. Right now about the data shows about 10k virus particles will likely cause an infection, all other things being equal. Someone, sick at a at a hospital by day 5 is exhaling about a 1k virus amount. This travels up to 13 feet. Another person in the room, If both are unmasked, would take about 10 minutes to become infected. A cough releases 10k, a sneeze 200k. It’s therefore no surprise that hospitals, prisons, assisted living homes, and one’s home are the highest sources of infection.

    With lockdowns, the main benefit was to not add to the list of places with a high probability of being exposed to high viral loads for enough time to get infected. From a strict standpoint of not infecting people is not to have to many in an enclosed space for to long. Also from a workers point of view aside from PPE, limiting the time of repeated unique contacts. If you want to get sick and maybe die,or be disabled then ignore this. The same applies to masks, especially indoors. Outdoors it’s a density problem, one wants to avoid people breathing on people. But a jogger running by you with no mask has a very low chance to infect. Outside, inside the issue is more one of social psychology and behavior reinforcement.

    Lastly, as to Clive’s query as to how to end up in an end state where people are cooperating. I can only suggest Jared Diamonds analysis of why past societies have succeed or failed. He is very exacting. My thinking is unless something happens that has yet to happen, like a revolt of the people, then Covid-19 will never going away. It truly is a much more horrible disease than most can imagine. And then of course there’s climate heating. Deus vult.

    Reply
      1. Bsoder

        Your god perhaps not mine. Mine only wants people to love one another even if it should their death. And one doesn’t need to invent god to sign up for that oath.

        Reply
        1. xkeyscored

          The five versions of [Pope Urban II’s] speech differ widely from one another in regard to particulars, but all versions except that in the Gesta Francorum agree that Urban talked about the violence of European society and the necessity of maintaining the Peace of God; about helping the Greeks, who had asked for assistance; about the crimes being committed against Christians in the east; and about a new kind of war, an armed pilgrimage, and of rewards in heaven, where remission of sins was offered to any who might die in the undertaking. According to one version of the speech, the enthusiastic crowd responded with cries of Deus vult!

          https://en.wikipedia.org/wiki/First_Crusade#Council_of_Clermont

          Reply
  21. Bsoder

    Jared Diamond
    Turning points for Nations in crisis

    1. Acknowledgment that one is in a crisis.

    2. Accept responsibility; avoid victimization, self-pity, and blaming others.

    3. Building a fence / selective change.

    4.Help from other nations. This a theme of help from others.

    5. Using other nations as models.

    6. National identity.

    7. Honest self-appraisal.

    8. Historical experience of previous national crises.

    9. Patience with national failure.

    10. Situation-specific national flexibility. Psychologists use the dichotomy of flexibility versus rigidity for characterizing people.

    11. National core values.

    12. Freedom from geopolitical constraints.

    Dr. Diamond would make the point you need to be have able most of this criteria if a nation is going to solve whatever problems it has. Some do some don’t. So some fail and some succeed.

    Reply
    1. Shiloh1

      The book The Big Sort, published 12 years ago. The country as presently constituted in well beyond it’s expiration date. Way to much of one side telling others what to do or not do. Very little connection between the puppets in D.C. and most of the country. Would Jefferson disagree? Time for a pre-Bismarck type arrangement, perhaps by county or new lines drawn of two or more separate countries altogether.

      Had a discussion with a neighbor about dissolving the State Of Illinois regarding the impending bankruptcy of the state, Chicago, and other sub-entities. Solution would be like the NFL draft and board game Risk. Adjacent states of WI, IN, IA, MO would absorb the state county by adjacent county. What would be left over by all states taking a pass – likely the Rump Chicagoland area – would be its own Washington D.C. type entity, Madiganistan.

      Reply
      1. Bsoder

        I’d add all the Great Lake states and Canadian provinces into a Great Lakes Free People’s League.

        Reply
        1. HotFlash

          Why would we want to amalgamate with them? I moved here 50 years ago to get out of that horrible country and it’s gotten ‘way worse since. Keep your Great Lakes States, please.

          Reply
  22. rtah100

    Yves, I would beseech you to qualify the statement “way too late for contact tracing to work”. It risks playing into the hands of the “there’s nothing to be done” fatalists / disaster capitalists.

    It’s never too late for contact tracing to work. The problem is that you need to suppress the absolute number of non-quarantined infectious cases to a level where the contact tracing can be real resource-effective (not cost-effective – we can create the money). The purpose of lockdown is bring the new case numbers down but it needs to be combined with:
    – quarantine of contacts, before their diagnostic confirmation
    – continued quarantined if confirmed infected

    As for the question of where these people go if their home circumstances do not enable isolation, the answer is obvious. Hotels, in the first step. They are empty. If they are confirmed as cases, they have to go to dedicated fever hospital, like the Chinese built (field hospitals for the ambulatory, with medical supervision and clear escalation pathways, ideally to the hospital next-door – but at least 2m away!). Young children need to isolate with a care-giver; older children could occupy their own room. If the care-giver gets sick, the children need to go to fever hospital or some other family member has to volunteer to enter quarantine with them.

    Reply
    1. Bsoder

      What you say will help, but there is a time factor going on. Unlike other virus – Covid-19 is Pernicious. Even if you had tests that work, the results are good for that day. There isn’t going to be any herd immunity for several reasons. One of which is with 50 states and some big states at that this pandemic is very local. So fine you get one area under control, but the nature of getting food & essentials to people means no matter how careful we are, everyone gets exposed to it in the end. Yes, delaying as long as possible is good, but entropy applies to humans as well as planets. Like the guy said “life finds a way”.

      Reply
      1. xkeyscored

        There may be reasons the US never gets to herd immunity, but how is ‘everyone gets exposed to it in the end’ one of them?

        Reply
    2. Senator Blutarsky

      Not only is there a point when it’s too late for contact tracing, it also requires policies and methods to be implemented to be succesful at all.
      You need good, exact tests, so you don’t get too many false positives.
      Then, you need to quarantine all of the potentially infected and hope you have the personnel to examine all the people the infected were in contact with. And you have to quarantine many of those, too.

      All of this only works, if you start doing it very early on. When you already have 10.000s of infected people, you may get a couple of hundred thousands they were previously in contact with.
      Where is the medical personnel to apply the tests and do the examinations?
      Where do you quarantine all of them?

      The software may work, but from a certain point on, things will blow up due to sheer numbers.

      Reply
      1. rtah100

        As Shelton says below, contact tracing is not an all-or-nothing proposition:

        First, test inaccuracies can be dealt with by the protocol:
        1) trace first, and then send contacts to self-isolation
        2) send them to quarantine hospital if symptoms arise or a positive test result
        3) release them after 14 days without symptoms AND some number of negative test results (whatever it takes to raise the probability of a true negative, say three negatives in a row).

        Second, we’re happy with an 80/20 paradigm here. Most of the spreading is caused by 20% of the cases, the “super-spreaders”. The technical point is that R(t) is a mean value from an over-distributed function, i.e. most people barely transmit enough to keep the chain of infection alive and a few transmit to loads of people! If you have limited resources, target them at the people who present a risk of super-spreading:

        – people who work with the public (transport, deliveries, cashiers, healthcare etc.)
        – people who live with more than one person (if couples stay home, worst case R is 1; if families stay together, R can be 3,4,5 etc.). This applies in spades to people in institutional environments: the UK death rate plateau is driven by care home increases matching hospital decreases.

        Third, not everywhere is equally affected. Contact tracing in Idaho is going to be a lot easier than in New York City. If you have limited initial resources, you can either throw them into the crucible of NYC or you can ramp up in the areas where the outbreak has not started accelerating and snuff it out, before moving onto the worse affected areas.

        Finally, even though the US and UK have locked down too late, provided there is a lockdown, new cases are declining. Adding contact tracing in will accelerate the decline. Throw a lot of people at the initial tracing and then *keep going*, the initial win will be small but it will cumulate over a few weeks and multiply the effect of the lockdown. Look at the graphs for in the article: these are presented without absolute scale and they show the effect of taking these simple measures on the outbreak, however big the country. And the US has resources in bulk (including the bulk collection of data, NSA!) to throw at the problem.

        Reply
        1. Yves Smith Post author

          Looks like you didn’t read the post in full, which is a violation of our site Policies.

          And I am tired of people who engage in wishful thinking choosing to hector realists, just because it feels better to Do Something that is guaranteed not to work than do things that are effective or adjust expectations downward to how bad things are likely to become.

          The money we are proposing to spend on contact tracing, which is a con except for employing people who are out of work, would be better spent on other measures…like giving out masks!

          You are in “assume a can opener” mode.

          “….send contacts to self-isolation.” Fewer than 40% of Americans with cell phones will install a tracing app! You seriously think they’ll isolate for two weeks, which is a vastly bigger ask?

          And as I said, what about people in households with only one full bath? They can’t self isolate even if they wanted to.

          Reply
          1. Oso

            Yves,
            your article and responses to comments actually gave me some hope, which i thank you for. I commented above about masks and youth so won’t repeat, but it’s very prevalent in the hood/varrio, noticeably so for those essential workers who work outside the hood in white areas. motivation is the disproportionate death rate, we see it up close and most of us are extended families, elders live with the young folks. seriously, knowing we are doing the right thing helps.

            Reply
    3. HotFlash

      About masks:

      They seem to help stop the spread of corona virus, esp from infected people to the non-infected, making it a mark of courtesy and respect to others. They are not difficult to find or implement, accessible to all. Home-made and improvised seem to be more or less as effective as store-bought, and can be quite cool. I, for one, like going around looking like a ninja, I use a wrap technique similar to a face-covering hijab but simpler. I have also been called Lawrence of Arabia and The Invisible Man (by a very old person). Add to this the obvious facial-recognition-twarting possibilities, you can see why ways to wrap a shemagh is a popular topic with preppers and quasi militia on youtube. Unless, of course, they are toting guns on the MI capitol buildin, I guess.

      Conclusion: cost is negligible in time $$ and effort, making and wearing can be fun, benefits esp to others, though not proven and may be nil, may also be quite high. A good society in a pandemic would do this voluntarily, doncha think?

      About contact tracing: this seems to be a process that, although I have read that it can be anonymized, probably will not be. I mean, if some/many people won’t voluntarily wear masks, then why would those people be expected to voluntarily self-quarantine? So if there is contact tracing, it would have to come with enforcement or it’s just a big waste of time. Big Data will get to hoover up even more about us and get paid handsomely to do it! I think this should be much more disturbing to people who actually value their freedoms, such as myself. Furthermore, if quarantine is compulsory, expect armed resistance. Add to that the unreliability of tests, shortages of hospital space, staff, and supplies, lack of effective treatment or vaccine, and that we really don’t even know how the corona virus is transmitted. Conclusion: meaningful benefits might be possible, but only after great costs in $$, person-hours, privacy, and personal liberty and probably life.

      Seems like a no-brainer, but perhaps that is the problem.

      Reply
      1. Math is Your Friend

        The problem is not contact tracing, it is contact tracing via automated surveillance.

        There are other problems with contact ‘apps’, particularly including the fact that they do not detect actual contact, but rather assumed contact via inaccurate locations. I can’t thinks of a smartphone method that has been proposed that is reliably accurate to 1 metre… which they must be to detect whether two people are within a 2 metre distance.

        Reply
        1. Yves Smith Post author

          The problem IS contact tracing, in the lame-brained way the US is planning to go about it. I am floored that reader keep repeating the phase “contact tracing” and refuse to think through all the things it takes for that to produce reduction in disease. The US plan amounts to “contact tracing for the hell of it”.

          It’s not connected to any effective action, either enough testing of the population or measures to force (and you do need to force) people to quarantine, and provide enough support (like bringing food and meds) to make quarantine tolerable. You need fines, as in South Korea, or physically detaining people, as in China. And how do you prevent people from just leaving their phones at home?

          Reply
  23. MLTPB

    It seems that the states here act more independently, and perhaps, in addition to the one chart for the US, we look at state charts.

    I’d be interested in Washington state’s, being an early zone.

    Reply
  24. Shelton

    This post is written as if contact tracing is pretty much an all-or-nothing proposition, and that perspective seems off to me.

    As I understand it, you need to be able to pursue contact tracing in an all-out way if you want to essentially quash the virus within a couple months. But all a contract-tracing strategy needs to do to substantially reduce the number of infections over a longer period is to get the R rate significantly below 1, because at that point you get the benefit of compounding in the *right* direction.

    Get R to 0.8 (for example), and you’ll have 80% as many active infections after one cycle (however long that is; a month?). And 64% as many after two cycles. And about half as many after three cycles. And so on. And meanwhile, better-quality masks will become widely available and other things will presumably happen that will also contribute to the lowering of the R rate.

    Yes, there’s nothing the US is going to do at this point that will make the coronavirus essentially go away anytime before there’s a vaccine. But a reasonably-effective contact tracing strategy can help *substantially* reduce the number of casualties between now and then.

    And masks/contact-tracing isn’t an either/or thing. Yes, everyone should be wearing masks, too. But I don’t think mask-wearing requirements alone are likely to bring R below 1 in most US areas, and that means the pre-vaccine plateau level will be much higher than it needs to be.

    Reply
    1. Yves Smith Post author

      Nassim Nicholas Taleb disagrees with you, and he’s run data on pandemics. Where is your data, pray tell?

      And you utterly ignore a key point, that “contact tracing” is UTTERLY POINTLESS if you cannot get people to quarantine. That is not, “mainly stay at home but go out to grocery stores and walk the dog”. As in you do not leave your room except to go to your bathroom and you don’t share that bathroom with anyone.

      Tell me how that happens here. How do people get food? In South Korea, everyone quarantined was assigned a health care worker who checked in with them, and brought food, medicine, cleaning supplies when needed. And they were fined big time if they turned off their phones or left their apartment.

      Contact tracing without a full blown regime with resources and teeth is worse than silly. It’s a waste of resources and a pointless violation of privacy.

      Reply
      1. Shelton

        Again, you seem to be viewing this in black and white terms. You say “you cannot get people to quarantine.” But the people with the LIBERATE attitude are very much the minority. Lots of Americans are quarantining, which is why the infection increases have stopped being exponential. And lots of Americans would cooperate with any contact-tracing regime. And if the conduct of the non-cooperators meant that R only went down to 0.8 rather than 0.7 (for example), that would still result, over time, in a substantial reduction in casualties.

        Reply
        1. td

          It’s not a matter of politics. At the very least, a substantial minority chooses to go out if they need something. In the absence of food delivery that is reliable and contact-free, the majority will go out at least once a week even if they’re sick. This is especially true in food deserts where many of the bottom 50% live and of rural areas and reservations.

          Reply
          1. Oso

            td good point about the food deserts. in some urban areas activists do their best to get food and hygiene supplies out, kinda like the parable of the starfish (seemingly impossible task but at least it helps a little bit) but mostly its desperate people walking a long way or taking a bus if they want real food/essentials rather than buying ramen from an overpriced neighborhood store.

            Reply
        2. rtah100

          The perfect is the enemy of the good.

          The money quote from a recent Harvard paper modelling the effective of contact tracing and quarantine on R(t).

          “The overall impact of contact tracing depends strongly on isolation and quarantine efficacy. Median reductions in Rt assuming isolation and quarantine efficacy of 25%, 50% or 75% were 11%, 19% and 27% respectively, for strategies that tested only symptomatic contacts, and 20%, 26% and 31% for strategies that tested all contacts. The contact tracing scenario with the greatest impact overall—defined by high levels of symptomatic detection and successful tracing, high isolation and quarantine efficacy, and testing of all contacts irrespective of symptoms—reduced Rt by 46%”.

          https://www.medrxiv.org/content/10.1101/2020.05.05.20091280v1.full.pdf

          If you could crush R by 46% from 0.9, you could reduce it to 0.4 in one serial interval and it would be close to zero after 5 serial intervals.Even small reductions in R(t) matter below 1.0. An R of 0.9 will halve the new case number in 5 serial intervals. An R of 0.8 will be just over 0.5 in 2 serial intervals and just over a quarter after 5 serial intervals.

          Now, Yves, I agree with you that the logistics of quarantine need to be sorted out so people do not die in their homes. But we should be promoting solutions, not problems. Testing, tracing and isolating all need to happen. Hotels are empty. Identify contacts (manual and/or digital surveillance); send them to the hotel (immediately); test them (as and when able, you’ve got 14 days so it’s not an immediate issue), send them to fever camp if they show symptoms or fail a test, let them go after 14 days and one/two/three negative tests (depending on how cautious you are / how accurate your sample gathering is – I think it is the sampling that causes test error, not the PCR technique, as long as you don’t use the CDC reagents!).

          The US has the real resources necessary standing idle. Hotels. Labour. It probably also has the legislative basis for doing this, left over from Typhoid Mary’s time (hell, if it doesn’t, it could declare coronavirus patient enemy combatants or something as a short-cut)

          It just lacks the will to use them.

          PS: also, I read the Taleb article as saying it was too late for contact tracing ALONE and that restrictions on free movement and association would be required once the outbreak reached acceleration phase. I don’t disagree – but we have these restrictions now, buying the time he proposed, and we are just wasting it by debating contact tracing rather than trying it.

          Reply
        3. Yves Smith Post author

          No, Americans are not quarantining. You really do not get it.

          Quarantining means no contact with anyone, even members of your own family. If you live with a family, that means not leaving your room except to go to the bathroom, having them leave food outside your door and you depositing your dirty dishes outside the door when done.

          You cannot quarantine if you are in a housing unit where you can’t have your own bathroom and keep everyone else out of it. So that means you have to go to a government isolation set up of some sort. South Korea would not let people who were quarantining stay in hotels or AirBnBs, too much contagion risk to workers.

          And if you quarantine an entire household because it has only one bathroom, how does anyone get food and if they need them, medications? South Korea had everyone assigned a social worker who’d bring them what they needed. How could this work even if anyone were willing to do in America outside central cities? Look how spread out LA is, for starters.

          And to the second comment, more recent studies suggest that the R0 with no intervention is 5.7. Only 40% of the people surveyed would even install a contact tracking app. Asking them to comply with a quarantine, as opposed to mere shelter in place, with no government support like meal provision, is a vastly bigger ask.

          40% of American adults are in households with kids under 18. You can be pretty sure that nearly most in that category will not leave their house and family unless forced by law.

          So take only 40% willing to cooperate with even an app and knock that down by at least 50%. You are below the 25% assumed as the low in that study. You need state compulsion for this scheme to work and it’s na ga happen.

          As I said, these proposals are all in the “assume a can opener” category. Providing a paper showing how great it would be in theory does not cure ANY of the problems with practice.

          Masks are more effective and faster to implement. Why are you arguing for a Rube Goldberg machine? If your counterargument is “We can’t make people wear masks” that goes times 10 for all the cooperation required for even some effective quarantining.

          Reply
          1. Shelton

            I’m sorry if I technically misused the term “quarantine” as if could apply to something less than 100% isolation. The point remains that contact tracing can substantially reduce Rt (just not as dramatically) and hence substantially reduce the number of infections (just not as quickly) without being a full-on, Wuhan-style regime where everyone who tests positive is reliably prevented from having any human contact at all. Full-on Wuhan is how to get Rt close to 0, but an Rt of 0.8 — as I and rtah100 and Voltaire have already noted — can end up having a dramatic (albeit slower) positive impact.

            As I understand it, Massachusetts, New York, New Jersey, California, and a number of other states are currently recruiting contact-tracer armies, and expect to commence less-than-full-Wuhan contact-tracing strategies in the near future. Will those strategies substantially reduce the transmission rates, or are those administrations engaging in silly magical thinking, and about to find out that their less-than-perfect systems are “UTTERLY POINTLESS” (as you’ve told me)?

            Stay tuned. I’ll meet you back in this thread in September.

            And in the meantime, I don’t disagree that we should all keep wearing masks whenever we step out.

            Reply
            1. Yves Smith Post author

              No, you are still are ignoring the point. You are talking theory and ignoring the realities.

              “Contact tracing” requires a full blown program, including compulsion with obtaining contact information and compliance with the quarantine requirement, as well as providing government support to make the compulsion not seem like abuse.

              Why don’t you walk me step by step as to what exactly these contact tracers will do. I can pretty much guarantee you have not worked even that part out. These are government programs so they will need detailed policies and operations manuals.

              And see my math above. You won’t get to even 20% compliance with a quarantine given that under 50% of smartphone users are willing to take the not-horribly-demanding step of installing an app. 80% smartphone users x <50% means <40% at one step, the easiest. Cumulative probability says you have to multiply across all steps to get the success rate.

              So first you have testing. As a charitable guess, say the US is at 50% of what is needed to catch everyone.

              Then you have 40% compliance at the installing the contact app phase.

              Then you have lower than 50% compliance with the quarantine due to people having kids and not being willing to go to a dorm, not having a separate bathroom, not being willing to stay truly isolated, etc, or just being cussed.

              Oh, and let's charitably assume the contact tracing once you identify someone as sick is 80% effective due to 80% of Americans having smart phones.

              0.5 x 0.4 x 0.8 x .0.5 = 8%. And my assumptions all skew generous.

              And then you need to add in only some states are on board. Down here in Alabama, we have counties which didn't lock down at all.

              Advocates act as if this is all a handwave. The only places this has worked is with state compulsion behind the testing, contact information collection, and forced quarantine. Thee key elements. Tell me where the model legislation is.

              This is just a waste of money and a diversion of energy from measures that would work a lot better.

              Reply
  25. Oso

    Lambert,
    to me what the Lakota tribe is doing is similar to South Korea’s approach – and the governor of South Dakota has given the tribe 48 hours to stop it. please keep in mind, this is tribal land, the checkpoints are all within the reservation.
    “According to Cheyenne River Sioux Tribe checkpoint policies posted on its social media, its reservation residents may travel within South Dakota to areas the state has not deemed a Covid-19 “hotspot” if it’s for an essential activity such as medical appointments or to get supplies unavailable on the reservation. But they must complete a health questionnaire when they leave and when they return every time they go through a checkpoint.

    South Dakota residents who don’t live on the reservation are only allowed there if they’re not coming from a hotspot and it is for an essential activity. But they must also complete a health questionnaire.

    Those from a South Dakota hotspot or from outside the state cannot come to the reservation unless it is for an essential activity — but they must obtain a travel permit available on the tribe’s website.

    Both tribes have also issued strict stay-at-home orders and curfews for their communities. Noem has not issued stay-at-home orders for the state.”

    https://amp.cnn.com/cnn/2020/05/09/us/south-dakota-sioux-tribes/index.html?fbclid=IwAR2qtQn1rilzEk_BJXIugTdOGcZP08ItgYszC3OV7odKHPdgodAKYfAb4A0#referrer=https%3A%2F%2Fwww.google.com&amp_tf=From%20%251%24s

    Reply
  26. Jed

    Non-medical grade masks can help get America working again because they are great for confidence, but only false confidence. The data supporting their efficacy in reducing respiratory disease transmission, not so much.* At a local city council meeting (held via Zoom of course) the City Attorney and a Council-member went on ad nauseum about how they, unlike a neighboring municipality which provided an exemption in its mask ordinance, would require children ages two and under to be masked at all times. This of course is contrary to the universally held and widely available public health opinion that masking a child that age creates a potentially lethal respiratory threat. But of course, not having any understanding of or regard for science is what got us into this mess. Six weeks may be enough to change public opinion, but its not going to change fundamental outlook or understanding.

    https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data

    Reply
    1. FluffytheObeseCat

      It’s amazing really, how various peoples throughout the east Pacific littoral can nearly all wear masks in public without succumbing to disease and discomfort (commonly in very humid, hot climates) and in the US we somehow can’t.

      We somehow can’t trace contacts, enforce public health regs, or ask damned near anything of the public. I feel a little silly saying “I never thought I’d live to see the day……”

      But, I never did. In the US, elites contempt for the people brought us to this pass, and they are so addicted to their dual flavors of contempt they can’t even stop themselves now, when their own well-being is at stake.

      Reply
      1. JTMcPhee

        The elites are just surfing the wave of stupidity and selfishness that is made up of ordinary people in America. And yes, doing what they can to boost that wave, over decades now. But in my little neighborhood, houses selling for about $150k these days, about 150 houses and another hundred rental townhouse-style apartments, nobody is wearing masks or distancing, there are clearly parties going on with a dozen or two participants. Lots of Muscle Cars and SUVs and giant pickups.The yard signs last time were Cruz and JEB! which got overlaid with TRUMP! And MAGA!.

        The Stupid is strong with them…

        Reply
        1. JBird4049

          The Elites actually supercharged the stupid with massive amounts of poo flinging with added lying. Since most of the media is paid very well to help with this just how does Joe Chump find the truth?

          Reply
    2. Yves Smith Post author

      Please show me who has passed a statute requiring masking of two year olds and under.

      As for CIDRAP, that op ed had a lot of hand waving and no links. This looked to be amplifying CDC anti-mask messaging to keep consumers from buying surgical masks and depriving medical personnel of them.

      Tell me the medical worker who wants to deal with patients with no PPE and maybe I’ll take this seriously. And the issues with social distancing are likely to run the other way, that mask use reminds people to take disease precautions.

      Reply
  27. SteveW

    The government won’t implement and the people won’t tolerate simple trivial temporary inconveniences such as face masks. Yet they do and put up with airport security post 911. Won’t spend pennies for masks just in case yet spent trillions in military hardware. Go figure.

    Reply
  28. Cuibono

    I want to thank the author for a really well-thought-out article. I think the Mantra of test Trace quarantine and support It’s still a worthy Mantra particularly in those areas that have gotten their case loads down to manageable levels. But I concur if that comes at the cost of relaxing more simple measures that the general public can do like continued hand-washing social distancing wearing of masks and a healthy dose of Common Sense it will be all for naught

    Reply
  29. David

    There seem to be some constants about messaging, and the mask saga illustrates a couple of them. Messages have to be clear and unambiguous, and preferably tell people to do or not do things that are obvious and can be enforced. For example, in the 60s, campaigns started telling people not to drink and drive. OK, but in fact what they were really saying was don’t drink too much and drive, but could only give very rough guidance about how much that was. And men of my father’s generation were generally pretty sure they knew how much they could take and still drive safely. All of which meant that the campaign took a very long time to be effective and there was a lot of resentment about attempts to enforce it. On the other hand, no-smoking measures were binary and simple to understand, and quickly became accepted. No western country, I think, has been able to explain simply why you, as an individual , should wear a mask. In France, government spokesthings have tied themselves in knots trying to do so, and people aren’t so much resistant as puzzled. If I’m not suffering from the disease (and can be sure I’m not) then there is no benefit to me or anyone else from me wearing a mask. If I do so, it’s to help create a climate where everybody does so, such that ultimately everybody who’s contagious does so. I think that’s the logic anyway, but try explaining that in the context of liberal individualism and the primacy of individual rights.
    The other thing is that governments are often slow to act because they are afraid of the consequences of being wrong. Governments and experts have been wrong about epidemics before. Imagine shutting down the economy only to find the virus never gets outside Asia? In a sense, it could be argued that some governments guessed right, based on what was known at the time, and some guessed wrong. Patterns which seem obvious in retrospect are not always so obvious at the time. At that point, what comes into play is the political credit of a government, and it would be interesting to see how that correlates with early action. It may not be a coincidence that a number of countries with weak or unpopular governments were among the slowest to act.

    Reply
      1. Clive

        People who compile comments on devices which have been set to a locale of non-US English find this often gets messed up due to circumstances entirely beyond their control. If I inadvertently leave my Windows PC set to a Japanese input method editor, I get the same effect. I try to remember to do a double-carriage return, but even then, it ends up more often than not duplicating the line breaks or even triplicating them. Please do try to spare a thought for those of us who sometimes don’t / can’t just work with nice, easy US-localised software. It causes more pain than you’d possible believe.

        Reply
        1. xkeyscored

          I suspect David is old school when it comes to prose, finding a double line break a hideous modern departure from well-established guidelines, and wishes NC’s comment thingy allowed for indenting of paragraphs as per tradition.

          Reply
          1. JEHR

            The thing is, I have difficulty reading something that has no breaks as the lines are difficult to separate. I don’t mean any harm; just saying.

            Reply
    1. Clive

      The U.K. government is just as all-over-the-place as France’s in terms of trying to get an intelligible message on “face coverings” (which apparently aren’t the same as “masks” — who knew?)

      I do have a soupçon of sympathy. On the one hand, you have to set clear guidance that mask wearing (or face covering) isn’t a substitute for staying at home if you have any symptoms at all. So you have to drum it into people that they can’t think, oh, I’m a bit under the weather today, but hey, I’ll pop on a mask just in case so that’s alright then.

      But then the mish-mash of situational advice about when and where masks should (or, as phrased certainly in the U.K. government advice “could”) be warn seems needless prevarication.

      Reply
      1. ClawM

        So you have to drum it into people that they can’t think,

        This entire article as well as the comments is clear evidence that various governments have been very successful in “drumming into people that they can’t think . . .”, just do what you’re told, even if it offends your rights, wrecks your economic and mental health and, by the way, destroys your immune system quicker than Cuomo can inflate numbers.

        sheesh

        Reply
  30. Arizona Slim

    I’m still waiting for my government-issued mask. Y’know, the one with the red, white, and blue color scheme! Stars and stripes included!

    Or how about a Rosie the Riveter model? With the slogan, “We Can Do It!”

    Reply
    1. wilroncanada

      Sorry Arizona Slim
      They made them all red and printed them all “MAGA”, and put the stiff part the wearer can pinch at the front rather than at the top.

      Reply
  31. JEHR

    Well, this article makes real sense to me. I remember travelers arriving in Canada from Europe, China and everywhere and someone commenting to the PM that no one who got off those planes was tested or even given instructions to isolate. And this happened in the middle of March and before that date and after that date. For some reason the information he was getting from his advisors did not include closing the borders in the air as well as on land. As a result, we are going to have a problem for many months down the road or at least until 60% or 70% of our population has acquired immunity through having had the virus. We have not been very smart about what this virus holds in store for us and do not seem to have the resources or determination to do what has to be done.

    Both my husband and I are old (80+) and immunity compromised so you can bet that we are isolating and will be doing so until some future time. It’s not that I think we are so precious to not be allowed to die, but that that death is so unnecessary just as all the residents in long care facilities that died en mass was not necessary and should not have happened. How careless we have become regarding the death of others! Is this what is meant by the war against covid: that there have to be a lot of casualties?

    We need to ditch that war analogy for describing everything that goes on in the world!!!

    Reply
    1. wilroncanada

      Another Canadian here, JEHR. The Government of BC was pissed off at the Feds for not enforcing “isolation” for all those entering or reentering Canada, and for not quarantining those with symptoms. People were landing in Montreal or Toronto, and then on to other parts of Canada to spread it around. BC demanded closing the border, with the US included, but Trudeau had to wait for the declaration from the DT’s, administration, drunk with power

      Reply
      1. JEHR

        Yes, it doesn’t take much. I see Trudeau as more neoliberal than I care to think, i.e., his idea that the airlines as necessary even during a pandemic!

        Reply
  32. gc54

    What is “faulty administration” of the PCR test? The reagent kit is standard, its parts are numbered and the steps are simple enough for even slack-jawed phone distracted users to follow. Are the replicating machines not being maintained? Easily contaminated? Not run long enough to build adequate DNA for a statistically sound signal? A neighbor down the street had many COVID-19 symptoms badly, was tested but told “you likely had it but the tests have high false negatives” following a week of pure misery. Surely this is easier to sort out than the overwhelming combinatorics of contact tracing. And we *still* don’t know if reinfection is unlikely, which would seem straightforward to actively study over many timescales (if unethical).

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    1. JTMcPhee

      Family members pretty clearly had it, based on presentation, timing, exposure and symptoms. Both had multiple “tests” that all came back negative. Thank goodness that they had relatively mild symptoms and their kids (2 and 5) just had a “chest cold” presentation. Both are young and pretty healthy, but are still feeling the effects.

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    2. ptb

      I am told that the early PCR test kits available in the US required university level lab technique. I know they were recruiting bio/chem grad students for volunteers when there was a dire need.

      The process can be reduced to a simple tool, and has been. For example, here is a domestic 15 minute test machine (I believe adapted from a diagnostic device previously marketed for a different disease, such as influenza).

      https://www.abbott.com/corpnewsroom/product-and-innovation/detect-covid-19-in-as-little-as-5-minutes.html

      The rate limiting step to get to national scale, is the consumable item (cartridge or something like that) that the machine eats for each sample. It is not entirely clear where the US is on that front. There are efforts underway in industry. When domestic manufacturing ramp-up is involved, you’re looking at many months even in an emergency situation. (outside of a national emergency, it would be a 2 years or more).

      China bragged about having deployed such things by March, though again the question is scale. By moving fast on a more technologically robust low tech approach, they did not require the massive number of DNA tests the US now does. It is worth saying, though, that in the past Chinese state has repeatedly distinguished itself in the management of mega projects and the ability to scale things up quickly. The US ability in managing large projects put together on short notice is more mixed. The Trump administration’s hostility will not be helpful, as access to Chinese test production would have been a vauluable resource.

      On the testing front, check back in a couple of months.

      Reply
    3. Yves Smith Post author

      Why don’t you use Google? This is classic “shoot the messenger” behavior. I’m reporting on actual results in the field and you yell at me as if I’m running a lab.

      Reply
  33. Craig Dempsey

    For those using homemade cloth masks, let me suggest an easy and inexpensive upgrade. Cut a 6 inch square out of a paper towel, fold it over and use as an insert. Throw it away when you are done. Clean the mask itself as usual. See here for a review of various home materials to use to make masks. Paper towels get a fairly good review. I have been using this setup for a couple of weeks, and all it has cost me is a few sheets off of the roll of paper towels.

    Reply
  34. JC

    Thank you for a well reasoned article. As somebody who has had to deal with a COVID outbreak in a semi-closed environment, my experience of contact tracing was unreliable at best. Please try and remember everybody you came into contact with over the past 5 days, and now imagine you are stressed because you have just found out you are positive? Never mind the fear? And they all have to go into quarantine, which is NOT self isolation. Quarantine is stay in your room for 14 days, no washing of clothes, food left at the door etc, etc. 2 cases resulted in 34 people in quarantine, that we knew of. Do the maths on 2,000 cases – per day? The time for contact tracing ended a long time ago.

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  35. ewmayer

    Re. the list of countries beating Covid-19, recently heard from a friend in onesuch, Austria, where the government appears to be playing with fire by proposing widescale reopening, including schools(!). This dated 3 May:

    Wir gehen derzeit in die siebente Woche des „Lock-down“ wegen der Corona-Pandemie und jetzt beginnt eine sanfte Öffnung, aber von Anfang an. Die Österreichische Regierung hat in der zweiten Märzhälfte praktisch über Nacht reagiert und umfassende Einschränkungen erlassen. Nachdem diese Maßnahmen von der Mehrzahl der Leute als sinnvoll empfunden wurden (auch von mir), haben sich alle im Wesentlichen daran gehalten. Für unsere Familie hat das bedeutet, dass [name of younger of 2 sons redacted] sein Studentenzimmer verlassen hat und wieder bei uns eingezogen ist und dass wir alle vier von zu Hause arbeiten. Schule und Studium funktionieren mit Skype, Webex und MS-Teams und für mich gilt das Gleiche im Home-Office. Ich will mir gar nicht vorstellen wie das in einer kleinen Wohnung funktionieren soll. Insofern sind wir unglaublich privilegiert, da jeder im Haus seinen Arbeitsplatz einrichten kann und wir in den Garten hinaus können, wenn es im Innenraum zu eng ist. Bis jetzt halten wir gut durch, es ist keine ideale Situation, aber es funktioniert. Wie gesagt werden Geschäfte jetzt geöffnet und in 2 Wochen fängt auch wieder die Schule an und dann wird man sehen ob die Zahlen der Corona Fälle wieder steigen. Noch sind wir vier gesund und ich hoffe stark, dass das auch so bleibt.

    My translation:

    We are currently entering the seventh week of the lock-down due to the Corona-pandemic and beginning a soft reopening, but right from the start. In the second half of March the Austrian administration reacted practically overnight and lifted most restrictions. As said measures were viewed by most poeple (including myself) as sensible precautions, most have continued to abide by them. For our family this means that [name of younger of 2 sons redacted] has vacated his student lodgings and moved back in with us, and that all four of us work from home. School and studies are conducted via Skype, Webex and MS-Teams and the same things holds for me in my home-office. I don;t even want to try to imagine how that would work in a small apartment. In that respect we are unbelievably privileged in that everyone in the house can set up their own workplace and we can go out into the garden when things get too close inside. So far we are holding up well, it’s not an ideal situation, but it works. As noted stores are reopening and in 2 weeks schools are as well, and then we’ll see if the case count begins to climb again. We four are still healthy and I really hope it stays that way.

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  36. Joe Well

    Here in Massachusetts, one of the hot zones in the US, most businesses now have signs up saying masks are required for entry, and almost all (not quite all) customers wear them inside, BUT–

    –I have seen many, many workers in these establishments, that is, the sainted essential workers whose martyrdom we keep hearing about, with their masks around their necks (that is, off their faces) or not covering their noses (which is almost the same as not wearing it). And frequently talking together within a few feet of each other.

    Reply

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