Tag: pandemic

Categories
science

On Masks

Lots of folks don’t seem to understand masks. I’ve seen some folks say that the virus is too small to be stopped. But most pollutants, dust, viruses, do not exist in air by themselves in a simple and lonesome form. Even when floating in air, things want to stick to other things. Regular stitched masks without special filters aren’t perfect, but they can block a lot of small conglomerations. Moreover, the more doublings of cloth can make that even better. The tradeoff of doublings up is the efficiency of breathing—the thicker the mask, the harder it is to pull air through.

In a different area, cholera in water, see NIH: Fogarty International Center: February 2015: “Sari cloth can filter cholera from water, research shows”. In that study, villagers in Bangladesh used simple cloths, folded twice (for four layers), to filter water as they collected it. It filtered 99% of cholera bacteria from the water in lab tests, and while the real-world use probably wasn’t as effective, it still cut cases and the cases that developed were milder.

Simple interventions can be effective. Masks do help, even if they aren’t N95 masks. Even if people make some mistakes in wearing them part of the time. They still help.

Separating the mouth covering and the nose covering would improve masks.

The nose is a challenge due to the variety of shapes, but more importantly it could be continuously covered even when the mouth needs to be uncovered. It is very easy for the public to cover the mouth and not realize their nose is uncovered, mainly because of the natural tendency to forget our noses. Noses are passive. Mouths are active. We do all sorts of things with our mouths, like eat, drink, brush teeth, talk, sing, whistle, play musical instruments, chew gum, and so on. Most of what we do with our nose is breathe.

I’ve often seen, sometimes in person, but often in photographs, people without their noses covered. I admit, I made the mistake on one occasion, myself. It’s an easy mistake, but we breathe through our noses, so it’s important to cover.

By covering the nose itself, or through some other method of protecting the entrances to the nasal airway separately, most of the inhaling could be protected and a common mistake could be countered. It would also make the masks more comfortable to wear, as a combined design is harder to make than two separate designs.

One of the most important things about that Sari cloth study is the fact that cases were milder. Masks do not block all cases, but likely do lead to milder ones. That may help reduce the transmission rate, but even if it doesn’t, it surely saves lives.

Categories
society

Where are We in this Thing?

It’s a good question, and one which doesn’t have a good answer. We don’t really have a consistent story of which states are doing what, much less what individuals are doing. The economic force, which is major, seems to be overpowering the protective force. A backfire is the major risk, with some areas of the country already seeing rises while others continue to fall.

The main challenge is, will the various governments be aware enough to catch new outbreaks early, and even if they do, will the stacks of human cordwood, that have their sights set on beaches and beer and all that, heed the call if a small flare-up risks becoming a five-alarm blaze?

The cordwood looks to do the heavy lifting, at least in the South, where the business community has caught the eye of the political class and they will not listen to science. If your area has an outbreak, and your government says all is well, believe the science. Practice the rules of prevention. At the least, you won’t be contributing to someone else’s misery with a deadly virus by not spreading it.

You don’t want to pass it on to your family or your hunting buddy, no matter how good a beer at the bar sounds.

Governments that are unwilling to follow science will be governments that find themselves without support in elections to come, and states that ignore science will be states that find people and businesses leaving. The short-term economy is currently the enemy of the long-term, in that sense.

What’s supposed to have happened is that testing would ramp up and tracing would ramp up and best practices, tailored to the business, would ramp up. Instead, testing is slowly getting better, but is unlikely to get to the levels really needed with asymptomatic transmission. Tracing doesn’t really do much without adequate testing. It has some marginal benefit, some localized protection, but not a ton if you don’t have the testing to feed it.

Best practices rely heavily on strong communication skills and coordination, but without governments leading on that, it’s a very sloppy and mixed effort. Some states aren’t even publishing their numbers honestly. (Same for nations.)

Think back on driver’s ed, and that old two-second rule. That you should be at least two seconds behind the car ahead, which means more distance at higher speeds. That you need that reaction time.

With our current trajectory in the pandemic, our lag time comes in around a couple weeks. That’s for the governments to act. Add at least a couple more days for the most aware citizens to act. Then a few more for the next half. The remainder, God knows.

At each stage of this crisis, there is an opportunity, there is time to be used to effect whatever changes make sense for the next moment. The administration hasn’t used any of them to do that.

  1. Early warning of emergent threat. The administration could have started ramping up PPE at that point, briefed governors on the basic playbook. They did neither. Donald John Trump turned a blind eye.
  2. Early domestic phase. Could have begun shutting down the largest of gatherings, put us on a kind of half-open footing some states are entering on reopening. Donald John Trump lied that it wouldn’t amount to anything.
  3. First wave hitting. Ramping testing up quickly. Work on mitigation plans for reopening. Donald John Trump Still said it would quickly vanish.
  4. First wave began to taper off. Begin demonstrations of how various workplaces should be operating. Have tracing network ready. Donald John Trump and his team chose to push to reopen without any real plan or messaging beyond that.
  5. Reopening begins. Donald John Trump and his daughter and son-in-law are not planning for how to handle new outbreaks, much less a new wave.

And that’s where we are in this thing.

Categories
society

The Oddity of Opening

The polling and reporting tells the following story:

  1. Most people think that the measures aren’t there to reopen.
  2. Republican-connected groups have been pushing protests to reopen.
  3. Based on that, some Republican governors have been getting ahead of themselves and reopening.

It doesn’t make a lot of sense. While some businesses have a majority of Republicans supporting reopening, a lot do not, and even where there’s a majority, it’s still split (though maybe less or more if you factor in margins of error). There is, once again, a minority Republican view being pressed and causing policy here.

More importantly, there’s a huge business case to be made to pay what’s actually needed to reopen (testing and tracing). It could even be done in a VAT or similar vehicle! But instead of doing it correctly, there are businesses pushing for blanket immunity.

The self-described pro-business lobbies always seemed a bit fucked in the head, but they’re really smashing the old Budweiser can on their forehead this time. If the virus gets worse, all those businesses that reopen will just keep losing revenue. Immunity from lawsuits doesn’t pay bills.

It’s been months now, coming up on five if you count from when the administration had a heads-up from the intelligence community. There’s been ample time to stand up supply chains, to ramp up testing. They haven’t been able to do it.

The problem is this: most people in most states aren’t going to be John Rambo, so most will stay home. Business revenue won’t be improving in the way the open-uppers think it will. But there also won’t be a viable way to open up more or get people back in public, because they still aren’t working on test-trace. So the economy stays a bummer, the virus stays a plateau, and we continue to waste time and money spinning our wheels. It’s stupid. It’s ridiculous. It’s Donald John Trump.

In order for an economy to function, you need supply and demand. The supply is shut for health reasons, but also for demand reasons. Even before stay-home orders hit, many businesses were seeing demand plummet. There is demand—aspirational, “wouldn’t it be nice” demand. But there is not “I’m getting in the car, let’s go now” demand, and there won’t be unless and until there’s a good bet you won’t get sick.

From a numbers point of view, if even 50% of regular demand is there, that’s probably not enough, and if new upticks in cases happen even under depressed demand, that 50% will drop even lower and won’t recover the next time a reopen is attempted.

From a numbers point of view, the cost of the shutdown is very high, far higher than what it would cost to implement real testing and tracing, and yet… the governments are still not saying that. They aren’t doing that. They are ignoring the facts that are plain as day.

Categories
society

The Challenge of Open

Shutting things down is hard, but minimizing transmission of pestilence in anything approaching normal conditions is at least an order of magnitude harder. Avoiding it entirely would require far more than what society is willing (perhaps able) to do.

We must recognize that opening up a bit means the containment will be less than it has been. It means some people will get sick, and some of those will die. It’s the nature of opening things up, just as some fraction of cases today still occurred under the relatively closed conditions we have.

The trade-off of opening up a bit is to be prepared to test and trace and isolate cases. Not doing so, and not planning to do so, invites uncontrolled spread and a fast retreat to stay-home.

A good mental model is cars. We have done a ton to make cars safer. Seatbelts, airbags, licensing, crumple zones, and so forth. They aren’t completely safe. People still die from car crashes. But we’ve tried to minimize that harm. The plans being worked on by businesses and governments are similarly designed.

They are weighing all sorts of options and considering the logistics, acceptability to customers and the public. Like on the Apollo 13 mission, trying to connect a square CO₂ scrubber to a round air exchanger takes a lot of thinking through. Unlike that mission, the danger is mostly contained as long as people stay home and the clock is more about trying to get people where they can work safely.

For example, if you went to a fine dining establishment, how would you feel about having the wait staff instruct you how to bus your own dishes or wipe your own table? Is that something we can comfortably ask the public to do? Or do we stick to take-out only, depriving work from those who would normally be in the dining rooms? Or do restaurants switch to disposable tableware and some easy way to biohazard the entire table in one fell swoop? Or some other option? What are the risks? What are the costs? How do we balance it all?

For example, with grocery delivery in-demand, can stores work with delivery services to streamline the process, to minimize transmission, improve contact tracing, and increase service throughput?

There are tons of businesses and they all need solutions that fit their business and the community. Some of them will make mistakes.

But the number one tool we have is technology. All manner of businesses need to look at how they can use phones and computers to rework their business so that contact is minimized. And that’s going to require new software. Now more than ever it should be built with standard interfaces, where one app can be used by multiple businesses rather than requiring every last business to have a custom app built. We simply do not have the developer bandwidth to do the latter.

It’s a heavy lift. But the alternative of an unprepared reopening—something some states might try (and something that, unfortunately, many on the right media are urging)—will see another spike and more death than necessary. And the economy will still be worse off for those states, after they have to tuck tail and deal with another round of stay home. Their citizens will be less willing to trust those governments, and they will be watching on TV as the slow-and-steady states see slow-and-steady improvements.

Society has been wounded by the virus. We are convalescing and have fresh stitches. Communities that try to get up and run will tear their stitches and have to be rushed to get themselves sewn back up and then back to bedrest. Places that take it slow, cautious, will heal faster and be back on their feet.

Unfortunately, with interstate travel, there’s always the risk of the stitch-tearer bungling into another patient, tearing her stitches too. The virus can bloom in a foolish state and infect a smart state anew.

As things do open up a bit, remember that you have the right to say no. If you think the precautions are inadequate, you should seek alternatives. If a business is asking you as a customer or worker to do something you think is unsafe, you should speak up.

In some other universe, Americans are seeing a coordinated federal response to the pandemic and, for the first time in decades, they are seeing what the machine, firing on all cylinders, is capable of. It must be a thing to behold, but sadly we are deprived it and its comfort in these trying times.

Categories
society

Risk and Economics in a Pandemic

There are a lot of different ways to think about recessions. One is a traffic model. A bustling economy is moving a lot of cars with little trouble. A hurting economy is moving fewer cars slower. Depression is outright gridlock. The need to get cars moving is the recovery mechanism. (The slow cars are slowing each other down, which is akin to cascading financial problems.)

Another metaphor is a tree, battered by disease or wind, having lost some of its leaves. It has to slow its growth to repair itself instead. In some cases, government provides artificial sunlight, artificial rain, etc. to nurture the tree along.

The main thing about economic downturns is that they are a signal that, in some way, our collective resources were misallocated. Either we didn’t regulate enough, or didn’t spend enough on the right things. Sometimes we took a calculated risk and are just unlucky. Other times, we did not calculate risk correctly.

One of those risk calculations is the healthcare and insurance system. It doesn’t fully cover the nation, and it’s largely subject to the same kinds of economic problems as the rest of the system. Under a true universal system, whether Medicare-for-All or not, that wouldn’t be. It would dramatically reduce the suffering, but it would also help to prop up the larger economy. To divorce vital industry from the economic winds is a great ballast. The tradeoff of ballast is that growth in (at least parts of) healthcare would be more limited. Slower to accelerate, but slower to halt.

Another risk calculation, made (or failed to be made) by Donald John Trump, was to underfund, reduce, and dismantle parts of our shield against pandemics. Even now, he keeps pushing for quick fixes, corner cuts, and premature reopening, all which threaten to undermine public health efforts that economic recovery depends upon.

Governors and mayors weighed the risk of stay-home orders. Ministers did, too. The risk, plus some luck either way, results in a signal of whether the decisions were apt. Sometimes the signal is in lives lost.

The Republican party in the state of Wisconsin decided the risk of having people vote the normal way at the normal time during decidedly abnormal public health conditions was worth the risk of more suffering and death.

The economic fallout will take some time to really become apparent in all of this. It depends on the length of the shutdown, which depends on the ability of government to manage test coverage in a way that ensures we can reopen and stay open. So far, that’s not materialized.

Which makes no sense! The economic output lost from having to keep protections higher, or the economic output lost from having more waves of virus or worse waves, are both in excess of the societal cost of ramping up testing to the level needed to avoid them! For all the monies appropriated by the Congress, for all the nonsense dispensed by the president (including his fantasy over an anti-malaria drug), they haven’t done the one thing! Testing! Even if a quinine-based drug were a magic bullet, testing would still be king!

The decision between minimizing risks and maximizing economy is false. Those who see what should be very welcomed reductions in projected deaths and say, “We should open up,” are inviting much larger outbreaks and tolls. Failure to expand testing is bad for the economy. Risk is what’s hurting the economy, so taking on more of the same risk is to invite ruin.

Happy and/or Merry Easter!