Economist Paul Romer tweeted today:
Doesn’t sound like China is going to sign up for the “Great Barrington” plan for surrendering to the virus. Wouldn’t it be refreshing to live in a country where everybody understands that it is the government’s job to do whatever it takes to protect public health?
He was referencing the following Associated Press item:
ASIA TODAY: Chinese health authorities will test all 9 million people in the eastern city of Qingdao for the coronavirus this week after nine cases linked to a hospital were found, the government announces.
I think Paul is correct to say that an authoritarian government such as China’s is unlikely to show as much tolerance for people’s freedom as the authors of the Great Barrington Declaration advocate.
It is disturbing, though, to see Romer write that it is government’s job to do whatever it takes to protect public health. His authoritarianism lives loudly within him.
In an email discussion, George Mason University economist Jon Murphy made a further relevant point:
Paul Romer is missing the far more obvious question:
Why can China test 9 million people on a whim but the United States does not?
What’s been missing from this whole nonsense is randomized testing so that we can determine the actual spread of the disease (and subsequently how it spreads, how deadly it is, etc). We don’t even know the N in this pandemic because there isn’t the testing going on.
I have an answer to the question (I think). It has nothing to do with state capacity or political will or anything like that. Simple expert failure (Roger Koppl) and dynamics of interventionism (Sanford Ikeda).
Trump invoked the Defense Production Act with testing kits. The predictable shortages of testing resulted in more being allocated to higher-valued uses: testing the people who are sick in the hospital. Thus, we didn’t have enough to do the lower-valued uses: randomly testing the population.
Isn’t it interesting how doing “whatever it takes to protect public health” can sometimes hurt public health. Unintended consequences anyone?
READER COMMENTS
Rob Rawlings
Oct 14 2020 at 8:49pm
If the ‘dynamics of interventionism’ have led the US government to be unable to deal effectively with the Covid pandemic compared to China (at least as far as mass testing goes) I guess if we we wait long enough we will turn into China and at least that problem will be solved !
(BTW, I’m a supporter of the general principals embodied in the Great Barrington Declaration, which I just signed, and my comment is meant as tongue in cheek)
Muhammad M Rashid
Oct 14 2020 at 11:23pm
It takes a lot of strength for Paul Romer an economist who is very well known for his defense of the spark of creativity that ought to exist in us humans.
Furthermore, for an economist to take a normative policy stance for the defense of the people is very rare to see in this day and age.
I also trust Dr. Romer’s intellectual insights and his being on the forefront since the plague hit us. The need for scientific action is greater and the economists in this day and age are equipped with the mind set to deal with a variety of critical issues.
AMT
Oct 15 2020 at 12:03am
“Whatever it takes” sure doesn’t sound likely to pass a cost/benefit analysis…it also reminds me of a work safety program, “Mission Zero,” which had the goal of achieving zero workplace injuries…
Don Boudreaux
Oct 15 2020 at 6:35am
Another criticism of Paul Romer’s statement warrants mention: He misinterprets the Great Barrington Declaration. It is not a libertarian call for the government to play no, or a suboptimal, role in protecting public health. It is, instead, a statement about what are the best means of protecting public health.
It’s true that the sponsor of the Declaration, AIER, is a pro-liberty organization. It’s true also that the authors the Declaration argue in this case in favor of fewer government-imposed restrictions. But the authors argue as they do so because they believe that what they call “Focused Protection” (as opposed to the centralized, unfocused manner in which lockdowns have been imposed) is a superior means of protecting public health.
Yet Romer reads the Declaration as an ideologically driven effort to minimize the role of government. The fact that he reads the Declaration in this manner suggests not only that he believes that the medical sciences (and the economics) are all settled on the Truth that lockdowns are the best means of protecting public health, but also that the authors and signatories of the Declaration accept this Truth but are driven by anti-government ideology to ignore it.
While improved public health is the main focus of the Great Barrington Declaration, it recognizes also, if only implicitly, that this desirable goal must be traded-off against other desirable goals. This fact about the Declaration only makes it stronger. It is more than odd that an economist writes, as Romer above does, as if protecting public health is not to be trade-off against any other desirable goal. As commenter AMT insightfully says above, ““Whatever it takes” sure doesn’t sound likely to pass a cost/benefit analysis….”
E. Harding
Oct 15 2020 at 7:59pm
No sensible country uses lockdowns as their primary anti-coronavirus strategy. Uruguay, one of the most successful countries in the Americas at tackling the coronavirus, has never had a lockdown. What the successful countries show is that contact tracing and isolation of all suspected cases is necessary to combat the virus. “Stay-at home” orders were a joke from the beginning as they did nothing to discover the potentially sick and isolate them from the rest of the population. Think Korea, not India. Think Uruguay, not Argentina.
Thomas Hutcheson
Oct 15 2020 at 7:31am
To much ink on the rhetorical phrase, “whatever it takes.” I think Romer just means that we should remove whichever of the one or more constraints (I doubt it is not just the mistaken use of the Defense Production Act) on investing in enough screening tests of asymptomatic people to a) understand the spread of the disease and b) allow infected asymptomatic people to self isolate so as to actually reduce the spread of the disease below what you get by people just taking precautions.
Jon Murphy
Oct 15 2020 at 8:57am
Those constraints being legal constraints.
Oh of course not. There’s a lot going on. We need to consider various public choice issues as well. The story of the DPA is just one key piece. Romer puts too much emphasis on political willpower and popular perceptions when there are far more reasonable explanations that require fewer assumptions and have evidence behind them.
Lyle Albaugh
Oct 15 2020 at 10:02am
I agree with Jon’s pushback on Romer. However, I think that mass testing is more of a problem than a solution.
“PCR detection of viruses is helpful so long as its limitations are understood; while it detects RNA in minute quantities, caution needs to be applied to the results as it often does not detect the infectious virus. This detection problem is ubiquitous for RNA viruses detection. SARS-CoV, MERS, Influenza Ebola and Zika viral RNA can also be detected long after the disappearance of the infectious virus.
Why does this matter? Because when it comes to Covid-19, insufficient attention has been paid to how PCR results actually relate to disease. The harms of false-positive results can be substantial: operations can be delayed or cancelled; patients are kept in hospital, just in case; further testing is required; in some cases, it drives local lockdowns. The results of our recent systematic review on viral infectiousness indicate that cycle thresholds are essential to understand who is infectious, and consequently, the extent of any outbreak and for controlling transmission.”
https://www.spectator.co.uk/article/could-mass-testing-for-covid-19-do-more-harm-than-good-/amp?__twitter_impression=true
“A recent New York Times article presented evidence that specimens detected in 27 to 34 cycles rarely show any live virus, and specimens detected above 34 cycles never show any live virus. ‘It’s just kind of mind-blowing to me that people are not recording the Ct values from all these tests — that they’re just returning a positive or a negative,’ said Angela Rasmussen, a virologist at Columbia University in New York.
The New York Times article said, ‘The standard tests are diagnosing huge numbers of people who may be carrying relatively insignificant amounts of the virus’ and that identifying these non-contagious people ‘may contribute to bottlenecks that prevent those who are contagious from being found in time.’
In a review of data from three labs, the New York Times found that ‘up to 90 percent of people testing positive carried barely any virus,’ meaning that only about 10% of people who test positive may actually need to isolate and submit to contact tracing. The recommended solution was to reduce the threshold to 33 cycles, based on CDC calculations…
The CDC’s new recommendation to only test symptomatic or exposed people is a good start to address the hysteria caused by rising case numbers and the social stigma faced by people with false positive test results. However, an additional change is needed: the FDA recommendation for 40 cycles of amplification in PCR testing is far too sensitive and is leading to alarm about high numbers of ‘cases’ in asymptomatic people, particularly young people like college students, who are often asymptomatic at the time of the positive test, possibly because they have already recovered from a previous mild infection.
The point of testing should be to identify infectious individuals, and the current testing procedures fail in that public health goal. The FDA should update their guidance to recommend no more than 34 cycles, require labs to communicate the number of cycles required to detect the virus for each positive test, and require labs to disclose the cycle threshold for all previous COVID tests (if that data is available) to clean up the inflated statistics (cases, hospitalizations, and deaths) associated with test results that exceeded 34 cycles.”
https://rationalground.com/why-mass-pcr-testing-of-the-healthy-and-asymptomatic-is-currently-counter-productive/
Jon Murphy
Oct 15 2020 at 2:46pm
I must disagree, Lyle (something I do with hesitancy). Testing symptomatic people works great when we understand the underlying dynamics of the disease. If we don’t, we need to get that information. Randomized testing does just that.
Charley Hooper
Oct 15 2020 at 1:43pm
Romer said:
The Great Barrington Declaration says nothing about the role of government. The role could be small. It could be huge.
The GBD has a stated objective: Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.
The GBD has a proposed strategy: Focused Protection.
Nowhere does the GBD say the government should step aside. Nowhere does it state actions that would preclude government involvement.
Plus, “whatever it takes”? Really? If it takes $50 trillion to save a handful of Americans from COVID-19, is that a good investment? What if the government must violate the Constitution? Where does that lead us?
“Whatever it takes” is the antithesis of economics, law, and rational thought.
Alan Goldhammer
Oct 15 2020 at 4:51pm
I covered The Great Barrington Declaration in my newsletter yesterday. It was stupid when I read it and it’s still stupid today. In no way is it focused protection as there is too much left to chance. The Lancet has an opinion piece on this topic today that is worth reading. They were more charitable than I was, commenting “Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable. This is a dangerous fallacy unsupported by scientific evidence.” They also have a better name for their position, “The John Snow Memorandum,” named after the man who discovered the drinking water association with cholera in London.
Most of the commenters to David’s post are overlooking the failures to adopt basic public health precautions. The US could have gone a totally different way and still maintained commerce. What is left is a disaster in many sectors that will not easily recover.
Jon Murphy
Oct 15 2020 at 5:29pm
We’re not overlooking that. That’s precisely our point, and the point of the Great Barrington Declaration.
I did have a question about the Lancet editorial that they do not seem to answer: we do focused protection for all other caronaviruses. Why is COVID-19 different?
Alan Goldhammer
Oct 15 2020 at 8:30pm
I assume you are talking about the run of the mill coronaviruses that circulate causing mild symptoms such as the common cold and not SARS-CoV-1 and MERS which were infectious and much more lethal than SARS-CoV-2. The answer is simple, SARS-CoV-2 has several orders of magnitude higher mortality than the normal coronaviruses and causes lots of hospitalizations as well.
You might want to look at the cautionary story of Gov Chris Christie who was in the ICU for over a week and treated with both remedesivir and the Lilly monoclonal antibody drug following exposure to the virus at the White House ceremony for Judge Barrett. He said he was wrong not to wear a mask and thought he was safe in the White House.
Jon Murphy
Oct 15 2020 at 8:38pm
No. Those too.
Ok. That has nothing to do with why we cannot selectively protect like we do with all other infectious diseases.
Charley Hooper
Oct 15 2020 at 7:19pm
Here are some comments about the Lancet opinion piece:
No. It is the writers of the Lancet article that deviate from scientific evidence.
That’s an oversimplification. The IFR is higher than the flu for those who are old and have comorbidities. For the young, the IFR far lower than that of the seasonal flu. That’s the motivation behind the focused protection strategy.
From what I’ve read, there have been a few confirmed and suspected reinfections. But remember, this is out of millions of cases.
If that’s the case, then it is unlikely that vaccines will save the day. Exposure to SARS-CoV-2 does induce our bodies to produce antibodies. That means that we should have long-term immunity. The reason we become reinfected by other coronaviruses, such as those that cause the common cold, is from rapid mutations. We haven’t seen that with SARS-CoV-2.
The Lancet authors listed Japan, Vietnam, and New Zealand as examples for how to control the virus. Southeast Asian countries have definitely done well. But is that due to genetics or past exposure to similar viruses? We don’t know. Regarding New Zealand, it’s an isolated island nation that has shut down its interactions with the outside world. I don’t see that as a model this country should follow.
This is one of the main reasons that motivated the Great Barrington Declaration. Instead of isolating everyone, why don’t we isolate/protect only the most vulnerable?
Never in the history of public health has the strategy been to isolate everyone. It isn’t supported by theory and it hasn’t worked well in this case. Let’s not keep banging our heads against the wall.
E. Harding
Oct 15 2020 at 8:06pm
“But is that due to genetics or past exposure to similar viruses? We don’t know.”
It’s not. Burma had no pandemic at all until August, now it has a raging pandemic. It was a product of policy (strong quarantine, weak contact tracing).
“why don’t we isolate/protect only the most vulnerable?”
Why don’t we isolate the sick and contacts, like sensible countries do (China, Uganda, Uruguay, Vietnam, etc.)?
“That’s public health 101 and it’s what the Great Barrington Declaration is recommending.”
No. “Herd immunity” is not the Chinese/Ugandan/Rwandan/Vietnamese/Thai/Uruguayan strategy.
“I don’t see that as a model this country should follow.”
Travel restrictions are necessary if the virus is to be contained.
Alan Goldhammer
Oct 15 2020 at 8:53pm
I am not going to get into the dueling battle of epidemiologists. I have maintained, and I believe the data is supportive that the case for public health measures is to reduce the burden on the hospital systems where there are outbreaks. Every state that has seen large COVID-19 outbreaks has seen the ICU bed capacity hit. Wisconsin is setting up some ‘field hospitals’ right now to increase capacity. I hope these are not needed!
I have seen no data that show this is the case for young people. One cannot go only by mortality as there are multiple syndromes that accompany COVID-19 infections that can cause medium and long term health issues. this is not the case with seasonal influenza.
There is a huge amount that we still do not know about the immune response to SARS-CoV-2. One of the unusual findings is that patients who get severe COVID-19 appear to have higher neutralizing antibody levels which is counter intuitive. Whether this is related to the cytokine storm observed in these patients is still an open question. There have been a lot of rapid mutations in SARS-CoV-2 and there are genomic libraries of these now. The predominant infectious strain ciruclating these days is not the Wuhan variety but one that arose in Italy during the pandemic there. Perhaps we should call it the Milan or Bergamo virus. It may be that periodic COVID vaccinations will be required; we don’t know right now.
There is no a priori way to define the most vulnerable. Adverse outcomes happen across all age groups. Even with all that we know right now there are still infections happening in assisted care facilities. Children are transmitting viral infections to other family members. My reading of the Snow Memorandum is they are not mandating lockdowns but rather adherence to the public health measures that are known to work. Absent doing that, infections will continue to wax and wane with associated morbidity and mortality. I think you are reading something into the statement that is not there.
My frustration is that we had very poor national leadership on the pandemic. There is blame to be apportioned on everyone and I don’t know of a single person, including some who have been ‘canonized’ by various parties that will come out of this with their reputations fully intact. Things could have gone very different and I am as frustrate, or perhaps even more than those who have commented here.
Charley Hooper
Oct 16 2020 at 5:05pm
Really? Is that the only objective of public health? To reduce the burden on hospitals? Not to reduce morbidity and mortality among the general population?
Check the CDC. https://covid.cdc.gov/covid-data-tracker/#demographics. Look at the number of infections compared to the deaths. The death rate is much higher for older Americans and lower for younger people.
That’s not true. Study after study show that age and comorbidities increase the infection fatality rate. Of course, we all must decide where the threshold is, but an 80-year-old, overweight person with heart disease is clearly vulnerable while a healthy 12-year-old isn’t.
That’s generally not true. There was an interesting study done in Iceland that showed that children rarely infect adults. In addition, we have good data from this country. YMCA child care centers have stayed open during the pandemic for front-line workers, taking care of tens of thousands of children, and there have been no coronavirus clusters or outbreaks. Infection rates were low among the children and among the adult staff.
reports Elliot Haspel, an education policy expert.
Charley Hooper
Oct 15 2020 at 7:30pm
One thing I forgot to add:
Just a few years ago the CDC did some strategic thinking to plan for the “next big pandemic.” What is noteworthy is the CDC didn’t even consider the approach employed in this country to lockdown almost everyone. Why? Because it’s a bad approach. The typical and thoughtful approach is to isolate the sick (so they don’t infect others) and the vulnerable (so they don’t become infected) and let everyone else live their lives. That’s public health 101 and it’s what the Great Barrington Declaration is recommending.
Somehow we went from “top scientists would never consider such an approach” to “only the stupid and evil would disagree with such an approach.”
E. Harding
Oct 15 2020 at 7:00pm
“I think Paul is correct to say that an authoritarian government such as China’s is unlikely to show as much tolerance for people’s freedom as the authors of the Great Barrington Declaration advocate.”
No. The citizens of China now have much, much more freedom than the authors of the Great Barrington Declaration advocate. Universal protection leads to universal freedom.
“It is disturbing, though, to see Romer write that it is government’s job to do whatever it takes to protect public health.”
I read “whatever it takes” as “the most efficient path”.
“Why can China test 9 million people on a whim but the United States does not?”
Simple enough. The U.S. has a lot more sick people. Testing 9 million would be pointless, as nothing would be done about it.
Alan Goldhammer
Oct 16 2020 at 8:51am
I will add one more comment to my replies above. The concept of herd immunity is complicated and varies by infectious agent. We know from the anti-vaccine movement that some pathogens such as measles, chicken pox, and whooping cough can return to communities where vaccination rates are as high as 90%. I was doing some fundamental research on the toxic factors of whooping cough in 1980 when there was a great controversy over the safety of the whole cell Pertussis vaccine. There were measurable side effects from the vaccine and some countries had dropped it from the childhood immunization programs. Things were fine for a period of time until they weren’t. The UK experienced a dramatic outbreak of whooping cough and the NHS had to scramble for vaccine doses to get kids immunized. Shortly afterward a new vaccine came on the market that had markedly fewer side effects.
the point of this anecdote is to highlight what I call the Rumsfeld Paradigm. We know a fair amount about SARS-CoV-2 but we don’t know what the herd immunity level is. You can do fairly simple calculations to get mortality numbers based on what might happen. My own personal estimation is that mortality from COVID-19 will eventually drop to the the 0.3-0.6% CRF range (the current mortality rate in the US based on diagnosed COVID-19 cases is 2.8% and dropping very slowly). 0.3% is what was observed in the UK for the 1957-58 Asian flu epidemic. I have seen projected infection rate figures for herd immunity ranging from 20-75% based on various models. Let’s say it is in the mid-range here, 50%. Let us also take the the low level of CRF. The mortality number for the US ends up as follows:
330 million people * 0.5 infection rate * 0.03 case fatality rate = 495,000 dead
This may be higher or lower based on what the herd immunity number ends up being as well as the availability of pharmaceutical interventions that prevent mortality (it looks right now that remdesivir does not help in this regard) in the absence of a vaccine. This is why just seeking herd immunity is not the way to go. I would refer folks to a new opinion piece that appeared this morning in STAT that addresses this.
Jens
Oct 16 2020 at 10:44am
Thank You Alan Goldhammer, a beacon in this debate.
Also Tyler Cowen: https://www.bloomberg.com/opinion/articles/2020-10-15/great-barrington-declaration-is-wrong-about-herd-immunity
Charley Hooper
Oct 19 2020 at 12:06am
(1) Your math is wrong.
(2) You shouldn’t use the case fatality rate; you should use the infection fatality rate. The case fatality rate refers to known cases. However, many people who become infected are never tested and therefore there are many more actual infections than known infections. The CDC has estimated the infection fatality rate at 0.0025.
(3) Because our immune systems can often fight off novel infections, some have argued that perhaps only 30-40% of the population will need to become infected to reach herd immunity.
330 million * 0.35 infection rate * 0.0025 infection fatality rate = 288,750.
We are currently at 220,000 and we might be closing in on herd immunity.
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