What We Would Now Know, If Demagogues Didn't Rule Every Country on Earth

I’m in favor of more voluntary experiments like the ones you propose.  And certainly paying people for any experiment that intentionally infects someone.  Not sure if it is necessary for basic things like serological prevalence studies, I think that plenty of people would volunteer for that without any promise of payment, just because they want to find out if they’ve had it.

However, it’s probably useful to mention the challenge and limitations from designing these kinds of studies and extrapolating to the real world.  A clinical setting with measured doses is pretty different from the exposure people would get in a more natural setting, you wouldn’t see the natural evolution of the virus over time, and plenty of other issues.  Still, it would at least give us more info that could inform how we think about the real world experience.

Honestly though, I’m just amazed at how few tests that don’t even require paid volunteers seem to be happening right now.  I can only recall hearing about 3 prevalence studies in the U.S. so far, 2 in CA and 1 in NY, all with methodological problems.  I’d think we would want to be doing random population testing in the major hot spots like NYC on a weekly basis, both to find out estimates of current infection rates and antibody testing to see if any regions are getting closer to what we hope is a herd immunity level (assuming that immunity is real, which as you rightly point out we don’t know yet).

YES. Exactly. Here are my guesses

1. What is the true Infection Fatality Rate (IFR)?

0.2%-0.3%. Will depend on the population age profile. Some would be higher than this.

2. What fraction of the population has COVID-19 now?

For countries in lockdown, 1%-2%.

3. What fraction of the population has already had it?

Varies. For societies that have been hit harder, 5%-15%.

4. How does the IFR really vary by age, gender, and prior health status?

By age, close to double digits for 80+, single digits for 70+, a couple of percentage points for 60+, a bit less for 50+, and flu levels for 30-50, and a negligible for the young.

By gender, no idea, haven’t looked at this in a while, guess it’s up to 50% worse for men compared to women – largely because men are in poorer shape in the 60+ age groups.

5. How much immunity to COVID-19 do recovered patients acquire?

Significant immunity, I’m guessing. I’m sick and tired of hearing, “But we don’t know if one becomes immune!..” Yeah, well, shove it. Viruses usually work that way. Perhaps you’ll be vulnerable to a mutated version a few years out, or in decades. We can deal with that later. But no one is going to get it now, then get it again soon.

6. What are the odds of contracting the disease indoors versus outdoors?  From asymptomatic carriers?

Outdoors vs. indoors?: Much higher indoors. People will be closer to each other and there are lots of surfaces to catch it from.

From asymptomatic carriers: Meh, I call bull$hit. Maybe there are small windows when these people are infectious. At the risk of revealing substantial ignorance, I think the significant virus shedders are going to be people whose bodies are struggling with the virus, and thus more likely to be symptomatic. Do asymptomatic carriers cough or sneeze? If so, aren’t they symptomatic? If they can infect others, how do they do it? Magic? The same people railing against others for potentially being asymptomatic and threatening Grandma’s life with their callous disregard of social distancing often act as if you can’t transmit this through surfaces. Hence the idiotic acceptance of food delivery as reasonable, but being 5′ from someone outdoors as apocalyptically dangerous. I think holding these two beliefs is a sign of stupidity.

7. How much does infection probability falls as social distance rises from 3 feet to 20 feet?

Not much at all. Unless one of the people is clearly symptomatic.

8. What are the odds of fomite transmission?

I suspect very significant.

9. How much does viral load affect infection severity?

Seems like it does so a lot. The anecdotal cases I’ve seen of healthy young people getting this seems to center on health care workers. Could be a bias in reporting, though. But intuitively, the higher the level of exposure, the likelier that exposure  would overpower an immune response, no? A little virus, the body takes care of it. A lot of virus, the body can’t respond quickly enough.

IANAD. These are just armchair guesses.

I think opposition to this is based on the theory that, if you do something for a reason, you are not free. Only pointless actions can be examples of free will. IOW, if you pay volunteers, that means you are coercing them.

There are two points to make here. First, tone policing:

“we are not comic-book villains” – no, you really are. Suggesting that a better world is one where it’s standard for the rich to go around buying the bodies of poor people for experimentation (“paid! voluntary!”) puts you well within the standard comic book villain range. Caplan has this notion that as long as he says it will follow his principles, then it definitely won’t be exploitative. All of history disagrees with him.

Second, the headline: “What we would now know”

The problem here is that there’s no evidence that “we” would know any of these things. In fact, there’s a lot of evidence that we wouldn’t. There are many unpoliced states in the world. No one in Somalia or Papua New Guinea knows any of these things. No company from the USA is running experiments like these in those unpoliced parts of the world. In general, countries with laxer ethics *have worse science*, not the other way round.

Are our leaders stopping this?

We have done deliberate infection of volunteers with common cold viruses and malaria I believe.

Human experimentation is typically regulated by Ethics Committees. Handling the virus is probably regulated by FDA like entities.

Researchers have to get past those two hurdles. Do we have any evidemce these bodies are stopping these studies? If they have are political leaders are interfering with their decisions?

Finally, someone has to fund these trials. Setting up facilities to grow GMP grade, quality controlled, minimal batch to batch variation virus will be expensive. Infecting volunteers on topic this is an additional large expense.

So, you need to convince a private funder or get a clinical trial grant from an NIH like body. However, you must compete against all the current applications and other ideas like vaccine and antiviral trials.

Now, you could say our political leaders should independently fund these ideas. The issue is hardly any are scientists or doctors, let alone immunologists or microbiologists by training.

‘Voluntary’ and ‘obstensively voluntary’ are not necessarily the same. This is particularly true for institutions that are organized around the principles of coercion, privacy invasion, and deceit — i.e. governments.

A typical member of society might find it very difficult to trust if another member truly volunteered for a rapidly organized government program. It would require that the program be longstanding with numerous widespread surviving witnesses over a long period of time (like with military service).

But there is no rational humanitarian argument for forcibly prohibiting reputable  private entities from paid voluntary human experimentation.

However, the fact is that both governments and private entities already engage in this. It is just that it is restricted to brief psychological and physical interventions with trivially low risk of permanent disability or death. You are arguing that that risk ceiling should be lifted.