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Coronavirus “hits all the hot buttons” for promoting the scientist-as-hero narrative (cognitive psychology edition)

The New York Times continues to push the cognitive-illusion angle on coronavirus fear. Earlier this week we discussed an op-ed by social psychologist David DeSteno; today there’s a news article by that dude from Rushmore:

There remains deep uncertainty about the new coronavirus’ mortality rate, with the high-end estimate that it is up to 20 times that of the flu, but some estimates go as low as 0.16 percent for those affected outside of China’s overwhelmed Hubei province. About on par with the flu.

Wasn’t there something strange . . . about the extreme disparity in public reactions?

While the metrics of public health might put the flu alongside or even ahead of the new coronavirus for sheer deadliness . . . And the new coronavirus disease, named COVID-19 hits nearly every cognitive trigger we have.

That explains the global wave of anxiety.

Wait a second! The article just said that the high-end estimate is that coronavirus could have a mortality rate 20 times that of the flu, and a low-end estimate that is about on par with the flu. Is it really “so strange” to have a wave of anxiety given this level of uncertainty?

Don’t get me wrong. I’m not saying that people are rational uncertainty-calculators. In particular, maybe the real lesson here is not that people shouldn’t be scared about coronavirus but that they should be more scared of the flu. But, as in our discussion the other day, I’m concerned about experts who seem so eager to leap up and call people irrational, when it seems to me that it can be quite rational to react strongly to an unknown risk. Even if, in retrospect, coronavirus doesn’t end up being as bad as some of the worst-case scenarios, that doesn’t mean it is a bad idea to be prepared. We don’t want to be picking pennies in front of the proverbial steamroller.

The Times article continues:

But there is a lesson, psychologists and public health experts say, in the near-terror that the virus induces, even as serious threats like the flu receive little more than a shrug. It illustrates the unconscious biases in how human beings think about risk, as well as the impulses that often guide our responses — sometimes with serious consequences.

Experts used to believe that people gauged risk like actuaries, parsing out cost-benefit analyses every time a merging car came too close or local crime rates spiked. But a wave of psychological experiments in the 1980s upended this thinking.

Really?

Really????

Reeeeeaaaaaalllllllllllly??????????

I am so damn sick of the scientist-as-hero narrative. It’s not enough to say that psychologists have learned a lot in the past 50 years about how we think about and make decisions under uncertainty. No, you also have to say that, before then, we were in the dark ages.

Is it really true that “Experts used to believe that people gauged risk like actuaries, parsing out cost-benefit analyses every time a merging car came too close or local crime rates spiked”? Maybe. I guess I’d like to see some quotes before I believe it. My impression is that experts used to believe, and in many cases still do, that parsing out cost-benefit analyses is a decision-making ideal that can be used as a comparison to better understand real decision processes.

But it’s obvious that people don’t “gauge risk like actuaries.” After all, if people really gauged risk like actuaries, we wouldn’t need actuaries! And, last I heard, they get paid a lot.

As with our discussion of that op-ed the other day, I have no problem with this news article regarding the public health details. Indeed, I don’t know anything about coronavirus, and it’s from articles like this that I get my news. The author writes, “Of course, it is far from irrational to feel some fear about the coronavirus outbreak tearing through China and beyond. . . . Assessing the danger posed by the coronavirus is extraordinarily difficult; even scientists are unsure. . . .”, so it’s not like he’s telling us not to worry. And I agree with the message that people should take their damn flu shots. I just don’t like how this interesting, important, and newsworthy story about uncertainty is being used as an excuse for an oversimplified model of decision science. As we’ve discussed earlier, it can be rational to react strongly to an uncertain threat. That scaredy-cat in the above image might be behaving in a smart way.

99 Comments

  1. Thanatos Savehn says:

    My least favorite trope in the scientist-as-hero narrative is that they’re always either “racing” or “scrambling” to save us. As a young trial lawyer you quickly learn that the surest way to faceplant in front of the jury is to race or scramble for a response when something unexpected arises. When action is elevated over reflection you get e.g. a mountain of studies and papers about the first considered Alzheimer’s target, beta amyloid, and decades later nothing to show for it other than all the racing and scrambling.

    • jim says:

      Thanatos Savehn says: ‘they’re always either “racing” or “scrambling” to save us.’

      That goes right along with the “fight” meme! In America, WE FIGHT EVERYTHING!!!!

      DAMIT THANATOS, WE’VE GOT TO FIGHT BACK AGAINST THE EXPERT DENIERS!!

    • Anoneuoid says:

      I’ve got a legal question I don’t know how to find an answer for. I don’t know anyone in this circumstance, it is just wondering.

      Say someone is in the hospital and a blood test shows they are deficient in (for example) magnesium. If the patient or family asks for additional magnesium supplements or in the nutrition drip until the blood test comes back normal, is the hospital/doctor legally obliged to give it?

      I mean the medical guidelines say such a result means a person should get more magnesium, so wouldnt it be negligent to fail to correct the deficiency, especially when the patient specifically asks for it? Yet from what I can tell this is very rare.

      • Terry says:

        Why is this not a straightforward malpractice question? Hospital should have done A. Hospital did not do A. Patient suffered harm as a result.

        • Anoneuoid says:

          That is what I would think, but afaik correcting the deficiencies is not standard practice. They just give them a standard nutrition and assume it is sufficient.

          Also consider that treating with a supplement or iv vitamin/mineral for whatever problem they have may actually be deviating from accepted practice, and if the patient is very ill they may need much more of it than usual due to poor absorption, etc. So giving enough to correct a deficiency may exceed the normal RDA too.

          • Terry says:

            I have talked to people with the opposite experience. They were diagnosed with a vitamin deficiency and prescribed large doses of the missing vitamin/nutrient. So it sounds more complicated.

            • Anoneuoid says:

              Were they in the hospital already for something else?

              • Terry says:

                No.

                I’m not trying to argue with you. Just trying to understand the question.

                You seem to be getting at something very specific, and it sounds like the answer is very fact-specific. It sounds like the best way to address the deficiency will depend on how urgent the issue is, the best way for the body to absorb the nutrient, relative costs, whether it might interfere with other medications, etc.

              • Anoneuoid says:

                Imagine you are in a car accident and recovering the hospital. They do a standard blood test and it shows you are deficient in some mineral or vitamin.

                My understanding is the standard of care is to not try to correct this. Perhaps it is wrong, I have no direct experience with this.

              • jim says:

                Anoneuoid says:
                “Imagine you are in a car accident and recovering the hospital. They do a standard blood test and it shows you are deficient in some mineral or vitamin. My understanding is the standard of care is to not try to correct this. Perhaps it is wrong, I have no direct experience with this.”

                My guess is that if your immediate survival depends on it, they would take what action was necessary. But if they don’t know the cause of the anomaly, then correcting it via IV might just be a waste of time and cost. If the fundamental problem isn’t addressed, then the minute the IV is removed, the anomaly will recur.

                If it’s not life threatening, the appropriate course of action is to advise the patient of the problem and let them address it through their PCP.

              • Anoneuoid says:

                Ok, but the question was whether they are legally obliged to attempt correcting the deficiency if the patient or family specifically asks for it.

                Obviously there could be some discussion about possible risks/costs, but if the patient/family insists after that, then what is the legal status?

              • jim says:

                “but if the patient/family insists after that, then what is the legal status?”

                Seems to me like Terry is right. Its not a straightforward question.

                a) who’s paying for the treatment? (cash, victim’s insurance, driver’s insurance, other driver’s insurance)
                b) is it a life-threatening condition? Is it caused by the accident?
                c) will the treatment eliminate the condition, or will the cause of the condition persist despite the treatment?
                d) can the patient speak for themselves regarding the treatment?

              • Anonymous says:

                a) who’s paying for the treatment? (cash, victim’s insurance, driver’s insurance, other driver’s insurance)

                – They are deficient according to the official guidelines. What should be done from there if we want to help the most patients?

                b) is it a life-threatening condition? Is it caused by the accident?

                – They are deficient in a mineral or vitamin. No one knows if is especially life threatening in that case. So if they ask for it I say give it…

                c) will the treatment eliminate the condition, or will the cause of the condition persist despite the treatment?

                – By definition correcting the deficiency will correct the condition. Whether the heath issues are resolved is another matter.

                d) can the patient speak for themselves regarding the treatment?

                – Yes.

  2. Dave says:

    I’m not sure how these authors are brushing aside that:

    – it appears to be highly contagious
    – it may have relatively high mortality rate compared to the flu
    and, most importantly,
    – no one is vaccinated for it (other than those who have already recovered from it, in some sense)

    Of course comparing something that just broke out 2 months ago will pale in comparison to the flu. These same writers might have told their readers to relax after the first couple of months of the bubonic plague. This won’t be that bad, but at certainly at some point after its outbreak, the bubonic plague also had a low death count too.

    If this coronavirus doesn’t spread widely in the US before a vaccine is developed, it will only be because of what seem to be unprecedented efforts to contain it.

    I’m not suggesting panic is the right answer, but heightened awareness and caution seem appropriate. Unless we don’t care about infants and the elderly, who are those at the highest risk.

  3. Zad says:

    Same pic twice?! Are you running out of cat pics??

  4. yyw says:

    A few scientists in history were heroes, not in the moral sense, but that their accomplishments awed us mere mortals. Most scientists are mediocre like us. Some are fools.

  5. Steve says:

    The author writes, “COVID-19 hits nearly every cognitive trigger we have.” What about a virus that is spreading at an exponential rate and may have a death rate several times more than the flu (for which there is a vaccine) should not solicit concern. To the contrary we are probably not be vigilant enough. A lot of the cognitive bias research is based on an incorrect assumption that there is one “correct” way to access risk. There isn’t. We can always explain peoples behaviors to make there choices seem consistent from one situation to the next by changing what they believe the payoffs or probabilities are. The COVID-19 is a pretty good example. Right now, we don’t know the risk and much of the information is coming from sources like the government of China that we know have lied to us. I bet the risk is big. If someone else thinks its small, is it really true that one of us is being irrational. We just disagreed about how to access uncertain data. There is no objective right or wrong answers. There is a range.

  6. Michael Nelson says:

    Are you saying we *can’t* be heroes, forever and ever? Some scientist Bowie was… :)

    Seriously, I think it can be fairly stated that economists for some time believed that they could include in their models the assumption that decision-making is mechanical, for simplicity, without sacrificing accuracy. I suspect they never believed the assumption was true, just convenient and harmless. It’s also true that psych experiments have shown that assumption–and the assumption about the assumption–to be questionable at best, but it’s my impression that economists didn’t catch on until the much later work by Thaler.

  7. Jonathan says:

    That narrative conflicts with the equally silly theme of scientist as madman. I can’t count how many scenes in movies are variations of ‘you don’t know what you’ll be unleashing …’

    I think a good hero scientist movie is The Andromeda Strain, partly because they aren’t heroic and their work turns out to be unnecessary because the virus mutates.

  8. TAS says:

    Is that Nick Drake with the cat?

  9. Bob says:

    The NYT likes the unconscious bias angle because it panders to their own prejudices. You can see this by the mention of terrorism, all those irrational plebs worried about something that kills fewer people than falling off ladders. What a bunch of dopes!

  10. Anoneuoid says:

    Is it really true that “Experts used to believe that people gauged risk like actuaries, parsing out cost-benefit analyses every time a merging car came too close or local crime rates spiked”?

    This is what I asked in a thread a few weeks ago. Are there really economists that ignore that the primary form of reasoning people use are various heuristics (consensus, authority, etc)?

    • jim says:

      People use the appropriate reasoning for the situation:

      For an approaching car, yes, there absolutely is a cost benefit analysis: is it worth it to try to cut across the road before this car smashes me?

      For electing one of the seventeen local judges that people have never heard of that they have to vote for every year or so, no, they don’t use a cost benefit analysis. They look at the party or use some other simple method that will allow them to make their decision in about 12 seconds.

      For buying a candy bar, do people perform an experiment to determine which bar has more nougat, then offer the shop keeper a price based on the nougat value? flup no. That would be stupid. The candy bar costs a dollar, why waste time on the $0.05 difference in price

      For buying car do people do a cost benefit analysis? Yes but that analysis may also include the social benefits of owning said car. And in any cost benefit analysis a key factor is how much a person has to spend. Did Jeff Bezos do a cost benefit analysis on his new Hollywood Mansion? No. He has so much money he couldn’t care less.

      sheesh, the problem is that most people cant understand how to apply a general concept so they simplify it to one they can understand then claim it doesn’t make sense.

      • Anoneuoid says:

        For an approaching car, yes, there absolutely is a cost benefit analysis: is it worth it to try to cut across the road before this car smashes me?

        I’ve seen it so many times that one person starts crossing the street, then 5-10 other people do.

        • jim says:

          Actually I was referring to turning left across traffic in a vehicle.

          I’d say it’s rational to expend as little effort as possible in determining when to cross the street. Some people even use the lights for that.

  11. jim says:

    I do think there is a lot of irrational panic going on.

    Definitely authorities have done the right thing in my view by imposing restrictions to isolate the virus. These measures are taken as a precaution because the virulence and mechanisms of transmission of the virus are both unknown, and new viruses *can* be extraordinarily virulent. Until more is known, precautions must remain in place.

    Just the same, the number of cases and deaths isn’t extreme. Several news outlets have reported 65K cases and 1.5K deaths: a higher death rate than “regular” flu from what I understand, but hardly a death sentence – there are 19M people in Wuhan metro alone, so the infection rate is <<<1%, which doesn't suggest a rapidly spreading virus.

    There are only 15 confirmed cases in the US, at least some of which have recovered already, and no deaths.

    No one needs to "trust the experts" on this one. Anyone can do their own analysis and come to the conclusion the freaking out isn't warranted – at least not yet. I don't see any reliable data to contradict this.

    • The problem is no-one trusts the Chinese govt, they *really are* involved in conspiracies and cover-ups and soforth on a regular basis. So I think there are plenty of people looking at numbers like 65k infected and 1.5k deaths and saying “what if it’s really 800k infected and 100k dead, or 10M infected and 800k dead” or something like that.

      This is a general rational principle of Bayesian reasoning, a small probability of a very bad thing dominates the decision theory result. I tried to explain this a while back in a thread on global warming, but there was a general lack of understanding there. I don’t think I did a good job.

      • jim says:

        Yeah, I mean I agree there’s some valid concern there.

        But what seems to be the case is that there’s no concrete evidence the gov story line is fake. And the infection rates in other countries seem to very roughly agree with what’s coming out of China.

        I understand that argument too with climate change. The differences between the two situations are the scale and cost of presuming a worst case scenario that never occurs, and the speed with which events unfold. For the virus, a worst-case could unfold in days or even hours. For climate change we have *a lot* of time to assess the gravity of the situation. For the virus, needlessly preparing for a worst-case scenario could cost – roughly – $50B or even $500B worldwide in lost productivity and everything. for climate change the sacrifices are many many orders of magnitude greater.

        And indeed delaying climate change regulation has paid off: the economy is decarbonizing with very modest incentives, as the worst case scenario recedes into the distance.

    • Quartz says:

      Fatality is not calculated like that, you must wait for the full course of the illness first to weed out unknown destinies, we’re in a spread phase, not a stationary one. We don’t know what part of the 65k is out already, and the 1.5k is just in the hospitalized group, many are dying at home and on the streets. There are no people in the Wuhan metro anymore, they’re no idiots. Experts say correctly the numbers are still highly uncertain. It could be anything between 2% fatality and 40%, even if we assumed official statistics were trustworthy. Analyses are quite complex, not for the layman even roughly. Extreme caution is mandatory, freaking out is never helpful.

      • jim says:

        “many are dying at home and on the streets.” ???

        I don’t see that being reported anywhere.

        “not for the layman even roughly.”

        I’m not a layman.

        • What is being reported is that people are being rounded up and put in concentration / quarantine / locked into their apartments etc. What happens after that is anyone’s guess.

          To me this seems like a serious problem, but it’s not inherently due to the severity of the virus, it’s the unfortunate product of living in a police state.

          In the end we will probably discover that China did a terrible job of managing this outbreak, and many many more people died than needed to. I don’t expect the death tolls to be anything like as high in France, Germany, Netherlands, Spain, Singapore, Japan, etc.

        • Olav says:

          See here, for example: https://www.scmp.com/news/china/society/article/3050311/its-pneumonia-everybody-china-knows-about-many-deaths-will-never

          What’s worrying about this virus is that although the mortality rate is pretty low given proper medical treatment, many patients (perhaps 10-20%) require very intensive medical intervention in an ICU. As the number of patients increases beyond the number of available ICU spots, the mortality rate will also increase. That’s what seems to have happened in Wuhan.

          • Very likely a factor in all of this is that populations that feel a lot of pressure to not miss work, because they fear loss of livelihood, homelessness etc you will get much faster transmission. In populations where people can stay home or work from home or have sufficient sick leave or protection from being fired for getting sick etc you will probably see less favorable transmission.

          • Anoneuoid says:

            They are dying from acute respiratory distress syndrome (ARDS), which has no treatment besides supportive oxygen, etc.

            IV vitamin C seemed to decrease mortality from 20% to 4% while getting it every day for 4 days, but then another group did a replication that cut the dose in half for some reason (and just assumed blood levels were the same). They saw no effect: https://www.mdedge.com/chestphysician/article/209105/infectious-diseases/vitamin-c-infusion-falls-short-sepsis-and-ards

            It is really annoying how no one can just do a simple direct replication of anything.

            • Right, this is like how zinc is basically a cure for rhinovirus, and it was well known and the conditions required were well known, it was patented, but no one could just go ahead and replicate the actual cure for like decades, they kept doing things like giving zinc lozenges with citric acid or vitamin c, both of which bind the ionized zinc and render it totally ineffective. Zinc gluconate lozenges taken orally without any agents that bind the zinc ions effectively cuts rhinovirus duration from 7-10 days down to about 3 and dramatically reduces severity. For decades no-one benefitted from this knowledge. Even today you’ll see lozenges sold as zinc+vitC or lemon flavored or whatever…

              • They’d also do studies where they just gave the zinc to patients without identifying the virus and then claim that it did nothing, because most of the cases were adenovirus or coronavirus or the like (coronavirus is common enough, it causes about 1/3 of all “common colds” it’s only this strain that’s of major concern)

              • Anoneuoid says:

                Interesting, I had not heard this one. But yea ascorbate chelates divalent cations and makes them harder to absorb and easier to piss out so it makes sense to me that if you need more zinc taking the two together may cause a problem.

              • It’s actually zinc in the mouth and throat that inhibits infection and replication of the virus, so it has to be free ions and both ascorbate and citric acid inhibit the effectiveness.

              • Anoneuoid says:

                link?

              • It’s been a long running controversy, it started back in the 80’s with papers like this:

                https://www.ncbi.nlm.nih.gov/pubmed/3440773

                https://www.ncbi.nlm.nih.gov/pubmed/6367635

                And then if you search on zinc lozenges or zinc gluconate through even the last few years you’ll see a bunch of controversy. The best explanation for the controversy is the kinds of stuff I mentioned. Check it out if you’re interested. A big part of the problem getting it to replicate was the number of people doing stupid things and then the number of people aggregating studies regardless of mechanism / method and finding mixed results

              • Anoneuoid says:

                Thanks, yes letting the tablet dissolve in your mouth seems to be key. Do you have one about the vitamin c interfering?

                I wonder how they came up with that dose (23 mg every 2 hrs)… Like anything, it is all about timing, route of administration, and dose. And the dose required may differ from patient to patient so using a standard one for everyone is not be ideal.

              • https://www.sciencedaily.com/releases/2017/05/170503110808.htm

                I don’t have a specific citation, but that example above is typical of the kind of thing you find if you do a deeper dive… citric acid is known to bind the free ions, and vitamin c will as well, free ion concentration in the saliva seems to be key, and can be achieved a variety of ways. I remember reading an article that discussed all of this and the thing about it was that it seemed to be well understood by the guys who first discovered the effect, but it took years before the result was accepted because people kept randomly trying stuff like zinc + vitamin C or zinc in a tasty lemon flavored lozenge (citric acid) or zinc citrate or zinc as a dietary supplement (ie. you swallow it) and the results were basically random…

                It’s a good example of the importance of having some kind of mechanistic idea of what’s going on in science… but also of the fact that even if you know exactly the mechanism it would take a miracle to keep people from fucking it all up through ignorance, stupidity, or a general inability to read and understand the most basic stuff.

              • Anoneuoid says:

                Thats funny becsuse I know of that guy. Harri Hemila is great, go check his publication history.

                But I was wondering about the “binding” because maybe instead ascorbate reduces Zn2+ to Zn1+, or there is a pH dependency (in which case sodium/etc ascorbate would not interfere).

                You sure you didnt read ascorbate and think of acetate, which is mentioned in that paper?

            • jim says:

              “It is really annoying how no one can just do a simple direct replication of anything.”

              Like I said, there should be funding stream dedicated to replication across all sciences.

              • Anoneuoid says:

                I agree. I think it’s a waste of time to fund a study without a replication. Exceptions would be pilot studies where people are just figuring out what to pay attention to, etc.

  12. “It’s not enough to say that psychologists have learned a lot in the past 50 years about how we think about and make decisions under uncertainty. No, you also have to say that, before then, we were in the dark ages.”

    This reminds me of my reaction to Dexter Kimball’s work in scientific management.

    “Under the old and still much-used methods, the common idea was to keep a man as busy as possible during the entire working period for which he had engaged. It now appears that he will do more and better work if given periodic rests.” (1939)

    Like you, I had that “Really???” reaction to the claim that this first became apparent with time and motion study.

    • jrkrideau says:

      Yaou have heard of Amazon?

      More seriously, in the 19th C 12 hour days, 6 days a week were common though as early as the 1880’s at least one German industrialist was experimenting with reduced work hours. So, while Kimball’s exact claim is likely wrong, the idea, in general, is not that wacky.

      I get the impression that employers in some industries, understood that the horses needed rest, humans….

  13. Steve says:

    A month ago, there were roughly the same number of “confirmed cases” in China as there are now in the US. The number increased at a rate of 2^11. Also, people have to remember that “confirmed” means “detected and confirmed.” Health officials in the U.S. are just detecting clinical cases. If there are around 20 detected and confirmed there are probably 3 to 4 times that numbers walking around. An epidemiologist in Britain estimated said 400,000 deaths in Britain was a reasonable estimate. There is so much uncertainty at this point, but sooner or later a global pandemic will hit and wipe out tens to hundreds of millions of people. Much more can be done, then is currently happening. I don’t see the panic, but if people are avoiding hanging out in groups are becoming more vigilant about washing their hands and not touching there face, if Westerners in cities adopted the Asian practice of wearing masks and not touching elevator buttons, all of that would slow the virus’ spread and be good. Of course, most viruses aren’t the Spanish Flu, but it is magical thinking to believe that because extinction level events are rare, the threat will never happen. The improbable happens all the time.

    • Nick Adams says:

      Steve,
      unfortunately coronaviruses can spread by aerosol – tiny droplets less than 5 microns. These particles are not filtered out by masks and do not require hands or door knobs for transmission. They float in the air for hours and can be transmitted over long distances by air conditioning. This is a different form of transmission compared to most other viruses such as influenza. The only other virus spread by this route is measles, the most infectious disease of humans. Unlike measles, almost nobody will be immune to this novel virus so it will spread everywhere. Unless you go and live like a hermit for the next 6 months you will contract Coronavirus.

      • Proper NIOSH N95 masks filter 95% of particles bigger than 0.3 microns. So, if you’re using the right kind of mask, yes they do provide excellent protection from aerosol droplets at 5 microns, more than 10x the filtration size (the bigger issue is leakage around the edge of the masks from poor fit).

        I doubt that Coronavirus will last “for hours” in viable form in droplets in the air in many places. Particularly in dry climates, such droplets will evaporate. Once a droplet has evaporated it is usually the case that the virus is inactivated.

        Coronaviruses are extremely common, about 1/3 of all “common colds” are caused one or another kind of coronavirus. This suggests that lots of people have had related viruses in the recent past, and that at least partial immunity is to be expected. Measles not so much. Relatively few people over age 10 have had recent exposure to measles through either vaccine or direct virus.

        Your statement “unless you go and live like a hermit for the next 6 months you will contract Coronavirus” is straightforwardly WRONG. There are tens of millions of people who live within a few miles of the center of the outbreak in China, and yet only on the order of tens of thousands to 100k of them have gotten the virus in the last 2 months. Do you actually believe that 1 Billion chinese people will have the virus by the end of 6 months, that 6-7 billion people around the world will have had the virus by July?

        The bigger problem than the virus itself I predict will be the failure of infrastructure that relies on people going out and interacting with each other. For example transporting food, medicine, maintaining utilities, etc. If people hole-up to avoid spreading the virus it can work for a couple weeks maybe, but at some point it doesn’t work anymore. You’ll see this in the area around Milan.

        • Nick Adams says:

          Recent research suggests that N95 masks don’t work in practice.
          Whether a Coronavirus causes upper respiratory tract infection (a cold) or lower respiratory tract infection (pneumonia) depends on which human cell receptors it can bind to. Lower respiratory tract infection is more serious and is clearly where the current virus is targeting.
          Immunity to one Coronavirus strain does not provide immunity to other strains (hence the commoness of the common cold).
          Not everyone infected with this Coronavirus develops symptoms and some develop mild symptoms. It is impossible to determine what proportion of the population in Wuhan have been infected given only a tiny proportion of them will have been tested.
          Theoretically, almost no-one will be immune to infection with a novel virus such as this.

          • Some of what you say is probably true, other things are maybe over-simplifications… for example:

            N95 doesn’t work in practice: a big part of this is people haven’t got a clue how to use them. You see people using them with just one of the two straps, or with the metal piece not properly bent into place over their nose, etc… For trained infectious disease workers I’m *quite* sure the effectiveness is way higher than for random person who buys one from a street vendor and has no knowledge.

            Immunity to one doesn’t provide immunity to other… should read doesn’t *necessarily* provide immunity to others. Sometimes it could, sometimes it won’t. It depends very much on how similar the strains are and which antibodies your body learned to produce. For example with Spanish flu it never got bad in china. Why? Because it probably started there and circulated before mutating in the trenches of WWI.

            Knowing whether a person was exposed and didn’t get infected is virtually impossible, so we have essentially no data on cross-immunity. The only thing we can say for SURE is that the estimate of zero cross immunity is dramatically biased low due to essentially sampling bias. The default, and WRONG model is that people who don’t get it are assumed to have not been exposed, rather than simply immune.

            not everyone gets serious symptoms: this in and of itself is evidence of cross immunity, that prior exposure to some other related virus produces partial resistance is a known fact about other viruses. People who get less serious symptoms are probably people who have partial immunity due to previous exposures. The common cold is common, but it’s hardly the case that 100% of everyone who is exposed gets the common cold.

            Theoretically, almost no-one will be immune… No, that’s not a reasonable theory. Almost everyone will have had exposure to something similar, certainly some will get more mild symptoms, or no infection due to their previous exposure (or alternatively some will get more violent symptoms due to previous exposure, just as people with allergies sometimes get more progressively reactive)

            The biggest wrong assumption in my opinion is that people who didn’t get the virus weren’t exposed. This seems to be standard among doctors, and produces estimates like “0% of people were immune”. Statistically, this is GIGO.

            A better model would be to acknowledge our uncertainty in percent of people who will be immune, put a prior on it say uniform(0,1), and do a Bayesian analysis. If you only look at people who got the virus, this will be uninformative as to percentage immune, and therefore your posterior would be uniform(0,1) as well… In other words, there is nothing to learn by being a doctor and treating sick patients only.

            if you go out of your way to find people who were in contact with known patients and didn’t get sick, you will have more information, and could easily result in posteriors for immunity that look like anything at all, even say 80% immune. Basically noone does that analysis so we’re living in the dark ages of knowledge about immunity.

  14. For those who are interested in timely moderated updates on Caronavirus https://twitter.com/cdavidnaylor

  15. https://www.snopes.com/fact-check/violent-aftermath-of-coronavirus/

    Here is an example of the kind of “Information Warfare” issues surrounding this coronavirus stuff… I have no doubt that some professional propaganda machine with falsified accounts cut together these videos and posted them to twitter etc with various captions and they were then spread around by innocent people who were genuinely assuming that what they were watching was either valid stuff, or just wanted someone to explain what was really going on… which nevertheless gets the video spread, and panic ensues. Exactly what was desired by the incipients.

  16. Stevec says:

    Learning about a complex subject from the media, whether about possible pandemics, or climate change – it’s usually negative knowledge.

    Not even a waste of time, instead an illusion that you now know something.

  17. Kaiser says:

    I think the fallacy behind the cognitive-illusion angle is the assumption that there is an appropriate response for everyone. The reality is differential risk tolerance!

    It is quite possible that after this is over, most of the economic damage will be self-imposed by excess of caution. But it’s not necessarily irrational given the uncertainty and the limited data to make these decisions.

    I’m more concerned about the situations with much more certainty. In my book, I look at e-coli outbreak investigations, and large-scale produce recalls. I think there is a case to be made there that the excess of caution is hurting the industry. We know a lot of e-coli outbreaks, and the fatality rate is low to zero.

    • I’ve been writing about this a bunch, both on my blog and for my friends via my FB feed. People are pretty confused about the whole thing in the general public. It seems like “no big deal” since there are only 200 some cases in the US… They don’t understand how that’s a highly biased estimate (it is in fact the minimum lower bound).

      The thing that’s obvious to me is that at some point soon, vast swaths of people will have to do social distancing to contain the spread. The duration of that and its effect is basically fixed, something like 15 to 30 days to let the virus run its course in the existing infected population. Either we do it NOW and have N people get the illness… or we do it LATER and have maybe 1000N people get the illness… Either way we do it… So we *SHOULD* all do it RIGHT NOW because we avoid 999N illnesses.

      In fact what will happen is everyone will freak out in about 10-20 days after tens of thousands have the illness. Doubling time in the US is currently somewhere between 2 and 5 days. It just doesn’t take long before 200 known cases which represent maybe 500 to 2000 actual cases becomes 20000 known and 100k total…

      • Kaiser says:

        It goes back to the risk assessment. If (and this is still not clear) this is not a particularly lethal virus, it should be okay to let it spread – in fact, as you pointed out, it’s inevitable. Maybe the efforts should be directed to the most vulnerable populations. I just read that the virus is easily killed by common wipes and cleaners, which is reassuring.

        • Carlos Ungil says:

          “Our colleagues coordinating the emergency ICU response in Northern Italy have sent me the following message which they wish to convey to all our members. [of the European Society of Intensive Care Medicine] [ …. ]

          “At this moment in time, we believe it is important to share our first impressions and what we have learned in the first ten days of the COVID-19 outbreak.

          “We have seen a very high number of ICU admissions, almost entirely due to severe hypoxic respiratory failure requiring mechanical ventilation.

          “The surge can be important during an outbreak and cluster containment has to be in place to slow down virus transmission.

          “We are seeing a high percentage of positive cases being admitted to our Intensive Care Units, in the range of 10% of all positive patients.

          “We wish to convey a strong message: Get ready!”

          https://mailchi.mp/esicm/the-future-of-haemodynamic-monitoring-first-webinar-of-the-year-1009715

          • Martha (Smith) says:

            This sounds like it’s saying that analysis calculations need to be more fine-tuned — in particular, to compare projected number of cases needing mechanical ventilation to availability of mechanical ventilation equipment.

            • It would be trivial to overwhelm our ability to provide mechanical ventilation no matter what that ability is today. With ~100k ICU beds total around the whole country, how many are in LA county? Let’s just pretend its impossibly high, say 50k. There are ~10M people in LA county. Suppose 10% get sick, and 10% of those need hospitalization, that’s 100k ICU beds needed *just in this county*.

            • Carlos Ungil says:

              One number is much larger than the other if there is a massive infection. No need for fine-tuning to realize that’s a bad scenario.

      • Anoneuoid says:

        It is already widespread in the US, it has been since mid-Jan. That is when it was time to do social distancing, etc. Now is the time to use common sense like don’t hug strangers, dont lick shrines, dont pack together like sardines in church/transport/etc. Basically it is already a pandemic so the time for containment measures has passed. Of course schools and nursing homes still shut down for the flu every now and then, but there is no point to doing it countrywide.

        What will happen soon though is they will start testing en masse.

        • In this thread, I am a bit concerned about the something like 15 to 30 days to let the virus run its course as all the expert opinion I have encountered is talking in months if not years. Now, if its noticed that infections are escalating, such a period might bring down the rate substantially. However, there will be a cost of doing that prematurely as we are dependent on functioning supplies of food, service and health care.

          Putting off unessential travel seems reasonable or anything else that does not hamper functioning supplies of food, service and health care. And as Kaiser pointed out the risks and risk tolerance are individual.

          And as Anoneuoid points out there are easy was to reduce the transmission rate. At my kickboxing club, I did get them to stop high fiving.

          Here’s another short list from the Public health Agency of Canada.

          Wash your hands frequently with soap and warm water for at least 20 seconds.
          Sneeze or cough into your arm or sleeve.
          Consider a wave or elbow bump in place of a handshake, hug or kiss.
          Reduce your exposure to crowded places by shopping or using transit during non-peak hours.
          Encourage those you know are sick to stay home until they no longer have symptoms.
          If you become ill, stay home until you are no longer showing symptoms. Contact your health care professional
          or local public health authority and tell them your symptoms. They will give you advice about what to do next [and all costs are covered for every resident.]

          • Carlos Ungil says:

            > At my kickboxing club, I did get them to stop high fiving.

            Made me chuckle.

          • Agreed that we need to prioritize keeping food supplies, and health care open. But that’s a pretty small fraction of all public jobs. You could close every Target, WalMart, Barnes and Noble, fast food restaurant, sunglass hut, Guitar center, Sears, plumbing supply store, hardware store (minus a few for maintenance of health care and soforth) for 30 days and it’d do very little to the GDP… people would just *delay* a lot of purchases, (it’d hurt the restaurants though! but there isn’t necessarily a way to avoid that. it’s not like it won’t happen eventually anyway) and when they reopened there’d be a bunch of activity, instead of a little bit each day during the closure period.

            If the US instituted UBI immediately the number of people who would stay home from work temporarily instead of trying to work through illness at restaurants or restocking shelves or whatever and spreading it around … would be dramatically lower. And post apocalypse the economic recovery would be dramatic.

            We’re already seeing cancellations of all soon upcoming conferences in technology industries, Caltech canceled their outreach program, USC is prepping for teaching courses entirely online. University of Washington has moved all its courses online…

            The result is inevitable, it’s just about whether we do it early enough that the sickness and deaths are low, or late enough that we fuck everything up… I’m betting on a more fuckup than needed.

        • Widespread geographically, but I’d doubt it’s more than 10 to 20x the official cases since around 10-20% of people seem to get seriously ill.

          Quoting fatality numbers without breaking it down by age is basically criminal mishandling of data… but breakdowns by age from the Chinese data are useful:

          https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

          It shows that kids and people under 40 or so are not at high risk, but I still think a 0.2% probability of death is a pretty expensive thing. Consider if someone would be willing to deposit $N in a trust account for your heirs, provided you would be willing to take a cyanide pill. What is your willingness to accept the cyanide pill?? for me it’s well over $10M. That puts 0.4% chance of death for a mid 40’s parent at well over $40k. That’s on the same order of magnitude as median income for a year (median family income is around $60k I think, individual income lower).

          On the other hand, you have for people 50+ or 60+ a dramatic rate of death in the several percent range, 8% for people in their 70+ range. This is an important factor in the lives of millions of children, so loss of say 10% of all grandparents would be a massive loss.

          No, it’s not reasonable to just “let this virus spread”. At the doubling every 2-5 days it’ll be millions of people sick by April, and at that point we’ll all shut down, and given the US inability to do anything good healthcare administration wise, it’ll result in dramatic overruns of healthcare and higher fatality rates than needed. AND WE WILL ALL WIND UP DOING THE HIDING OUT ANYWAY.

          So the difference between closing schools, workplaces, sports stadiums etc NOW vs not is that we’ll have HIGHER COSTS in dollars and lives if we don’t do it now.

          On the other hand, *if we do it now* then the economic costs will be attributed to the administrators and things who made the decisions, and the outcomes will seem like “no big deal”… SO everyone who called off the various events will be fired for incompetence… If we wait till later, lots of people die, and the virus gets blamed.

          So, we’ll wait til later.

          I personally have pulled my kids from school and have signed up to get a 3 week independent study. I’m enjoying teaching them about electronics, having them read about women scientists on simple english wikipedia, and taking hikes… but on the other hand, I’m not on the edge of paying rent and worried about becoming homeless soon if I don’t work every day.

          Our country needs UBI for the resilience it creates.

        • Martha (Smith) says:

          “What will happen soon though is they will start testing en masse.”

          Are you sure of this? My impression is that the facilities for testing are not currently enough to handle mass testing.

          • Anoneuoid says:

            U.S. laboratories should have the materials capable of performing about a million coronavirus tests by the end of the week, U.S. Food and Drug Administration (FDA) Commissioner Stephen Hahn claimed, as cases across the nation rose to more than 100 and health officials warned of a surge in numbers.

            https://www.theepochtimes.com/one-million-us-coronavirus-tests-to-be-available-by-end-of-week-fda-official_3259437.html

          • Kaiser says:

            I’m concerned about test accuracy. When they could come up with a test so quickly, it makes me wonder. Our knowledge of the virus at the start would not be that great. I’m not a medical expert so maybe someone knows better.

            • Carlos Ungil says:

              What is surprising is that “they” (the CDC) had so many problems to develop a test.

              The technology used is pretty standard and the genetic sequences required to identify the virus have been available for almost two months: https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf

              “While other countries have been able to run millions of tests, the CDC has tested only 1,235 patients.”

              https://www.technologyreview.com/s/615323/why-the-cdc-botched-its-coronavirus-testing/

              • Anoneuoid says:

                Yes, but what is the specificity and sensitivity of the tests being used in China, South Korea, Italy, etc? What gold standard was used?

                It seems clear to me the CDC and FDA did not trust those tests.

            • As I understand it, the test is based on real-time rtPCR (reverse transcriptase polymerase chain reaction). https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html

              it detects some fragment of the RNA of the virus that’s “unique” to that virus by amplifying it around 2x per thermal cycle. Each thermal cycle takes a minute or something, so typically they’ll do 25 to 30 thermal cycles, so you’re talking a couple hundred million to a billion copies of whatever was there, if there was something there. In a half hour, you can run an array full of tests, I don’t know something like 96 wells at a time. You need some positive and negative controls, but basically figure they can run around 100 tests per machine per hour (it takes time to make the prep and time to run). There might be tens of machines at any one lab.

              The biggest problem is that even a single virus particle contaminating an otherwise “clean” sample will result in a positive… so you’ll have generally more false positives than negatives. Because of this they’re running two samples per person. So the millions of test kits are really only hundreds of thousands of people who can be tested. Better than before by a lot…

              My biggest worry is that they’ll just throw away the data when it comes back negative, rather than reporting it and using it to estimate the prevalence… But I’m hoping that they’re required to report the results of every test.

              PCR tests are very accurate, very sensitive, but prone to contamination based false positives.

              • OK it is in Canada (1/10 the size of US)

                As of March 6, 2020, the National Microbiology Laboratory has confirmed 538 negative cases and 15 positive cases of COVID-19. More tests were done by provinces – current confirmed cases overall is at 49.

                Further details here – https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

                I would be shocked if the negatives are not being tracked as all the postives (until a day or two ago) were traced and all their known contacts in Canada contacted (with the exception of one that took public transit. That bus was taken out of service before the next run – complete one out and one return trip – it’s route and time identified in the media and all known riders on the bus were sent messages). So there needs to be a lot of work done while the waiting for the test result.

                OK, we are expecting US media to suggest the virus came from Canada just like the 911 terrorists ;-)

      • Anoneuoid says:

        Here is a good post:

        Let me put it another way: at the time of the evacuation of Americans from Wuhan, when there were well under 10k reported cases in a city of 11 million, if you were a customs officer, and someone was flying from Wuhan into your country, there would be a 0.0009% 0.09% chance that a random traveler from Wuhan would have the virus. Yet in Australia, in that week, 15 people who got off the plane had the virus.

        https://old.reddit.com/r/COVID19/comments/feasms/can_someone_help_me_try_to_understand_this_math/

        Nothing make sense unless you assume there are far more cases than have been reported.

        During the interval between February 19 and 23, 2020, Iran reported its first 43 cases with eight deaths. Three exported cases originating in Iran were identified, suggesting a underlying burden of disease in that country than is indicated by reported cases.
        […]
        We estimated that 18,300 (95% confidence interval: 3770 to 53,470) COVID-19 cases would have had to occur in Iran, assuming an outbreak duration of 1.5 months in the country, in order to observe these three internationally exported cases reported at the time of writing.

        https://www.medrxiv.org/content/10.1101/2020.02.24.20027375v1

        18,000 real cases for every 43 reported cases (0.2% detection rate) is probably too extreme, but something like that is going on. I’d guess 1-10% of cases are being detected.

        • 1-10% of cases detected is in line with my guess too.

          • Anoneuoid says:

            For me that leads to the conclusion it really is not very scary and has already been around in the US for quite awhile.

            If you only look at confirmed cases of the flu 14% end up in the hospital, but that is like 1-5% of the total number of cases.

            And keep in mind the “health authorities” remain more scared of smoking than this virus. If not they would be investigating why there are so few smokers.

            Nonetheless I expect a massive increase in cases and news coverage over the next two weeks.

            • >For me that leads to the conclusion it really is not very scary and has already been around in the US for quite awhile.

              I don’t think that at all. They know this virus jumped to humans in China around end of december in a particular meat market or something. So unless “quite a while” for you means 2 months or something, then no.

              There are ~ 300 cases in the US confirmed. If you multiply by 10 that’s 3000, by 20 = 6000 so this is still piddly numbers. On the other hand it’s doubling around every 3 days, so wait 21 days and it’ll be 300000 to 600000 if we don’t take steps to change that.

              It’s definitely not the case that 10% of confirmed flu cases need ICU and ventilators. It’s not the case that 8% of flu cases over 70 die. In the absence of sufficient ICU / ventilators, essentially 100% of the people who need ICU/ventilators will die. In a case where we have rapid peaking of cases, it’d be easy to produce 1 Million cases in LA county alone left unchecked (ie. if everyone were stupid and went to Disneyland and Universal Studios and big tech conferences and things), if 10% need ventilators, there’s maybe capacity to ventilate 20k people… ~80-200k people could die within a month in LA county alone.

              This virus is likely to be ~ 10x worse than typical flu. That’s a big deal. I get the flu shot every year because the few times I’ve had the flu it was bad.

              I agree with your assessment that it’s more widespread than acknowledged, by maybe a factor of 10, but I disagree with your conclusion. Remember it’s got ~ 5 day incubation period, and peak symptoms are at ~10 days post onset of fever. Doubling every 3 days, let’s back extrapolate from 6000 circulating cases today, how many were there 12 days ago say? only 375… So essentially ALL the cases out there in the US are still in the early enough stages that people don’t realize they have a serious problem… they’re only ~ 3 to 7 days into symptomatic period.

              • Anoneuoid says:

                There are probably already more than 100k infections in the US.

              • Based on what calculation? This is just your gut instinct? There are ~100k confirmed worldwide. You could guess maybe that across all of the world only 10% of infections are confirmed, so that it’s currently 1M but there are only ~300 confirmed in the US, so your assertion is that only 0.3 % of infections have been confirmed. That seems unlikely.

                My own take is that we know ~300 is the lower bound, if 10% of cases are bad enough to get tested we’d expect about 3000 cases, if 5% of cases are bad enough to get tested there are 6000, if only 1% of cases are bad enough to get tested it’s still only 30,000

                A disease where only 1% of people even get sick enough to get tested is not consistent with the Chinese experience in my opinion.

  18. Anoneuoid says:

    Is there a way to whitelist my email from the spambin? I’m being punished for including links (sources) and now have 3 spambinned posts.

  19. Although it’s not ideal, this map based display is the best thing I’ve found, and seems to be updated a couple times a day or so:

    https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

    The size of the dots is somehow related to the number of cases, but it isn’t what I’d call a good relationship, doesn’t seem to be area proportional to number of cases…

    the graphs on the lower right, when plotted on the log scale, show the exponential growth outside china (yellow dots) and you can estimate the slope of the line to get a doubling time (basically mouse-over any point, then move forward in time until you see about double what was displayed on the first dot… it’ll be around 3 to 5 days later for the data after start of february.

    I suspect for now the growth rate of confirmed cases is similar to the growth rate of all cases, though I think all cases will be around 5 to 20 times what the confirmed count is at least outside china.

    in the US, you’ll see a rapid increase in cases over the next few days which is indicative of more widespread testing rather than growth in case number…

    • Keith O’Rourke says:

      > more widespread testing
      That will be informative.

      Meanwhile up north in Canada, the province of BC has a 4 month plan to make sure such things as grocery stores are stocked and health care workers can be moved around as necessary, 27 million is flowing into covid19 research now with more available when useful, income maintenance plans are being put in place for those who need to self quarantine, etc.

      Should I set up a blog post for covid19 “sourced” coverage of what’s (actually) happen, with “opinions” without sources blocked?

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