On the one hand, I probably could have done a better job of finding and reading non-coronavirus pieces this week. On the other hand, understandably, it seems everyone is writing about exactly the same thing. At least the first link is unrelated...
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Eight marvelous and melancholy things I've learned about creativity / The Oatmeal
Ten years ago I created The Oatmeal. I thought an appropriate way to mark the decade would be to publish a comic called "Ten things I've learned about creativity in ten years." Ten things. Ten years. Clean, simple, appropriate. That was the plan. It was a good plan. But as you'll see, creativity is not a horse. It cannot be trained or ridden. You cannot tell creativity, "I would like ten of those, please." Because creativity is not a horse. It is a mountain lion.
My husband, a tall, robust 56-year-old who regularly goes — who regularly went — on five-hour bike rides from our Brooklyn neighborhood to Jamaica Bay in Queens and back, has been lying on his back, staring at the ceiling, or curled on his side, wearing the same pajama bottoms for days because it is too hard to change out of them, too hard to stay that long on his feet, too cold outside the sheets and blankets he huddles beneath. It has been 12 days since T woke up in the middle of the night on March 12 with chills. [...] Now we live in a world in which I have planned with his doctor which emergency room we should head to if T suddenly gets worse, a world in which I am suddenly afraid we won’t have enough of the few things tempering the raging fever and soaking sweats and severe aches wracking him — the Advil and Tylenol that the doctors advise us to layer, one after the other, and that I scroll through websites searching for, seeing “out of stock” again and again. We are living inside the news stories of testing, quarantine, shortages and the disease’s progression. A friend scours the nearby stores and drops off a bunch of bodega packets of Tylenol. Another finds a bottle at a more remote pharmacy and drops it off, a golden prize I treasure against the feverish nights to come. [...] CK and I confine ourselves to the half bathroom, the one with the litter box, which she is now in charge of. Over the past days and days, drifty, dreamy CK has become my chief assistant on my nursing/housekeeping/kitchen rotations, feeding the cat and cleaning the litter box, folding laundry, preparing T’s small meals, washing dishes and pots, coordinating with me in a complicated choreography when I come out of the sickroom holding dishes so we can get them into the dishwasher without my touching the handles or having to wash my dry, raw hands even more. “I feel like we’re talking to each other more like equals now,” she says. She is right. I am consumed with trying to keep us safe. I wipe down the doorknobs, the light switches, the faucets, the handles, the counters with disinfectant. I swab my phone with alcohol. I throw the day’s hoodie into the laundry at night as if it were my scrubs. I wash all our towels, again and again. When CK wants to shower, I wipe down the whole main bathroom — where T refills his water cup, where he has had diarrhea, where he coughs and spits out phlegm — with bleach, take out T’s washcloth, towels and bathmat and replace them with clean ones, telling CK to try not to touch anything, to shower and go right back to her room. Then I do the same. If T needs to use the bathroom before we’re ready to shower, I do the whole bleach routine again before we go in. Twice, in the first week of the illness, I eased him into an Epsom-salt bath. But not since then. He is too weak. It would be too much. There is no way. When he shuffles down the hall from the bedroom to the bathroom, he lists against the wall. He splashes water on his face in the bathroom, and that has to be enough.
OxVent: could this prototype ventilator save thousands of lives? / The Face
I loved this story of ingenuity and resourcefulness; while the device hasn't been approved yet, I love the spirit with which people are trying to help:
In just one week, a team at Oxford University and King’s College London have built a simple ventilator that could potentially save thousands of lives as part of the UK and the world’s fight against coronavirus. The OxVent is a rapid prototype ventilator that could keep people breathing while they battle the worst impacts of COVID-19. Andrew Farmery of the University of Oxford, one of the people involved in its development, talks about its past, present, and potential. [...] How are you? [...] I’m very well, although slightly knackered. It’s been a very long week. It’s been absolutely incredible, from nothing a week ago when we first had an idle chat Monday morning last week, to this afternoon, when we pitched it to the Cabinet and the MHRA (Medicines and Healthcare Products Regulatory Agency). We’re waiting to hear whether they think it’s a goer or not. It’s been phenomenal, just going through several different designs and prototyping, involving all the different people, engineers, regulation experts. It’s been an amazing collaboration between my colleagues at Oxford and also King’s and all sorts of people just phoning up and offering to take on tasks and get all the documentation together, which is about as tall as I am. Now we’re just waiting for the call from the Cabinet Office. [...] The difference in our system is it uses the same basic principle that is used in a fairly simple operating theatre ventilator, but it doesn’t use any of the same components. It has basically repurposed all sorts of different components that are already in the NHS supply chain – bits of tubing for this, breathing valves for that and bags for this and the other. None of them are ordinarily used to make a ventilator. We were mindful of the fact that supply chains would be absolutely at a standstill so we couldn’t say: “I want a three-eights, 20cm water pop off valve machined and built with this thread,” because we simply wouldn’t get it. We went through the supply chain looking for bits that were designed for some other purpose in the NHS and were on the shelves. The whole design strategy was simplicity: very few moving parts, and very few parts at all. It needs to be cheap – it’s probably less than £1,000 – and could be put together by anybody, really. For quality control purposes we’re probably going to restrict it to ISO-certified fabricators, but literally a 16-year-old could do it in their bedroom.
By 1996, though, growth was again slowing, and Pfeiffer needed a new plan. Part 1 was expanding into more markets; Bloomberg explains part 2: [...] To get there, Compaq has already started “virtualizing” parts of its business. After cutting $57 off the cost of each home PC last year by building the chassis at its plant in Shenzhen, China, the company went a step further in cutting the cost of business desktop PCs: Instead of investing millions to expand the Shenzhen plant, Gregory E. Petsch, senior vice-president for operations, persuaded a Taiwanese supplier to build a new factory adjacent to Compaq’s to build the mechanicals for the business models. The best part of the deal: The Taiwanese supplier owns the inventory until it arrives at Compaq’s door in Houston. “This is the right way to do it,” says Sanford C. Bernstein & Co. computer analyst Vadim D. Zlotnikov. [...] Brand names were simply that: names, and not much more. This, of course, made for a fantastic return on assets; it was not so great for long-term sustainable revenue and profits. It is at this point, 1400+ words in, that I must make what is probably an obvious analogy to the historical moment we are in. While there may have been an opportunity to stop SARS-CoV-2 late last year, by January, worldwide spread was probably inevitable. [...] Since then, though, there has been divergence between countries that acted and countries that talked. Taiwan, where I live, is perhaps the best example of the former. [...] The contrast with Western countries is stark: to the extent government officials across the Western world were discussing the coronavirus a month ago, it was to express support for China or insist that life carry on as before; I already praised the role Twitter played in sounding the alarm — often in the face of downplaying from the media — but even that was, by definition, talk. What does not appear to have happened anywhere across the West is any sort of meaningful action until it was far too late. This has resulted in two problems: first, by the time Western governments acted, the only available option has been widespread lockdowns. Second, the talk itself is missing even the possibility of action. [...] And yet, life here is normal. Kids are in school, restaurants are open, the grocery stores are well-stocked. I would be lying if I didn’t admit that the rather shocking assertions of government authority and surveillance that make this possible, all of which I would have decried a few months ago, feel pretty liberating even as it is troubling. We need to talk about this! [...] Moreover, if the real tradeoffs to consider are about trading away civil liberties — which is exactly what has happened in Taiwan, at least to some extent — then the imperative to preserve debate about these matters is even more important. The most precious civil liberty of all is the ability to talk. Indeed, that is the terrible irony of losing the capability and will for action: it ultimately endangers the only thing we seem to be good at, and in this case, the potential writedown to too terrible to consider.
The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out. [...] With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency. That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition; some worried hospitals have bought out large quantities of supplies, in the way that panicked consumers have bought out toilet paper. Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear. Instead of springing into action, America sat idle. Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.” [...] After 9/11, the world focused on counterterrorism. After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies. Expect pandemics to top the agenda at the United Nations General Assembly. Anthony Fauci is now a household name. “Regular people who think easily about what a policewoman or firefighter does finally get what an epidemiologist does,” says Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security. Such changes, in themselves, might protect the world from the next inevitable disease. “The countries that had lived through SARS had a public consciousness about this that allowed them to leap into action,” said Ron Klain, the former Ebola czar. “The most commonly uttered sentence in America at the moment is, ‘I’ve never seen something like this before.’ That wasn’t a sentence anyone in Hong Kong uttered.” For the U.S., and for the world, it’s abundantly, viscerally clear what a pandemic can do.
An article by Nick Triggle on BBC Online raises the issue of whether many deaths from COVID-19 would have occurred anyway as part of the ‘normal’ risks faced by people, particularly the elderly and those with chronic health problems who are the main victims of COVID. To provide some background, I’ve had a look at how much ‘normal’ risk COVID seems to represent. [...] So, roughly speaking, we might say that getting COVID-19 is like packing a year’s worth of risk into a week or two. Which is why it’s important to spread out the infections to avoid the NHS being overwhelmed.
Coronalinks 3/27/20: We're Number One / Slate Star Codex
I rarely read Scott's weekly links (I suppose that's a bit ironic given this e-mail I send, particularly since I read everything else he writes); maybe I should. This post is an excellent combination of interesting sources and thoughtful commentary:
There isn’t a lot you can do to improve your chances if you get coronavirus, but one really important intervention you can take right now is to STOP SMOKING. I try not to lecture my patients on their health failings. I am not a jerk to obese people or people who don’t get enough exercise. But I try to tell every smoker, at least once, to STOP SMOKING. Studies have shown that having a doctor or other authority figure say this actually helps a lot, and every person who STOPS SMOKING gains 5 – 10 years of life expectancy. There is nothing else you can do as a doctor or a human being that gives you a medium chance of saving ten life-years with a ten second speech. Everything that effective altruism has to offer pales in comparison. So even though I hate lecturing people – on this blog as much as in my medical practice – I suck it up and tell everyone STOP SMOKING. If you need a reason to quit now instead of later, here it is: coronavirus is a lot worse for smokers. [...] I want to clarify that what I’m telling you right now is totally unprincipled propaganda, intended to take advantage of a moment of panic – realistically, on the list of ways smoking can kill you, coronavirus is somewhere near the bottom. [...] Honestly, coronavirus shouldn’t even figure into your calculations here. But since you are panicking about coronavirus right now, you might as well use it as motivation to STOP SMOKING. [...] Japan should be having a terrible time right now. [...] This is the most successful coronavirus containment by any major country’s, much better than even South Korea’s, and it was all done with zero effort. The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer. But at this point, it should be beyond their ability to cover up. [...] Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am. Some people have gestured at the Japanese being an unusually clean and law-abiding people. [...] One way this should affect us Westerners is by making us worried that an Asian-style containment strategy wouldn’t work here. The evidence in favor of such a strategy is that it worked in a bunch of Asian countries like South Korea, Taiwan, Hong Kong, and Singapore. But if there’s something about wealthy orderly mask-wearing Asian societies that makes them mysteriously immune to the pandemic, maybe their containment strategies aren’t really that impressive. [...] Also, what about Iran? [...] A UK critical care doctor on Reddit wrote a great explanation of their recent about-face on coronavirus strategy. They say that over the past few years, Britain developed a cutting-edge new strategy for dealing with pandemics by building herd immunity. It was actually really novel and exciting and they were anxious to try it out. When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things. But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Something something technocratic hubris vs. complexity of the real world.
Epidemiologist Larry Brilliant, who warned of pandemic in 2006, says we can beat the novel coronavirus—but first, we need lots more testing.
I am a privacy activist who has been riding a variety of high horses about the dangers of permanent, ubiquitous data collection since 2012. But warning people about these dangers today is like being concerned about black mold growing in the basement when the house is on fire. Yes, in the long run the elevated humidity poses a structural risk that may make the house uninhabitable, or at least a place no one wants to live. But right now, the house is on fire. We need to pour water on it. [...] Every one of us now carries a mobile tracking device that leaves a permanent trail of location data. This data is individually identifiable, precise to within a few meters, and is harvested by a remarkable variety of devices and corporations, including the large tech companies, internet service providers, handset manufacturers, mobile companies, retail stores, and in one infamous case, public trash cans on a London street. Anyone who has this data can retroactively reconstruct the movements of a person of interest, and track who they have been in proximity to over the past several days. Such a data set, combined with aggressive testing, offers the potential to trace entire chains of transmission in real time, and give early warning to those at highest risk. This surveillance sounds like dystopian fantasy, but it exists today, ready for use. All of the necessary data is being collected and stored already. The only thing missing is a collective effort to pool it and make it available to public health authorities, along with a mechanism to bypass the few Federal privacy laws that prevent the government from looking at the kind of data the private sector can collect without restraint.
Back when the COVID-19 pandemic was beginning to be taken seriously by the American public, 3blue1brown’s Grant Sanderson released a video about epidemics and exponential growth. (It’s excellent — I recommend watching it if you’re still a little unclear on how things are got so out of hand so quickly in Italy and, very soon, in NYC.) In his latest video, Sanderson digs a bit deeper into simulating epidemics using a variety of scenarios. Like, if people stay away from each other I get how that will slow the spread, but what if despite mostly staying away from each other people still occasionally go to a central location like a grocery store or a school? Also, what if you are able to identify and isolate the cases? And if you can, what if a few slip through, say because they show no symptoms and aren’t tested? How does travel between separate communities affect things? And what if people avoid contact with others for a while, but then they kind of get tired of it and stop? These simulations are fascinating to watch.
Where does all the heterogeneity come from? / Marginal Revolution
Nobody asked me, but it seems one contributing factor could be variation in timing of when snowball effects start; it remains possible that Iceland / Sweden / etc. are just a few weeks behind:
What is going on in the Icelandic numbers? What accounts for this apparent heterogeneity? Dosage? Is it that Icelandic clustering is mostly in one easy to control central city and the rest already is “socially distanced,” even in the best of times? [...] Similarly, Sweden hasn’t restricted public life very much and they do not seem to be falling apart? [...] By the way, on the “everyone already has it” theory, a semi-random sample of 645 from Colorado showed zero positives. So where is all this heterogeneity coming from? Is it all just bad data? That seems hard to believe at this point, and Iceland seems like a plausible source of reasonably good data. As for concrete conclusions, these heterogeneities should make us more skeptical about any models of the situation. But it would be wrong to conclude that we should do less, arguably risk-aversion could induce us to wish to do more, including on the lock downs front.
A number of countries have imposed export bans on medical equipment. This is a natural, knee-jerk, reaction but a mistake for two reasons. First, no country in the world produces everything it needs. An export ban imposed by one country benefits that country but when all countries ban exports, it’s likely that no country is better off and all are worse off. A prisoner’s dilemma. The prisoner’s dilemma is even worse than the basic analysis indicates because supply chains are globalized so it’s not even that one country produces ventilators and another produces masks and they are better off trading. Rather, it’s that both ventilator and mask production rely on inputs from other countries. What this means is that export bans make it more difficult for anyone to produce anything. [...] The second reason why export bans are a mistake is that when there are economies of scale banning exports can decrease local consumption. A company that knows that it cannot export will be less willing to invest in building new plant and infrastructure, for example. We see exactly this phenomena in the brain drain “paradox”. Brain drain proponents argue that developing countries need to ban exports of human capital (i.e. don’t let people leave) to keep skilled workers at home. But in fact places like the Philippines, which export a lot of nurses, also have more domestic nurses.
While it predates the COVID-19 pandemic and its accompanying social distancing by several years, José Manuel Ballester’s Concealed Spaces project reimagines iconic works of art without the people in them (like what’s happening to our public spaces right now). No one showed up for Leonardo’s Last Supper.