The Great Barrington Declaration, COVID-19 and Herd Immunity

One of the problems with DIY Science is that an awful lot of people use terms of art incorrectly. The term “herd immunity” is one such term. It refers to a point of steady state equilibrium. In essence, a sufficient proportion of the population has been infected and retains sufficient immunity such that it shields most of the rest of the population from infection. 

This does not mean that the virus is eradicated. Nor does it imply stasis. People who got infected can and probably will be infected again. That is the pattern of other corona viruses, for instance, the flu. But the body’s defenses build up and the virus weakens over time, consequently reducing the severity of subsequent infections, until such time as the immune system weakens with age. That is why the sensible course of action is to take steps to develop effective therapeutics and protect vulnerable populations, particularly the elderly. 

That said, there should be no illusion that COVID-19 is going to be eradicated. The only virus in the world that has been successfully eradicated is smallpox. All the rest are still with us and contained by the use of vaccines, proper sanitation (like clean water) and other public health measures. Parenthetically, it should be noted that vaccines, which are often only 50% effective, are but one tool in the arsenal whose function is to contain the virus and treat patients. Eradication is not likely to be in the cards. 

It is important to consider another factor, namely that the infection estimates that are published daily in the U.S. are very likely incorrect, perhaps by an order of magnitude. Various studies have shown that actual infections far outnumber confirmed infections, possibly by as much as 6 to 24 times the amount. See for instance, this article in Reason Magazine and this column by Holman W. Jenkins in the Wall Street Journal

It is unfortunate that coverage of the Coronavirus pandemic has verged on the hysterical. Why is an interesting question. It is clear that many journalists writing about the virus have no understanding of science. They do not understand the distinction between a data point and a sample; nor do they understand the basics of research design or statistical methodology. Nor have many read, much less understood, the research papers they cite.  

But it is vitally important to understand the nature of the virus and the policy implications for dealing with it. That means understanding the costs, benefits and trade-offs needed to contain and treat it. The authors of the Great Barrington Declaration have provided a framework for doing just that. Below is an interview with Oxford Professor Sunetra Gupta, one of the authors of the Declaration. It is well worth watching. 

Professor Sunetra Gupta

JFB

Joe Biden: Super Hero

It is hard to imagine that anyone could figure out a way to be more juvenile and petty than Donald J. Trump. But the Democrats have managed to do it. They are going to blame the COVID19 crisis on Donald Trump. And Joe Biden is slated to be the messenger. His job is to read the teleprompter and avoid extemporizing. 

I can hear the wail of protest now. The Democrats will argue that they are not blaming the virus on Trump; only that his belated response caused the virus to get out of hand. And we are meant to believe that the Democratic Party’s standard bearer would have done much, much better. 

If, for some reason, you ignore (1) who the standard bearer is actually likely to be, and (2) the time line of what actually happened, the argument has surface plausibility. But then reality sets in. The Party is poised nominate Joe Biden, a 78 year old with mental faculties obviously in decline. Not that they were anything to write home about to begin with.

So let’s look at the time line.

January 14, 2020—The World Health Organization (WHO) voiced the Chinese government’s party line. WHO said “Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel coronavirus (2019-nCoV) identified in Wuhan, China.” (See the Federalist). 

January 30, 2020—WHO declares a public health emergency of international concern and confirms person-to-person spread of the virus. 

January 31, 2020—President Trump declares a U.S. public health emergency and issues a ban on travel between the U.S. and China. That decision was endorsed by Dr. Anthony Fauci who later in an interview with Lester Holt, said “One of the things we did right was very early cut off travel from China to the United States…outside of China, where it originated, the countries in the world who have it are through travel.”

What was Joe Biden’s reaction?  Joe Biden reacted that day on the campaign trail in Iowa by saying “This is no time for Donald Trump’s record of hysteria and xenophobia.” 

And what has Joe Biden proposed to handle the crisis? Well, he has called for “a decisive public-health response.” This is a pretty typical Biden non-response, on par with his penchant for referring to working with “the international community” whenever a foreign policy dilemma makes an appearance. And believe it or not, on the campaign trail he promised that if he is elected President, “Were gonna cure cancer.”

Really. He actually said that. 

And we are supposed to take Joe Biden seriously?   Why?

JFB

Why is there a Shortage of Medical Equipment to Fight COVID-19?

Gary Becker, a Nobel Prize winning economist from the University of Chicago was once asked what government’s mainly produces. “Lines” he replied.

So here we are in March 2020 with the economy screeching to a halt and citizens staying in their homes largely as a result of government decree. The reason? There is not enough equipment available to test to see who has COVID-19 so that they might be isolated and treated, and the spread of the disease stopped.

Why did we lack adequate supplies of diagnostic kits, hospital beds and other treatment facilities and equipment? Routine bureaucratic incompetence. See the video below. Then think again about a “single payer” system.

JFB

The Narrative

One of the more disheartening developments in what we laughingly call public debate has been the extraordinary emphasis placed on “the narrative”. The whole point of “the narrative” is issue framing. Instead of facts like who, what, where, why and when, the narrative seeks to define the contours of a story, and therefore the way the story is understood. In this manner, a story becomes part of a larger picture, woven into a tapestry of stories, pointing in the same direction, supposedly revealing a larger truth. 

But there is a problem with this. It is reasonably easy for unscrupulous players to get away with deliberately mischaracterizing issues by slippery uses of language and symbols, especially when they are not called out by the press. To be clear, it is not just deliberate mischaracterization that is a problem; it is also results from intellectual laziness and sloppy thinking that comfortably fits into the accepted “narrative”. 

Consider recent developments. The Corona virus is now charting a devastating path across the globe. With few exceptions, Taiwan being one, governments have been caught flat-footed. In part this is due to the dishonestly of the Chinese government which tried to cover up the outbreak at its epicenter in the Wuhan province. But other governments and international agencies like the World Health Organization (WHO) chose to believe them or pretend to believe them, giving the virus time to metastasize around the globe before effective containment efforts could begin. 

Let’s acknowledge that there are reasonable people (most politicians excluded) on all sides of the discussion considering the likely path and severity of the virus. In part this is due to a lack of data. As the Wall Street Journal reports, CDC officials botched the initial development of a test kit; resisted calls from state officials and medical providers to broaden testing, and health officials failed to coordinate with outside companies to ensure needed test-kit supplies. As a result, largely due to lack of information, U.S. efforts to contain the virus were hamstrung from the very beginning. 

Add to that the magical thinking of President Donald J Trump. The irony is that Trump, a germaphobe, apparently decided that the whole exercise was nothing more than a publicity problem. And so he embarked on a regimen of happy talk in the hope that it would all go away, thus displaying for the umpteenth time how utterly unsuited he is for the office he holds. 

Which gets us back to the narrative. 

There is little question that Trump put on a breathtaking display of incompetence in his initial response to the threat posed by the virus. That said, it is also the case that we have a systemic failure on our hands. The failure has been years in the making. It is the result of bureaucratic ineptitude and policies adopted across many levels of government over a long period of time. It is not the singular fault of Trump as the developing narrative has it. Nor is the solution to simply hand out buckets full of cash, which is the usual progressive solution to just about everything. 

Consider, for example, the latest policy initiative which is to “flatten the curve”. When epidemiologists talk about flattening the curve, they mean to spread out over time, rather than reduce, the incidence of contagion. The rationale for this is to avoid a concentrated case load that would overcome the treatment capacity of the health care system. Note that this approach, designed to save the system rather than individual patients, may very well result in more rather than fewer people becoming infected. On the other hand, if the system did become overwhelmed, it is quite possible, if not probable, that more people would die. 

Why Are We in This Mess?

At this stage of the game it is worth asking why the wealthiest, most powerful nation on earth finds itself with a potential shortage of hospital beds, other relevant medical equipment, doctors, nurses and other health care professionals. One important reason, although not the only one, is the collection of perverse incentives embedded in the health care system. 

Consider the question of hospital bed capacity. The limited number of available hospital beds is not an accident; it is there by design. Hospitals are subject to state as well as federal regulations.  Among those are requirements for hospitals to acquire a “certificate of need” or CON from state regulatory authorities before adding hospital beds and some other types of equipment, e.g.,— MRI machines. Partially as a result, the U.S. has only 2.8 beds per 1,000 people—less than the 3.2 beds Italy has. By way of contrast, South Korea heads the list with 12.3 beds per 1,000 people. (For an in depth discussion, please see this article in Reason Magazine.)

Anti-competitive restrictions on hospital beds and other capital equipment are not the only problem. The system is driven by price controls that discourage innovation. The biggest spender for health care is the federal government, which decrees what it will pay for certain services through Medicare and Medicaid. In turn, these pricing policies affect what insurance companies will pay providers. Which in turn affects premiums that customers pay. Which, of course, our modern central planners want to eliminate by making private insurance illegal, thus locking in all the market distortions the current system has embedded in it. A single payer system would rely on mandates and allow no competition, and would guaranty that supply and demand would remain out of alignment. 

But rational discussion of supply, demand and market pricing is to be avoided at all costs. The all important and phony narrative must be maintained. The problem is really the result of waste, fraud, abuse and corporate greed. Couple that with the fact that Donald Trump is president. Add the fantasy that he is illegitimate because Vladimir Putin put him there, and all the ingredients are there to believe anything. Anything but the truth of the matter, which is that a combination of incompetent leadership and the command and control system put in place over the years failed us. As usual.

Not surprisingly, because it fits the narrative, the solution being crafted in Washington is to throw money at favored constituencies, which may or may not have anything to do with the virus. Consider the argument for sending out checks to citizens in order to stimulate the economy. Does anybody seriously believe that sending citizens checks and then telling them to stay home is even remotely stimulative?

It is certainly the case that many citizens will experience significant hardship over the months ahead as the unemployment rate rapidly heads north. In this emergency situation it is proper for the government to act as a backstop, especially since it is a response to a situation utterly beyond the control of the citizenry. But it is important to note that the rescue is not free; the bill will have to be paid later. In addition, it should serve as a wake up call for reform that moves in the opposite direction we have been headed. The health care system should move toward decentralization, market pricing and local decision making rather than more centralization, price controls, and top down bureaucracy.  

But I’m not holding my breath. 

JFB