Author: chogan@directresearch.com

OK, next question:  Fine and dandy if this appears an obviously cost-effective gamble (just prior post).  Where are we going to get 250,000,000 masks?  In the next couple of days?

That’s the wrong question.

Here’s the right first question:  What is the best expedient mask, that can be made in a typical community, quickly and in volume, from commonly available materials and semi-skilled labor?

A Victory Mask, if you will.

Lord knows, a crapload of people have a crapload of time on their hands just right now.  It’s a huge labor force.  All of us could take an hour off from streaming video, and chip in.  If we had guidance, and leadership that endorsed the concept.

I say, let’s ask the US Army Corps of Engineers for a design or two.  They seem to have their act together.

If there is a single figure who appears to know what he’d going, who inspires confidence, who talks sense, and who looks like he can get done what needs to be done, I say it’s Lt. General Todd Semonite, Chief of Engineers and Commanding General of the US Army Corps of Engineers.  Watch this clip (caution, it’s Rachel Maddow), and see if you agree.

I realize they have more than enough on their plate.  But you wonder if they couldn’t just knock out a pattern for this, without a huge diversion of effort.

Heck, in some sense, this is well within their current mission.  A bed that isn’t going to be filled is a bed that doesn’t need to be built.  Kind of a reverse Roemer’s Law.

I’m going to work on my best shot at this.  Just examining materials, I’m not immediately dismissing 3M Filtrete plus Tyvek as a reasonable basis for reasonable multi-fabric-layer mask.  But I have no way even to conceive of how to test it.

Clearly, there’s no way that 3M could ever endorse that use.  They’d get sued if they did.  But there’s nothing to stop US citizens from using it “off label”.  If it has any sort of effectiveness at all.

Barring the US Army Corps of Engineers, where are the Mythbusters when you need them?  Seems like an ideal project for them to work out.

Source:  www.maskssavelives.org

I have worn a beard of some sort pretty much since my mid-20s.  I’m clean shaven now.  And that’s because I’m not going to enter any enclosed public space without wearing a mask, until such time as I can get vaccinated against this.  And a surgical mask doesn’t work well with a goatee.  So, it’s time to shave.

That mask use runs contrary to current CDC guidance.  But I’m not the only one disagreeing with CDC guidance in this regard.  This article was brought to my attention by a colleague, and I think everybody in the USA should read it.  Start with that.

And it looks like, nationally, a lot of people are more-or-less coming to the same decision.  Fully realizing that the main purpose of the internet is to allow crazy people to find each other and reinforce their views, the push to use some sort of mask in public, or at least to question the official CDC guidance, appears to be growing.

At present, I’m sitting here trying to sift through the available science on masks.  I cannot tell you that there is a good evidence basis behind wearing a mask.  I’m pretty sure that cheap ones don’t do much to protect you, but I’m beginning to suspect that they do something.  And that, as importantly, they do something to protect others from you.

So, I know what science questions I need to ask, I’m just not finding answers. And my profession isn’t medicine, I don’t really have the bona fides to answer those questions anyway.

But, as an economist, I am qualified to do a quick little cost benefit analysis.  Let me do it in the form of a word problem.

A 3M Aseptex non-sterile mask retails for about $0.40.  Let’s say that universal use of those masks, by adults, would shorten the pandemic a bit.  Let’s say that adults can reuse them as some hospitals now are, by the simple expedient of putting them in a paper bag to dry overnight.  And let’s further say that, at some point, this pandemic is going to grind the US economy to a halt.  There are about 250 million adults in the US.  And the 2019 US GDP was $21.44 trillion dollars.

Question:  How much would universal mask use have to shorten this pandemic, in order for it to be cost-effective.

Answer:  About three minutes.  If universal mask use shortened the duration of the US coronavirus epidemic by three minutes, it would be cost-effective.

Calculation:  Total cost is $0.40 x (250×10^6) = $1×10^8.  (A hundred million dollars).  The fraction of a year’s GDP is $1×10^8/$2.144×10^13 = 4.66×10^-6.  There are 365*24*60 = 5.26*10^5 minutes in a year.  And so that fraction of GDP amounts to 4.66×10^-6 X 5.26*10^5 = 2.45 minutes.

For the more medically minded, we could also do this by focusing narrowly on medical care costs, and do this in terms of cost-to-treat.  How many (say) hospitalizations would need to be avoided by universal adult mask use, in order for the reduction in hospital costs to offset the cost of the masks?  Guessing that a 12-day ICU-intensive is the median for this, based on the previously discussed WHO report on the Chinese experience, I’d guess a cost per discharge around $100,000.  If masks are $0.40, then if universal mask use merely avoided one hospitalization for every 250,000 US adults, it would be worthwhile from a cost-benefit standpoint.  Since there are 250 million adults, that means that if it merely avoids 1000 coronavirus hospitalizations, over the course of the pandemic, it more than pays for itself, merely looking narrowly at hospitalization cost, and ignoring the much larger GDP loss as the economy shuts down.  Either way, seems like a bet well worth taking.

It’s not rocket science.  Masks are cheap.  GDP loss is hugely expensive. Hospitalizations are somewhat expensive.  All that a policy of universal mask use needs is just a tiny probability of modest success, and such a strategy would be  hugely cost-effective. In my opinion, the evidence, such as it is, gives you that tiny probability, and then some.  It’s a cheap bet.

Seriously, in terms of taking a bet on something, that seems like a pretty cheap one, to me.  As in, what on earth are we waiting for?  It may be time to push the medical establishment aside on this issue, and let the economic consequences of action or inaction drive the decision, despite possibly ambiguous scientific evidence.

Continue reading Post #587: Mask-oriented post #1

I’m going to drop some threads here, and emphasize others.  And probably change the splash page, as this blog no longer has anything to do with MAC zoning.

But first, here’s a brief note on temporarily avoiding newspaper paywalls during this crisis.  It is, in some sense, anti-social of me to publicize this, but I keep linking to articles in newspapers that you cannot easily read without this technique.  Here goes:  Disable javascript in your browser.  Many (but not all) newspaper paywalls use javascript to obscure the text.  If you temporarily disable javascript in your browser, then reload a page, you can frequently read the text (but not, e.g., see the pictures).   This is, I believe, why most browsers make it incredibly difficult to disable javascript these days, when it was a common feature in the past.  For Firefox, I use a legacy javascript on-off applet, which I first picked up because javascript is a security hazard.  If you can find a javascript on-off applet, and install it, and use it, you will be able to read paywalled articles on some, but not all, newspaper sites.

And now I return to my regularly scheduled programming. Continue reading Post #586: Housekeeping issues for this website

Again, I’ll make this rare plea:  If you know someone in a position of responsibility that you think would benefit from reading this post, please pass this on.

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Recall Post #573, where I talked about aerosol transmission of COVID-19 versus droplet transmission.  In particular, where I note that the issue is tiny “aerosol” particles (less than 5 microns) that can remain suspended in air, resulting in “airborne transmission” of the disease.  Versus droplets (larger particles) that rapidly fall out of the air, but can result in “droplet transmission” of the disease if you are near somebody who (e.g.) coughs, and a droplet lands on you (and directly infects you by (e.g.) landing in your mouth, or indirectly infects you because you, yourself, manage to transfer that material to your mouth/nose/eyes by touching your face.).

CDC advice to the public focuses primarily (perhaps, solely) on preventing droplet transmission.  That is, in large part, the theory behind social distancing.  Stay out of range, and don’t touch your face, and wash your hands.  A lot.

To which I added, and shut up in public.  Not for your benefit.  But for everybody else’s benefit.  Based on the potential for aerosol (“airborne”) transmission.  Because speech generates large numbers of aerosol (5 micron or smaller) particles.

Now go read this article.

Choir practice turns fatal. Airborne coronavirus strongly suspected

By Richard Read, LA Times, March 29, 2020, 7:34 PM.

From a single chorus practice with a 60 member chorus, where nobody was visibly ill, where they used hand sanitizer at the door, where nobody shook hands, or hugged — 45 have now tested positive for coronavirus. Continue reading Post #585: Really, no kidding — shut up in public. Aerosol transmission of this disease appears possible.

Source:  Analysis of Johns Hopkins coronavirus map database.

Still too soon to tell if we’ve hit the inflection point.

There’s a farmers’ market at the Holy Comforter church this morning (3/29/2020). 

It ends at 1:30 today. 

It is completely stocked, and there are no customers.  I mean, clearly more vendors than customers.  They apparently more-or-less failed to advertise it.

So let me assure you, you’ll have no problem maintaining proper social distancing.

Maybe you want some fresh produce, meat, eggs, cheese, baked goods, etc.

Maybe you want to support local agriculture.   Honestly, at the current rate, these folks aren’t going to cover the cost of the gas it took to get them here.

Maybe you just feel the need to talk to somebody other than your immediate family.  Out in the fresh air.  Among what has to be the lowest-risk set of vendors you’re going to come across in the near future.

Maybe you just want a rare opportunity to go to a farmers’ market, on a Sunday morning, in an Episcopal church parking lot.

However you slice it, this is a fine opportunity.  But it’s a limited time offer.

Please pass the word.

Sometimes it takes a while for things to sink in.  Yesterday (Post #579) I brought up the Kinsa health weather map.  This tracks trends in rates of fever across the US, as a byproduct of the anonymized data produced by their their internet-connected thermometer.  Like so:

Source:  Source:  Kinsa health weather map.  Blue = declining trend in abnormal amounts of fever, compared to what would be expected at this time.

Now, I’m pretty savvy when it comes to health care data.  So when I saw their map — saw the perfect blue shade of it all across the US — I knew it was too perfect.  I was able to figure out that this probably wasn’t showing anything to do with COVID-19.  In terms of number of cases, common flu is vastly more prevalent than COVID-19.  All this shows is that our social distancing measures have successfully interrupted the transmission of influenza in the US.

All.  (Face-palm).  I said that wrong.  Let me try again.

This shows that our social distancing measures have successfully interrupted the transmission of influenza in the US.

And, you know what?  If those extreme measures interrupted the transmission of flu, odds are good that they interrupted the transmission of  COVID-19.  Which, per the CDC, pretty much spreads by the same mechanism that flu spreads, droplet transmission (with, IMHO, the chance of occasional aerosol transmission.)

Here’s today’s track for overall rates of fever in the US, as of about midnight 3/29/2020:

Source:  Source:  Kinsa health weather map.

As before, the blue band is the prevalence of fever that Kinsa expects to see, based on their projections of the flu season.  I read up on their methodology yesterday, and I’d say they’re pretty good at what they do.  In other words, that blue band isn’t some random guess, it was pretty tight estimate of where you’d expect us to be.

But that prediction is based on normal behavior.  That’s based on normal rates of flu spread, as we go about our usual school, work, and social activities.

Our behavior is now so unusual, we’ve actually driven the prevalence of fever well below the expected level.  To me, the only sensible explanation of that, given the relevant prevalence of disease, is that we’ve accidentally interrupted the spread of flu in the US.  But I’d say that makes it a good bet that we’ve also done what we set out to do, which was to interrupt the spread of COVID-19.

So I can’t yet guarantee you that social distancing is working on the virus it is targeting.  Nobody can.  But, at this point, I can confidently say that social distancing appears to be doing something to some virus.  Probably, due to the vastly larger number of cases, what we’re literally looking at its the impact on flu virus transmission.  But I’d bet good money, based on the similar means of transmission, that this is a crude proxy for interruption of spread of COVID-19.  I’d go so far to say it it strains credibility to think that we could interrupt spread of one and not the other, given the similar means by which they are most commonly transmitted, per the CDC (droplet transmission).

(Other explanations just don’t pan out due to small numbers — e.g., this isn’t the impact of COVID-19 cases being hospitalized and so not using their thermometers, this isn’t the impact of new thermometer sales to the worried-well, and so on.   Case counts are just too small relative to flu, I think. The Kinsa data is a flu-tracking system, and that’s almost certainly what it’s doing now.  The uptick in fevers due to COVID-19 was visible as long as it was seen against a normal background of a much larger number of flu fevers.  But once we interrupted the spread of flu, the loss of those flu fevers swamps everything else.)

COVID-19 has a long “pipeline”, so we aren’t seeing the inflection point in new cases yet.  We’re still observing cases that entered the pipeline two-plus weeks ago (infection) that are now coming out the other end (tested positive).  But this shifts my subjective odds that we’re going to see that inflection point soon.

I should also note in passing that I don’t think this has ever been observed before in the US.  This, being, the interruption of a flu season.  Ever.  That’s how crazily unusual this impact is.  You want crazy crazy?  This makes me wonder whether we might actually see an overall decline in the US mortality rate this year, assuming social distancing is successful.  Not a lot of (e.g.) car accidents happening at present.  In addition to flu deaths.

I have a couple of more things to say, but I’m just going to stop there.  This realization literally brought me awake at 3 AM.  The rest can wait for later today.  On that note, I leave you with a clip from one of my all-time favorite movies, The Emperor’s New Groove.

Orange bar is Fairfax County.  My heart wants to sketch in the other side of the hill, past the end of the graph.  My brain knows it’s far too soon to tell.

The Fairfax case count stands at 156, based on the Johns Hopkins database as of 6:30 this evening.

Source:  Kinsa health weather map.  Blue = declining trend in abnormal amounts of fever, compared to what would be expected at this time.

Source:  Kinsa health weather map.

Kinsa makes an internet-connected thermometer, and they use the resulting data for, among other things, monitoring trends in flu.  Lately, it seems to have value in monitoring trends in coronavirus.

Above, the dashed blue line is the amount of fever they expect to see at this time of year.  Band around that is (probably) the 95% confidence interval (what you could reasonably expect to occur, purely by chance).  Orange/red line is the actual observed level of fever.  Red is “atypical”, meaning above that 95% confidence interval band.  The little peak of the red portion is literally the day after Fairfax County shut the schools.  So, FWIW, their count of atypical fevers has been declining pretty much ever since Fairfax County closed the schools.

Caveat:  You can never be sure whether that’s a true result related to coronavirus, or just an artifact of odd changes in people’s behavior in these odd times.  That solid-blue map just looks too good to me, and I wonder whether (e.g.) the lack of kids catching the flu, with schools closed, is swamping any signal they might be getting from a change in coronavirus cases.  At this point, I don’t see anyone pointing to this and jumping up and down, other than a single business publication (see below).  And Kinsa itself is not saying that this heralds a decline in future coronavirus cases.

It is what it is:  it’s a general, non-disease-specific measure of the level of fever in the US population.  Plausibly, social distancing may have perturbed the calibration of their system.  (In effect, suppressing the normal levels of normal flu).  But at the minimum, it shows that any continued growth in coronavirus is too small to be seen against that background.

In terms of real-time data, it looks like that’s the only source.  It’s the only source I’ve found so far.  And for what it’s worth, it’s showing declines in unusual amounts of fever all across the US.  On the way up, this thing did seem to be flagging hotspots of coronavirus activity.  You have to cross your fingers and hope that it’s flagging the reduction of those hotspots, on the way down.  But you have to be aware of the possibility that the vast change in population behavior with our “social distancing” orders might produce a false signal.

The maps above were updated as of about midnight yesterday (midnight of 3/27/2020), per the Kinsa website. Continue reading Post #579: No inflection point for Virginia today, but maybe the Kinsa data show us where we’re headed.