Monday, November 30, 2020

That's the wrong focus.

Not a lot of data in here but it is at least some reporting on an otherwise mystifyingly comprehensive underreporting of an intriguing case study - Taiwan.  From Viruses, Lockdowns, and Biomic Learning by George Gilder.

In all the annals of Covid, Taiwan remains an outlier. Out of a population of 24 million, and an extraordinary population density of 1,739 per square mile, it registered only 573 “cases.”

At just one test per 100,000 of population, it did the lowest rate of testing in the industrial world, restricting tests to those with symptoms. It imposed the lowest “stringency” of government policy (as measured by one of the world’s most limited lockdowns, far less severe even than Sweden’s, with scant closing of schools, restriction of travel, or banning of gatherings and other events).

Yet Taiwan experienced only seven total deaths, the lowest level of per-capita deaths among all populous countries.

As we work our way through Covid-19 and "experts" continue to demonstrate inconsistency, bias, error, and capriciousness, it seems clear that there is something odd going on.  The problem is that our responses and most of all quantifications are so deficient that it makes it hard to sort where the confounds are coming from.  The one thing that remains clear is that no one knows what is going on and many in the marketplace are substituting misplaced fervor for a clear understanding of what is happening.

No - New York has not handled the pandemic well.  In fact, they have been among the wort performers in the nation and the world.  But they were among the first widespread outbreaks in the nation.  We now know not to do many of the things they did.

It is not clear whether track-and-trace can work even if it could work in our multi-jurisdictional, freedom oriented nation.  In other words, for those regions or nations where track-and-trace has appeared to be done well, it is not clear the extent to which it made a practical difference.  

Africa, despite initial fears, seems to have escaped the worst?  Superior health systems?  Excellent government health policies?  I think not.

And then there is Taiwan.  As Gilder points out, they are the odd man out.  How can they be so globally interconnected, so demographically packed in, so laissez-faire in the health policies, so sparing in so many of the coercive policies implemented elsewhere and yet have such a low incident and death rate?

My growing suspicion is that we have been indulging in a massive Kabuki theater whose goal seems to have been to bolster central government coercive power but which has repeatedly, with every false forecast and and every failed containment policy, demonstrated government incompetence, arrogance, and ignorance.  

All nations, all states, seem susceptible to the pandemic to a greater or lesser degree sooner or later.  The star today becomes the dog tomorrow and vice versa.  And everywhere, pundits propound on the differences (championing or discounting depending on ideological orientation) and attribute any rise of fall in deaths/cases solely to policy.  And that clearly is not what is happening.

Policy can make a difference.  Better measurement mechanisms and standaridzed definitions would be among the first improvements which would help.  It seems demonstrably the large majority of those who are claimed to have died from Covid-19, actually died with Covid-19.  The died from is a small fraction of the died with.  

So what are the missing independent variables?  One is that which Gilder alludes to.  Perhaps differences in national susceptibility has more to do with population history than with government policies?  If your population has had extensive past exposure to variants of whatever the new virus is, perhaps that drives lower infection and death rates now?  Perhaps if your population exists in an environment of frequent infectious disease outbreaks (even if unrelated), they may have a heightened resistance to Covid-19.

Similarly, perhaps there are variants of the virus that are sufficient to drive lower infection and death rates?

Perhaps there are differences in population genetic susceptibility?  As a crude example, what if the evolutionary adaptation of lactase persistence in Europeans and among pastoralist populations made those populations more or less susceptible to Covid-19.  I am not proposing that as a mechanism, merely illustrating that minor local population gene variation might be a plausible variable.

I have seen hints of research for the first two and virtually nothing on the third.

The point is not that any one of these, or combination of these, might be demonstrated to be a clear causal mechanism of otherwise inexplicable differences in infection and mortality.  The point is that they are plausible and under-investigated.

We have not approached the pandemic in an open-minded fashion.  We have favored compliance and lockdowns over other evidence as to effectiveness.  It feels like we are not really trying to understand the disease.  We seem to be focused on justifying government actions.  That's the wrong focus.

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