Coronavirus — good sources (including Tomas Pueyo)
More detailed comments on Tomas Pueyo and his 2 earlier articles are here:
Since then, he has released this one, which is also an impressive presentation, with some questionable elements:
Questionable element #1:
When assessing outbreaks, absolute numbers are more relevant. When assessing how bad the situation was a posteriori, relative numbers will be more relevant.
That is a bizarre statement — the most relevant numbers/metrics do not change from day to day.
Statements like that undermine the credibility of the wider piece. As does the fact that (as far as I could see) all numbers are taken at face value, with few or no caveats — e.g. clearly there are massive differences between countries (and even within the same countries, over time) in terms of their methodologies / competence / honesty.
Another example — too much weight seems to be attached to figures relating to 1918. We have enough problems collecting reliable data for 2020, with all the technology and tools at our disposal. Okay, current data does take time to filter through the system, but still.
Questionable element #2:
Looking at “Cases as a % of tests” is more informative than looking at absolute number of cases — that’s true (and contradicts the statement in #1 above).
But that’s of little use if you don’t know who they’re testing in each location. If you just (i) test people who turn up in hospital with a fever and a bad cough — that’s completely different from (ii) testing people at random in a representative sample, or (iii) something between those two extremes.
It’s unbelievable that (ii) hasn’t been implemented in every country, at least on a small scale, to aid policy making.
Questionable element #3:
The implication that beaches (or common spaces more generally) are a prime spot for spreading viruses.
The 16 March 2020 Imperial College study stated that:
“Stopping mass gatherings is predicted to have relatively little impact […] because the contact-time at such events is relatively small compared to the time spent at home, in schools or workplaces and in other community locations such as bars and restaurants.”
Maybe it’s this finding that’s questionable, rather than the line taken by Pueyo — the press supports the latter position, but that’s not saying much.
In any case, surely there’s a big difference between:
(i) A beach party with people dancing, mingling, etc, then subsequently travelling to their home cities/countries; and
(ii) People from a local area walking around on a beach/in a park, in couples or small family units (who they would have been with at home anyway), keeping a reasonable distance from others nearly all the time.
A number of sensible observers have condemned the proposed closure of parks, beaches etc, pointing out that humans & their immune systems respond well to fresh air & sunlight, whereas viruses do not. More generally, advocating a middle-ground. A number of governments, including where I live, do not allow anyone to leave the house for exercise. Meanwhile bright-spark vigilantes where my relatives live in the UK call the police if they see people approaching the nature reserve for a walk. (Before the bright sparks pop out to the shops, full of surfaces, closer contact with people & “shared air”, to buy some crisps, probably.)
Questionable element #4:
commented on Pueyo’s “Out of Many, One” article:“Can you please factor in the coming waves of COVID 19 that will repeatedly happen with intermittent social distancing measures until 90% herd immunity is achieved either through disease or effective vaccination? Seems like that will affect your analysis of the economic recovery scenarios.”
Pueyo replied:
“I don’t think that’s necessary. It is definitely not what the most experienced countries, SK SG TW CN, are aiming for.”
That is a bizarre comment— the virus couldn’t care less what anyone is “aiming for”. Economic outcomes (which themselves have a massive impact on health outcomes) are also not particularly influenced by “aims”.
This glib response from Pueyo suggests that he has his take, and is sticking to it, and is less willing to consider other factors or contradictory evidence. “I’m not an epidemiologist, but” any analysis or model that focuses merely on the short-term, and fails to give due weight to the following year (or more) is surely misleading. For example, it may be that Sweden’s more laisser faire approach is damaging in the short-term, but better over the medium term of multiple waves of contagion, with increasing herd immunity.
Questionable element #5:
Vastly increased testing is advocated. This is perfectly sensible in theory, but in practice the finished products and (I believe) raw material supplies are simply not available. So the only relevant recommendations are those based on what is available now, and what will become available, in a reasonable scenario. This is sort of line taken by Dr Michael Osterholm.
Questionable element #6:
“At some point, it becomes clear that the death toll will be worse than Iraq. Worse than Vietnam. Worse than World War II. Worse than all of America’s wars combined.”
Umm, I’m pretty sure you’re talking about Americans only, there — which is indeed how some people look at the world.
If you look at Wikipedia, WW2 involved approx. 25m military deaths and 85m total deaths — not to mention further subsequent deaths caused by the damage to economies and infrastructure. Who knows what the figure would be for “all of America’s wars combined.”
Questionable element #7:
There needs to be a relentless focus on the age (and underlying health conditions) of the people who are dying, and the rate of death needs to be compared to the rate in a “normal” year (and/or a bad flu year, to which we generally pay little or no attention).
Without this, there is no chance that people will keep things in perspective.
“The way we calculate this is by asking ourselves: How much are we willing to pay to extend our life? In healthcare in the US, that number turns out to be between $50,000 and $150,000 per year.”
Questionable element #8:
The bits at the end were pretty nauseating / tone deaf, I thought:
“The United States is the strongest country in the world. It has the most vibrant economy, the mightiest military. It has inspired democracies through history, and shines the values of freedom around the world.”
“That triumph emerged from the union of the original thirteen states. Independent, they couldn’t beat the mighty United Kingdom. Together, they did.”
(That would have been Great Britain, by the way — the UK did not exist as a country then.)
Conclusion
Other than the above, it was a good piece! And I do think all the Pueyo pieces are good — wonderful graphics, rapidly prepared, and filling a gap that the media and academics do not seem to be very good at addressing.
He does, however, overstate his case, and fails to explain his credentials, so that the millions of readers can take a preliminary view of how to assess what he is telling them.
I recommend the following other sources:
(1) Dr Michael Osterholm
Unassuming, experienced, advocating a pragmatic approach. Interesting interview with the excellent Joe Rogan, pieces in the Washington Post and the New York Times, and a weekly podcast (here’s the one from 8 April):
(2) Sam Harris’s podcasts
Can be a little slow-moving, but highly intelligent analysis:
https://samharris.org/all-episodes
The interview with Nicholas Christakis was the best of this recent series touching on the virus.
The one with Amesh Adalja was astonishingly complacent — an infectious disease doctor who basically wasn’t really bothered about taking preventative measures in his own life.
General Stanley McChrystal and Chris Fussell were interesting, though a bit generic.
(3) Bret Weinstein & Heather Heying’s “Dark Horse” podcasts
Recently featuring a number of “livestreams” by the two biologists. Amateurish but likeable, and interesting to observe two scientists applying their minds to the issues arising from the virus. A little too ready to engage in conspiracy theories, in my view.
(4) The Atlantic — many excellent analyses
When you consider that this was published on 24 February, when this wasn’t particularly a big issue in the USA, it’s remarkable:
A bit of historical perspective:
More recently:
