Wednesday, 25 March 2020

Houston, we have a knowledge problem #Covid19NZ [update 2]


If you don't test, you don't know.

In New Zealand, we haven't been testing. Not enough. So we don't know.

Because we haven't been testing enough, we don't truly know how many here are actually sick. We don't know the number for the very thing that is critical in this crisis, and on which all decisions are being based -- including the decision to lock us all up.

In South Korea they have been testing at the rate of 6741 per million of population. In Singapore, 6739. Here in little old relaxed New Zealand, medics have tested just 8300 people at the rate of 1669 per million people.

Medics can't really test more because there aren't enough testing kits here. So only the already sick are swabbed.  But because people are asymptomatic for fourteen days, you may communicate the disease even if you are not sicked. Can you be tested just to make sure? No, you can't, because there aren't enough testing kits in the country.

Think about that. The number one question people have in this crisis is: do I have the Coronavirus? Am I passing it on to loved ones or strangers without knowing it? This more than anything else is everyone's central concern. Remarkably, we're not allowed to know, and we have no means of finding out. Why? Because there aren't enough testing kits in the country. So no-one knows, and no-one has the means to find out. And everyone and everything flips out. This, right here, is our knowledge problem. A problem rooted in the lack of an essential supply.
F.A. Hayek was right that the use of knowledge in society is the central issue in economic and social organisation. We have been cut off from the knowledge flow that otherwise would have been ours had we left this issue entirely to the private sector, which would have brought a Coronavirus test to you as quickly as you can order a pizza.
Importantly, we do know from overseas that because testing rates are so low that there is no truly reliable date on either the prevalence of the disease or its communication rate. We do know however that, as testing rates improve, so too does the ability to plan ahead. And we know too that as testing rates increase the reported death rates fall dramatically (in Germany, for example, it is now virtually the same as the seasonal flu [UPDATE: but see here]).

So how many here in New Zealand are carriers of the disease? Frankly, no-one has any fucking idea. (Why? Because, while it's increasing, our testing rate is still abysmally low.) But that's why we're all locked up. Because the one thing we desperately need, we don't have. Knowledge. (And even more remarkably, a few days ago New Zealand's Health Minister did not even know how many Covid-19 testing kits there are in the country.)

We do know what we don't know, which is helpful. But we are being locked up because of what's unknown: because of the fear of community transmission from persons unknown. And they'll remain unknown just as long as we don't test them, and find out who they've contacted. How did Singapore manage more than 500 cases without closing their schools and locking up their population? By finding cases and isolating their contacts.

Not here. Here, we have a minister-inflicted knowledge problem. And instead of testing, they're locking us up.

So ... what do we know?

We do know that this is serious. We do know that we don't yet have any treatment for the disease, only for the systems. We do know that ventilators are absolutely necessary for treating the very worst of these symptoms, to staving of patients' death. We know that these are critical. And we do know that (as of last night) there are 563 beds around public hospitals in New Zealand capable of looking after ventilated patients, and 520 ventilators in all-- and a further 22 ICU beds and 250 ventilators in private hospitals. But it was only a week ago that there had been any moves at all by the minister to increase this. (The minister, in our centrally-planned system, being the only one who is allowed to make this call. Yet the least able to.)

At the same time, we know that the number of people infected tends to double every three to five days. We know that (as of this morning) there are 155 people in NZ reported to be infected with the virus (up 40 from yesterday), four of those by "community transmission" rather than being someone from overseas. We do know that there are possibly many more that have not and cannot be tested, because we have been testing at too slow a rate to tell.

And we do know therefore that the present capacity to treat any more people here beyond those we already know to be infected is seriously limited. And we think we know that there are too few staff to treat patients and operate all the ventilators that will be needed. Leave it to government, and there'll be a shortage of all essentials. And here we are.

And this is the primary reason we're being locked up for four weeks. This is why businesses are forced to close down, and the government is telling us where, with whom, and when we can associate, and why they're talking about putting the army on the streets. Because we have a shortage of knowledge and of government-supplied capacity. Officials don't really know how many are infected, but they do know we lack any kind of capacity to treat many more. They think they know there are too few staff, but ignore that there are many thousands of trained nurses and doctors in this country who have been driving taxis and picking fruit because they have been refused permission to work. (Time to let them work!)

What else do we know? We know that (as of tomorrow morning) we will all be locked up tight in the expectation that in twenty-eight days, after two complete cycles of the virus's incubation period, the virus should have been flushed away -- apart from those few still needing treatment.   We know that this "pulse" should clear us of the virus temporarily. But only temporarily. What we have to hope is that over those four weeks the minister -- who, a week ago still didn't realise that more ventilators were already needed -- and who, a few days ago still didn't know how many testing kits there were in the country -- will be able to increase the capacity of testing kits, of ventilators, and of ventilator-ready beds so that when these numbers begin to rise again they won't have to lock us up all over again!

It shouldn't have been necessary to send everybody home, shut down businesses, and lock everyone up at home. But as Damien Grant says "We're doing it. We're going to incur the price if it works or fails. So let's do our best to make it work."

* * * * *
UPDATE 2: John Cochrane at the Grumpy Economist blog mounts a similar argument about the American situation:
Closing down the economy is a panic response. It is not how we should be fighting the virus. We should be following the Korea, Taiwan, Singapore models: Test everybody. Trace all their contacts. Isolate those who test positive or with symptoms. Isolate people who are most likely to get really sick and use scarce ventilators. Tamp down hotspots with local [shutdowns]. Allow business to open, but with stringent protocols adapted to that business and its employees. The options are not [shutdown] vs. back to nothing. The needed option is reopen with social distance.
   The cat is out of the bag on that one, as our governments were caught flat-footed -- as governments almost always are -- and responded late. The snafus and regulatory roadblocks to get testing ramped up and even to produce or allow the importation of masks and gowns are scandalous. But here we are. The situation is out of control. Sometimes you do hit the panic button.
   Closing down the economy is the panic button. It is going to cost something like a trillion dollars a month. So during the next few weeks, our governments -- federal state and local -- need to be getting ahead of the curve, so they can implement the above appropriate public health response. NOW...
Much of the [shutdown] is to keep hospitals from getting full. Most of the people hit by this disease are old. And retired people by and large are not counting on a monthly paycheck. That's what "retired" means. The obvious conclusions: Older and retired people may face lockdowns while healthy people can go to work. That and location and contact tracing are horrendous violations of civil liberties, yes...
Prepare ... to claw back civil liberties promptly when the pandemic is over, as we did after wars. There are a lot of empty hotel rooms, with cable TV, and lots of empty restaurants who would like more takeout business, and lots of unemployed uber and grub hub drivers. Want a stimulus? Anyone who tests positive gets a free two week stay at the hotel, meals included, at government expense.
   A trillion dollars a month is an immense cost. The shadow value of those missing masks and ventilators is huge. And it's worth spending an immense amount of money to avoid a trillion dollars a month. No, we don't need the defense production act. Just pay 10 x cost -- pay $100 billion for masks ventilators and test kits, and remove the regulatory barriers, and we'll be flooded. Defense production is what a government does that wants battleships but can't afford to pay for them. We've got oodles of money. Profit is a fine motive.
   It is even more important for our governments to get the real public health plan going NOW because we are in the calm before the storm. In two to three weeks the crush at the emergency room will be in full swing, and there will be no political breathing space for anything but more panic. This too can be an advantage. People will see the need for the extensive virus safety protocols they will have to follow at work. But that will be a terrible time to start thinking about how to save a tanking economy, and vanishing public trust. People will not wait for the last case to pass, and the government to sound the all clear in July or August, emerging from their homes like the end of a Zombie movie to find a destroyed economy around them. The choice is sensible plan NOW or widespread disobedience and chaotic re emergence of the virus over the [northern] summer and fall.

UPDATE 1: 

Results of Covid-19 tests have been delayed for up to six days, raising questions about the efficacy of New Zealand's testing regime... Professor Michael Baker, an expert on infectious diseases at the University of Otago's Department of Public Health, worries that a significant testing backlog could hide widespread transmission of Covid-19 in the community.
   "That is obviously not acceptable. It has to be much faster than that," Baker said.
   "In general, we know that our testing and follow-up capacity is really stretched in New Zealand. It is ramping up quickly, but we started from a very low base. This is obviously not something that the system has been set up to do.
   "One of the main justifications for putting the country into shutdown is exactly this problem. One of the really important things is that we use this four weeks to ramp up our capacity for testing and isolation of cases and contact tracing and quarantine." ...
"The Ministry of Health is doing the best it can under the circumstances [says the Science Media Centre], "but the testing labs are in crisis."

NB: Generous use has been made of Jeffrey Tucker's excellent article, making similar points, on American blunders. See: An Epistemic Crisis.
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10 comments:

  1. It's a shame that neither the media nor the asleep-at-the-wheel opposition are calling out the government for their shameless use of this issue to implement their hideous agenda that has nothing to do with coronavirus. They have already admitted that the pointless and morally repugnant benefit rises are permanent, and only the incredibly foolish would expect the new raft of rules for landlords will be rolled back any time soon. But of course who would expect this to be called out by the Jacinda cheerleaders who slavishly wet their pants about anything this incompetent shower of losers who have never worked a day in their life in honest businesses do.

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    1. Yes. I'm learning who can be frightened into violating my rights, and it's not pretty. It includes Objectivist and libertarian types I've known for years. I see through Jacinda and I'm surprised they can't. It's because they are getting fearful and in getting fearful they are getting authoritarian.

      Principles are for when we are frightened, can't think straight, and are prone to pragmatism.

      Choosing the initiation of force limits one's imagination and also reveals one's character.

      Life entails risk. If you are afraid of this - stay home. I have the luxury to stay home the vast majority of the time, but others don't. I have noticed that those pushing strong for the shutdown are those who already have that luxury (they are generally older and rich). It's curious.

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  2. Peter, I was just going to message you and ask you what you think about all of this. Then I decided to go here and see instead. I agree. 100%. And that's from someone who has been harping from day one, practically (late January) on what a serious thing this disease is. But I didn't move to this country to see it become a full-on police state with people cowering in fear like where I came from. I already see nobody for practically months on end, but now I've got to ride my bike (which I just bought for the purpose) 10 km to work (where I see not a single other person because I'm the only employee) so I can avoid being in a car, so I can avoid being stopped my police and asked questions? Yesterday they said we could drive to the beach. Today, no, and there may be military on the streets. Is this North Korea? I can use the exercise, but what if there are further restrictions and I can't even bike? How long is this to go on? What if a vaccine is never developed? People will die if I don't get my product out, but those lives aren't counted here. Central authority cannot plan these things. Period. I hope serology testing comes rapidly online very soon so we can see how many asymptomatic there are, and I bet it will be a lot, given the recent research (50%-75%). Which is the reason for all of this. They now have confirmation that they can't stop the spread by focusing on symptoms. Yet the mortality data are very, very clear. The vast majority at risk are elderly or with comorbidities. Not the young. These people will have to protect themselves if the world is to function to earn the income to pay for their benefits. We cannot put ourselves in a time capsule, causing a Great Depression, and completely retreating from society to prevent the death rate from doubling one year out of a hundred. There has to be another way.

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    1. Everything Monica says/writes is bang on. The societal damage caused by the reaction will be huge. She is not going to catch Wuhan flu in the fresh air. She might catch up with a zombie steroid imbecile Policeman .The tests are not accurate according to all good reports. She has chosen a bad time to come to New Zealand, many of us have left. Tday in Thailand 3 Wuhan deaths, 10 Islamic terror deaths, 25 road deaths, and about 300 of the other 3000 deaths asociated with Respiratory illness, probably including the original [ before Wuhan laboratory ] Corona virus.

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  3. P.S. Minor quibble: the death rate in Germany is most likely because they are ascribing cause of death to underlying conditions, not COVID.

    In South Korea, it's risen from 0.6% to 1.1% and there are a large number of young cases with mild symptoms. It’s also one of the least obese populations in the western world.

    CFR tends to rise over time because there's a considerable delay from infection to death (on average 23 days). One can't calculate the death rate on day 1, day 14, etc. of an epidemic. We won't know the true death rate or CFR for the covid pandemic until it's all over.

    That said, we do have enough data to know by now that it kills the old, the obese, the people with comorbidities. This isn’t killing children in very large numbers. If it was, I’d feel much more concerned (but still not concerned enough to shut down civilization).

    Til now, I’ve been a very strong critic of people who are too Pollyanish about this disease.

    But being told that I have to stay locked up from making a lifesaving drug, a process that would bring me into contact with NO ONE, because some fat people failed to control their blood pressure (!) is a recipe for hardcore resentment.

    It bothers me intensely that there’s no clear exit strategy, and that people who should know better are trusting the government (any government) for protection when the government has already screwed up too much.

    The fear of my friends is turning them into control freaks, and it’s deeply saddening.

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    1. Thanks Monica. (Have updated the post to link to your comment.)
      It's the "denominator problem," isn't it. Imposssible to even talk properly about rates of anything when you're not testing sufficiently to know that number, and when (as you say) we're still in the epidemic's midst.
      I'm guessing the piano playing has stopped for the duration?

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    2. I am pretty sure that because NZ is so behind in its outbreak compared to other nations that we will benefit from learning what others do and the mistakes they make. The situation in the US is an unmitigated disaster (see this video by an Objectivist doctor). It's understandable why NZ does not want that here. It's a happy, secure little place. "We" do not want all of that disrupted. I get it. I just wish there was a better way.

      The massive testing in South Korea is only part of the solution. They use very draconian tracking apps to ensure self isolation and case contact tracing. That's what NZ is trying to do "by hand" without the use of technology. It's a difficult task. But in a way, I'd rather be locked down for a month than have all my movements tracked by cell phone in perpetuity for the purposes of "public health."

      We will get serology testing eventually to see how many people have been infected and asymptomatic. Those tests are rolling out in the UK and have already rolled out in Singapore and South Korea.

      Despite the fact that I don't like this lockdown from an individual rights perspective, I suspect it will work from a scientific one, and then we can go back to work in a month. It will reduce community transmission *enough* that they can feel confident they can get on top of it once it starts again.

      Yep, I'm working from home. Rest home volunteering was locked down a few days before step up to Level 4 was announced. Hope you and Carol are well. <3

      https://www.nytimes.com/video/nyregion/100000007052136/coronavirus-elmhurst-hospital-queens.html?fbclid=IwAR0b1KUkHe9ZFXNxtXsmo0w-W5JgYePqP0GXNymIYp-vSkaILcJfB3uwHa0

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    3. P.S. I suspect NZ's outbreaks are very small and most cases are being caught. NZ's positive rate is 2.5%. That's pretty low. The rate in the US is, on average, 15%. That's extremely high and means there are so many people out there spreading it around. I have more confidence in NZ than you. :P Haha! I just don't like the authoritarian tone and these creepy alerts on our phones and creepy COVID 19 ads from the NZ government. CREEPY! Orwellian.

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  4. Further, being in a military State over here, ofcourse I can do, say, and think what I like. It's the socilaist democracies which are scary, and you people are going to get it. If I do something really really bad here I might get fined, you know maybe 1000 baht, $50, pay on demand to the smiling Policeman happy family go home no worries.

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  5. Sociliast above is typo for Socialist which means totalatarian mad Government and revolution required.

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