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  • Risk Register

    Posted by Jay Manifold on April 18th, 2020 (All posts by )

    There are, of course, many items that could be placed in a risk register for our ongoing management of COVID-19. I find myself drawn to those categorizable as, or perhaps triggered by, human perception and behavior. By way of limiting the scope of this post to reasonable attention spans, here are my current top 3:

    1. Underappreciation of Complex Payoffs

    I intend complex payoffs” in the Talebian sense, alluded to in item #6 of In Medias Res (posted all of two weeks ago, a/k/a the Bronze Age). The US encompasses such an immense variety of physical and socioeconomic environments that aggregate statistics about it are almost always misleading. State-level numbers are often no better. I’m seeing a chasm in perception between acquaintances who are either high-risk personally or live in a high-risk environment and those who are, or do, not. Thus the vehement insistence that the pandemic is killing vast numbers and is on the verge of disabling this or that crucial element of society—hospitals and the grocery supply chain are popular candidates—and the equally vehement insistence that this is no worse than a regular flu season and the response has been wildly disproportionate and is causing another Great Depression—often followed by accusations of political opportunism, escalating to full-blown conspiracy theories.

    Geography matters. Population densities of the order 10,000 km⁻² and mass-transit ridership of several million on the average weekday (New York City) represent a completely different set of conditions from the well under 1,000 km⁻² and a few tens of thousands of mass transit riders per day where I live. And in turn, my environment differs just as greatly from that of rural counties in my state, which are ~10 km⁻² and have zero mass transit. The EDR (excess death rate) in NYC is stratospheric. In most rural areas it is nil.

    Comorbidities are a huge variable, sometimes in conjunction with geography. Old age, interaction with blood pressure medications, diabetes, obesity, and a history of frequent infections all drive the likelihood of developing a serious case of the disease up by several hundred percent. Most of these conditions are far more prevalent in urban African-American neighborhoods than in more affluent (and less dense) suburban and exurban communities. Disease rates in both Kansas Cities reflect this, and it is probably the single greatest factor in the high EDR of New Orleans.

    When the disease does strike in a rural county, though, it can quickly lead to the de facto elimination of medical care for the local populace. A single case in Henry County, MO resulted in emergency services being diverted from Golden Valley Memorial Hospital in Clinton (population 9,000) and the hospital being advised not to admit new patients.

    Historical perspective can help. The EDR in Kansas City from what I like to call the Kansas Flu was 580 per 100,000. A proportionate calamity today would kill over 12,000 across the entire MSA. Taking the latest available—and, as of just yesterday, dramatically reduced—projections from healthdata.org, combining the statewide numbers for Missouri and Kansas, and dividing by 4 to get the share of deaths occurring in the KC metro, I get ~140, which is nearly 99% lower. Reiterating that all disasters are local … our local death rate is thereby projected (by me) to be ~70 per million. This is many times lower than that of NYC or New Orleans and only about a third of the national average, which is still projected to be ~200 per million.

    Couple of caveats, though—one minor and one major. The minor one is that excess deaths in KC during the heat wave of 1980 were ~150 per million, and that was bad enough that no one who lived through it will ever forget. The major one is that all these numbers are for the first wave of the disease.

    Strategy to address this risk: find someone whose perceptions contrast highly with yours and exercise Habit 5.

    2. Reactivation of NPI

    Non-pharmaceutical interventions” is the catchall term for the variety of impositions we’ve endured over the past month or more: borderline-OCD levels of personal hygiene, somehow training yourself not to touch your face, wearing a mask whenever near other people, maintaining 2-meter separation from nearly everyone, avoiding essentially all group gatherings indoors, minimizing even local travel, and not to overlook the obvious, suspension of employment for many millions of people.

    All this may have been the practice round.

    Way back on Wednesday 25 March, the National Academy of Medicine and the American Public Health Association presented a webcast, a transcript and PDFs of slides from which you may find at COVID19Conversations.org under “The Science of Social Distancing, Part 1.” Presentations by Marc Lipsitch of Harvard and Howard Markel of the University of Michigan covered historical experience (Kansas Flu, referenced above) and attempts at modeling the likely rate of occurrence of COVID-19.

    Briefly, further waves are a distinct possibility, with attendant applications of NPI to keep the numbers of serious cases below the capacity of our health-care system. The obvious, historically-based scenario is a double-peaked EDR, with the second peak during regular flu season, that is, starting in about another 6 months. But it may happen sooner—seasonality of the virus is still unknown. We could end up in lockdown every third month through at least early spring 2021. The presenters used the term “cycled distancing,” but I think “pumping the brakes” (which analogy I did not originate) is a more intuitive phrasing.

    The problem, which to their credit they did mention, is—how to obtain cooperation? Because, make no mistake, these measures are voluntary, at least at the individual level. Keeping large gatherings from occurring in public buildings is one thing, but anything like strict enforcement of a stay-at-home order is mathematically impossible. The areal density of on-duty police in KC is such that at any given moment, any given pair of cop cars is separated by a good mile of street, minimum. No more than a handful of checkpoints could be sustained in the entire city before drawing manpower down to a dangerously low level. And the Missouri Army National Guard adds only another few hundred personnel to this, evenly distributed on a per capita basis, to cover hundreds of square miles; so much for “martial law.” It’s toothless.

    This is why I don’t see the point of the protests being mounted against the various orders in effect, because “stay-at-home” is just going to dissolve over the next couple of weeks anyway. If you want to indulge in some IF/F signaling and go to one, fine, but private gatherings are going to start happening in any case—if they ever really stopped—and plenty of “non-essential” businesses will simply reopen. The moderately interesting question is whether the dissolution of the orders will be accompanied by violence.

    Referring back to the “chasm of perceptions” in the first section: suppose you’re in the high-risk category and observe a near neighbor to be hosting a large gathering. You (entirely understandably) feel threatened; you call the police; and, as per the previous paragraph, nothing happens. Now what?

    Well, if you feel strongly enough, you confront your neighbor, possibly with one or two other adjacent high-risk neighbors, suitably socially distanced but visibly obvious … because you’ve recalled Al Capone’s dictum that you can get much further with a kind word and a gun than with a kind word alone. After all, what are they gonna do—call the cops? They’re the ones breaking the law; you’re acting in self-defense. (And just to reiterate, as Cyrus explains, the cops are seriously outnumbered.)

    To be sure, this is unlikely in an upper-middle-class setting, assuming that residence in said setting is the result of, among other things, many years of good impulse control. But there are certain sections of Kansas City that I wouldn’t advise you to try to invade. So by way of making this a falsifiable prediction, keep an eye on the homicide rate in major cities over the next month or two.

    Strategy to address this risk: plan to prepare for at least one future (attempted) lockdown, possibly occurring well before late autumn.

    3. Xenophobia

    While I’m sure everyone reading this hopes for all the recent “temporary” repeals, exemptions, waivers, and announcements of non-enforcement to be made permanent, there remains the possibility that we are descending into a deeply illiberal world order. Characteristics of such a society would include:

    • massive protection for domestic industries due to near-total bans on imports
    • both international and domestic air travel restricted to a wealthy, powerful elite, and always requiring a passport
    • local content” regulations severely limiting availability of even domestically-produced items from farther away than a few hours’ ground-travel time
    • frequent spot shortages and/or much higher prices for many consumer goods; waves of panic buying and Soviet-style queueing for necessities
    • extreme vulnerability of small businesses of all types due to sudden restrictions on service provision and consumer movement
    • high structural unemployment, maintained by a combination of restrictions on labor-market entry (including a high minimum wage) and “generous” transfer payments
    • a new Cabinet-level department ostensibly for the management of biomedical risk
    • marginalization of religious believers due to their supposed role in spreading disease
    • in the short term, escalatory rhetoric effectively calling for war with China

    oh, and

    • furious denunciation of anyone questioning the necessity for/inevitability of any of the above

    It’s painfully obvious, really; just imagine the wish lists of nativists and progressives getting combined. In this connection, I can do no better than to proffer my favorite Ayn Rand quote:

    The greatest guilt of today is that of people who accept collectivism by moral default; the people who seek protection from the necessity of taking a stand, by refusing to admit to themselves the nature of that which they are accepting; the people who support plans specifically designed to achieve serfdom, but hide behind the empty assertion that they are lovers of freedom, with no concrete meaning attached to the word; the people who believe that the content of ideas need not be examined, that principles need not be defined, and that facts can be eliminated by keeping one’s eyes shut. They expect, when they find themselves in a world of bloody ruins and concentration camps, to escape moral responsibility by wailing: But I didn’t mean this!

    And, of course, a nation divided, living in separate bubbles, with their attendant complex payoffs, makes regional or even county-level xenophobia all the more likely.

    (Having said all that, I remain optimistic, partly because of the astonishing market recovery currently underway. As I post this, the Wilshire 5000, the broadest American stock market index—that is, the furthest thing from a curated collection of blue-chip or tech companiesafter plummeting from over 34,500 to just above 22,000, has regained more than half its losses in the past four weeks, is above its level of as recently as January 2019, and is above its level at any time before December 2017. I expect at least half the unemployed to be back to work well before the end of the year, and possibly by the end of the summer.)

    Strategy to address this risk: repent of disdain and scapegoating and utopianism, resist demagoguery, and resolve to continue the greatest political experiment in history.

     

    21 Responses to “Risk Register”

    1. Assistant Village Idiot Says:

      I hope your worst-case scenarios are far wrong, but thank you for bring them up. they are at least plausible, especially in their milder versions.

    2. Kirk Says:

      Remove China and its utter disregard for food safety and public sanitation from the equation, and you have an exponentially reduced risk from novel virus products. You could eliminate tropical Africa with its endemic “bush meat” markets from the equation and watch your risk factors go damn near down to zero.

      The problem here is the species mixtures; you have animals that rarely encounter each other brought into close proximity, and the virus loads they carry are suddenly able to jump species. That’s why Southeastern China is the hotbed it is for things like new influenza strains–That’s where ducks, pigs, and people live together like rats in an overpopulated cage, and the viruses jump back and forth changing hosts, increasing their lethality with each leap.

      Remove China from the equation, and you solve most of your problem. It’s a near-certainty that the so-called Spanish Influenza originated in China and was brought over to North America by the Chinese labor drafts made by the British. The spread tracks only too well–And, it’s probably about damn time we reimpose the same level of contagious disease control measures we had back then. The fact that you can be in a city like Wuhan today, pick up a novel virus, and be back home in Vancouver, BC tomorrow before anyone even realizes that there is a new virus out there…? Yeah.

      And, here’s a news flash for anyone who thinks this only got out of Wuhan in January: There’s near-certainty that there were asymptomatic people leaving Wuhan with COVID-19 back in November and December, or there wouldn’t be the number of people we have showing up asymptomatic and carrying antigens showing they already had the disease. More testing, and more accurate testing for exposure/antigens is only going to provide more proof.

      What this is was a warning shot; the next “novel virus” to come boiling out of the Chinese or African miasma may not be relatively harmless, and may actually approach the higher lethalities of the Spanish Influenza or the Black Death. Unless measures are taken to isolate and/or contain China and Africa, the rest of the world may well end up suffering a Black Swan disease event that essentially destroys modern civilization as we know it.

      The current cluster-f**k–And make no mistake, that’s what it is–Only goes to demonstrate the essential dysfunction and worthlessness of our current disease control regime. As late as January, the WHO was insisting that there were no signs of human transmission. Let that happen with a Captain Trips-level pathogen, and we’re gonna make Justinian’s Plague look like a minor disaster.

    3. Mike K Says:

      Remove China and its utter disregard for food safety and public sanitation from the equation, and you have an exponentially reduced risk from novel virus products. You could eliminate tropical Africa with its endemic “bush meat” markets from the equation and watch your risk factors go damn near down to zero.

      Yes, but this is going to take some time. China, as in the communist Chinese regime, is not going to take this lightly. One scenario I have seen is that American companies, like pharmaceuticals and manufacturing might be repatriated but they would be faced with Chinese competitors using their own IP to compete as cartels undercutting prices. This is exactly what happened with pharmaceuticals. Chinese plants are “inspected” by FDA “inspectors” who do not speak or read Mandarin and who are lied to. They cannot read documents.

      We, or rather our elites, have spent 30 years doing this, beginning with Bill Clinton or perhaps GHW Bush. It will take time and pain to reverse this. There will be organized resistance from the same Deep Staters that have led the resistance to Trump. The corona virus anger may be enough to overcome this but there are many, especially in the Democrat Party, who are deeply infiltrated. Diane Feinstein and her Chinese” driver” who was with her 30 years. China has bought a lot of influence and there is not doubt that much of the DC elites were for sale.

      Trump has begun well with the tariffs and he is the only one I could think of who would make this attempt. Victor Davis Hanson sees him as a tragic figure destined to fail but it is worth the effort. First, we will get nowhere with Nancy Pelosi and her Chinese connections running the House. The American education system is rotten all through with Gramscian poison. I don’t know if we can do it.

      There is not much that is good about being 82 years old but the fact that I won’t have to live with this is one. In spite of all, I am optimistic.

      Remember, if FDR had not called upon businessmen, Bill Knudson and Ferdie Eberstadt, we might well have lost WWII.

    4. Anonymous Says:

      “This is why I don’t see the point of the protests being mounted against the various orders in effect, because “stay-at-home” is just going to dissolve over the next couple of weeks anyway.”

      What you are saying, Mr. M., is that you expect civil disobedience to grow on a scale not seen since Gandhi led Indians to independence from England. Bill Clinton at Waco showed that a Democrat President, with full protection from the media, could unleash violence on US citizens on US soil, including burning children to death, and suffer no consequences. Situation today would be different since the President is not inoculated by a (D) after his name — but we should not ignore the possibility of Governors ordering violence in response to civil disobedience … unless the scale of disobedience is so large that the Political Class decide to repeal their restrictions instead of invoking violence.

      Let’s be optimistic and hope that politicians do not over-react as We the People get restive about being treated as a “herd”. But what would be the consequences of us realizing that we can ignore the Law with impunity? What happens when we become a nation of Hillary Clintons? Why pay taxes? Why obey speed limits? Why file for construction permits?

      I hope for once the Political Class gets ahead of the curve, and roll back their ridiculous counter-productive lock-downs before the fabric of civilization gets ripped.

    5. Gavin Longmuir Says:

      Sorry, that Anonymous was me.

    6. MCS Says:

      If we’re going to eliminate reservoirs of trans-species disease, don’t forget beef, dairy, swine, poultry, rabbits and American wild game. All have contributed in the past. Get rid of them all.

    7. D Says:

      >One scenario I have seen is that American companies, like pharmaceuticals and manufacturing might be repatriated but they would be faced with Chinese competitors using their own IP to compete as cartels undercutting prices. This is exactly what happened with pharmaceuticals. Chinese plants are “inspected” by FDA “inspectors” who do not speak or read Mandarin and who are lied to. They cannot read documents.<

      Well no FDA approval no imports from Xiland. No imports from Xiland American companies retake American market.

    8. MCS Says:

      Objection: Assumes motivation not in evidence.

    9. lusitano Says:

      This came from a lab. Not exotic food.

    10. Kirk Says:

      MCS, do note the “novel” aspect of it all. The usual domesticated animals and we have already gone through the process of becoming accustomed to each other’s pathogens and parasites. We understand them, we know how to treat them, and we’re fairly well-adapted to dealing with them.

      Diseases of the bat and other such animals, we are not. Cut out the exposure to them, and there won’t be “novel” coronaviruses coming into contact with human beings except on very rare occasions. Hell, the last outbreak of pneumonic plague came from some Central Asian rednecks that wanted to eat some fresh marmot for the “medicinal” qualities… Chalk up another one for “Traditional Asian Medicine”.

      I’m seeing less and less value to continued engagement with the Chinese. Let them go back behind their Bamboo Curtain, and play their nasty little games with themselves. Nixon thought he was saving China from itself; instead, what he accomplished was spreading Chinese values and Chinese corruption across the world. They’ve been like this since the time of the Manchus, and it’s about time the rest of us did what the expat Chinese have already done, and get the hell out of China. There really isn’t a more telling thing than the fact that so many of China’s best and brightest would rather go through hell and risk being done in by foreigners in places like Indonesia, rather than live under their own people.

    11. MCS Says:

      Swine flu, avian flu, tuberculosis, brucellosis, chronic wasting disease, BSE, tularemia and that’s just off the top of my head. Just proves that there’s a lot out there that we don’t know about.

      Doesn’t mean I disagree about China.

    12. Grurray Says:

      We can cut off China, but we can’t force Europe to do the same. The spread from Europe is why New York City is now in such dire straits. I don’t expect meaningful cooperation from them anytime soon. Most Europeans think America deserves what we’re getting because we elected Trump. If we want to isolate China then we also need to break up the EU and the UN, and we then need travel treaties with individual compliant nations.

      The moderately interesting question is whether the dissolution of the orders will be accompanied by violence.

      That’s our big concern in Chicago. The police were minimally patrolling the streets and enforcing the law even before the ChiCom flu for fear of civil rights lawsuits. There’s no way they are going to touch anyone on lockdown. Social distancing and home isolation down here is all thanks to civil cooperation. If that breaks down then look out.

    13. PJ Says:

      All this talk of “cutting off China” is about as convincing as the desire to send all the brown people back to Africa. It’s not going to happen.

      What may happen are internal reforms that accomplish the same thing – where diseases are concerned anyway. The Chinese government has lost a lot of face over their handling of this mess. The nice thing about being more a dictatorship is that some fairly comprehensive reforms can be carried out quickly. For example, the eating of exotic species is a phenomenon of the rich, carried out in restaurants specific to that market (at least that’s so in Hong Kong). How hard would it be for that to be terminated at once? Most average Chinese would rather eat beef.

      China now has huge dependence on trade. They are going to go to great length to protect their access to foreign markets. If that means getting rid of a few questionable practices, then that is what will happen.

      China has almost always had the highest population densities in the world, going back into pre-history. While that makes for large losses when a disease or a war breaks out, it also means that to get to that condition in the first place, their cultural hygienic practices had to be superior. Chinese were put off by how dirty Europeans were when first encountered. We should be careful to avoid being taken in by demonization designed by our own ruling classes to spark a war.

    14. Bay Area Guy Says:

      Great piece. Here in California (pop. 40 Million), there are only about 1,100 Covid deaths over 3 months.

      That’s much less than car accident fatalities or flu deaths for the same period of time. Source: CDC

      And if one were to look at the 1,100 California deaths, one would likely find many 70- 80 year old folks in nursing homes with many other serious ailments.

      There is no valid rationale for keeping California on lockdown, and probably there never was.

    15. Jonathan Says:

      PJ: We should be careful to avoid being taken in by demonization designed by our own ruling classes to spark a war.

      I thought the problem was more that our ruling classes have done everything in their power to distract the public’s attention from the corruption and hostility of the Chinese regime.

    16. MCS Says:

      Has anybody seen any mention anywhere of what all these brave governors are going to cut to make up for the inevitable revenue shortfalls from this lockdown? They’d better start now. Have any reporters even asked?

      I’m pretty sure that any of them that expect the Feds to just print enough money to make them whole will get a lesson in Federalism. Expect much wailing and rending of garments.

      A trillion here, a trillion there, at this point, what does it matter?

    17. PenGun Says:

      Blame the Chinese, sure that will work. ;) And you blow through 40,000 dead today.

    18. Him Says:

      I live in a near west suburb of Chicago. No one in my network of friends and/or relatives are sick. No one knows any one sick. We are middle age and older. Take vitamin D3 everyday. Lose weight. Don’t smoke. Be free. I remember what freedom used to look like.

    19. OBloodyHell Says:

      Him Says:
      April 19th, 2020 at 1:47 pm
      I live in a near west suburb of Chicago. No one in my network of friends and/or relatives are sick. No one knows any one sick. We are middle age and older. Take vitamin D3 everyday. Lose weight. Don’t smoke. Be free. I remember what freedom used to look like.

      Yup. Seems like a hell of a lot of Chicken Little Shit.

      Zerohedge has a piece about how totally out of whack the predictions were for the death toll of CV…

      https://www.zerohedge.com/health/look-how-ridiculously-wrong-all-covid-19-models-were

      These models ASSUMED that the steps taken were done — and still there would be dead everywhere.

      Meanwhile…

      Massachusetts Researchers Tested People On The Street For Coronavirus Antibodies. One Third Had Them.
      https://www.dailywire.com/news/massachusetts-researchers-tested-people-on-the-street-for-coronavirus-antibodies-one-third-had-them

      It’s DW, so, open to counter-argument, and it’s neither a proper sample or a proper “study”, it’s still interesting that they found that many people who had been exposed, yet had no notable symptoms, nor illness as a result of it, and no idea they had it.

      This seems as though, if you get it serious, it’s pretty bad… but your chance of getting it serious ain’t that high.

      The only tales I’ve heard of people with it are third-tier — That is, (people I know)-> (people they know) -> [people those people know]

      With the victims in the [] group.

      Assuming the breakpoint at each level is 100 people, then it’s about 3 people in 100x100x100… or 3 in a million. And only one of those died, to the best of my knowledge, and he was, I’m told, 80y old. The other two were younger, but one has recovered. Dunno about the third one.

    20. Mike K Says:

      More on trying to get an accurate count of the real WuFlu deaths.

      Guidelines recently released by the Centers for Disease Control bolster concerns that the death toll is being rigged to show a higher fatality rate.

      “In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as ‘probable’ or ‘presumed’,” the agency advises. “In these instances, certifiers should use their best clinical judgment in determining if a COVID–19 infection was likely.”

      That clinical judgment, alarmingly, does not require administering a test to confirm the presence of the virus.

      “Ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty,” the guidelines state.

      There is no valid reason this cannot be done. The “Guideline ” is BS. I suspect that as many as 10,000 deaths reported as due to the virus are in fact flu and other pulmonary causes. All we will have when this is over is a total “Excess Deaths” which might be a negative number compared to average flu deaths per year.

    21. Mike K Says:

      PenGun with the usual troll comments. I guess Jonathan likes having him around.