In 2015, Bill Gates put the risk of a global pandemic “worse than Ebola” at 50% within his lifetime. Bill Gates is 64. Should we listen to Bill Gates because he is rich? Of course not. But we should listen to him because his foundation is focused on public health, preventing and preparing for the sort of thing that is unfolding right now.
Category Archives: Web Article Review
coronavirus stats by metro area and normalized for population
I like this City Observatory approach to coronavirus stats. They are reporting numbers by metropolitan statistical area and normalizing them per 100,000 population. They are also reporting the rate at which cases are growing in each metropolitan area. They are using static tables and graphs but I think these provide much better information than the fancy maps and dashboards I have seen. The fancy maps and dashboards are updated more often – the ideal approach would blend all this together. As long as I am making a wish list, it would be nice to see the number of people hospitalized in each metro over time. That is the number we are looking for – the stock of available beds to first reappear as a positive number, then start to grow. When that happens I think we will start to see more public and political pressure to get people back to work. I expect high risk people to have to hide in their homes for quite some time after that, which is sad but I think that is the balance our society is likely to strike. If there comes a point later in the year where that stock of available hospital capacity starts to shrink or disappear in a given metro, that is when we might see shorter, more geographically targeted social distancing orders come and go.
Apple and augmented reality glasses
Apple is beta-testing lidar technology on its latest ipad. The rumor is that this is a test run for a new line of augmented reality glasses.
Google’s pedestrian foot traffic data
The Philadelphia Inquirer has an article showing foot traffic at various locations around the city during the coronavirus shut down compared to average. As might be expected, foot traffic is down pretty much everywhere except grocery stores, where it is up slightly. This matches my personal observations. It doesn’t match the media accounts of crazy lines at grocery stores and big box stores in the suburbs. Maybe this is because in a dense walkable city, we have many small stores instead of a few large stores, and people tend to spread out their shopping over the entire day and week and to buy just a bag or two at a time that they can carry home. There are odd, sporadic shortages, but I have not observed any extreme shortages of basic goods.
The data supposedly come from Google. I tried to find out more about how, where and when Google is collecting this data, and came up short after 15 minutes or so of looking.
Now, I admit that clearly dense cities with a lot of social interaction have their down side right now. The big dense cities are also where the most international arrivals happen, and this factor along with density might be why they are the worst places to be right now. Hopefully they also have the largest medical facilities with the most experienced medical staff, but whatever we have is clearly not going to be enough to help everyone who needs help in the next month or so.
more epidemic simulations
Okay, the current pandemic is not a game and not fun, people are suffering and I certainly don’t want to make light of it. But maybe we can at least learn something about systems, such as positive and negative feedback loops, S-shaped curves, and time delays. Netlogo has a few agent-based virus simulations to play with. The MIT system dynamics people put together a whole lesson on simulation of an epidemic as a teaching tool. (This is part of their “road maps” series, which you can find here. Just be warned that many of the hyperlinks don’t work, but if you cut and paste the names of the documents into a search engine, you can usually find them.)
And of course, there is the old flash game Pandemic 2, which is kind of fun in ordinary times but seems a little crass to play now, or at least to admit that you’re playing it. (Your goal is to kill everybody in the world, for example by making them vomit blood from their eyes…) On the other hand, Flash seems like it is on the way out so if you want to try this game it may be best to try it soon. And those of you stuck at home without multiple small children to entertain (not a category that includes me!) might have the time right now.
coronavirus simulations
The Washington Post has some interesting simulations that explain why quarantine is not all that effective a strategy, and why aggressive social distancing can be so effective. Basically, by isolating healthy people from each other you can drastically slow down the rate of spread and reduce the number of cases hitting the health care system at any one time to something manageable. These are agent-based simulations with accompanying time series graphs, and I find them pretty intuitive and informative.
the goal of social distancing
Vox has an informative article with some visuals on the goal of social distancing in an epidemic. If you can reduce the total number of infections that is a bonus, but the primary goal is to reduce the peak number of infections happening at any one time. You can do this by delaying cases and spreading them out of time, so that the capacity of the health care system is better able to deal with them. This looks very similar to a stormwater or flood control engineer – often, our goal is also to reduce and delay the peak. Reducing the volume is a bonus if you can manage it. The lesson is not that epidemics are like hydrology, it’s that there are certain fundamental system structures that lead to fundamental behaviors, and they are shared between systems. A couple more that come to mind along the lines of this basic model are congestion pricing to spread traffic out over time, and batteries to store solar and wind energy and trickle them back over time.
another indicator that the U.S. is falling behind
The Atlantic has an article on just how badly the United States has dropped the ball on testing people for the novel coronavirus compared to other developed countries. We can add this to list along with overall life expectancy, child and maternal mortality, mass incarceration, depression, suicide, drug overdoses, blackouts, traffic delays, educational outcomes, drinking water quality, poverty, and the list goes on. We were great once, in the sense that we were the world’s leader on most or all of these categories. Over the last decade or two, we have not just lost that leadership position, we have fallen to the bottom of the pack and continue to lose ground. True patriots don’t just say their country is great again and hope that makes it true in the face of contrary evidence, they face the facts and do something about it.
the Flynn effect and the reverse Flynn effect
When IQ tests are taken by each generation, they are always normalized so that the average is a score of 100. However, when people are asked to take tests from older generations, they tend to do better than the older generations did. This is the Flynn effect. It was very consistent throughout the second half of the 20th century and into the 21st, but a number of studies in Scandinavia indicate that it may have reversed more recently. Immigration is one controversial explanation that has been suggested, whether due to genetic or cultural reasons. But the study I link to here tested the effect within families against the effect across unrelated people, and found that it is just as strong within families. This suggests environmental factors such as education and nutrition as the culprits, although the article does still put “migration” in this category. I suppose if you had a society with a high quality of nutrition and education, and you then have an influx of new people with more bad habits (let’s say, a high rate of smoking), that could have an effect.
private equity and surprise medical billing
This article from Center for Economic and Policy Research (I admit I don’t know much about this organization) claims that private equity firms have bought up medical practices and intentionally insert out-of-network doctors into teams treating you at your in-network hospital. Members of Congress have introduced legislation to curb this, but the financial lobby has been too powerful to beat.
Private equity-owned physician staffing firms grow by buying up many small specialty practices and “rolling them up” into umbrella organizations that serve health care systems across the United States. KKR-owned Envision Healthcare with 69,300 employees, and Blackstone-owned TeamHealth with 20,000 employees, dominate the market for outsourced doctors’ practices. A team of Yale University health economists examined what happened when private equity-owned companies EmCare (part of Envision Healthcare) and TeamHealth took over hospital emergency departments.5 They found that when EmCare took over the management of emergency departments, it nearly doubled its charges for caring for patients compared to the charges billed by previous physician groups. The researchers also found that TeamHealth took a somewhat different tack. It used the threat of sending high out-of-network surprise bills for ER doctors’ services to an insurance company’s covered patients in order to gain high fees from insurance companies as in-network doctors.6 This avoids the situation where a patient gets stuck with a large, surprise medical bill, but it raises premium costs for everyone. In both cases, healthcare costs increase when outsourced emergency rooms and other physician services are owned by private equity firms.
My take: Campaign finance reform and Medicare for All, baby!