Thanks for taking the time to think and write about how we can reduce the risk of getting ill. I think it’s fair to say that this advice is a bit more alarming than what other organizations are saying, like the Centers for Disease Control, the National Health Service, the World Health Organization, and the UK Foreign Office. For example, NHS.uk says that you don’t need to self isolate unless you are feeling unwell and have been to one of the listed countries recently, and they also say that even if you are self isolating, it is ok to accept food drop-offs. This contrasts with the advice above.
Could you tell us a little about why you think these organisations aren’t giving us the same advice as what you’ve written above? I’m finding it hard to give credence to this when the official picture is so much more subdued. I would guess that maybe there is a concern about creating hysteria or pressures on supplies of resources, but it would be good to know what you think.
Yeah, its an obvious tension. I’m not sure I can satisfactorily resolve it from the perspective of appealing to authority. My advice is based on first principles and aggregating the thoughts of other people who are primarily thinking from first principles. The first principle argument goes like this:
1. It is very unlikely that this disease will be contained in western countries. The CDC apparently agrees with this for the United States.
2. Medical countermeasures are unlikely to be widely available this year. There is some chance that the virus will struggle to transmit in warm weather but this is not high enough to be comfortable.
3. This means the virus is going to spread. Both models and reference class forecasting against diseases with similar R0 suggest that a large fraction of the population will be infected before treatments arrive, e.g. Harvard School of Public Health’s Marc Lipsitch citing 40-70% of population infected.
4. All of this is uncertain, and maybe we are saved by something we haven’t thought of, but given both the median and upper tail scenarios, it makes sense to be prepared. This is not only good for you but also a prosocial action which will flatten the case curve, reduce load on the hospital system, and protect elderly and vulnerable people in your contacts.
So why haven’t they made recommendations to prepare? Not sure. In the SARS outbreak, I don’t believe CDC made recs to prepare, but this Senior CDC official guy reports in his book to have called his wife during the early part of the outbreak (when it looked really bad) to get enough food to stay home for a few months.
My model of the world says that when things get bad enough for the CDC to have the political will to announce needed prep measures, it will be well after the time where it made sense to actually prepare (and may lead to runs on grocery stores etc). I don’t know how the NHS works so maybe you’d expect them to be right on the money?
I should say that this advice is largely directed at folks in the U.S., so haven’t thought through the U.K. situation fully.
That’s probably not satisfying. I wonder, though, if anyone could articulate what the (CDC, NHS etcs) first principles argument is for not taking these largely prosocial steps (with exception of N95 which I tried to emphasize is only for extenuating circumstances) to prepare?
Re: the UK response, the UK distributed the following guidance to schools to be passed on to parents on February 26th (since updated more extensively). The original guidance was first published on Jan 23:
3. This means the virus is going to spread. Both models and reference class forecasting against diseases with similar R0 suggest that a large fraction of the population will be infected before treatments arrive, e.g. Harvard School of Public Health’s Marc Lipsitch citing 40-70% of population infected.
Do you have any thoughts on the Metaculus estimate?
Thanks for taking the time to think and write about how we can reduce the risk of getting ill. I think it’s fair to say that this advice is a bit more alarming than what other organizations are saying, like the Centers for Disease Control, the National Health Service, the World Health Organization, and the UK Foreign Office. For example, NHS.uk says that you don’t need to self isolate unless you are feeling unwell and have been to one of the listed countries recently, and they also say that even if you are self isolating, it is ok to accept food drop-offs. This contrasts with the advice above.
Could you tell us a little about why you think these organisations aren’t giving us the same advice as what you’ve written above? I’m finding it hard to give credence to this when the official picture is so much more subdued. I would guess that maybe there is a concern about creating hysteria or pressures on supplies of resources, but it would be good to know what you think.
Yeah, its an obvious tension. I’m not sure I can satisfactorily resolve it from the perspective of appealing to authority. My advice is based on first principles and aggregating the thoughts of other people who are primarily thinking from first principles. The first principle argument goes like this:
1. It is very unlikely that this disease will be contained in western countries. The CDC apparently agrees with this for the United States.
2. Medical countermeasures are unlikely to be widely available this year. There is some chance that the virus will struggle to transmit in warm weather but this is not high enough to be comfortable.
3. This means the virus is going to spread. Both models and reference class forecasting against diseases with similar R0 suggest that a large fraction of the population will be infected before treatments arrive, e.g. Harvard School of Public Health’s Marc Lipsitch citing 40-70% of population infected.
4. All of this is uncertain, and maybe we are saved by something we haven’t thought of, but given both the median and upper tail scenarios, it makes sense to be prepared. This is not only good for you but also a prosocial action which will flatten the case curve, reduce load on the hospital system, and protect elderly and vulnerable people in your contacts.
So why haven’t they made recommendations to prepare? Not sure. In the SARS outbreak, I don’t believe CDC made recs to prepare, but this Senior CDC official guy reports in his book to have called his wife during the early part of the outbreak (when it looked really bad) to get enough food to stay home for a few months.
The CDC is also really botching testing by all accounts, including both screwing up the reagents so the test is inconclusive and refusing to test people who pretty obviously have the disease. Not to mention the increasing politicization of the virus as well as what appear to be outright gag-orders on US. public health officials.
My model of the world says that when things get bad enough for the CDC to have the political will to announce needed prep measures, it will be well after the time where it made sense to actually prepare (and may lead to runs on grocery stores etc). I don’t know how the NHS works so maybe you’d expect them to be right on the money?
I should say that this advice is largely directed at folks in the U.S., so haven’t thought through the U.K. situation fully.
That’s probably not satisfying. I wonder, though, if anyone could articulate what the (CDC, NHS etcs) first principles argument is for not taking these largely prosocial steps (with exception of N95 which I tried to emphasize is only for extenuating circumstances) to prepare?
Re: the UK response, the UK distributed the following guidance to schools to be passed on to parents on February 26th (since updated more extensively). The original guidance was first published on Jan 23:
https://publichealthmatters.blog.gov.uk/2020/01/23/wuhan-novel-coronavirus-what-you-need-to-know
They’ve also already set up isolation pods in some hospitals (i.e. St. Mary’s in London, John Radcliffe in Oxford), and are planning to expand this to every hospital with an A&E: https://metro.co.uk/2020/02/29/coronavirus-isolation-pods-installed-every-ae-unit-uk-sees-confirmed-cases-12325487/
Update: The UK has released an action plan (March 3)
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/869827/Coronavirus_action_plan_-_a_guide_to_what_you_can_expect_across_the_UK.pdf
Do you have any thoughts on the Metaculus estimate?
I think it is a little low but right order of magnitude (lower when you asked this question).