Monthly Archives: August 2020

Teachers Face Low-to-Moderate COVID Risk

29 Saturday Aug 2020

Posted by in Education, Pandemic, School Choice, Uncategorized

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A quick follow-up to my recent post “COVID Hysteria and School Reform“: the graphic above is from an occupational risk study recently conducted by Swedish health authorities. The horizontal axis is obscured by the lower banner from Twitter (my fault), but the average risk of infection across all occupations was slightly less than 1%, and the highest-risk occupations were in the 4 – 5% range. Keep in mind, the data was collected while the virus was still raging in Sweden, while schools remained open. The virus hasn’t completely vanished in Sweden since then, but it has largely abated.

The study found that teachers had roughly average or below average risk, especially for pre-school and upper secondary (so-called “gymnasium”) teachers. The results demonstrate the lack of merit to claims by teachers unions that their members are somehow at greater risk of contracting coronavirus than other “essential” workers. We already know that children have extremely low susceptibility to COVID-19 and that they do not readily transmit the virus.

The health benefits of closing schools or taking them on-line do not compensate for the loss of educational effectiveness and detrimental health effects of preventing children from attending schools. The digital divide between children from disadvantaged households and their peers is likely to grow more severe if online learning is their only option. They should have choices, including functioning public schools.

To the last point, however, read this link for the sort of thing one teachers union supports. If the members are okay with that insanity then they shouldn’t be teaching your kids.

COVID Hysteria and School Reform

24 Monday Aug 2020

Posted by in Education, Pandemic, School Choice

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Many haven’t quite gathered it in, but our public education system is an ongoing disaster for many low-income and minority students and families. The pandemic, however, is creating a major upheaval in K-12 education that might well benefit those students in the end. But before I get into that, a quick word about National Public Radio (NPR): it doesn’t make its political leanings a secret, which is why it should not be supported by taxpayers. Yes, like many other mainstream media outlets, NPR serves as a political front organization for Democrats (and worse).

Last week, NPR did a segment on “learning pods”, which I’d describe as private adaptations to the failure of many public schools (and teachers’ unions) to do their job during the pandemic. Glenn Reynolds passed along an interpretation of that NPR segment from a friend on Facebook, which I quote in its entirety below (bold emphasis mine). It was either this segment or else NPR has taken it down … but that link more or less matches the description. The post is somewhat satiric, but it captures much of what was actually said:

“Hilarious NPR, last week’s edition. They had an hour-long segment on learning pods. Participants: Host (white woman), Black Woman Activist, Asian Woman Parent, School-System Man.

Slightly editorialized (but true!) recollections below.

Host: In wealthy areas, parents get together and organize learning pods. What do we make of it?

School-System Man: Inequitable! Inappropriate! Bad! We do not support it!

Asian Woman Parent: Equity requires that we form these pods to educate our own children! Otherwise, only the rich can get education! Rich bad!

Host: Rich bad.

School-System Man: Rich horrible! They withdraw kids from public schools during the pandemic, so schools have less money!

Asian Woman Parent: We have no choice. You are not teaching.

Host: But what are you doing for the equity?

Asian Woman Parent: Why are the parents supposed to be doing something for the equity? That’s why we pay taxes, so professionals do something!

School-System Man: We cannot fix equity if you are clandestinely educating your own children, but not everyone else’s children!

Asian Woman Parent: The proper solution would have been to end the pandemic. But Trump did not end the pandemic. So, we must do learning pods. As soon as the pandemic is over, we’ll get back to normal, and everyone will catch up.

Everyone [with great relief]: Trump bad. Bad.

Black Woman Activist: No, wait a minute. This sounds as though in a regular school year, black children get good education. And they are getting terrible education! Unacceptable!

Host: Bad Trump!

Black Woman Activist: Foggeraboutit! It’s not Trump! It’s always been terrible! Black children are dumped into horrible public schools, where nobody is teaching them! So, my organization is now helping organize these learning pods for minority kids everywhere.

School-System Man [cautiously]: This is only helping Trump…

Black Woman Activist: Forget Trump! Don’t tell me black kids get no education because things are not normal now. When things were normal, their education was just as bad!

School-System Man: Whut??? How dare you! Our public schools are the best thing that ever happened to black children.

Asian Woman Parent: I’ll second that. Public schools in my neighborhood are just svelte.

Black Woman Activist: That’s the point! You live in a rich suburb, and your kids get a great public school! Black kids don’t!

Asian Woman Parent: If Trump managed the pandemic properly, we would not be having this conversation.

Host: Bad Trump!

Everyone: Bad Trump!

The end.”

Ah yes, so we’re back to blaming Donald Trump for following the advice of his medical experts, most prominently Dr. Anthony Fauci. And, while we’re at it, let’s blame Mr. Trump for following federalist principles by deferring to state and local governments to deal flexibly with the varying regional conditions of the pandemic, rather than ruling by federal executive edict. Of course, some of those state and local officials botched it, such as Andrew Cuomo. That’s tragic, but had Trump followed a more prescriptive tack, the howling from the Left would have been even more deafening.

We know that children are at little risk from the coronavirus. Nor do they seem to transmit the virus like older individuals, but teachers unions are adamant that the risks their members face at school would far exceed those shouldered by other “essential” workers. And the unions, not shy about partisanship even while representing public employees, want nothing more than to see Trump lose the election. So the unions and the schools districts they seem to control hold parents hostage. They collect their tax revenue and salaries while delivering virtual service at lower standards than usual, or no service at all. (Of course, public schools in some parts of the country are in session.) 

The teachers’ unions and public schools might get their comeuppance. The situation represents a tremendous opportunity for private schools, home schooling, and innovative schooling paradigms. Many private schools are holding classes in-person, more parents are homeschooling, and alternative arrangements like learning pods have formed, many of which are quite cost-effective.

Pressure is building to allow education dollars to follow individual students, not simply to flow to specific government schools. You can buy a decent K-12 education for $12,000 a year or so, and it’s likely to be a better education than you’ll get in many public schools. (One of the panelists on the NPR segment smugly called this an “insidious temptation”). At long last, parents would be allowed real choice in educating their children, and at long last schools would be incentivized to compete for those students. That might be one of the best things to come out of the pandemic.

COVID Seasonality and Latitudes

23 Sunday Aug 2020

Posted by in Pandemic

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The coronavirus (C19), or SARS-CoV-2, has a strong seasonal component that appears to closely match that of earlier SARS viruses as well as seasonal influenza. This includes the two distinct caseloads we’ve experienced in the U.S. 1) in the late winter/early spring; and 2) the smaller bump we witnessed this summer in some southern states and tropics. 

COVID Seasonal Patterns and Latitude

The Ethical Skeptic on Twitter recently featured the chart below. It shows the new case count of C19 in the U.S. in the upper panel, and the 2003 SARS virus in the lower panel. Both viruses had an initial phase at higher latitudes and a summer rebound at lower latitudes.

 

 

 

 

 

 

 

 

 

 

I particularly like the following visualizations from Justin Hart demonstrating the pandemic’s pattern at different latitudes (shown in the leftmost column). The first table shows total cases by week of 2020. The second shows deaths per 100,000 of population by week. Again, notice that lower latitudes have had a crest in the contagion this summer, while higher latitudes suffered the worst of their contagion in the spring. Based on deaths in the second table, the infections at lower latitudes have been less severe.

Viral Patterns in the South

Many expected the pandemic to abate this summer, including me, as it is well known that viruses don’t thrive in higher temperatures and humidity levels, and in more direct sunlight. So it is a puzzle that southern latitudes experienced a surge in the virus during the warmest months of the year. True, the cases were less severe on average, and sunlight and humidity likely played a role in that, along with the marked reduction in the age distribution of cases. However, the SARS pandemic of 2003 followed the same pattern, and the summer surge of C19 at southern latitudes was quite typical of viruses historically.

A classic study of the seasonality of viruses was published in 1981 by Robert Edgar Hope-Simpson. The next chart summarized his findings on influenza, seasonality, and latitude based on four groups of latitudes. Northern and southern latitudes above 30° are shown in the top and bottom panels, respectively. Both show wintertime contagions with few infections during the summer months. Tropical regions are different, however. The second and third panels of the chart show flu infections at latitudes less than 30°. Influenza seems to lurk at relatively low levels through most of the year in the tropics, but the respective patterns above and below the equator look almost like very muted versions of activity further to the north and south. However, some researchers describe the tropical pattern as bimodal, meaning that there are two peaks over the course of a year.   

So the “puzzle” of the summer surge at low latitudes appears to be more of an empirical regularity. But what gives rise to this pattern in the tropics, given that direct sunlight, temperature, and humidity subdue viral activity?

There are several possible explanations. One is that the summer rainy season in the tropics leads to less sunlight as well as changes in behavior: more time spent indoors and even less exposure to sunlight. In fact, today, in tropical areas where air conditioning is more widespread, it doesn’t have to be rainy to bring people indoors, just hot. Unfortunately, air conditioning dries the air and creates a more hospitable environment for viruses. Moreover, low latitudes are populated by a larger share of dark-skinned peoples, who generally are more deficient in vitamin D. That might magnify the virulence associated with the flight indoors brought on by hot and or rainy weather.   

Mutations and Seasonal Patterns

What makes the seasonal patterns noted above so reliable in the face of successful immune responses by recovered individuals? And shouldn’t herd immunity end these seasonal repetitions? The problem is the flu is highly prone to viral mutation, having segments of genes that are highly interchangeable (prompting so-called “antigenic drift“). That’s why flu vaccines are usually different each year: they are customized to prompt an immune response to the latest strains of the virus. Still, the power of these new viral strains are sufficient to propagate the kinds of annual flu cycles documented by Hope-Simpson.

With C19, we know there have been up to 100 mutations, mostly quite minor. Two major strains have been dominant. The first was more common in Southeast Asia near the beginning of the pandemic. It was less virulent and deadly than the strain that hit much of Europe and the U.S. Of course, in July the media misrepresented this strain as “new”, when in fact it had become the most dominant strain back in March and April.

What Lies Ahead

By now, it’s possible that the herd immunity threshold has been surpassed in many areas, which means that a surge this coming fall or winter would be limited to a smaller subset of still-susceptible individuals. The key question is whether C19 will be prone to mutations that pose new danger. If so, it’s possible that the fall and winter will bring an upsurge in cases in northern latitudes both among those still susceptible to existing strains, and to the larger population without immune defenses against new strains.

Fortunately, less dangerous variants are more more likely to be in the interest of the virus’ survival. And thus far, despite the number of minor mutations, it appears that C19 is relatively stable as viruses go. This article quotes Dr. Heidi J. Zapata, an infectious disease specialist and immunologist at Yale, who says that C19:

“… has shown to be a bit slow when it comes to accumulating mutations … Coronaviruses are interesting in that they carry a protein that ‘proofreads’ [their] genetic code, thus making mutations less likely compared to viruses that do not carry these proofreading proteins.”

The flu, however, does not have such a proofreading enzyme, so there is little to check its prodigious tendency to mutate. Ironically, C19’s greater reliability in producing faithful copies of itself should help ensure more durable immunity among those already having acquired defenses against C19.

This means that C19 might not have a strong seasonal resurgence in the fall and winter. Exceptions could include: 1) the remaining susceptible population, should they be exposed to a sufficient viral load; 2) regions that have not yet reached the herd immunity threshold; and 3) the advent of a dangerous new mutation, though existing T-cell immunity may effectively cross-react to defend against such a mutation in many individuals.

 

The FDA Can Put Virus Behind Us, Sans Vaccine

19 Wednesday Aug 2020

Posted by in Liberty, Pandemic, Vaccinations

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Most of the news about COVID vaccine development is positive, but there are still huge doubts about 1) whether an effective vaccine(s) will ever be available; 2) when it will be available; 3) in what quantities (supply chains for vaccines present issues that most lay persons would never imagine) ; 4) the best approaches to allocation across young/healthy vs. old/vulnerable; 5) how long it will provide protection (the news is good on lasting immunity as well); and 6) whether people will actually take it. Given all these uncertainties, it’s worth considering an approach to stanching the coronavirus that won’t require a vaccine while still allowing a return to normalcy: cheap, rapid tests available to consumers on a daily basis in their homes or in businesses.

The full benefits of cheap, rapid tests can take people a while to wrap their heads around. In fact, there are skeptics who’s views on any and all testing are colored by suspicions that increased testing is some sort of conspiracy to spread fear and keep the economy hobbled. It’s true that increased testing drove much of the increase in COVID cases this summer, which caused the mainstream media to delight in spinning alarmist narratives. Fair enough, but that misses the point, which I’ll try to elucidate below. I credit a John Cochrane post for bringing this to my attention.

A successful vaccine breaks the so-called “transmission chain”, but so does frequent testing to identify infectious individuals on an ongoing basis so they can self-quarantine. As Alex Tabarrok has emphasized, we should worry about identifying infectious individuals, as opposed to infected individuals. They are not the same. Cheap, rapid, and easy-to-administer tests have already proven to be fairly accurate during the infectious stage. The idea is for individuals to self-test every day and stay home if they are positive. Or, employers can test workers every day and send them home if they are positive. Frequent testing also makes it simpler to trace the source of an infection and may reduce the importance of tracing.

To those who say this represents an affront to personal liberty, and I’m very touchy on that subject myself, recall that even now people are being screened in their workplaces using thermometers, questionnaires, or on the basis of any frogginess perceived by supervisors and co-workers. Those “tests” are far less accurate in identifying COVID-19 contagiousness than the kinds of cheap tests at issue here, and they are certainly no less intrusive. Then there are the many businesses facing restrictions on their operations: how “accurate” is it to keep everyone at home by locking down places of business? How intrusive is that? Those restrictions are indefensible, and especially with the advent and diffusion of cheap, rapid tests.

Of course, people might cheat and not report positives. Tests could be administered at workplaces to avoid that possibility, or at points of admission to businesses and facilities, but a few minutes of delay would be necessary. I would not support a centralized database of daily test results. If nothing else, relying on the good faith of individuals in reporting their results would be a giant leap forward in breaking the transmission chain now, rather than counting on the possibility of a successful virus in the indefinite future. And we might then avoid the whole pro-vax/anti-vax imbroglio that already foments, which raises major questions bearing on individual liberty.

Then there is the question of positive tests within multi-person households. Should the entire family or household self-quarantine? I say no, not if the others are negative, but then the others should test twice before going out, which dramatically reduces the probability of a false negative, and they should probably test more frequently, perhaps several times a day.

There are other important details to address: Who will pay for the tests? Will workers be paid to stay home if they test positive? How long will they be required to stay home? How will repeated tests be treated? I don’t want to get into detail on all of these points, but cheap, fast tests can help overcome many of these difficulties, and I believe many of the details can and should be worked out privately.

Unfortunately, the FDA has approved only two rapid tests, and they are not very rapid and not cheap enough. Only one had been approved up until last weekend because the FDA found the accuracy to be lacking … compared to PCR tests! But the FDA finally issued an Emergency Use Authorization for a saliva-based test (SalivaDirect) developed at Yale, partly funded by the NBA and the Players Association. The test still requires processing at a lab, so it’s really not convenient enough and not fast enough. Here is Zach Lowe on the cost:

“The cost per sample could be as low as about $4, though the cost to consumers will likely be higher than that — perhaps around $15 or $20 in some cases, according to expert sources.”

Not bad, but it’s much higher than more rapid, paper tests developed by Harvard’s Wyss Institute for Biologically Inspired Engineering and a company called E25Bio. Both of those are expected to cost about $1 per sample and can be completed anywhere. That’s a price that can work. And there are other promising candidates.

The benefits of tests that are rough, ready, and cheap will be huge. Such tests will also enable retesting, which helps to overcome the dilemmas of false positives and negatives. False negatives might be of greater concern to the FDA, but again, false negatives are less likely during the contagious stage of an infection, and the tests will be accurate enough that transmission risk will be drastically reduced.

The FDA needs to move beyond its stodgy insistence on achieving laboratory levels of accuracy. It’s unlikely that a single test source will be adequate to stanch the transmission chain, so the agency should rush to approve as many cheap, rapid tests as possible, with as many advisories and patient warnings regarding test results and follow-up instructions as it deems necessary. Remember, these tests are much better than thermometers!

Evidence of Fading COVID Summer Surge

16 Sunday Aug 2020

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Lately I’ve talked a lot about reported deaths each week versus deaths by actual date of death (DOD). Much of that information came from Kyle Lamb’s Twitter account, and he’s the source of the charts below as well. The first one provides a convenient summary of the data reported through last week. The blue bars are reported deaths each week from the COVID Tracking Project (CTP), which are an aggregation of deaths that actually occurred over previous weeks. Again, the blue bars do NOT represent deaths that occurred in the reporting week. The solid orange bars are “provisional” actual deaths by DOD. “Provisional” means that recent weeks are not complete, though most deaths by DOD are captured within three to four weeks. The CDC also produces a “forecast” of final death counts by DOD, shown by the hatched orange bars.   

Note that the recent surge in deaths has been much smaller than the one in the spring, which was driven by deaths in the northeast. The CDC “expects” actual deaths by DOD to have declined starting after the week of July 23rd. However, CTP was still reporting deaths of over 1,000 per day last week. The actual timing of those deaths in prior weeks, and the ultimate extent of the summer surge in COVID deaths, remains to be seen.

Certain leading indicators of deaths are signaling declines in actual deaths in August. Two of those indicators are 1) the positivity rate on standard PCR tests for infections; and 2) the share of emergency room visits made for symptoms of “COVID Like Illness” (CLI). The charts below show those indicators for FEMA regions that had the largest uptrends in cases in June and July. Florida is part of Region 4, shown in the next chart:

Here is the Region 6, which includes Texas:

Finally, Region 8 includes Arizona and California:

Out of personal interest, I’m also throwing in Region 7 with a few midwestern states, where cases have risen but not to the levels reached in Regions 4, 6, and 8:

With the exception of the last chart, the clear pattern is a peak or plateau in the positivity rate in late June through late July, followed by declines in subsequent weeks. The share or ER visits for CLI was not quite coincident with the positivity rate, but close. The decline in the CLI share is evident in Regions 4, 6 and 8. Again, these three regions include states that drove the nationwide increase in cases this summer (AZ, CA, FL, and TX), and the surge appears to have maxed out.     

Here is a chart showing the share of CLI visits to ERs for all ten FEMA region from mid-June through last week. Clearly, this measure is improving across the U.S.

Nationwide, the CLI percentage at ERs has decreased by about 47% over the past four weeks, and the positivity rate has decreased by about 28% in that time. In addition to these favorable trends, COVID hospitalizations have decreased by about 40% over the past three weeks. All of these trends bode well for a downturn in COVID-attributed deaths.

The summertime surge in the virus was not nearly as ravaging as in the spring, and it appears to be fading. We’ll await developments in the fall, but we’ve come a long way in terms of protecting the vulnerable, treating the infected, approaching herd immunity thresholds (which means reduced rates of transmission to susceptible individuals), and the real possibility that we can put the pandemic behind us. 

Joe’s Moronic Outdoor Mask Mandate

15 Saturday Aug 2020

Posted by in Pandemic, Public Health

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Do you wear a mask whenever you step outside? In your yard? At the beach? In the park? On an empty sidewalk? Then congratulations! You are a colossal imbecile, like all the others in the mandatory mask crowd. Now, Joe Biden, in an attempt to prove either dementia or a full-fledged alliance with irredeemably lefty Karens, is demanding a three-month nationwide mandate for masks to be worn by everyone … OUTDOORS!

Really, what kind of moron believes there is any real danger of contracting coronavirus outside short of close and prolonged exposure to an infected individual? We know outdoor transmission is extremely rare. Nearly 100% of cases are contracted indoors, almost always in tight, poorly ventilated spaces.

It’s not hard to fathom why outdoor environments are of such low risk. Outdoors, air is of such enormous volume that virus particles are quickly diluted, dramatically reducing any viral load one might encounter. Air circulation is much better outdoors as well, driven by differences in temperatures across lateral and vertical space. Any breeze effectively disperses the particles. And those small loads drifting through open air won’t survive long: the ultraviolet waves in direct sunlight tend to kill it very quickly. Humidity is also associated with more rapid deactivation of the virus. Air tends to be more humid outdoors whenever forced air heating or air conditioning are used without sufficient humidification.

Cloth masks, in any case, may be effective against transmission by droplets expelled from coughs or sneezes, but they are of questionable value against transmission by aerosols from exhaled air. Outside, if you are distanced, you really have only aerosols to worry about. Under those circumstances, cloth masks are more for show than anything else.

And on what pretext do officials, or your nitwitted neighbors, get the idea that mandatory masks OUTSIDE is in the interest of public health? I mean, besides buying-in to a ridiculous nanny-state narrative promoted by the media? Well, there is also some crap “research” to consider. Here is a good example: a study on masks from the Kansas Department of Health and Environment (KDHE). Take a look at what these guys tried to pull off…  Here’s what KDHE hoped would serve as “proof” of the dramatic efficacy of masks:

Wow! Notice two things in this chart: 1) the two lines are plotted with respect to different vertical axes; and 2) the chart begins on July 12th. Now take a look at a longer history in which the lines are plotted against the same axis.

It certainly doesn’t appear that the mandate beginning on July 3 had a favorable impact on new cases. What KDHE did here was incredibly dishonest, and I applaud the Kansas Policy Institute and it’s publication The Sentinel (linked above) for calling out KDHE for their dishonest piece of crap.

Other studies have exaggerated the general efficacy of masks as well. It’s also noteworthy that Europe’s medical establishment is unimpressed with masks. And after all, to my knowledge there have been no randomized control trials supporting the efficacy of masks — the only acceptable form of test according to Anthony Fauci! Now, none of that means masks don’t reduce COVID transmission. I happily wear a mask when I enter public buildings. What’s at issue here is whether masks should be required outdoors. Furthermore, I dispute the notion that a nationwide mask mandate is needed, because not all localities are at equal risk. I’m an advocate of the federalist principle that the best state and local solutions are crafted at the state and local levels. And at a personal level, I say ignore the intrusive bastards. Get outside in the fresh air, and forget the mask if you have some space.

Election Snafus, Fraud: Invite and They Will Come

12 Wednesday Aug 2020

Posted by in Democracy, Pandemic, Voter Fraud

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There is understandable controversy over the prospect of more mail-in voting, but it’s reasonable to believe that some additional mail-in or postal voting may be necessary in light of the pandemic. Social distancing reduces the volume of activity that polling places can handle in a single day, and administrative decisions about the voting process can’t be deferred until late October in order to observe the state of the pandemic and make last-minute changes. Most states already permit voters to request a mail-in ballot for a variety of reasons: travel, illness, or other exigencies are usually sufficient, if a reason is even required. In the context of the pandemic, such a request should certainly be granted to those most concerned about contracting the coronavirus. So the option to vote by mail seems reasonable, at least in the abstract, as long as those who prefer to cast their ballots in person can do so.

“Universal” mail-in voting is another story, but the term first requires some qualification. I construe “universal” in this case to mean voting by citizens of the United States, a right protected and reserved to citizens by the 19th Amendment to the Constitution. That also means voters must be registered and must comply with state requirements for identification, if any, before receiving a ballot. In other words, under current state laws, a voter might be required to appear before an election authority to obtain a ballot for return by mail. The proponents of universal postal mail, however, seem to think states should simply mail ballots to the addresses of all registered voters. Many proponents go further, suggesting that all individuals of voting age should be mailed ballots.

The first major problem with a large expansion of postal voting is administrative complexity. It would represent a significant challenge for many jurisdictions to arrange in short order. It’s bound to create major delays in counting and reporting results, and it is likely to create doubt as to the reliability of the official election results. Here are some administrative issues and examples worth considering:

This recent experiment by CBS revealed delays in the official receipt of mailed ballots, a problem that will be more acute given plans in some jurisdictions to send ballots to postal voters only a week prior to the November election. The study also revealed some mis-sorting and misplacement of returned ballots. It concluded that a percentage of voters is likely to be “disenfranchised” by mail-in voting.

In early August, primary balloting by mail in Atlantic County, NJ was said to be especially problematic. Signatures on ballots were difficult to match to DMV records signed on “screen”; there was an extra step in delivering ballots to a central post office location and then on to election officials, causing delays; the voter registration system was plagued by technical glitches related to heavy demand for updated records; and there was insufficient time between sending ballots to voters and the deadline.

New York City’s primary election in June was similarly afflicted with a high rate of invalid mailed ballots. “The city BOE received 403,103 mail-in ballots for the June 23 Democratic presidential primary. … But the certified results released Wednesday revealed that only 318,995 mail-in ballots were counted. … That means 84,108 ballots were not counted or invalidated — 21 percent of the total. … One out of four mail-in ballots were disqualified for arriving late, lacking a postmark or failing to include a voter’s signature, or other defects. The Post reported Tuesday that roughly 30,000 mail-in ballots were invalidated in Brooklyn alone. … The high invalidation rate provides more proof that election officials and the Postal Service were woefully underprepared to handle and process the avalanche of mail-in ballots that voters were encouraged to fill out to avoid having to go to the polls during the coronavirus pandemic, critics said.”

From the New York Times, “In the last presidential election, 35.5 million voters requested absentee ballots, but only 27.9 million absentee votes were counted, according to a study [NYT link is bad] by Charles Stewart III, a political scientist at the Massachusetts Institute of Technology. He calculated that 3.9 million ballots requested by voters never reached them; that another 2.9 million ballots received by voters did not make it back to election officials; and that election officials rejected 800,000 ballots. That suggests an overall failure rate of as much as 21 percent.”

The problem of rejected mail-in ballots is all too common throughout the country. For example, redistricting can cause mail-in voters to cast their votes in the wrong precinct at a higher rate; people move frequently, especially low-income voters, so updating voter rolls is a tremendous challenge; and voters often fail to follow instructions carefully, and there is no one at hand to offer assistance.

Again, these are just the administrative problems. The upshot is that mail-in voting is likely to introduce uncertainties and delays in determining election outcomes, and is likely to result in numerous legal challenges as well.

This piece by Eric Boehm in Reason is skeptical of our ability to vote by mail without major complications of that kind. Boehm then turns to the question of mail-in ballots and fraud, however, quoting a variety of experts who claim that election fraud is a miniscule problem and that fraud has not had a partisan bias in the past. But partisan bias is not really the critical issue… fraud is, party by party, district by district, and state by state.

Despite Boehm’s protestations and widespread denial in the news media, election fraud is a “thing”. More importantly, the risk of election fraud is a thing. It’s instructive that two U.S. Senators (Ron Wyden (OR) and Amy Klobuchar (MN)) have introduced legislation that not only would authorize more widespread voting by mail, but “ballot harvesting” as well. The latter is the practice of visiting homes and “offering” to collect residents’ postal ballots for delivery to collection points. It has been a flagrant form of vote fraud in the past.

So what is our experience with fraud? Here is a “sampling” of 1,290 cases of election fraud, many of which involved absentee ballots and ballot harvesting. Detail on most of these cases can be found here.

The following testimonial reinforces the ease with which fraud can be perpetrated via mail-in voting:”I know because I did it“:

“Last year, a political operative working for North Carolina Republican congressional candidate Mark Harris was charged with fraud for directing a group of people to fill out as many as one thousand absentee ballot requests on behalf of voters — most of whom were unaware the ballots were being requested. … These people then collected the ballots and filled them out themselves. … 

Also in 2019, a Democratic city clerk in Southfield, Michigan, was arrested and charged with six felonies for falsifying absentee ballot records to say that 193 of the ballots in one election were missing signatures or a return date, when in fact they had both. The correct records were found in the trash can in her office.

… J. Christian Adams of the Public Interest Legal Foundation (PILF) says if states aren’t careful, they’ll be issuing ‘an open invitation to fraud. … There are two big problems with vote by mail,’ Adams told InsideSources. ‘Number one … people voting the ballot for other people through undue influence. … The second one — the voter rolls are a mess.’ … Adams’ organization has sued several states and counties for refusing to maintain accurate voter rolls, allowing the names of thousands of dead voters, felons and non-citizens to remain in the system.”

Fraud risk always exists even if detected and proven levels of fraud are low, and the level of risk scales with the extent to which ballots are cast by mail. The sudden, massive expansion in mail-in voting now contemplated by some would create unprecedented opportunities for fraud.

Consider the 28 million mail-in ballots that went missing between 2012 and 2018, roughly 20% of mail-in ballots issued during those years. According to Logan Churchwell of PILF:

“So what do people that really focus on the election process do about that? They go into ballot harvesting. If there’s so many ballots out there in the wind unaccounted for by election officials, surely some manpower could be dedicated to go bring them in. And that’s another part of the system where you have weaknesses and risk.”

It takes only a small percentage of the vote to swing many elections, so ballot harvesting, enabled by more widespread voting-by-mail, is a serious threat to the integrity of the democratic process. The last link cites a few reports that should give mail voting proponents some pause:

“There’s little doubt that as the number of mail-in ballots increases, so does fraud. A 2012 report in The New York Times noted that voter fraud involving mail-in ballots ‘is vastly more prevalent than the in-person voting fraud that has attracted far more attention, election administrators say. In Florida, absentee-ballot scandals seem to arrive like clockwork around election time.’ According to a Wall Street Journal report on voter exploitation in Hispanic communities in Texas, mail-in ballots have ‘spawned a mini-industry of consultants who get out the absentee vote, sometimes using questionable techniques.’ Poor, elderly, and minority communities are most likely to be preyed upon by so-called ballot ‘brokers.’

Concerns about fraud in mail-in ballots were serious enough that a 2008 report produced by the CalTech/MIT Voting Technology Project recommended that states ‘restrict or abolish on-demand absentee voting in favor of in-person early voting.'”

It’s no coincidence that most countries in the European Union restrict mail-in voting to those who are unable to vote in-person, such as those working or studying abroad, as well as the sick and elderly. There are exceptions, of course, but many of these developed countries reject the notion that mail-in voting is worth the risks.

It’s reasonable to expect many cautious voters to request ballots for return by mail. But at a minimum, any large-scale transition to postal voting should be done with care for the security and integrity of the voting process. It is not an exercise to be done in haste, as proponents now demand. The result of such a drastic change would be significant delays, legal challenges, and reduced confidence in the outcome of elections. And there will almost certainly be fraud. As in almost all things, a voluntary option subject to jurisdictional risk controls is far preferable to either mandatory or “universal” postal voting.

TikTok Tax: The Heavy Wants a Cut

05 Wednesday Aug 2020

Posted by in Industrial Policy, Regulation, Trump Administration

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I have a certain ambivalence toward Donald Trump, and I could go on and on about why it’s so “complicated” for me. One thing for which I’ve credited the Trump Administration is its effort to “deconstruct the administrative state”, as Steve Bannon so aptly put it shortly after the 2016 election. Of course, the progress thus far hasn’t always lived up to my hopes, but the effort to deregulate continues. And after all, the regulatory state is deeply entrenched and difficult to uproot.

Then my eyes glazed over as Trump floated an idea so bad, an intervention so awful, that I can hardly gather it in! It has to do with TikTok, the Chinese video sharing service that has gained popularity worldwide. Crazy as this might sound, it’s not so much Trump’s threat to shut down TikTok’s U.S. operations. Like most libertarians, I’d find that appalling in and of itself, except for the legitimate data security issues at stake. The company’s ties to the Chinese Communist Party (CCP) are a national security concern and an ethical blot on the company, given the CCP’s brutal treatment of Muslim Uighurs, its roughshod treatment of Hong Kong, and its threats to Taiwan. In any case, at least Trump said he’s amenable to a sale of the company’s U.S. operations to a domestic firm. Several large tech firms have expressed strong interest, including Microsoft. So, while any government imposed shutdown or forced sale makes me squirm, it’s not my main issue here.

What really stunned me was to hear Trump say the U.S. Treasury must get a cut of the deal! This is “Hall-of-Fame” statism. Where in the hell does the U.S. government get a legitimate financial claim to the value of any private business that changes hands? Well, Trump seems to think the federal government is adding value as the heavy:

“But if you buy [TicTok], the United States, which is making it possible to buy, because without us they can’t do anything, should be compensated.”

Yes, the buyer would be the beneficiary of a shakedown, and the demand is another poke in the eye to the Chinese. Of course, it might well threaten the transaction, and I’m not even sure it’s in Trump’s interest politically. But that’s not even the worst of it: as Warren Meyer explains, it would be hard to think of a better way to weaponize financial regulation than having the Treasury at the bargaining table in private negotiations for corporate control:

“Already there are too many regulatory hurdles to doing about anything, and Trump wants agencies to use regulatory approvals to hold up corporations for payments. And you can be sure this is a precedent the Democrats will be only too happy to latch onto — want a pipeline built, where’s our vig? Who wants [this to be] the first Trump decision AOC comes out in support of? The Republican Party sure has come a long way in my lifetime.”

The Left would certainly love to exercise this kind of coercion as a revenue source, as a cudgel of industrial policy to wield against disfavored firms and industries, and as a way to favor cronies. It’s a ready extension of Barack Obama’s deranged “You-didn’t-build-that” theme.

Is this one of trade advisor Peter Navarro‘s brainstorms? I was relieved to see Trump economic advisor Larry Kudlow cast some doubt on whether the government would follow through on Trump’s idea:

“‘I don’t know if that’s a key stipulation. …. A lot of options here,’ Kudlow told ‘Varney & Co.’ on Tuesday. ‘Not sure it’s a specific concept that will be followed through.’“

I think Trump would really like to kill TikTok. Maybe his grudge is driven in part by the presumptive role that TikTok played in his under-attended Tulsa rally. But there are domestic competitors to TikTok, so consumers will have alternatives. The most popular of those seems to be another Chinese app called Likee. In any case, downloads of other video sharing apps have spiked over the past few weeks. If Trump’s real aim is simply to shut down TikTok in the U.S., I’d almost rather see him do that than start making a practice of horse trading with cronies over shares of corporate booty.

COVID at Midsummer

04 Tuesday Aug 2020

Posted by in Pandemic, Public Health

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It’s been several weeks since I last posted on the state of the coronavirus pandemic (also see here). The charts below show seven-day moving averages of new confirmed cases and reported C19 deaths from the COVID Tracking Project as of August 3. Daily new cases began to flatten about three weeks ago and then turned down (it can take a few days for such changes to show up in a moving average). Daily C19-attributed deaths began climbing again in early July, lagging new cases by a few weeks, and they slowed just a bit over the past several days. Obviously, both are good news if those changes are maintained. The other thing to note is that deaths have remained far below their levels of April and early May.

The daily death count is that reported on each date, not when the deaths actually occurred. Each day’s report consists of deaths that were spread across several previous weeks or even a month or more. That makes the slight downturn in deaths more tenuous from a data perspective. There are sometimes large numbers of deaths from preceding weeks reported together on a single day, so reporting can be ragged and the final pattern of actual deaths is not known for some time. More on that below.

States

The increase in cases and deaths during late June and July was concentrated in four states: Arizona, California, Florida, and Texas. Here’s how those states look now in terms of cases and deaths, from the interactive COVID Time Series site:

 

New cases began to flatten or drop in these states two to three weeks ago, driving the change in the national data. Daily deaths have not turned convincingly, but again, these are reported deaths, which actually occurred over previous weeks. One more chart that is suggestive: current hospitalizations in these four states. The recent declines should bode well for the trend in reported deaths, but it remains to be seen. 

Meanwhile, other parts of the country have seen an uptrend in cases and deaths, such as Illinois, Missouri, South Carolina, and Tennessee. Here are new cases in those states:

It’s worth emphasizing that the elevated level of new cases this summer has not been associated with the rates of fatality experienced in the Northeast during the spring. There are many reasons: better patient care, new treatments, more direct summer sunlight, higher humidity, and tighter controls in nursing homes.

More On the Timing of Deaths

Back to the discrepancies in the timing of reported deaths and actual deaths. This is important because the reported totals each day and each week can be highly misleading, even to the point of frightening the public and policy makers, with consequent psychological and economic impacts.

The latest summary of provisional vs. reported deaths is shown below, courtesy of Kyle Lamb, who posts updates on his Twitter feed. This report ends with the last complete week ending August 1. It’s a little hard to read, but you might get a better look if you click on it or turn your phone sideways. Some of the key series are also graphed below. 

The table shows the actual timing of deaths in the fourth column, with dates alongside. The pattern differs from the statistics reported by the Covid Tracking Project (CTP) in the top row (shaded orange), and from the totals of actual deaths by reporting day in the third row (shaded gray). The reporting dates are always later than the dates of death. This can be seen in the chart below. The most obvious illustration is how many of the deaths from around the peak in mid-April were reported in May. In March and April, the daily reports were short of the ultimate actual death counts because so few deaths with associated dates were known by then.

 

The right-hand end of the red line shows that many deaths reported by CTP have not yet been placed at an actual date of death by the CDC.  At this point, the actual date of death has not been placed for over 10,000 deaths! Again, those will be spread over earlier weeks.

The blue line is dashed over the last four weeks because those counts are most “highly” provisional. Small changes in the actual counts are likely for dates even before that, but the last four weeks are subject to fairly substantial upward revisions. Eventually, the right end of the blue line will more closely approximate the totals shown in red.

To get an indication of trends in the actual timing of deaths, I plotted the weekly actual deaths reported for the last four reporting weeks going back in time. In the table, those are the four lowest, color-coded diagonals. In the graph below, which should include the qualifier “by recency of report week”, actual deaths in the most recent report week are represented by the blue line, the prior weekly report is red, followed by green (three weeks prior), and purple (four weeks prior… sorry, the colors are not consistent with those in the table). The lines extend farther to the right for more recent report weeks.

The increase in actual deaths occurring in July has declined or flattened in each of the four most recent report weeks. Only the second-to-last week increased as of the August 1st report. On the whole, those changes seem favorable, but we shall see.

Closing

It’s getting trite to say, but the next few weeks will be interesting. The increase in deaths in July was a sad development, but at least the extent of it appears to have been limited. Even with a somewhat higher death count, the fatality rate continued to decline. Let’s hope any further waves of infections are even less deadly.

Dr. Fauci, RCTs, and Large Sample “Anecdotes”

01 Saturday Aug 2020

Posted by in Uncategorized

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Anthony Fauci insists that the only valid test of efficacy for a pharmacological treatment is a randomized control trial (RCT). Other kinds of evidence, he claims, are merely “anecdotal”. Well-designed, large sample RCTs are highly desirable, of course, but both of Dr. Fauci’s statements are balderdash. Real world RCTs often have design flaws and drawbacks, and they often produce biased results. We certainly shouldn’t invest such confidence in their universal superiority over other clinical evidence, which for years has been relied upon in the FDA’s reviews of drugs and other interventions for safety and efficacy.

An RCT is a prospective study in which subjects are randomly assigned to one or more groups who receive different treatments, one of which is a control group receiving “standard care” or a placebo. The so-called “gold standard” of trials is the double blind RCT, which means that neither the subject nor the researchers know the treatment to which the subject is assigned.

On multiple occasions, Fauci has erroneously claimed that positive findings from anything short an RCT are “anecdotal”, which, if meaningful in any way, implies that only RCTs have samples of adequate size. That’s false: traditional clinical trials (TCTs) are not at any systematic disadvantage to RCTs in terms of sample size. The difference is that individuals are not randomly assigned to different treatment groups, but rather are assigned with the researcher’s intent, by dint of opportunity, or happenstance. These groups may include a pure control, and they may be balanced according to medical history, condition, or other potentially confounding influences. TCTs might be prospective (subjects are observed over time), or retrospective (which exploit previous case files).

The idea of double-blind, random assignment to treatment groups is appealing because it prevents researchers from exerting any bias in the selection of groups that might influence the results. That’s good, but random assignment can still lead to unbalanced comparisons, and RCTs can be flawed in many other ways. This paper discusses a number of fine points of RCTs that can lead to bias, but here are a few important ones, not all of which are covered at the link:

  • The most glaring difficulty is that random assignment can result in very unbalanced characteristics across groups. The findings can be so sample-specific as to lack external validity. This is especially problematic when group sub-samples are small, as is often the case in medical research, but it is often true in samples of moderate size or even large samples. This contrasts with selecting groups with deliberate balance across key characteristics.

“Contrary to frequent claims in the applied literature, randomization does not equalize everything other than the treatment in the treatment and control groups, it does not automatically deliver a precise estimate of the average treatment effect (ATE), and it does not relieve us of the need to think about (observed or unobserved) covariates. Finding out whether an estimate was generated by chance is more difficult than commonly believed.”

  • An implication of the heterogeneity across participants and random assignment of confounding attributes is that even with large treatment groups, the tests reveal differences in central tendencies, but they might not apply well to large subsets of patients. Some researchers go so far as to say all RCTs are biased in one way or another. TCT’s are also subject to bias, of course, but the point is that RCT’s are subject to significant risks of bias for reasons that TCTs often avoid.
  • Comparisons of small treatment group samples results in low-powered tests that are often statistically insignificant. This weakness is shared by all RCTs and TCTs having inadequate samples to divide between the desired number of treatment groups.
  • “Blindness” is often violated because treatment can involve a large number of  personnel and roles. This may influence outcomes, for example, if some caregivers alter standard treatment in an effort to compensate for its perceived deficiencies.
  • Recruiting for RCTs is often difficult. This leads to the small sample problems discussed above. Sometimes participation in RCTs is heavily qualified. Sometimes patients are reluctant to participate because they don’t want to be assigned to a treatment randomly. Sometimes delays are caused by the fact that RCTs require approval by an independent review board, whereas assignment in a TCT might require only treatment decisions by different physicians.
  • An RCT can be highly misleading if treatments are poorly targeted. This might take several forms: Failure to screen for conditions that might lead to treatment complications can be dangerous and counter-productive, since the general safety of the treatment might be falsely implicated. Likewise, a treatment might be effective only under certain conditions or at a certain stage of a disease, but the selection of participants might not meet those conditions. Or a treatment might be most effective in combination with other interventions, but failing to combine them will overlook the effect. Misapplications of this kind are likely to lead to erroneous conclusions.

The last bullet point has been a major bone of contention in the debate over the efficacy of hydroxychloroquine (HCQ) in the treatment of the novel coronavirus. Proponents of the drug contend it is most effective in early treatment, but a number of negative tests have studied only late treatment. Also, proponents contend that HCQ works best in combination with zinc and a Z-pak (antibiotic), but many studies have failed to use or control for those combinations.

Here are a few examples of the kinds of difficulties encountered by RCTs, as well as issues creating doubts about the results. All involve trials of HCQ .

  • NIH cancels three trials: the first trial involved only hospitalized patients, though that might not have qualified as early treatment in all subjects. The other two trials were cancelled because of recruitment problems!
  • A study of HCQ without zinc or Z-Pac antibiotic on hospitalized patients found that HCQ was associated with a greater likelihood of death and longer hospital stays, but in addition to the use of HCQ only, the study appears to have been mis-targeted at advanced cases of C19 infection.
  • This study also endeavored to investigate HCQ as a treatment, but not only did it fail to combine HCQ with zinc and a Z-pac; over 40% of the participants never tested positive for COVID-19! It’s also not clear that participants were adequately screened for complications. The following results were statistically insignificant, indicating a possible lack of statistical power, though they favored HCQ (which is not noted by the authors):

“At 14 days, 24% (49 of 201) of participants receiving hydroxychloroquine had ongoing symptoms compared with 30% (59 of 194) receiving placebo (P = 0.21).  … With placebo, 10 hospitalizations occurred (2 non–COVID-19–related), including 1 hospitalized death. With hydroxychloroquine, 4 hospitalizations occurred plus 1 nonhospitalized death (P = 0.29).”

  • This study was on a relatively small sample of non-hospitalized patients. It found only a small difference favoring HCQ in terms of viral load at day 7, as well as the following statistically insignificant results otherwise favoring HCQ:

“This treatment regimen did not reduce risk of hospitalization (7.1%, control vs. 5.9%, intervention; RR 0.75 [0.32;1.77]) nor shortened the time to complete resolution of symptoms (12 days, control vs. 10 days, intervention; p = 0.38).”

For a more comprehensive view of the evidence, this link contains a compendium of studies on HCQ 1) as a treatment at various stages of C19 infection, 2) as pre-exposure prophylaxis (PrEP) against infection; or 3) a post-exposure prophylaxis (PEP). It includes high-level details on many of the studies as well as links to most of the studies. A few of the studies are RCTs, but most are either prospective or retrospective TCTs; some are in vitro (lab) studies, and some are meta-analyses covering multiple prior studies; some address the safety of HCQ only.

The site includes a kind of “scorecard” at the top categorizing 66 of the studies as either positive (HCQ is effective) or negative within four categories: PrEP, PEP, early-stage infection, and late-stage infection. Studies were excluded from the scorecard for various reasons, including meta-analyses, in vitro studies, safety studies, those terminated due to inadequate recruitment, and studies that were deemed inconclusive due to data inadequacies and questions of interpretation awaiting feedback from authors.

The results for HCQ as a prophylactic were uniformly positive, as were the studies involving early-stage treatment. Results were mixed for late-stage treatment. Of special interest is the meta-analysis of 12 studies of high-risk outpatients by Harvey A. Risch, the seventh listed in the compendium referenced above. The 12 studies analyzed by Risch all showed that HCQ is highly effective. He calls out those who would insist that those studies be disregarded because they were not RCTs, including one critic who, like Dr. Fauci, abuses the term “anecdotal”:

“… to distinguish from the ‘magic’ of randomized controlled trials, when government medical and scientific regulatory agencies of western countries around the world routinely use epidemiologic evidence to establish facts of causation, benefit and harm. This disingenuous argument has been discussed at length elsewhere…. Finally, in pandemic times when months and years of delay cannot be tolerated before large randomized controlled trials are completed, it is possible to quibble with apparent imperfections in almost any study. That misses the forest for the trees.”

The “elsewhere” link in the quote above includes an excellent summary of the battle waged over the efficacy of HCQ. It became a media war, which relied in part on the false assertion that only RCTs are acceptable. That was abetted by certain public health experts and researchers who might have had financial or political interests in promoting new drugs, rather than the safe, cheap alternative that had been used safely for many decades. The article notes that few media sources carried the following, which was released only days after the FDA revoked its Emergency Use Authorization for HCQ (based on faulty evidence):

“TUCSON, Ariz., June 22, 2020 /PRNewswire/ — Today the Association of American Physicians & Surgeons files its motion for a preliminary injunction to compel release to the public of hydroxychloroquine by the Food & Drug Administration (FDA) and the Department of Health & Human Services (HHS), in AAPS v. HHS, No. 1:20-cv-00493-RJJ-SJB (W.D. Mich.). Nearly 100 million doses of hydroxychloroquine (HCQ) were donated to these agencies, and yet they have not released virtually any of it to the public…

‘Why does the government continue to withhold more than 60 million doses of HCQ from the public?’ asks Jane Orient, M.D., the Executive Director of AAPS. ‘This potentially life-saving medication is wasting away in government warehouses while Americans are dying from COVID-19.'”