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Weekend reading: Under-infected, over-optimistic

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What caught my eye this week.

Mixed events in the global soap opera saga Coronavirus this week.

The good news is the Prime Minister returned from that episode to tell us we’re probably past the peak of Covid-19.

The focus now is on R, aka the reproduction number. Keep it under ‘1’ and the pandemic is not spreading exponentially.

As a nation our R number is now somewhere under 1. Probably between 0.5 and 0.75, although it may still be higher in some places like (tragically) care homes.

Ruh-Roh

The lower the R the better, obviously, but the question will increasingly be how much more [insert what matters most to you] damage we can take to lower it further?

Getting R down from the 3 to 4.5 level that looked like it might overrun the NHS was a no-brainer. But there’ll be diminishing returns.

Full lockdown – or even just heavy social distancing – has health as well as economic consequences, too. Some people will die earlier because we brought a recession upon ourselves.

Yet equally, every micro-notch higher in R that we accept means someone somewhere will die before their time from Covid-19.

That’s the equation for the upcoming weeks.

There are no easy answers. Perhaps there was a more promising hypothesis, but the past seven days looks to have done for it.

Spread ’em

I’ve been mildly obsessed with Covid-19 since January (and mildly infected, I believe, in early March). I’ve ridden a rollercoaster from being precociously concerned to evasive action to believing things might not be as bad as was thought and now I’m halfway back again.

Long story short1 a series of intuitions (or guesses, if you prefer) informed by endless reading about Covid-19 convinced me the virus was spreading far faster in the UK than was generally thought likely.

All the experts knew the virus was spreading more quickly than reported cases, of course. But I (no expert) believed it was circulating faster again.

That was a comforting thesis because it suggested (1) the virus wasn’t as deadly as even the more middling predictions suggested and (2) we might reach some level of herd immunity sooner rather than later.

It’s long been clear this virus has a Great White Shark’s nose for the elderly and vulnerable, and I’ve been frustrated we either couldn’t or didn’t shield them better.

But in a super-infectious scenario, for the vast majority of us Covid-19 would be a very mild infection, mostly asymptomatic.

And by the time full lockdown was called, I felt it was possible a large number of us in London at least had already had it.

That proved to be right… a bit.

Peak deaths for the virus occurred in early April. Working backwards gets you to peak infections towards the end of the second week of March.

But how many? For that we can first consider deaths.

It’s hard to unpick the roughly 30,000 or so excess deaths we’ve seen so far in England and Wales in 2020.

Most will be due to Covid-19, but some may have been attributed to the virus incorrectly. For example, there were fewer heart disease related deaths in March. Perhaps some were blamed on Covid-19?

But just crudely guessing 30,000 and assuming an infection fatality rate (IFR) of 1%, that gets you to three million or so infected, with peak infection probably occurring in or around the period of voluntary lockdown, but just before mandated lockdown.

So overall millions have been infected – but not enough to be good news.

Unless… the IFR was much less than 1%, because far more people had been infected?

Start spreading the blues

That left antibody testing carrying the baby.

The hope was antibody testing would reveal that in areas of rampant morbidity to the coronavirus – such as Italy, London, and New York – many, MANY more people had been infected.

If this was true then you could indeed pull down the IFR.

Well, over the past seven days we got the first large scale data – from New York City and Stockholm – and it’s probably not good enough.

The New York City testing is the most promising, implying 25% of its citizens have had Covid-19. However, while that shocked the media it was much lower than I’d been hoping for.

Indeed as reader @Vanguardfan points out, 25% implies an on-consensus IFR of around 1%, if you take into account the number of presumed deaths to Covid-19 in New York City.

And 1% is no comfort if you apply it to the UK’s population of 67 million.

Now, not every last citizen will need to throw the viral dice – we should get some natural resistance to the virus on a population level, before everyone has had it.

However if we assume the chunky herd immunity thresholds that most experts think we’d need to see – at least 50%, possibly more like 70+% – even New York is far from having ‘earned’ an inherent resistance through its deathly exposure2.

This is disappointing to me, though it won’t be unexpected to the experts. It looks like they called it.

Hopium

Much is still unknown about this virus. For every potential fact I find in early research about it, you can retort with another. Anyone waiting for scientific confidence (proof, for shorthand) better have a lot of series lined up on Netflix.

The huge list of Covid-19 links below (perhaps 20% of what I’ve read this week) gives just a taster.

It’s possible that amid this uncertainty there may be other off-ramps from the bad (though not worst-case) scenario:

  • Maybe a large number of people can kill the virus with their immune system so easily that they don’t develop antibodies.
  • Or maybe it’s spread much more widely among the most vulnerable parts of society, which is terrible news right now, but may have elevated the fatality rate and hopefully left the survivors with some resistance.
  • Summer could well curb the spread anyway, which at the least should give us time to better prepare for any resurgence.
  • Maybe the herd immunity threshold will prove lower than presupposed.
  • Or more likely it may turn out that just a few key social distancing actions – no handshakes, avoiding crowds indoors, and washing your hands – will do 90% of the R-lowering. (The Swedish approach.)
  • Kids may not be infectious, too, taking them out of the equation altogether.

I have reasons for making all those suggestions, based on my own reading.

But the truth is there’s an equally long list of reasons to be pessimistic.

As Freddie Sayers concludes in a sober piece on UnHerd that pits Sweden’s top epidemiologist against our own leading figure:

…it’s time to stop pretending that our response to this threat is simply a scientific question, or even an easy moral choice between right and wrong.

It’s a question of what sort of world we want to live in, and at what cost.

An ‘ell of a recession

Bottom line: I no longer hope for a very quick exit from this nightmare, unless perhaps R collapses extremely rapidly in the next few weeks and we can go back to trying test and tracing.

And this probably kicks the V-shaped recovery into the long grass. The drag from physical distancing and other anti-viral precautions alone could knock a few percentage points off GDP, even if we go back to semi-normal.

What are football matches, trade conferences, pubs, easy air travel, and the Glastonbury Festival worth to GDP, to name but a few lost causes?

Even if fatal Covid-19 cases do plunge and more normality can be reinstated, for as long as outbreaks flare up it may be hard to persuade some people to take their chances.

We’ve been bombarded with deathly warnings about the virus and kept under house arrest for a couple of months on its account. Dinner and a show on Friday night? Many may continue to Deliveroo and chill instead.

And while a cocktail of better treatments (drugs and regimens) will probably be assembled by the end of the year, that’s, well, the end of the year.

So L-shaped recovery it is. Probably what’s priced in by the global stock markets, anyway.

You see, a lot of people are talking about market mania after the quick bounce from the March lows.

But this is mostly a US market thing. And in the US market it’s mostly a tech thing. And of the tech companies, it’s mostly a bunch of cloud giants who couldn’t have come up with a better driver of demand than ‘shelter in place’. Strong demand now, plus their valuations turn on the years of prodigious earnings they’re expected to make long after Covid-19.

No, if you want a market that’s geared to the global economy, look to the UK’s FTSE 100. Its 2020 performance (red) already looks like an ‘L’, versus the (blue) S&P 500’s squint a bit ‘V’:

[Click to increase the suffering]

Source: Yahoo Finance

I’ve always been more worried about the financial impact of global lockdown than most, even while I was slightly more sanguine about the virus.

And now I see economy-dinging restrictions continuing.

So I’ve a horrible feeling that while the UK pandemic probably is past its peak, with the economy it’s like we’re back when people were gasping at footage of Italians stuck inside, hardly realizing the sort of misery we’d soon face.

Note: Fed up with virus chat? I’m planning to drastically reduce the number of Covid-19 links here next week. We’ve just hit that peak, too!

From Monevator

Do US Treasury bonds protect UK investors better than gilts? – Monevator

From the archive-ator: Reminiscences of a stock market wallflower – Monevator

News

Note: Some links are Google search results – in PC/desktop view you can click to read the piece without being a paid subscriber. Try privacy/incognito mode to avoid cookies. Consider subscribing if you read them a lot!3

Sales of almost 400,000 homes stalled due to lockdown, says Zoopla – Guardian

Millions face ‘financial cliff edge’ due to Covid-19 crisis, says Citizens Advice – Guardian

Nationwide: Pre-pandemic house prices rose 3.7% – Financial Reporter

British manufacturers record worst slump since records began 30 years ago – ThisIsMoney

Royal Dutch Shell cuts its dividend for the first time since 1945 – Guardian

Virtual rate cut forces Nintendo Animal Crossing gamers into riskier assets [Free to read]FT

The US has now seen 30 million people file for unemployment – NPR

[Click to enlarge]

Good letter to investment partners on the current Covid-19 reality [PDF]Mary Meeker

Products and services

Treasury to allow first-time buyers to access Lifetime ISAs without penalty – ThisIsMoney

Investment platform account openings surge, despite coronavirus uncertainty – Which?

Tui cancels all beach holidays until June; a million customers affected – Guardian

Sign-up to Freetrade via my link and we can both get a free share worth between £3 and £200 – Freetrade

How to apply for a three-month mortgage payment holiday – Which?

Homes on a hillside for sale [Gallery]Guardian

Comment and opinion

Three points to note on active funds and bear markets – Evidence-based Investor

Less is more – Humble Dollar

A defensive move: Looking at gilts – DIY Investor

What was the catalyst for the market rising? – The Irrelevant Investor

Talk is cheap – Of Dollars and Data

Quick look at what a bear market does to a real-life financial plan – Where Eagles Fear To Perch

But what if we’re wrong and the market never bounces back? – Abraham Okusanya

Why I’m not invested in gold – Get Rich Slowly

When you have no idea what happens next – Morgan Housel

Why value died – A Wealth of Common Sense

Naughty corner: Active antics

Terry Smith: If you must do dividends, look to family-owned firms – Portfolio Advisor

Three burning questions for Warren Buffett at tomorrow’s Berkshire event – Morningstar

When Buffett was a quant [On deep value]Verdad [via Abnormal Returns]

This market-timing model just flashed a bullish four-year outlook for stocks – MarketWatch

Musings on misadventure and market madness – Simple Living in Somerset

Timing, luck, and surviving – Fred Wilson

Coronavision

[In email? Visit Monevator if you can’t see a YouTube lecture from CMO Chris Witty]

Self-care in a coronacrisis

This is why you can’t remember yesterday – Medium

Why you should give up on your social life when you’re in a pandemic – Slate

People are having less sex in lockdown – BBC

Feelin’ Groovy – Humble Dollar

Nobody knows what is going on – Mark Manson

All about those antibodies

Antibody testing: A user’s guide to the immune system [Great primer]The Atlantic

It usually takes about 13 days for antibodies to show up in the blood [Research]Nature

25% of NYC residents test positive for Covid-19 [Sadly, result supports a c.1% IFR]Newsweek

Can antibody tests tell if you’re immune to Covid-19? – LiveScience

The false hope of antibody tests – The Atlantic

What policymakers need to know about Covid-19 protective immunity – Lancet

The rest of Covid-19 cornered

Social distancing reduces ‘overshoot’ on the way to herd immunity – Carl Bergstrom via Twitter

Why the Coronavirus pandemic is so confusing [Primer]The Atlantic

Which epidemiologist do you believe? [Sweden versus UK, with videos]Unherd

Experts fail to find a single case of children passing virus to adults – The Age

Social-distancing at airports is ‘impossible’, says Heathrow boss – BBC

What drug trials tell us so far about the anti-viral treatment remdisivir – Science

US germ warfare lab creates test for pre-infectious Covid-19 carriers – Guardian

How does Britain compare with other countries? [It’s too soon]Guardian

Covid-19 deaths twice as high in poorest areas in England and Wales – Guardian

Low Covid-19 death toll raises hopes Africa may be spared worst [Free to read]FT

AI models suggest that masks can ‘significantly’ reduce the spread of coronavirus – Venture Beat

Masks & emasculation: Why some men refuse to take safety precautions – Scientific American

A cautionary tale from San Francisco’s re-opening in the 1918 flu pandemic – NBC News

Many US prisoners test positive in four US jails; reportedly few with symptoms… [to-date]Reuters

…although later stories talked about deaths [Seemingly earlier in breakout?]NBC News

Sweden had no lockdown, but its economy is expected to suffer as badly as neighbours – CNBC

What is the hidden health cost of coronavirus? – BBC

How Italy became ground zero for Europe’s coronavirus crisis [Deep dive, blames business]CNBC

Political prison

Coronavirus & Brexit: the connections and their consequences – Chris Grey

Has Sweden’s coronavirus strategy played into the hands of nationalists? – Guardian

Kindle book bargains

The Basic Laws of Human Stupidity by Carlo Cipolla – £0.99 on Kindle

What You Do Is Who You Are: How to Create Your Business Culture by Ben Horowitz – £1.99 on Kindle

Money: A User’s Guide by Laura Whateley – £0.99 on Kindle

The Hating Game [‘The very best book to self-isolate with’] by Sally Thorne – £0.99 on Kindle

Off our beat

Meteorologists say 2020 on course to be hottest year since records began – Guardian

Microsoft Word now flags double spaces as errors, ending the great space debate – The Verge

Pentagon releases three UFO videos taken by US navy pilots – Guardian

And finally…

“Even the darkest night will end and the sun will rise.”
–Victor Hugo, Les Misérables 

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  1. Read the past two months of Weekend Reading comments for the real-time discussion! []
  2. Presuming such an immunity actually exists, which isn’t definitively proven, but which seems likely. []
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{ 223 comments… add one }
  • 1 Amit May 2, 2020, 12:24 am

    The Lifetime ISA link description might be a bit of a click bait. From reading the link, I think they are saying penalty will be 20% instead of 25%.. effectively the bonus will have to returned but no further penalty on the investor’s contribution.

  • 2 ermine May 2, 2020, 12:40 am

    At the risk of being charged with being part of the Imperial conspiracy, take a look at the projection of the infection rate on this modelling report

    That winter peak disturbs me. I have been amazed at the ability of countries to keep the wheels running on what is basically a skeleton staff. But we all had big stocks of stuff etc. We have done well in keeping people fed and keeping the lights on.

    So there will be a summer lull, and the weakened economy will not restock as efficiently. And as October draws to a close the rates will rise again, as winter comes.

    Britain didn’t handle the first peak well. The NHS will be worn down by the months long battle, and supply chains will be less well stocked. We sort of won the fight against the first peak, the Nightingale hospitals are empty, which is not a sign of failure or error. But the second peak will hit us at a bad time and in a bad state. This fight is not over, IMO. Hopefully we will prevail. But looking at that report does not give me the feeling that we are match fit for the late autumn/winter.

  • 3 MK May 2, 2020, 12:49 am

    Thanks for the links. I’m finding the debate on masks fascinating and enjoyed your two articles on this. Boris Johnson’ comments this week implied they will be soon recommended to some degree in the UK and the Arxiv study seems to show the science/modelling is moving that way. It’ll be homemade masks initially but I’m also going after a quality one for the longer term with a proper facial seal, high grade filters and that isn’t going to have any impact on healthcare availability (this one if interested: https://the-airhead-pollution-mask.kckb.st/06ba9bd4)

    The psychoanalysis on Trump and masculinity makes sense. He is an unusual character so hopefully his position on this is not too widespread.

  • 4 Learner May 2, 2020, 1:49 am

    I keep hearing we’re past the peak, presumably referring to deaths, but the rate of new confirmed infections looks more like an inverted hockey stick: increasing dramatically until restrictions began and now plateau’d near that peak with scarcely any decline in several weeks. My own region shows virtually the same new daily case count this week as in late March.

    That daily rate has to show significant decrease before people will be comfortable resuming normal life and the gradient right now suggests that scenario is a very long way off. I feel for folks being forced to return to work in May.

  • 5 Penelope May 2, 2020, 5:31 am

    @Ermine

    Neil Ferguson from Imperial College went head to head against Swedish epidemiologist Professor Johan Giesecke in an interesting series of interviews recently:

    https://unherd.com/2020/04/which-epidemiologist-do-you-believe/

    As they say in Scandinavia, your boys took a hell of a beating.

  • 6 JimJim May 2, 2020, 7:06 am

    @ermine. RE “I have been amazed at the ability of countries to keep the wheels running on what is basically a skeleton staff. But we all had big stocks of stuff etc. We have done well in keeping people fed and keeping the lights on.”
    Whilst agreeing with you about this point, my eyes have been opened to just how much of our income we no longer need to spend and so how much of it was not necessary (I thought we were already frugal!). I shop for an elderly couple in my hamlet as they are late eighties/early nineties and very much in the at risk bracket. Their weekly grocery bill is usually less than £20, mainly from Aldi and they eat well. I can’t afford to travel to work for that money. Looking at our own reduced expenditure it only highlights just how much we spend upon leisure and socialising, which, arguably we could (if we wished) cut down on. My point is the necessities are cheap, my thoughts upon the option of retirement, which for me is the point of this money building game have been consolidated. I believe I can live on less and live well now. We have just tested it out. The Irony is that we will need to unless the markets manage to put on some serious fat in the next five years.
    JimJim

  • 7 Marco May 2, 2020, 8:09 am

    If they are going to ease lockdown schools/nurseries need to be the first thing to start back in some form. There is evidence that under 10s have caused zero cases if transmission.

    I’m a hospital doc and I have noticed with mild bemusement how many of the same people in my local area who are out clapping for the nhs are also treating me like I’m a carrier of the plague (to be fair I do work on the COVID wards).

    Some comments I have read on the local Facebook:
    – I’m not sending my kids back to school if they have to mix with key workers kids
    – it’s disgusting they let NHS staff into the shop an hour early, spreading all their COVID around.

  • 8 FI Warrior May 2, 2020, 8:53 am

    What a difference in gravity, serenity, perspective, you name it from the Swedish heavyweight expert, vs the shrill, hysterical 24/7 wall of fear emanating from most politicians and mainstream media. (Professor Johan Giesecke) He was an oasis of calm in that interview and we should be asking why people like that can never get to be minister of health in our systems, you truly do get the government you deserve.

    As for sanctifying the NHS and its staff now after decades of creeping sabotage by piecemeal privatisation, underfunding, removal of free nursing training, low pay, extortionate charging in hospital carparks to name just a few, yes the hypocrisy is gargantuan. People say one thing but do another, which shows their real values, if I worked in the NHS I would keep quiet to protect myself from ignorance, like landlords evicting tenants out of primitive fear.

    Public support for the lockdown may be riding high now, but for John or Jane Unconnected, wait until savings have been eroded away, the mortgage is biting and your job is lost, trashing the economy is a high cost.

  • 9 jim May 2, 2020, 9:00 am

    Why don’t they just remove LISA from benefit/bankruptcy assessment putting it more on par with a pension and keep the early withdrawal at 25% – suppose it would cost in universal credit claims…Just looked up our total welfare bill – has more than doubled allowing for inflation last few decades

  • 10 The Investor May 2, 2020, 9:11 am

    @Penelope — That’s an excellent article that I somehow missed. I’ve added a reference to the piece above!

  • 11 Chris Bateman May 2, 2020, 9:49 am

    Jim Jim, I’ve had very similar experiences and thoughts recently (pre-Covid) on retirement which has changed my views and plans considerably. My partner’s gran is 84 and had came through knee replacement surgery and I was doing her shopping. She had £400 in her bank, built up from her state pension while she was in hospital, and genuinely felt well-off. Long story short, she is active and lives well for her age but manages to do so off a basic pension. During this period I also visited my old aunt (84) and uncle (90). More or less the same story, with both very content pottering about in their garden and taking visitors. My 65 year old dad is slowing down from workaholic to a happy grandfather, now enjoying furlough as a prelude to (again) a basic retirement which he’ll top up doing a bit of training work to pay for some holidays. My mum took early retirement at 60 on a paltry 7 grand a year occupational pension but they quite happily get by and get their couple of holidays a year in the sun. So what’s likely – bar a wee bit of aspiration for far-flung foreign travel – to be different about me and to require a significant higher retirement income (presuming the mortgage has been paid)? Not a lot, I don’t think. The main difference will be that I want a bit more financial freedom during my working life and not to have to go through the grind til I hit the age where someone else can provide for me.

    So my plan has changed quite a lot, on that reflection (helped admittedly as I have a decent career average pension which will provide the income floor I’ll need, even if accessed early). Rather than forego that family holiday now to oversave for the future I’m going to have it. And rather than pay into (additional) pensions for the tax advantages, I’ll save or invest a bit of cash into ISAs every month which I can access as and when I might need or even just fancy it.

  • 12 Naeclue May 2, 2020, 9:49 am

    @Jim, does that welfare bill include state pensions and/or allow for increased population?

    It would be interesting to see a proper non-political breakdown of where the money is going compared with 10 years ago and the reasons behind the changes. Spending on pandemic preparation definitely of interest!

    The LISA rules do seem contradictory. Either they are assessed for benefits and the withdrawal penalty is 20%, or they are not and the penalty is 25%. Penalising people who are trying to do the right thing but fall on hard times is bonkers.

  • 13 Penelope May 2, 2020, 10:09 am

    @The Investor

    Thank you.

    Let’s see how the Imperial College fanboys try to spin this one away…

  • 14 Jonathan May 2, 2020, 10:11 am

    Pedant’s corner: R without the zero is the infection rate under current circumstances, R0 is the value in the absence of any measures.

    The Oxford Centre for Evidence Based Medicine which seems to be a good source recently gave their best estimate of infection fatality rate as between 0.1% and 0.41% (https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/) but in another of their papers on that website they point out that the IFR for previous pandemics was over-estimated at the time by up to ten times.

    So @TI you can still indulge your pet theories!

    The good thing is that the number of RT-PCR tests now available means they can do reasonable scale random population sampling to determine R, and they finally seem to have got their heads round using lab-based ELISA antibody tests to start estimating the number infected to date. They might be able to plan the next steps rationally.

  • 15 Snowman May 2, 2020, 10:13 am

    @Penelope

    Watched those interviews with Neil Ferguson and Johan Giesecke a while back. It’s scary to me to think that Neil Ferguson is influencing UK Government policy.

    I’ll leave it to others to watch both interviews and make up their own minds as to whose critical thinking is clearest.

  • 16 Penelope May 2, 2020, 10:28 am

    @Snowman

    Indeed. Maybe one day Neil’s spreadsheet models will be right…just like a broken clock is right twice a day.

  • 17 Guido Maluccio May 2, 2020, 10:39 am

    @FI Warrior On shrill voices: I thought @TI might post Elon Musk’s outbursts this week 😉 https://www.theguardian.com/technology/2020/apr/29/tesla-quarterly-earnings-coronavirus-shares

  • 18 The Investor May 2, 2020, 10:43 am

    @Jonathan — Thanks for the clarification, I’ve seen it used interchangeably which is probably due to all the people like me who are writing about something they only learned about in the past few months! I’ve amended the article.

    Re: the IFR, I’ve seen estimates all over the place but I’m trying to tone my confirmation bias down for a while as I’ve been pretty dismayed by that raw antibody count in NYC so far. Give it another two weeks and it should tick up as more people who were infected late develop antibodies, but can’t see it getting much about 30-35% on the back of this wave.

    Re: My pet theories, I suppose I still lean Swedish — take measures, but not the most Draconian — and even more so shield the vulnerable/elderly. Nothing in the crisis has changed the view they’re overwhelmingly the most at risk (from memory we’re running at half of deaths above 80yo and the vast majority over 70yo) and despite the odd horror story the numbers for young people getting seriously ill from the virus are tiny.

    Given all the spare hospital capacity we have now (six Nightingales as the PM mentioned, all pretty much empty) it seems to me we should get the under-30s who are able to mix with each other more or less exclusively out pronto. Assuming that goes okay, maybe the under-45s a few weeks later, and see what happens. This view is informed by my darker prognosis for the consequences of a deep recession/depression. Others may legitimately feel different. This crisis is evolving into world view territory as the curve flattens.

    I know some feel demographically-targeted lockdown isn’t realistic because of this or that reason (most pertinently elder-adjacent transmission, but also because it half-arses a return to companies functioning properly etc) but out of a bunch of bad choices, I don’t really see why demonizing 22-year-olds who want to hang out with other 22-year-olds has much justifiable road left to run.

    In a fantasy world where all the under-30s had been infected and now had (presumed, maybe temporary) immunity and kids don’t spread the virus (as seems very likely albeit not conclusively proven) we’d surely be in a far better place — we’d have 25-million odd firebreaks in our population, slowing the viruses spread.

  • 19 FI Warrior May 2, 2020, 10:56 am

    @Guido, maybe Musk is panicking in case he drops down the Forbes list of billionaires, I can’t know for sure, but it could be that that’s how the uber-rich feel mortal pain. 🙂

    More likely he (Musk, not @TI) is worried about car sales, my close cousin in Northern Italy has a company that earns him a living derived from car advertising and he is justifiably terrified about his business surviving this.

  • 20 britinkiwi May 2, 2020, 11:03 am

    Came across this report on the ICL model recently – applied to Sweden.

    https://www.aier.org/article/imperial-college-model-applied-to-sweden-yields-preposterous-results/

    As the Guardian author (David Spiegelhalter) states we won’t know for months which strategy works and has the least impact on us – every (developed) country is pursuing it’s own experiment – and some, like the US, multiple experiments by state. Sometimes its for good reasons, if debatable, sometimes…not so much.

    Happy to be here in NZ though – we seem to be doing well so far (fingers crossed!)
    Kia kaka

  • 21 Tony Edgecombe May 2, 2020, 11:04 am

    “Experts fail to find a single case of children passing virus to adults”

    This is probably the best news so far.

    I wouldn’t be surprised if we also find that transmission without symptoms is rare, at least without close contact.

    @JimJim This has been our experience as well. I think of us as a fairly frugal family but our spending has fallen through the floor.

  • 22 Guido Maluccio May 2, 2020, 11:05 am

    @FI_Warrior Yeah, I guess this is how Musk thinks he’ll remain top-dog. On the other hand I’m somewhat surprised their not embracing the Creative Destruction taking out their competitors; somehow it is always the small guys who end up being the victims.

  • 23 Passive Investor May 2, 2020, 11:12 am

    @ TI thank you for the brilliant links and excellent analysis that is completely on point IMHO. I am a slightly long in the tooth ICU Consultant who has worked through the Covid-19 response in London but I am not an epidemiologist so make of these observations what you will. I have used data from hospital deaths from public health England, Census 2011 data on nursing home residents, the FT analysis looking at excess deaths, David Spiegelhalter’s twitter feed and other data referenced by you and others.
    1. C-19 is overwhelmingly a disease of the elderly. 52% of patients dying in hospital are over 80 and 0.7% (149 in England up to 30 April) are less than 40.
    2. 80% of nursing home residents are over 75 of who 44% are over 85. Some 70-80% of these people will have dementia. The median survival of residents is less than 18 months.
    3. ICU and ventilators have attracted a lot of attention but in public health terms are almost a side-show. By the end of this surge there will have been 8,000-9,000 admissions of whom 4,000-4,500 will have survived. These ICU patients are mainly in the 40-69 age group with only 20% over 70 – so a very very selected group compared with the general population of C-19 patients.
    4. Looking at the decline in hospital admissions and the known figures for excess weekly deaths (FT analysis) a very back of the envelope estimate would be that 30,000 will have died in hospital with perhaps 20,000 outside hospital. Combining the age distributions of the hospital deaths and nursing home deaths significantly more than 50% of deaths will be in people over 80 most of whom are frail for their age and many of whom suffer with dementia. Less than 0.5% of deaths will be in under 40s.
    5. All this is with the lockdown of course with perhaps 15-20% of people getting the disease. So if say 75% of the population get Covid (a slightly high estimate for herd immunity) there may be 200-250,000 deaths in total with say 1,000-1.500 deaths under 40 (most of whom by the way will have serious health conditions). There are some 600,000 deaths a year in normal times.
    This is all terrible of course and I wouldn’t want to imply that the lives of people with poor chronic health or elderly people with or without dementia shouldn’t be valued. I also think that the lack of protection for people in nursing homes with PPE, testing of residents of staff etc has been a serious policy failure. But is doesn’t seem right to me that the opportunities of people in the under-40 age group are being sacrificed and perhaps their lives permanently diminished for a disease of old age.
    The rational policy would surely to be reduce restrictions on the young, give better protection to nursing homes, and make help the elderly to voluntarily socially distance. I do understand that it is difficult (perhaps impossible) to control R precisely once it gets above 1 but the current strict lockdown of the whole population is not rational or fair to the young.

  • 24 Madflier May 2, 2020, 11:15 am

    As a front line anaesthetic doctor, and producer of many protocols and policies over the last couple of months, I am absolutely delighted and relived by the double space after a full stop issue. It drives me nuts. A million thanks

  • 25 Passive Investor May 2, 2020, 11:16 am

    Correction final paragraph:
    ….. and help the elderly to voluntarily socially distance (but not completely isolate).

    ….but the continuing strict lockdown….

  • 26 Vanguardfan May 2, 2020, 11:21 am

    Re IFRs – I’ve said this before so apologies – it’s not a single fixed rate, it will vary by time and place, depending on population characteristics and access to healthcare (in a surge that overwhelms, like in Wuhan, NYC and N Italy, it will likely spike upwards. I hate to think what it may be in Rio, or Calcutta, or Mogadishu). It looks like anywhere between 0.1 and 1% has been experienced in populations so far, and it cannot be lower than 0.15% in NYC, as that’s the death rate so far.

    Re children’s role in transmission. I would urge caution before concluding that it is insignificant. There is very little evidence to go on. I have tried to track down primary research papers with limited success. I believe the epi studies from China (which I think are the source of this ‘no transmission from under 10s’ idea), were conducted quite early in the spread of the infection. If the virus circulated first where adults gathered, and they took it back into households, then that could explain why adults were more likely to be index cases in family clusters. There have, certainly, been reported cases of children transmitting the disease within households. I think it’s entirely possible that schools could become significant sources of infection (which wouldn’t affect the kids so much as vulnerable staff and family members) – we just don’t have the evidence or experience to rule it out yet. After all, in the places where the epidemic has surged, schools are closed.
    This is the Royal College of Paeds president outlining what is, and isn’t, known:
    https://www.rcpch.ac.uk/news-events/news/rcpch-responds-pre-print-study-suggesting-children-could-be-infectious-adults

    I want to see schools open as soon as possible. However, I think we need to be careful not to make assumptions at this stage that the risks are low. It would be unusual if children did not transmit, given they certainly become infected (albeit with less severe symptoms than adults).

  • 27 Vanguardfan May 2, 2020, 11:47 am

    @passive investor. The population distancing policy is certainly rational. It is the only tool we have to put a brake on population level transmission when an outbreak threatens to overwhelm. It works by reducing the social connections by which the infection spreads. That protects the vulnerable from becoming infected. It’s crude, but effective. It is however a tool of last resort. And fair? Nothing about this is fair.

    The other effective tool to control an outbreak of infection is to separate infected and uninfected by means of rigorous contact tracing and quarantine: we gave up on this, and many other countries found it insufficient to contain the initial surge . It might work once the first peak has subsided, if done well enough. My confidence is not high.

    Personally, I think trying to separate vulnerable people from less vulnerable people is simply not going to be effective or feasible. I’d reconsider my view if I read a convincing study of this approach in a respiratory outbreak.

  • 28 ZXSpectrum48k May 2, 2020, 12:09 pm

    @Vanguardman. I agree with both your comments above. What keeps being stressed to me on calls on COVID is that IFR is a range. I’m hearing 0.2%-1.2% is a broad consensus. A big question being asked is why viral loads vary so substantially from region to region. Is it variations in strains of SARS-Cov-2? Is it due to factors like mass transit resulting in multiple exposures in places like NY or London etc?

    I’ve had two calls with German institutes who are arguing to be very careful with the view that “children are not vectors” and therefore schools can be reopened. It might be the case that children have milder cases and thus that the transmission channel adult -> child -> child -> adult is a low probability event. Nonetheless, given the high number of interactions, the cumulative probability of transmission could still be significant. Again we just don’t know.

    We simply don’t have a handle on this disease yet. I still think Knightian uncertainty is dominant. Any relaxation of the lockdown needs to be taken in small steps. I also continue to think that we haven’t really quantified how much excess damage the economy is taking from the lockdown. We know significant outright damage is being done but what proportion would exist in the counterfactual scenarios where no lockdown had occured and what sort of damage will still persist once the more severe elements of lockdown have been relaxed is again very hard to quantify.

  • 29 jim May 2, 2020, 12:12 pm

    @naeclue must admit to scan reading it but this is the website I went on
    https://obr.uk/forecasts-in-depth/brief-guides-and-explainers/an-obr-guide-to-welfare-spending/
    Appears state pension is 40%, which can’t really grumble with if NI has been paid in expectation of receiving.

  • 30 The Investor May 2, 2020, 12:31 pm

    And fair? Nothing about this is fair.

    You can hardly say this if you’re a public figure, but I’m not so sure it’s unfair that very old people over-80 who find themselves with multiple health conditions and very near the end of their life are more likely to die in a pandemic than young people at the start of theirs.

    I’ve said this a few times during this crisis and had variously reasonable levels of pushback, but try inverting it: a disease that killed 0.1% of the over-80s but 15% of young people under-20. Now that would be ‘unfair’, if such a term can be applied in this circumstance anyway.

    From memory estimates of the case fatality rate for over-80s has been estimated at 10-30%, but varies a lot as usual by how you count (some territories more severe etc). So call it 15%. That means 85% of over-80s don’t die of it, either.

    Should we try to protect them? Absolutely. I’ve never advocated no measures or no social/physical distancing, and I’m not now. Content with the first emergency lockdown, too, even more so given the latest data that’s come in that I’ve talked about above. I want more shielding. I want targeted food drops, PPE and testing directed towards care homes, etc. That should always have been at the top of the focus for me.

    But should we accept, say, a multi-year economic depression, with all its knock-on consequences including life expectancy for everyone if that’s what the cost was, to stop the life expectancy of all 80-year olds declining by a few months in a once-in-a-century global pandemic?

    We keep hearing it’s a war. Well, we accept the deaths of thousands of soldiers and civilians — sometimes hundreds of thousands — in the prime of their lives, with 60+ years to live, in a war.

    I say none of this glibly, and I don’t really like some of the bedfellows even my more modified view of this pandemic puts me in.

  • 31 The Investor May 2, 2020, 12:45 pm

    p.s. Regarding the ultimate cost of various lockdown strategies, it’s true we don’t know this yet and obviously no counterfactuals.

    Also, there’s a prisoner’s dilemma element to all this. An argument could be made that if the whole world had ‘done a Sweden’ then the global economy would have suffered far less and it’d be more rationale for us to as well, but given that the world didn’t we’re set to import a recession anyway, so why sacrifice a few thousand more lives in a vain attempt to prevent one. I understand that line of thinking.

    With all that said, I feel we’re reflecting our biases in where we’re more prepared to take the uncertainty.

    For instance, a serious piece of research highlighted above — observational, certainly, but hardly based on one bloke talking about his mates or whatnot — said that contact tracers failed to find a single case of child transmission of Covid-19. It’s not proof they can’t, but it’s pretty suggestive. Why continue to say that it’s pretty likely that school children will be pretty significant sources of infection, given the only data we have is they aren’t? Sure they could be, but that isn’t what the early findings suggest.

    At the same time, we have economy uncertainty of course — but we also have for instance 30 million Americans filing for unemployment in the space of about a month. That’s out of all precedent in the history books, we’ve never seen anything like it. Ditto literally half the world in lockdown and working from home. It seems to me that looking rationally at such data, one would at least bias your uncertainty to the downside.

    I’m not saying here I’m right and anyone else is wrong. I am just noting how we weight our uncertainties according to our model/fears of what’s going on.

  • 32 Duncurin May 2, 2020, 12:45 pm

    The low level of antibodies in the population may not be quite as disappointing as it sounds. The Times quotes Sir John Bell, regius professor of medicine at Oxford, as saying that in Sars the long-term immunity is all T-cells, not the antibodies. Apparently the vaccine being developed at Oxford is designed to produce both antibodies and a T-cell response.

  • 33 Ste May 2, 2020, 12:52 pm

    @Vanguardfan re Mogadishu, and in response to FT link on Africa: https://www.theguardian.com/world/2020/may/02/somali-medics-report-rapid-rise-in-deaths-as-covid-19-fears-grow

    Potential risk factors of lower income countries: underdeveloped health systems, testing/reporting/CRVS systems, population density; potentially mitigating: age structure, mostly warmer climate (I think evidence on that re virus spread is weak or tentative). Sorry for post format, writing on mobile.

  • 34 Passive Investor May 2, 2020, 1:11 pm

    @vanguardfan – The rationality or otherwise of the population distancing policy is contingent on the desired goal. So certainly it was rational to dampen the surge to avoid overwhelming the hospitals and that is why I and most people supported it.
    It would also be rational (though wrong in my view) if the stated aim was to prioritise deaths from C-19 over other causes of death (cancer, heart disease, domestic violence etc). Or indeed if there were a vaccine or treatment available in the near future (there isn’t).
    My argument is that (provided the hospitals aren’t overwhelmed) it isn’t rational to continue such extreme social distancing to save lives (or arguably even just to postpone deaths – area under the curve of deaths vs time seems to be the same whatever the speed of spread of the disease).
    It is an irrational and an ugly policy (I would say) that puts a disproportionate burden on under-40s for what is mainly a disease of the very elderly. All the more so when the financial cost of any lives saved by continuing the current policy are way higher than what we normally consider right.

    Finally, yes there is much that is unfair about covid-19 and indeed life in general. But policy-makers shouldn’t aim to increase unfairness.

    I am disappointed that you aren’t optimistic about the test-trace-quarantine policy (your field not mine). In the absence of a vaccine or testament I had been pinning some hope on that.

  • 35 Factor May 2, 2020, 1:13 pm

    @ Passive Investor #23

    You say “nursing homes” several times. Do you mean just nursing homes, or do you mean nursing homes and care homes, since in my experience the former are for people who are ill enough, or who are recuperating, to need at least some degree of “real nursing”, and who may thus be more likely to be in the pre-existing health condition category?

  • 36 Passive Investor May 2, 2020, 1:22 pm

    @factor Apologies for the sloppiness – I wrote nursing homes but meant care homes which is what the figures I gave were referring to.

  • 37 Indecisive May 2, 2020, 1:36 pm

    Whilst we’re talking about Neil Ferguson and Imperial, a reminder that Private Eye’s Not The Foot And Mouth report into the 2001 fiasco is available to read for free:
    https://www.private-eye.co.uk/special-reports/not-the-foot-and-mouth

  • 38 ermine May 2, 2020, 1:40 pm

    @Penelope
    Thank you for that link. It is how discourse should be done, in a measured way

    > Let’s see how the Imperial College fanboys try to spin this one away…

    It isn’t tribal 😉 Johan’s discourse was cogent and delivered in a measured way. I see nothing wrong with his arguments. As he said, perhaps we will only know in April 2020. How one responds to the very uncertain information and balance the costs and benefits is a political decision. I am glad that I don’t have to make these decisions.

  • 39 ZXSpectrum48k May 2, 2020, 2:08 pm

    @TI. What about Drosten’s research (leading virologist in Germany) ?
    https://www.bloomberg.com/news/articles/2020-04-30/children-with-coronavirus-may-be-just-as-infectious-as-adults. I think there is a huge risk here basing policy decisions on limited scientific studies with poor confidence levels.

    I tend to think the same about the economic side. The volatility cone in UK economic consensus forecasts already shows huge dispersion (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/879642/Forecomp_April_2020.pdf). These were late Mar/early Apr forecasts so will clearly be marked more negative in May. It’s not clear to me that at that point, economic data will be clearly tilted to the downside vs. that resulting probability density. Moreover, the UK economy is likely to come out of this weaker than many other economies due to pre-existing conditions, most of them self-inflicted.

    In terms of world view, I think I differ from you in the sense I’m more relaxed about many UK businesses going bust. The high street was obsolete anyway, airlines should go bust, the petroleum industry needs massive downsizing. The FTSE is not coming back because it full of crap companies with obsolete business models. The S&P and Nasdaq are not.

    I’m also more relaxed about higher unemployment. The UK made a sort of Faustian bargain: low unemployment for high underemployment and low skill base. Taxpayers subsidize many corporates and SMEs, through low taxation and incentives, to provide rubbish jobs on low pay. These jobs should have been offshored to EM markets years ago. It’s unsustainable for UK workers to be paid 3-5x an EM worker for something where they offer no advantage. It’s also results in terrible productivity and low capex.

    I’m clearly going to have to pay more tax after this crisis. I’d much prefer to pay people UBI so that they could stare at the ceiling, than see my tax used to subsidize Richard Branson, Mike Ashley or Phillip Green. Machine learning and AI is going to make many middle class people unemployed. We might start getting used to it now and stop stigmatizing those who don’t have jobs. A generation or two from now being unemployed might well be the norm.

  • 40 Penelope May 2, 2020, 2:22 pm

    @Indecisive

    Exactly, Ferguson’s magic spreadsheet has form. Anyone can google the number of human deaths that his model predicted from Mad Cow disease and then compare them to actual deaths. Garbage In => Garbage Out.

  • 41 The Investor May 2, 2020, 2:22 pm

    @ZXSpectrum48K — Well I’ve not seen the primary research, but on the basis of that article he is saying kids can get infected (which we knew) not that they are in turn infectious (which the other research said they could not find evidence of). But certainly it’s all, um, uncertain and not yet proven.

    On the economic front, big picture we probably agree with the way things are going far more than we disagree, with perhaps the exception that I have dialed back my concerns about middle-class jobs going to AI/robots. (I think today’s jobs will go, but I’ve moved back towards thinking there’ll be other new jobs. A discussion for another day). Certainly agree about the High Street etc. I’ve had a good 2020 so far return-wise, amazing relatively speaking, and it’s partly because I’m overweight tech/growth/disruption. So we’re on the same hymn sheet there.

    Where I’d disagree I think is the pace of change. If what you describe happens over 5-15 years that’s one thing. If it all happens in six months, that’s another.

    I’d draw a parallel with the Thatcherite changes of the early 1980s. Unlike many with my (albeit personally non-party) political leanings — and unlike more or less everyone where I grew up — I believe the most of those changes were necessary. The world was changing rapidly.

    However was it too much, too soon, too recklessly? I have a lot of sympathy with that view, too.

    On another note, I wanted to ask if you have any links to whether the various strains of Covid-19 have different virulence levels? I mentioned it in an offline discussion as a potential cause of varying fatality rates in different regions (not saying it was, just raising) and I was more or less laughed down. On Googling, I could only find people saying it “might” be the case that different strains were more virulent, but we didn’t know. Would love to see anything more concrete if it’s out there, cheers.

  • 42 FI Warrior May 2, 2020, 2:33 pm

    @ZX, Hahaha, the UK’s ‘productivity mystery’ solved in a few pithy words, excellent !
    I too would rather have my taxes pay UBI than crucify the underclass (which will soon encompass the majority) after the coming bonfire of bullsh*t jobs. What I’m betting will happen instead though is what always does, the likes of the oligarchs you sample will have another pass at the taxpayer trough while the poor, the most recent immigrants and others who can’t defend themselves, get scapegoated again. Why change a winning formula.

  • 43 Art May 2, 2020, 2:51 pm

    I would be surprised if different strains have different virulence levels.
    The difference between most strains only involve nucleotide mutations that do not result in amino-acid changes (i.e. the proteins, which are the parts that are going to form the virus, are the same) and thus virulence should be identical.
    There are now some sub-groups of mutations that do cause amino acid changes and thus, could change the structure of viral protein(s). Whether one amino acid modification is enough to change how the virus will act (and its virulence) is a good question.
    See here:
    https://www.pnas.org/content/117/17/9241
    The authors do caution that “Nevertheless, it would be prudent to consider the possibility that mutational variants might modulate the clinical presentation and spread of the disease.”.

  • 44 Vanguardfan May 2, 2020, 2:56 pm

    @passive, you wrote that the current lockdown was irrational, which I took to understand that you thought the intervention had no basis in logic or science. I’m glad that wasn’t what you meant.

    Re contact tracing and quarantine. My lack of confidence comes from two issues. The first is the nature of the virus. If a lot of transmission is driven by unnoticed or presymptomatic infection, then it’s going to be harder to break transmission – it needs lots and lots of testing, and it also needs very quick turnaround of test results. We’ve not done so well on that, but in fact, no country has been able to control this epidemic by this method alone, that’s why the globe is in lockdown.

    My other concern is how well we will implement it here in the UK. From what I’ve seen so far of the testing debacle and the lack of integration with local services, I think this might be another cock up in the making. Public health manpower has been much reduced in the last decade, organisationally fragmented and disconnected from the NHS. PHE is run by government diktat, with no local autonomy. My heart sinks when Hancock announces the number of staff to be recruited before he outlines the strategy – how can they know how many are needed before they’ve worked out how it will operate? It’s just another simplistic government slogan like 50,000 nurses (and 100,000 tests per day).

    It’s not that I think it’s a flawed approach, I just don’t believe we’ll do it well enough. We’ve destroyed our capability.

  • 45 FM May 2, 2020, 3:14 pm

    “Peak deaths for the virus occurred in early April. Working backwards gets you to peak infections towards the end of the second week of March”.

    “More or Less” Radio 4 on 29 April ( about 9 mins in to broadcast) Tim Harford made a claim in the programme the previous week that working backwards from 8 W April took you to 18 March for peak of infections i.e prior to lock down. The maths was disputed by a mathmatician – and they discussed the Mean /Medium /Mode /Average and skewed distribution. Conclusion – lockdown was main factor in reducing infection.

  • 46 Vanguardfan May 2, 2020, 3:26 pm

    @anyone who favours age stratified release from lockdown. I’m sure ONS will have, somewhere, data on household composition by age. I can’t be bothered to do the legwork, but why don’t you check how many households are inhabited exclusively by under 30s, under 45s or whatever you think is the best age cut off?
    (declaration of interest – two under 30s and two over 50s in our household!)

  • 47 Pendle Witch May 2, 2020, 3:36 pm

    @ Indecisive. What a distressing read on the foot and mouth crisis of 2001. But to pull out the Imperial model from all that is being ridiculously super-selective.

    Prof. Anderson (Imperial, but a refugee from Oxford, having exhibited male entitled professoriasis one too many times), with Chief Scientist King (Cambridge chemist) neither with any animal disease experience whatsoever. But lots of confidence, eh?

    EU rules/directives and intransigence, MAFF’s witlessness, desperation and illegal activities. Blair’s dithering and image fixation, not to mention blindness for rural life. (A London-centric bubble, you say?) Ministerial and opposition incompetence.

    After 11 September it largely disappeared from the headlines. Many farmers’ livelihoods gone, suicides, bloated compensation for some, nothing for others. £2.5 bn spent to save a £0.5 bn export market.

    Surely we know 20 years later that models can be no good without proper data. And we can only wait to see what a similar report will reveal about the current virus strategy in months or years to come.

  • 48 ZXSpectrum48k May 2, 2020, 4:01 pm

    @TI. Regarding different strains producing different viral loads. There is the well publicised paper from China (Zhejiang University School of Medicine https://www.medrxiv.org/content/10.1101/2020.04.14.20060160v2). This implied that the strains in Europe/NY produced larger viral loads and mortality rates than say the Seattle cluster in the US or parts of Asia/Australasia. If you look at https://nextstrain.org/ncov/global then you can see clear clusters of different strains and how they migrated.

    I haven’t seen any other preprints on this topic but it’s been getting attention for a few weeks on conference calls to possibly help explain varying mortality rates, especially NY. Demographics, population density, mass transport etc explain this to some degree but attention has moved toward looking at the various strains. Initial thoughts (two months ago) seemed to imply the strains were fairly similar but it seems that researchers are questioning that. I was on a call over a week ago with a US uni computational virology lab (who are heavily involved in nextstrain) and they found that adding in some level of “strain lethality” as an explanatory variable did help predict why the Seattle cluster and NY cluster produced quite different mortality rates. Like everything else we know far too little.

  • 49 The Investor May 2, 2020, 4:10 pm

    @ZXSpectrum48k @Art — Very interesting, thanks for those contributions. Will read up further.

  • 50 Passive Investor May 2, 2020, 4:36 pm

    @vanguardfan
    *It’s not that I think it’s a flawed approach, I just don’t believe we’ll do it well enough. We’ve destroyed our capability.*

    I’ll take some reassurance from that. Although clearly down the line we will need to understand how the UK went into this so badly prepared (ICU beds, ventilators, PPE, testing etc) it has been impressive to see the hospitals mobilise, the Nightingale hospitals get built and the testing get scaled up quite quickly so perhaps we will be able to build the contract tracing capability in time. Fingers crossed.

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