Covid-19 – Page 18 – artdiamondblog.com

Why “Efficacy” Is Greater Than “Effectiveness”

Some literature in medicine distinguishes between the “efficacy” of a medicine and the “effectiveness” of a medicine. The efficacy is measured by the medicine’s success in a randomized clinical trial; the “effectiveness” is measured by the medicine’s success in actual clinical practice. Since medicines are usually administered under better conditions, and often to cherry-picked patients, in randomized clinical trails, the “efficacy” of a medicine is almost always higher than the “effectiveness” of the same medicine.

In recent months a study has shown that airline air ventilation technology has very high efficacy in preventing the spread of Covid-19. Yet other studies have shown that in actual practice the “effectiveness” of airline technology has allowed cases of substantial transmission of Covid-19. The article quoted below, plausibly explains that ventilation systems are often turned off, or operate at low levels, when planes are on the ground. Puzzle solved.

(p. A9) The Federal Aviation Administration has few ventilation requirements in cabins, generally deferring to requirements from manufacturers. This has been an issue in the past, when cabins were left without ventilation for long periods with passengers on board. The FAA has issued guidance to airlines recommending passengers be taken off planes if cabin ventilation is shut down for more than 30 minutes, an FAA spokeswoman says.

Leonard Marcus, the director of Harvard’s Aviation Public Health Initiative, says that researchers have found that it’s important to have ventilation running full force on the ground.

“The risk of transmission is increased when people are walking up and down the aisle, when they are putting their luggage in the overhead, when they are breathing on top of one another,” Dr. Marcus says. “So to compensate for that, you have to keep the airflow moving, which is true for all communicable diseases of this nature.”

American says its procedures call for the use of ground air while at the gate and during boarding. Spokeswoman Sarah Jantz says captains have discretion to turn on the APU “if the flow of preconditioned air is not sufficient” or not cooling the aircraft enough. American didn’t change procedures during the pandemic, but did provide additional education to crews “to ensure optimal ventilation,” she says.

. . .

Airline claims about the safety of travel are predicated on functioning ventilation systems. An October [2020] study from Harvard University’s School of Public Health, funded by the airline industry, used mathematical models and found a low risk of coronavirus transmission on airplanes because of a layered approach, including aircraft ventilation and masks.

The study, directed by Dr. Marcus, did recommend extending “in-flight level of ventilation while on the ground.” It didn’t estimate the risk of being in an airplane with even brief periods of little or no ventilation.

For the full commentary, see:

Scott McCartney. “THE MIDDLE SEAT; The Importance of Airflow Before Takeoff.” The Wall Street Journal (Thursday, April 8, 2021): A9.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the commentary has the date April 7, 2021, and has the title “THE MIDDLE SEAT; The Key to Safe Airflow for Planes Before Takeoff.”)

China’s Economic Surge Not Shared by Consumers and Small Businesses

(p. B1) Factories are whirring, new apartments are being snapped up, and more jobs are up for grabs. When China released its new economic figures on Friday, they showed a remarkable postpandemic surge.

The question is whether small businesses and Chinese consumers can fully share in the good times.

China reported on Friday that its economy grew by a jaw-dropping 18.3 percent in the first three months of the year compared with the same period last year. While the figure is steep, it is as much a reflection of the past — the country’s output shrank 6.8 percent in the first quarter of 2020 from a year earlier — as it is an indication of how China is doing now.

A year ago, entire cities were shut down, planes were grounded and highways were blocked to control the spread of a relentless virus. Today, global demand for computer screens and video consoles that China makes is soaring as people work from home and as a pandemic recovery beckons. That demand has continued as Americans with stimulus checks look to spend money on patio furniture, electronics and other goods made in Chinese factories.

China’s recovery has also been powered by big infrastructure. Cranes dot city skylines. Construction projects for highways and railroads have provided short-term jobs. Property sales have also helped strengthen economic activity.

But exports and property investment can carry China’s growth only so far.

. . .

(p. B3) A slow vaccination rollout and fresh memories of lockdowns have left many consumers in the country skittish. . . . When virus outbreaks occur, the Chinese authorities are quick to put new lockdowns in place, hurting small businesses and their customers.

. . .

Families continue to save at a higher rate than they did before the pandemic, something that worries economists like Louis Kuijs, who is head of Asian economics at Oxford Economics. Mr. Kuijs is looking at household savings as an indication of whether Chinese consumers are ready to start splurging after months of being stuck at home.

“More people still seem to not go all the way in terms of carefree spending,” he said. “At times there are still some lingering Covid concerns, but there is perhaps also a concern about the general economic situation.”

. . .

Mr. [Jinqiu] Li, who is recently married and has a baby at home, is still choosing to save instead of spend. He had planned to work for the family business, but it has been hit by the pandemic and he doesn’t think there is much opportunity for him if he stays.

“The whole family has some sense of crisis,” Mr. Li said. “Because of the pandemic and because of family business, I have a sense of crisis.”

For the full story, see:

Alexandra Stevenson and Cao Li. “China’s Gain Is Hardly Felt by the People.” The New York Times (Friday, April 16, 2021): B1 & B3.

(Note: ellipses, and bracketed first name, added.)

(Note: the online version of the article has the date April 15, 2021, and has the title “China’s Economy Is Booming. Shoppers Are Skittish Anyway.” The quote starting “More people” appeared in the print, but not in the online, version of the article.)

Productivity Pessimist Robert Gordon Becomes More Optimistic

(p. A2) After a decadelong drought, worker productivity might be about to accelerate thanks to pandemic-induced technological adoption, which could lift economic growth and wages in coming years while staving off inflation pressure.

. . .

Robert Gordon, a professor at Northwestern University who has studied productivity and living standards during the past century, said productivity growth slowed after 2005 because the payoff from computers faded and new inventions such as smartphones and tablets didn’t revolutionize business operations. In 2015 he had predicted productivity growth of only 1.5% a year over the next 25 years. Recent developments have made him more optimistic, and he expects annual productivity growth of about 1.8% this decade.

A shift toward e-commerce should push up productivity by eliminating workers needed in bricks-and-mortar stores, Mr. Gordon said. Videoconferencing should also help, though the public-transit sector could offset some of the gains because buses and rail transit will carry fewer riders, he said.

. . .

Remote work could deliver a one-time 4.7% lift to productivity after the pandemic, though a large share of the growth will stem from shortened commutes that government productivity data won’t fully capture, according to a working paper from Stanford University’s Nicholas Bloom and co-authors.

For the full commentary, see:

Sarah Chaney Cambon. “Productivity Looks Ready to Pick Up.” The Wall Street Journal (Saturday, April 5, 2021): A2.

(Note: ellipses added.)

(Note: the online version of the commentary has the date April 4, 2021, and has the title “U.S.’s Long Drought in Worker Productivity Could Be Ending.”)

Gordon’s pessimistic old views were most fully expressed in his much-discussed:

Gordon, Robert J. The Rise and Fall of American Growth: The U.S. Standard of Living since the Civil War. Princeton, NJ: Princeton University Press, 2016.

The working paper co-authored by Bloom is:

Barrero, Jose Maria, Nicholas Bloom, and Steven J. Davis. “Why Working from Home Will Stick.” Working Paper, April 1, 2021.

Differences in Study Results Are Seldom Due to Whether Study Design Is Observational or a Randomized Clinical Trial

(p. A17) The health system would be less burdened if more patients were treated before they require hospitalization, and there are promising therapeutic options that patients can administer themselves at home. This was the subject of a Nov. 19 [2020] hearing before the Senate Homeland Security and Governmental Affairs Committee.

Testimony from the hearing underscored an important issue: Too many doctors have interpreted the term “evidence-based medicine” to mean that the evidence for a treatment must be certain and definitive before it can be given to patients. Because accusing a physician of not being “evidence based” can be a career-damaging allegation, fear of straying from the pack has prevailed, favoring inertia and inaction amid uncertainty about Covid-19 treatments.

For diseases with established treatment options, holding out for certainty may be prudent. But when options are limited and there are safe treatments with evidence for effectiveness, holding out for certainty can be catastrophic. Requiring a high degree of certainty during a crisis may elevate the augustness of medical organizations and appease the sensibilities of medical professionals, but it does nothing for patients who need help.

The penchant for certainty is visible in the frequently updated treatment guidelines for Covid-19 from the National Institutes of Health. These guidelines were developed by scientists around the country, but because of a mentality that is biased toward virtually irrefutable evidence, no distinction is made for treatments with evidence for effectiveness that falls below the mark of certainty. This framework almost certainly has contributed to many avoidable deaths during this pandemic.

. . .

While some health officials dismiss nonrandomized studies, the Cochrane organization, an international leader in evidence-based medicine, published a review of several hundred studies showing that randomized clinical trials and nonrandomized studies of treatments generally yield similar findings. Modern epidemiologic and statistical methods can usually overcome biases inherent in nonrandomized study designs.

For the full commentary, see:

Joseph A. Ladapo. “Too Much Caution Is Killing Covid Patients.” The Wall Street Journal (Wednesday, Nov. 25, 2020): A17.

(Note: ellipsis, and bracketed year, added.)

(Note: the online version of the commentary has the date November 24, 2020, and has the same title as the print version.)

The Cochrane organization review mentioned above is:

Anglemyer, Andrew, Hacsi T. Horvath, and Lisa Bero. “Healthcare Outcomes Assessed with Observational Study Designs Compared with Those Assessed in Randomized Trials.” In Cochrane Database of Systematic Reviews, 2014.

“A Public Choice Analysis of Mandated Randomized Double-Blind Clinical Trials”

My “A Public Choice Analysis of Mandated Randomized Double-Blind Clinical Trials” was presented on April 13, 2021 in the Law & Economics session of the Association of Private Enterprise Education meetings. I am grateful to Ray DeGennaro and Matthew McClanahan for including me in McClanahan’s session and to Lauren Nicole Hughes for recording the session on her smartphone.

To some extent, the presentation was an outgrowth of my book:

Diamond, Arthur M., Jr. Openness to Creative Destruction: Sustaining Innovative Dynamism. New York: Oxford University Press, 2019.

Etsy and Shopify Platforms Enabled Many Small Businesses to Survive the Pandemic

(p. B4) While the year has been a struggle for small businesses, some companies that host their transactions have been soaring.

Shares in Etsy Inc. and Shopify Inc., whose e-commerce platforms primarily cater to small businesses, have surged during the pandemic. Etsy has more than quadrupled this year, while Shopify has tripled.

. . .

For many small-business owners, the technology platforms have served as a lifeline as their companies shift to a focus on online sales.

Matthew Cummings owns a glass-blowing company that makes custom beer glasses in Knoxville, Tenn. He has been on Etsy since 2012, but didn’t move fully online until the pandemic hit and he had to close the doors of his bricks-and-mortar store. He said his Etsy sales are about 10 times higher this year.

Mr. Cummings said that his sales on Etsy have helped him cover his business expenses and that he was able to come out of 2020 with a profit because of his online store. He plans on selling through the platform after the pandemic, with his business now reaching as far as Australia. He has seen a new wave of repeat customers seeking to complete sets of his custom beer glasses.

. . .

One type of sale that might not last beyond the pandemic is masks.

Etsy reported that masks accounted for 11% of overall gross-merchandise sales in the third quarter.

For the full story, see:

Amber Burton. “Sales Platforms Etsy, Shopify Thrive From Small Businesses.” The Wall Street Journal (Thursday, Dec 24, 2020): B4.

(Note: ellipses added.)

(Note: the online version of the story has the date December 23, 2020, and has the title “Etsy and Shopify Buoyed as Covid-19 Boosts Online Sales.”)

22% of U.S. Small Businesses Closed from February to April 2020

(p. B4) In early February [2020], things were looking good for Practice San Francisco, a center offering individual psychotherapy and classes for children and adults that promote physical and mental well-being. Business was so good that owner Nina Kaiser, a psychologist, had just renovated and moved into a bigger space with the goal of doubling revenue.

Then the coronavirus pandemic hit. In early March [2020], Ms. Kaiser moved all her classes and counseling services online. Fairly quickly, however, video fatigue set in. “After a few weeks, we saw a big downturn in attendance across all our programs, even psychotherapy,” she said. Thus began a period of “endless pivoting and troubleshooting.”

Like many other small businesses, Practice San Francisco, which has been around for three years, has essentially become a start-up again, employing a strategy similar to the “fail fast” approach well known in start-up culture: A change is made to some aspect of the business and if it works, it sticks, but if it fails, data is collected and something else is tried.

“There has been a lot of flying by the seat of your pants,” Ms. Kaiser said. “We see what doesn’t work, where we run into trouble, and we course-correct. It’s this constant, iterative process.”

That process is crucial right now for small businesses, whose numbers dropped by 22 percent — 3.3 million — between February and April [2020], according to the National Bureau of Economic Research.

For the full story, see:

Eilene Zimmerman. “Small-Business Owners Pivot and Troubleshoot In Battle to Stay Afloat.” The New York Times (Tuesday, December 1, 2020): B4.

(Note: bracketed years added.)

(Note: the online version of the story was updated Dec. 17 [sic], 2020, and has the title “Can a Start-Up Mentality Save Small Businesses?”)

The published-online-ahead-of-print version of the National Bureau of Economic Research (NBER) working paper mentioned above is:

Fairlie, Robert. “The Impact of Covid-19 on Small Business Owners: Evidence from the First 3 Months after Widespread Social-Distancing Restrictions.” Journal of Economics & Management Strategy (2020): 10.1111/jems.12400.

Pfizer Refused Federal Subsidy so They Could “Liberate” Their “Scientists From Any Bureaucracy”

In September [2020], the CEO of Pfizer, Albert Bourla, appeared on CBS News’s “Face the Nation,” where he was asked about not accepting government funding for development.

“The reason why I did it was because I wanted to liberate our scientists from any bureaucracy,” Bourla explained. “When you get money from someone that always comes with strings. They want to see how we are going to progress, what type of moves you are going to do. They want reports. I didn’t want to have any of that. I wanted them — basically I gave them an open checkbook so that they can worry only about scientific challenges, not anything else.”

“And also,” he added, “I wanted to keep Pfizer out of politics, by the way.”

For the full story, see:

Philip Bump. “No, Pfizer’s Apparent Vaccine Success Is Not a Function of Trump’s ‘Operation Warp Speed.” The Washington Post (online posted Monday, November 9, 2020).

(Note: bracketed year added.)

Unintended Consequences of Centralized Lockdown in India Spread Covid-19

(p. A1) SURAT, India — The crowds surged through the gates, fought their way up the stairs of the 160-year-old station, poured across the platforms and engulfed the trains.

It was May 5 [2020], around 10 a.m. Surat was beastly hot, 106 degrees. Thousands of migrant laborers were frantic to leave — loom operators, diamond polishers, mechanics, truck drivers, cooks, cleaners, the backbone of Surat’s economy. Two of them were Rabindra and Prafulla Behera, brothers and textile workers, who had arrived in Surat a decade ago in search of opportunity and were now fleeing disease and death.

. . .

They were among tens of millions of migrant workers stranded without work or food after Prime Minister Narendra Modi imposed a national coronavirus lockdown in March. By spring and summer, these workers were so desperate that the government provided emergency trains to carry them back to their home villages. The trains were called Shramik Specials, because shramik means “laborer” in Hindi.

But they became the virus trains.

India has now reported more coronavirus cases than any country besides the United States. And it has become clear that the special trains operated by the government to ease suffering — and to counteract a disastrous lack of lockdown planning — instead played a significant role in spreading the coronavirus into almost every corner of the country.

The trains became contagion zones: Every passenger was supposed to be screened for Covid-19 before boarding but few if any were tested. Social distancing, if promised, was nonexistent, as men pressed into passenger cars for journeys that could last days. Then the trains disgorged passengers into distant villages, in regions that before had few if any coronavirus cases.

. . .

(p. A12) On March 24 [2020], at 8 p.m., Mr. Modi hit the lockdown switch. In a televised address, he ordered the entire nation to stay inside their homes for three weeks — starting in four hours.

The decision was pure Modi: sudden, dramatic and firm, like when he abruptly wiped out nearly 90 percent of India’s currency bills in 2016, a bolt-from-the-blue measure that he said was necessary to fight corruption but proved economically devastating.

Prafulla and Rabindra Behera had just finished a dinner of rice, lentils and potatoes, their usual fare. They lived in squalid, bare rooms in Surat’s industrial zone, sleeping wall to wall on the floor with a half dozen other laborers. Within minutes of Mr. Modi’s address, they started getting calls.

“Everyone was thinking the same: This will be over soon and somehow we’ll pass the days,” Rabindra said.

At the time, India had fewer than 600 known virus cases.

Many experts have criticized Mr. Modi’s government for overlooking the plight of migrant laborers, who suddenly had no work, no income and no support network in the cities. The government’s Covid-19 task force lacked migrant specialists and was hardly representative of India. Of its 21 members, only two were women and the rest were largely upper-caste men. Many of the migrant laborers came from lower castes and economically underprivileged backgrounds.

. . .

In Surat, the Behera brothers were down to their last bag of rice. They could not work — the factories were closed. But they weren’t allowed to leave the city, where virus cases were beginning to surge.

“We were trapped,” Rabindra said.

On May 1, India’s Labor Day, the railways ministry made a grand announcement: Shramik Specials. Routes were drawn up from Surat, Mumbai, Chennai, New Delhi, Ahmedabad and other cities deep into rural areas.

. . .

The Beheras were told they would quarantine for 21 days at a center and each was given a toothbrush, a slice of soap, a bucket to wash with and a thin sheet to sleep on.

But the next morning, Prafulla awoke with a splitting headache. A doctor didn’t think he had coronavirus but suggested, as a precaution, that he be moved into the courtyard, away from the other men.

The following morning, Prafulla could barely breathe and called his wife on his cellphone.

“Come and bring the girls,” he whispered. “I need to see you.”

An hour later, he was dead. A subsequent test revealed that Prafulla Behera was Ganjam’s first coronavirus death.

For the full story, see:

Jeffrey Gettleman, Suhasini Raj, Sameer Yasir, Karan Deep Singh and Atul Loke. “Rails Spread Virus as Workers Fled India’s Cities.” The New York Times (Wednesday, December 16, 2020): A1 & A12-A13.

(Note: ellipses added.)

(Note: the online version of the story was updated Feb. [sic] 2, 2021, and has the title “The Virus Trains: How Lockdown Chaos Spread Covid-19 Across India.”)

On Vaccines and Economics, Europe Suffers “the Same Bureaucratic and Intellectual Rigidity”

(p. A25) Europe’s vaccination debacle will almost surely end up causing thousands of unnecessary deaths. And the thing is, the continent’s policy bungles don’t look like isolated instances, a few bad decisions made by a few bad leaders. Instead, the failures seem to reflect fundamental flaws in the continent’s institutions and attitudes — including the same bureaucratic and intellectual rigidity that made the euro crisis a decade ago far worse than it should have been.

The details of the European failure are complex. But the common thread seems to be that European officials were not just risk averse, but averse to the wrong risks. They seemed deeply worried about the possibility that they might end up paying drug companies too much, or discover that they had laid out money for vaccines that either proved ineffective or turned out to have dangerous side effects.

So they minimized these risks by delaying the procurement process, haggling over prices and refusing to grant liability waivers. They seemed far less worried about the risk that many Europeans might get sick or die because the vaccine rollout was too slow.

For the full commentary, see:

Paul Krugman. “A Fiasco That’s Very European: Vaccines.” The New York Times (Friday, March 19, 2021): A25.

(Note: the online version of the commentary has the date March 18, 2021, and has the title “Vaccines: A Very European Disaster.”)

Hacked Trove of Documents Show China’s “Weaponized System of Censorship”

(p. 1) In the early hours of Feb. 7 [2021], China’s powerful internet censors experienced an unfamiliar and deeply unsettling sensation. They felt they were losing control.

The news was spreading quickly that Li Wenliang, a doctor who had warned about a strange new viral outbreak only to be threatened by the police and accused of peddling rumors, had died of Covid-19. Grief and fury coursed through social media. To people at home and abroad, Dr. Li’s death showed the terrible cost of the Chinese government’s instinct to suppress inconvenient information.

Yet China’s censors decided to double down. Warning of the “unprecedented challenge” Dr. Li’s passing had posed and the “butterfly effect” it may have set off, officials got to work suppressing the inconvenient news and reclaiming the narrative, according to confidential directives sent to local propaganda workers and news outlets.

They ordered news websites not to issue push notifications alerting readers to his death. They told social platforms to gradually remove his name from trending topics pages. And they activated legions of fake online commenters to flood social sites with distracting chatter, stressing the need for discretion: “As commenters fight to guide public opinion, they must conceal their identity, avoid crude patriotism and sarcastic praise, and be sleek and silent in achieving results.”

The orders were among thousands of secret government directives and other documents that were reviewed by The New York(p. 14)Times and ProPublica. They lay bare in extraordinary detail the systems that helped the Chinese authorities shape online opinion during the pandemic.

At a time when digital media is deepening social divides in Western democracies, China is manipulating online discourse to enforce the Communist Party’s consensus. To stage-manage what appeared on the Chinese internet early this year, the authorities issued strict commands on the content and tone of news coverage, directed paid trolls to inundate social media with party-line blather and deployed security forces to muzzle unsanctioned voices.

. . .

The documents include more than 3,200 directives and 1,800 memos and other files from the offices of the country’s internet regulator, the Cyberspace Administration of China, in the eastern city of Hangzhou. They also include internal files and computer code from a Chinese company, Urun Big Data Services, that makes software used by local governments to monitor internet discussion and manage armies of online commenters.

The documents were shared with The Times and ProPublica by a hacker group that calls itself C.C.P. Unmasked, referring to the Chinese Communist Party. The Times and ProPublica independently verified the authenticity of many of the documents, some of which had been obtained separately by China Digital Times, a website that tracks Chinese internet controls.

. . .

“China has a politically weaponized system of censorship; it is refined, organized, coordinated and supported by the state’s resources,” said Xiao Qiang, a research scientist at the School of Information at the University of California, Berkeley, and the founder of China Digital Times. “It’s not just for deleting something. They also have a powerful apparatus to construct a narrative and aim it at any target with huge scale.”

“This is a huge thing,” he added. “No other country has that.”