An update on a pre-registered result about the coronavirus(kalzumeus.com)
kalzumeus.com
An update on a pre-registered result about the coronavirus
https://www.kalzumeus.com/2020/04/21/japan-coronavirus/
25 comments
One might argue that a "true count of infections" is not falsifiable -- people aren't getting tested, causes of deaths aren't properly attributed, officials are juking the stats.
A more falsifiable claim is "a breakdown of provision of care in Nagoya, Osaka, and Tokyo, before the end of April".
If patients are in parking lots or bodies are in refrigerated trucks and mass graves, that evidence is harder to hide.
There are 10 days left in April, but at this point, is there any evidence of "a breakdown in the provision of care"?
A more falsifiable claim is "a breakdown of provision of care in Nagoya, Osaka, and Tokyo, before the end of April".
If patients are in parking lots or bodies are in refrigerated trucks and mass graves, that evidence is harder to hide.
There are 10 days left in April, but at this point, is there any evidence of "a breakdown in the provision of care"?
Refusing to test, secret testing locations, over two hours on hold on the COVID hotline. Things aren’t looking great.
https://www.facebook.com/groups/524159784940511/permalink/52...
> 4/17 Friday: At noon my friend wakes up and asks if I can call her ward's 保健所 and make a PCR test appointment for her. I call them at 12:30.
> It took 2 HOURS to set up a PCR test.
> As I expected, the staff was INCREDIBLY resistant to offer a test, and spent 2 hours asking me 100 questions about her symptoms, what treatment she had received so far, what hospital she went to the night before, name of the doctor who recommended her a test etc. I'm put on hold for an extra hour as they sort their things out. They finally call me back and tell me all of the information for her test. But here's the kicker. It's a secret location. It's a medical facility that's currently closed, but is being used as a corona testing site on the downlow. To enter the building, she'll have to walk through the parking lot and use the staff entrance. The woman on the phone makes me promise not to tell ANYONE other than my friend the name of the place where she is being tested. Because if people knew they were doing testing there it would "cause a commotion." I really wish I was making that last part up. It's absolutely horrific how much they are trying to cover this up and keep the official numbers low. I am currently waiting for them to call again with her test results. Getting her tested required 1 ambulance ride, two visits to the hospital and 5+ hours on the phone. This is ridiculous and something needs to change."
https://www.facebook.com/groups/524159784940511/permalink/52...
> 4/17 Friday: At noon my friend wakes up and asks if I can call her ward's 保健所 and make a PCR test appointment for her. I call them at 12:30.
> It took 2 HOURS to set up a PCR test.
> As I expected, the staff was INCREDIBLY resistant to offer a test, and spent 2 hours asking me 100 questions about her symptoms, what treatment she had received so far, what hospital she went to the night before, name of the doctor who recommended her a test etc. I'm put on hold for an extra hour as they sort their things out. They finally call me back and tell me all of the information for her test. But here's the kicker. It's a secret location. It's a medical facility that's currently closed, but is being used as a corona testing site on the downlow. To enter the building, she'll have to walk through the parking lot and use the staff entrance. The woman on the phone makes me promise not to tell ANYONE other than my friend the name of the place where she is being tested. Because if people knew they were doing testing there it would "cause a commotion." I really wish I was making that last part up. It's absolutely horrific how much they are trying to cover this up and keep the official numbers low. I am currently waiting for them to call again with her test results. Getting her tested required 1 ambulance ride, two visits to the hospital and 5+ hours on the phone. This is ridiculous and something needs to change."
This seems like exactly the measures I would institute if I just plain didn't have enough tests to test everyone who wants one (i.e. almost all humans). The secrecy sounds perfectly normal if the goal is to not be swarmed by masses of people who likely just need to stay home.
Ugh, that sounds like a system designed to frustrate and obfuscate at every level.
But at some point, it's impossible to hide behind bureaucratic procedures to limit testing.
@patio11's most falsifiable prediction was for a "breakdown of provision of care" -- too many sick people for the number of critical care beds, patients warehoused in hallways, lobbies, parking lots, tents and stadiums.
And if sick people don't show up there, then they eventually show up at the morgue.
If there's a public health catastrophe in Japan, at some point it must be too big to hide.
But at some point, it's impossible to hide behind bureaucratic procedures to limit testing.
@patio11's most falsifiable prediction was for a "breakdown of provision of care" -- too many sick people for the number of critical care beds, patients warehoused in hallways, lobbies, parking lots, tents and stadiums.
And if sick people don't show up there, then they eventually show up at the morgue.
If there's a public health catastrophe in Japan, at some point it must be too big to hide.
The timeline from Italy shows this can happen in a matter of days.
Exponential growth means fully half of the present population occurred in the last growth cycle (presuming R0 ~ 2).
With a mean time to symptoms of 14 days, depending on what Japan is doing, 10 days is an age (though it's worth noting that severe respiratory symptoms set in in week 3).
With a mean time to symptoms of 14 days, depending on what Japan is doing, 10 days is an age (though it's worth noting that severe respiratory symptoms set in in week 3).
14 days is, I believe, the estimated 99th percentile for incubation time, not the mean.
Mean is more like 5 or 6 days.
Mean is more like 5 or 6 days.
The normal range of each phase is described in https://patient.info/news-and-features/coronavirus-how-quick...
The average is 5-6 days to show any symptoms. That is the figure that you are remembering.
If it is going to turn severe, the average to develop severe shortness of breath from first symptoms is another 7-10 days. Which means that the range from exposure to severe shortness of breath is 12-16 days...or an average of 14 days.
Which is exactly what the person that you were responding to said. So your memory was correct in so far as it went, but you were remembering the wrong fact about COVID-19.
The average is 5-6 days to show any symptoms. That is the figure that you are remembering.
If it is going to turn severe, the average to develop severe shortness of breath from first symptoms is another 7-10 days. Which means that the range from exposure to severe shortness of breath is 12-16 days...or an average of 14 days.
Which is exactly what the person that you were responding to said. So your memory was correct in so far as it went, but you were remembering the wrong fact about COVID-19.
They clearly said mean time to symptoms, not mean time to severe symptoms.
Oops. You are right.
Though 14 days is probably a mean time to getting tested.
Though 14 days is probably a mean time to getting tested.
> The current count is ~21,000 with the number of confirmed daily cases declining for 6 days straight
Yes, but all of those 6 days are still higher than 7 & 8 days ago. In fact, all the days you picked are also higher than they were through March 15st-April 4th too - and several days between April 4th onwards as well.
Today's new cases in Japan are many multiples higher than most days in March - but I do hope they continue their recent trend of decline.
> So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society.
Maybe, but they did use the term "true count" which appears to mean: asymptomatic and those who have it but haven't/won't get tested.
As the US has learned, once you start to ramp up testing the case count ramps up too.
Looking at Japan's testing, they are testing more per day now than in March[0] but their total number of people tested is still not very high at almost 117k[1] - given they have ~125m population.
[0] https://ourworldindata.org/grapher/full-list-covid-19-tests-...
[1] https://ourworldindata.org/grapher/full-list-total-tests-for...
Yes, but all of those 6 days are still higher than 7 & 8 days ago. In fact, all the days you picked are also higher than they were through March 15st-April 4th too - and several days between April 4th onwards as well.
Today's new cases in Japan are many multiples higher than most days in March - but I do hope they continue their recent trend of decline.
> So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society.
Maybe, but they did use the term "true count" which appears to mean: asymptomatic and those who have it but haven't/won't get tested.
As the US has learned, once you start to ramp up testing the case count ramps up too.
Looking at Japan's testing, they are testing more per day now than in March[0] but their total number of people tested is still not very high at almost 117k[1] - given they have ~125m population.
[0] https://ourworldindata.org/grapher/full-list-covid-19-tests-...
[1] https://ourworldindata.org/grapher/full-list-total-tests-for...
Looks like the breakdown in provision of care will happen before the end of April after all.
https://twitter.com/patio11/status/1252836409406152709?s=21
> NHK confirms that coronavirus-appropriate hospital beds are 80%+ filled in Tokyo, Osaka, Ishikawa, Hyogo, Shiga, and Okinawa.
> Experts threshold of concern for imminent impact on medical care is 30%, again per NHK.
> The 28 prefectures which are above that threshold will not fit in this tweet.
> NHK reports that several prefectures which were unable to sustain the prior strategy of hospitalizing all diagnosed cases have begun moving less severely affected patients to hotels/etc or asking them to self-sequester at home, temporarily freeing up bed space.
>!NHK reports that while reprioritization of hospitalization strategy and urgent measures to add more beds may buy some time, the situation risks a collapse in the provision of medical care, and that experts explain we cannot be optimistic.
https://twitter.com/patio11/status/1252836409406152709?s=21
> NHK confirms that coronavirus-appropriate hospital beds are 80%+ filled in Tokyo, Osaka, Ishikawa, Hyogo, Shiga, and Okinawa.
> Experts threshold of concern for imminent impact on medical care is 30%, again per NHK.
> The 28 prefectures which are above that threshold will not fit in this tweet.
> NHK reports that several prefectures which were unable to sustain the prior strategy of hospitalizing all diagnosed cases have begun moving less severely affected patients to hotels/etc or asking them to self-sequester at home, temporarily freeing up bed space.
>!NHK reports that while reprioritization of hospitalization strategy and urgent measures to add more beds may buy some time, the situation risks a collapse in the provision of medical care, and that experts explain we cannot be optimistic.
Maybe I read that wrong, but wasn't the point that Japan wasn't acting appropriately, and that white paper, along with other research, forced (for lack of a better word) them to own up to the scale of what they were seeing?
Isn't the point that, while the particulars were proved false, the overall thrust of the article that Japan was stalling action which MAY lead to those numbers was true?
Did I miss the point of this entirely?
Isn't the point that, while the particulars were proved false, the overall thrust of the article that Japan was stalling action which MAY lead to those numbers was true?
Did I miss the point of this entirely?
Everyone with disastrous predictions about the coronavirus can and does make that claim. If my predictions aren't true, give it a few weeks and exponential growth will make them true. If they still aren't true, then they would have been true, but whatever we did a few weeks ago must have been the correct reaction to my predictions.
The very general thrust - that Japan surely had community spread - I agree was true and not widely acknowledged at the time. But I don't think that exempts the more specific projections from analysis.
The very general thrust - that Japan surely had community spread - I agree was true and not widely acknowledged at the time. But I don't think that exempts the more specific projections from analysis.
I understand the problem with some of the claims people make about things being really bad being unfalsifiable.
At the same time, the expected outcome of social distancing is for the outcome to be not as bad... so people will always be able to make this complaint. What exactly do you expect from people who are advocating social distancing?
At the same time, the expected outcome of social distancing is for the outcome to be not as bad... so people will always be able to make this complaint. What exactly do you expect from people who are advocating social distancing?
I expect a degree of epistemic humility. "We don't know how bad it's going to get, but we know that the worst case is very bad, so let's go to extreme lengths to make sure we don't hit it" - no objections to that message. But in my local area, and from what I understand many others, people were saying in mid-March that it was already too late and there would surely be bodies in the streets.
Which hasn't been that bad until now, but it's going to be an increasingly large problem as most countries pass the peak and try to reopen. A lot of people have been convinced that reopening can never happen, that if people are allowed to go to school or restaurants that'll be what tips the health care system over.
Which hasn't been that bad until now, but it's going to be an increasingly large problem as most countries pass the peak and try to reopen. A lot of people have been convinced that reopening can never happen, that if people are allowed to go to school or restaurants that'll be what tips the health care system over.
"We took the measures that mitigated a disaster, therefore the disaster was never going to happen" is an idiotic opinion.
A virus that spreads from close proximity with infected people, and you're arguing that shoving people back in close proximity is not going to contribute to spreading it? Why? On what basis will this not happen, despite this being exactly what happened?
Spain took about 1 month to go from "hm this coronavirus thing is spreading" to "if you're over 75 we're not going to bother with ventilators because we can't spare the capacity".
Things have to reopen eventually, but if you haven't actually increased your test and tracing capacity, then the effect is going to be exactly what happened in 1918 https://www.popsci.com/story/health/coronavirus-1918-flu-pan... (wherein an experiment with a control was accidentally run at a substantial cost in lives between two US cities).
A virus that spreads from close proximity with infected people, and you're arguing that shoving people back in close proximity is not going to contribute to spreading it? Why? On what basis will this not happen, despite this being exactly what happened?
Spain took about 1 month to go from "hm this coronavirus thing is spreading" to "if you're over 75 we're not going to bother with ventilators because we can't spare the capacity".
Things have to reopen eventually, but if you haven't actually increased your test and tracing capacity, then the effect is going to be exactly what happened in 1918 https://www.popsci.com/story/health/coronavirus-1918-flu-pan... (wherein an experiment with a control was accidentally run at a substantial cost in lives between two US cities).
Sorry, what's the accidental experiment here? The article doesn't suggest any cities in 1918 were doing testing or contact tracing - they couldn't have been, because they didn't even know that the flu was a virus at the time. And I'm not seeing anything about a general closure of non-essential businesses either.
I certainly wouldn't dispute that closing schools and banning public gatherings were good moves.
I certainly wouldn't dispute that closing schools and banning public gatherings were good moves.
Quarantine measures were widely implemented in major cities during the 1918 pandemic, but at different times in response to different catastrophes and with a very different result in deaths per capita.
See the bottom graph. Deaths/week vs when closures were implemented. Another more wordy source: https://www.businessinsider.com.au/history-of-how-st-louis-v...
> Around the same time, the city of St. Louis was closing schools, libraries, courthouses, churches, playgrounds as well as limiting the number of people on streetcars and staggering work shifts to minimise contact.
St Louis did relatively well - but they released quarantine measures early and got an unnecessary double peak (see the first source, which shows exactly pretty clearly exactly when they did it, and then quickly reimplemented it).
The lessons of history here really could not be clearer.
See the bottom graph. Deaths/week vs when closures were implemented. Another more wordy source: https://www.businessinsider.com.au/history-of-how-st-louis-v...
> Around the same time, the city of St. Louis was closing schools, libraries, courthouses, churches, playgrounds as well as limiting the number of people on streetcars and staggering work shifts to minimise contact.
St Louis did relatively well - but they released quarantine measures early and got an unnecessary double peak (see the first source, which shows exactly pretty clearly exactly when they did it, and then quickly reimplemented it).
The lessons of history here really could not be clearer.
Your more wordy source does not describe general business closures and doesn't say the word "quarantine". The lessons of history are clear that we needed to do something, certainly.
"It doesn't say the word quarantine, it only describes it" is a weird hill to die on.
> The article doesn't suggest any cities in 1918 were doing testing or contact tracing - they couldn't have been, because they didn't even know that the flu was a virus at the time.
That's silly.
They didn't know it was a virus. They certainly knew it was communicable. Contact tracing is entirely possible; we were doing that in the 1800s. https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outb...
That's silly.
They didn't know it was a virus. They certainly knew it was communicable. Contact tracing is entirely possible; we were doing that in the 1800s. https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outb...
Testing in the modern sense was impossible as a matter of science.
Modern contact tracing could in principle have been done, but it's my understanding that it wasn't. The kind of tracing in the Broad Street outbreak is very different - cholera mostly doesn't spread from person to person, so John Snow had to figure out only where each of the victims spent their time and not an exponential sized web of people they went out drinking with.
Modern contact tracing could in principle have been done, but it's my understanding that it wasn't. The kind of tracing in the Broad Street outbreak is very different - cholera mostly doesn't spread from person to person, so John Snow had to figure out only where each of the victims spent their time and not an exponential sized web of people they went out drinking with.
i'd love some media humility as well. the self-righteous corona-panic bias of the media i tend to consume (npr, nytimes, etc.) is unwavering and nauseating.
the last couple months of experience tells us (imperfect) physical distancing has done the heavy lifting in flattening the curve, and yet the media orthodoxy is still that stepping one unsheathed toe outside your door is just asking for death. this morning an npr reporter openly mocked a governor for even suggesting a loosening of the lockdown. it's brainless.
the last couple months of experience tells us (imperfect) physical distancing has done the heavy lifting in flattening the curve, and yet the media orthodoxy is still that stepping one unsheathed toe outside your door is just asking for death. this morning an npr reporter openly mocked a governor for even suggesting a loosening of the lockdown. it's brainless.
Honestly, who has 1-1.5h to read this without skimming through most of the verbiage to tease out the point? I read the "pre-registered" part. It was wrong on a bunch of points, both numbers and impact. I strongly doubt a major world economy of 126 million people with many world-class epidemiologists and doctors and generally non-disastrous political leadership was 'forced' into anything by this.
The hubris of this guy is quite off-putting.
The hubris of this guy is quite off-putting.
> Honestly, who has 1-1.5h to read this without skimming through most of the verbiage to tease out the point?
I’m not trying to flex on you, but it didn’t take me nearly that long to read it. And it really does not demonstrate good faith on your part to come here and tear down patio11 without even doing the basic due diligence of actually reading the damn thing you’re commenting on first.
I’m not trying to flex on you, but it didn’t take me nearly that long to read it. And it really does not demonstrate good faith on your part to come here and tear down patio11 without even doing the basic due diligence of actually reading the damn thing you’re commenting on first.
You would be surprised by how doctors are forced to agree with medicial associations or lose their licease.
Can your point be made more explicitly? I fail to see a connection between my comment and your reply to it.
Yeah, I'm withholding judgement till "the end of April", but given Japan's doubling time is roughly 10 days, you'd expect there to be ~2.5k severe cases right now. Given that Japan's official count is ~11k, is there reason to believe 1/4 of all official cases are "severe"?
Does anyone have up-to-date data on "excess deaths" in Japan for the past few months?
Does anyone have up-to-date data on "excess deaths" in Japan for the past few months?
> Given that Japan's official count is ~11k, is there reason to believe 1/4 of all official cases are "severe"?
Yes. That fits data out thus far.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
> Although the majority of reported COVID-19 cases in China were mild (81%)
Combine the 19% severe cases number out of China with Japan's aging population (which COVID-19 hits substantially harder), and 1/4 is entirely reasonable.
Yes. That fits data out thus far.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
> Although the majority of reported COVID-19 cases in China were mild (81%)
Combine the 19% severe cases number out of China with Japan's aging population (which COVID-19 hits substantially harder), and 1/4 is entirely reasonable.
Is "mild" vs. "severe" dichotomous? I feel like I've usually seen the trichotomy of "mild" => not needing hospitalization, "moderate" => needing hospitalization, "severe" => needing ICU treatment.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guida...
> The largest cohort of >44,000 persons with COVID-19 from China showed that illness severity can range from mild to critical38:
> * Mild to moderate (mild symptoms up to mild pneumonia): 81%
> * Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14%
> * Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%
> The largest cohort of >44,000 persons with COVID-19 from China showed that illness severity can range from mild to critical38:
> * Mild to moderate (mild symptoms up to mild pneumonia): 81%
> * Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14%
> * Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%
It's not too harsh. It seems pretty clear to me the blasé conclusion that essentially "things are gonna get much worse in a month" (no duh) was loosely backfilled with numbers after the conclusion was already made.
Writing in a circuitous manner may have been necessary due to the author's immigration status but it's also a very convenient smokescreen that makes his group's results look more dramatic.
For example, the timeline for March 24th, the day before this epic whitepaper was released: "a sporting event is postponed." This "sporting event" was the Tokyo OLYMPICS! But showing that Japan was already starting to take COVID-19 a lot more seriously than some of their public pronouncements may lead you to believe before the whitepaper release date might undercut the article's implication that his whitepaper changed the public narrative and thus the author would be less deserving of asspats and clout.
I've heard people say that this pandemic highlights the (unfortunate) severe lag time of real-life discourse to Twitter's discourse (what is "known" on Twitter versus public narrative).[^1] From that angle this report could be a good thing to try to short-circuit that gap. My opinion is the attempt failed (more accurately their conclusion was already stale), and this writeup brings it right back around to the worst parts of Twitter's discourse - personal brand marketing and clout-chasing.
[^1]: While that's undoubtedly true, Twitter also generates a massive amount of garbage takes which are conveniently forgotten through severe selection bias (looking back with hindsight to see who was right is easy). Online takes also have zero cost compared to reality; you can throw infinite virtual darts at a dartboard but in reality you can steer your meat machine down only one path. Thus there will always be a lag between the two.
Writing in a circuitous manner may have been necessary due to the author's immigration status but it's also a very convenient smokescreen that makes his group's results look more dramatic.
For example, the timeline for March 24th, the day before this epic whitepaper was released: "a sporting event is postponed." This "sporting event" was the Tokyo OLYMPICS! But showing that Japan was already starting to take COVID-19 a lot more seriously than some of their public pronouncements may lead you to believe before the whitepaper release date might undercut the article's implication that his whitepaper changed the public narrative and thus the author would be less deserving of asspats and clout.
I've heard people say that this pandemic highlights the (unfortunate) severe lag time of real-life discourse to Twitter's discourse (what is "known" on Twitter versus public narrative).[^1] From that angle this report could be a good thing to try to short-circuit that gap. My opinion is the attempt failed (more accurately their conclusion was already stale), and this writeup brings it right back around to the worst parts of Twitter's discourse - personal brand marketing and clout-chasing.
[^1]: While that's undoubtedly true, Twitter also generates a massive amount of garbage takes which are conveniently forgotten through severe selection bias (looking back with hindsight to see who was right is easy). Online takes also have zero cost compared to reality; you can throw infinite virtual darts at a dartboard but in reality you can steer your meat machine down only one path. Thus there will always be a lag between the two.
You forgot that test capacity in Japan is still close to nil.
Yeah, I don't understand at all what the purpose of publishing this hash was supposed to be. Is it just to be able to say "I told you so!" (or in this case, I didn't tell you so, but I really did think this) at some later date?
> In a world where I was wrong, people who trust me professionally would likely think less of me. That was an acceptable risk.
Yeah, what a hero taking an extremely slight risk to his reputation in the middle of a pandemic.
Sorry, I normally generally like things patio11 writes on here (he's the bingo card guy, right?) but this whole thing reads like a lengthy ego-stroke.
> In a world where I was wrong, people who trust me professionally would likely think less of me. That was an acceptable risk.
Yeah, what a hero taking an extremely slight risk to his reputation in the middle of a pandemic.
Sorry, I normally generally like things patio11 writes on here (he's the bingo card guy, right?) but this whole thing reads like a lengthy ego-stroke.
"I don't understand at all what the purpose of publishing this hash.."
The author was explicit: "sending up a flare", hoping "someone would read between the lines".
The author was explicit: "sending up a flare", hoping "someone would read between the lines".
The point of the hash is a marker to force yourself to come to terms with your idea.
You make it public and then act on it.
The author has a visa to stay in Japan, a country with strict rules on the disruption of public order. Spreading unfounded speculation on a pandemic might rule afoul of such rules.
The author has a visa to stay in Japan, a country with strict rules on the disruption of public order. Spreading unfounded speculation on a pandemic might rule afoul of such rules.
But...posting a hash doesn't force you to do anything. All it does is help you be cryptographically-verifiably smug after the fact.
But if you didn't act on it then you're just a shmuck that knew something and didn't help their neighbors, if you did act, you can justifiably _be_ smug because you did something about it.
Posting it and acting on it build a "track record" that is harder to dismiss.
Posting it and acting on it build a "track record" that is harder to dismiss.
No, it demonstrates that you're not backtesting whatever your model was to fit the current reality.
I found the post to be lengthy, lacking focus and specificity. More compelling case could be made in a fraction of its length. Hardly worth reading.
The tedious timeline, tweeting hashes as if that meant anything other than: "do you see how I was right all along".
The whole concept of tweeting a hash of a whitepaper as form of endorsing it is kind of absurd.
The tedious timeline, tweeting hashes as if that meant anything other than: "do you see how I was right all along".
The whole concept of tweeting a hash of a whitepaper as form of endorsing it is kind of absurd.
I don't think the set of people whose opinions patio11 cares about would forget about him tweeting that hash (especially given the emphasis he placed on it).
The hash concept depends on social norms, and it's a fairly strongly enforced in his corner of the internet.
The hash concept depends on social norms, and it's a fairly strongly enforced in his corner of the internet.
Most of this seemed blindingly obvious to me and my peers (in the US) at the time that Patrick tweeted his hashes. Several of the replies to his tweets correctly guessed the topic, and most came to similar conclusions. Anybody with half a brain knew what was going on.
Maybe Japanese culture really is "different" and things really did need to be done this way, but I find myself agreeing with other comments here that this whole effort seems puzzlingly labrynthine with relatively little to show for it, other than providing an opportunity to tweet hashes.
Maybe Japanese culture really is "different" and things really did need to be done this way, but I find myself agreeing with other comments here that this whole effort seems puzzlingly labrynthine with relatively little to show for it, other than providing an opportunity to tweet hashes.
Yeah, I think it didn't take much to put two and two together, even without much familiarity with Japan:
https://twitter.com/davidnwelton/status/1241556680833298434
https://twitter.com/davidnwelton/status/1241556680833298434
Yeah, making a secret prediction seems only justified when your position is in the extreme minority and when it contains fairly surprising and/or specific claims. When your claim is just supporting a "strong minority viewpoint", doing so secretly ridiculous.
I think the article points out the justification as a counter point to the likely official statements everywhere that "Nobody could have known".
> A long time ago I did a bit of work on disaster alert systems. They’re not dissimilar to fire alarms. The engineered purpose of a fire alarm is not merely to let people know there is a fire. Many will have already perceived the fire. The alarm, buttressing training delivered far before the alarm rings, gives you unquestionable and immediate permission to evacuate. We know that otherwise some people, smelling smoke and feeling uneasy, would look around the room, see other people not moving, and conclude “Who am I, to disrupt everything going on by shouting ‘Fire! Fire! Fire!’?” The history of humanity has seen far too many rooms where no one shouted ‘Fire!’ early enough.
This alone is a pretty interesting point. Can apply to many other systems that are much less significant than literally "life or death."
This alone is a pretty interesting point. Can apply to many other systems that are much less significant than literally "life or death."
This novella was worth reading just for this gem. It is equally applicable in "boiling frog" scenarios as in the "fire" cases.
The clearest communication about the use of hashes rather than direct publication is laid out quite simply in patio11's original memo:
> I have concerns about saying this loudly because I have an immigration status and because Japan has previously shot the messengers in times of national emergency, including in the wake of the 2011 disaster. As someone who has spent their entire adult life in Japan, who lives here with my wife and children, and who has family on the front lines, I pray daily that I am wrong.
> I have concerns about saying this loudly because I have an immigration status and because Japan has previously shot the messengers in times of national emergency, including in the wake of the 2011 disaster. As someone who has spent their entire adult life in Japan, who lives here with my wife and children, and who has family on the front lines, I pray daily that I am wrong.
At which URL did you find that text? I can't locate it on his site.
I can confirm, though, as an expat, that there is a special kind of fear/restraint involved in needing an opt-in, discretionary permission from a government to be permitted to physically return to your home (which you already paid for) and your family. It causes a lot of security-conscious people to err far on the side of caution, which, indeed, may not even be an error at all.
Immigration policies generally affect a very small minority of people in a country, so strengthening the rights around them simply isn't a priority in most societies, and risks/chilling effects like this fall out as a result.
I can confirm, though, as an expat, that there is a special kind of fear/restraint involved in needing an opt-in, discretionary permission from a government to be permitted to physically return to your home (which you already paid for) and your family. It causes a lot of security-conscious people to err far on the side of caution, which, indeed, may not even be an error at all.
Immigration policies generally affect a very small minority of people in a country, so strengthening the rights around them simply isn't a priority in most societies, and risks/chilling effects like this fall out as a result.
http://media.kalzumeus.com/covid-19/japan-covid19-memo-20200... - linked from “I did not publish the memo at the time.” just before the “ Why did you publish the hash and not the memo?” title.
I usually like patio11's writing style, but this is super verbose even by his standards and oddly evasive/defensive to boot. There's a number of important messages here, but they make up perhaps 10% of the content, and I still don't really fully understand the rationale behind the cloak and dagger "hash of report" business.
> I still don't really fully understand the rationale behind the cloak and dagger "hash of report" business.
I didn’t read every word of it but got the sense there were political and/or Japanese cultural sensitivities why he didn’t initially feel comfortable with a full public, attributed release.
I didn’t read every word of it but got the sense there were political and/or Japanese cultural sensitivities why he didn’t initially feel comfortable with a full public, attributed release.
I think you're being a bit too accommodating. McKenzie does have a flair for the dramatic; he did the same thing with Tether where there really was no reason he couldn't just say what he thought when he thought it.
At the same time, yeah, it seems very plausible that a white guy in Japan announcing the Japanese pandemic response is run by fools would face blowback for it.
At the same time, yeah, it seems very plausible that a white guy in Japan announcing the Japanese pandemic response is run by fools would face blowback for it.
>At the same time, yeah, it seems very plausible that a white guy in Japan announcing the Japanese pandemic response is run by fools would face blowback for it.
Haha, yeah pretty much that. And any blowback may also have been directed at his employer, Stripe. So there was certainly cause for caution.
That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
Having that realization back in January is evidence of foresight, but late March not so much. But maybe the situation was different in Japan and merits it, dunno.
Haha, yeah pretty much that. And any blowback may also have been directed at his employer, Stripe. So there was certainly cause for caution.
That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
Having that realization back in January is evidence of foresight, but late March not so much. But maybe the situation was different in Japan and merits it, dunno.
That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
He made it amply clear to me that it wasn't much of a leap of insight, and the point of his original essay was to create proof that he knew that at the time.
The fact that taking the action that he did resulted in a group of people who put together a compelling enough argument with good enough connections to get the New York Times to write about it DOES seem like it is worthwhile.
As it turned out, having the New York Times asking whether the emperor had clothes caused lots of people in Japan to ask the right question which in turn caused the government to switch courses. The fact that this happened again underscores the point that, on publicly available data at that time, it didn't take an amazing leap of insight to understand that the Japanese story didn't add up.
He made it amply clear to me that it wasn't much of a leap of insight, and the point of his original essay was to create proof that he knew that at the time.
The fact that taking the action that he did resulted in a group of people who put together a compelling enough argument with good enough connections to get the New York Times to write about it DOES seem like it is worthwhile.
As it turned out, having the New York Times asking whether the emperor had clothes caused lots of people in Japan to ask the right question which in turn caused the government to switch courses. The fact that this happened again underscores the point that, on publicly available data at that time, it didn't take an amazing leap of insight to understand that the Japanese story didn't add up.
That is cool if it got the NYT to publish it, and in turn got a national government to upgrade their outbreak response.
>The fact that this happened again
What do you mean by "again" in this sentence? What was the first time?
>The fact that this happened again
What do you mean by "again" in this sentence? What was the first time?
I meant “again underscores the point”.
The point being that this was foreseeable at the time. Which was indicated the first time when he said that he assumed that the authorities in charge with access to more data than he had already had come to same conclusions that he did.
The point being that this was foreseeable at the time. Which was indicated the first time when he said that he assumed that the authorities in charge with access to more data than he had already had come to same conclusions that he did.
> That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
Having that realization back in January is evidence of foresight, but late March not so much.
If this had been obvious to the Japanese authorities in late March they would have declared a nationwide state of emergency in late March, not late April. They would have issued stay at home orders for almost everyone 25 days ago, not five days ago. Being right when the government is wrong, it being wrong will cost lives and trying to get them to save those lives is not trivial.
The doubling time of this virus is well under ten days. If lockdown had begun on the date this memo was published there would be under a quarter as many cases as there are now.
If this had been obvious to the Japanese authorities in late March they would have declared a nationwide state of emergency in late March, not late April. They would have issued stay at home orders for almost everyone 25 days ago, not five days ago. Being right when the government is wrong, it being wrong will cost lives and trying to get them to save those lives is not trivial.
The doubling time of this virus is well under ten days. If lockdown had begun on the date this memo was published there would be under a quarter as many cases as there are now.
Don't know why you were being downvoted, your comment seems reasonable, have an upvote.
I thought the same, like he's walking on eggshells? Maybe it's his assocation with Stripe or due to someone else in the working group? The memo doesn't read as particularly controversial nor did it recommend much concrete action.
I left Japan in early March, by personal anecdote masks seemed pretty ubiquitious (and all public facing employees were wearing them), hotels were screening guest temperatures, warning signs everywhere, etc.. Time will tell, but I still think I'd have been better of staying there than returning to the US.
I left Japan in early March, by personal anecdote masks seemed pretty ubiquitious (and all public facing employees were wearing them), hotels were screening guest temperatures, warning signs everywhere, etc.. Time will tell, but I still think I'd have been better of staying there than returning to the US.
That is his m.o. when critiquing Japan.
If you read between the lines to what he is really saying, I would think you would revise your opinion substantially.
If you read between the lines to what he is really saying, I would think you would revise your opinion substantially.
> The memo doesn't read as particularly controversial nor did it recommend much concrete action.
Well it was pointing out that the current plan was B.S. and had already failed, and that the testing plan in place resisted falsification by preventing testing of unconnected / asymptomatic people. no biggie.
The point of the memo was to gather and surface disparate information already public separately un-worrisome but that together might be able to be paid enough attention to for a (positive) governmental reaction.
It was to force agencies to connect dots that the authors believe were not being connected. (Maybe it just wasn’t anybody’s job to connect them)
Well it was pointing out that the current plan was B.S. and had already failed, and that the testing plan in place resisted falsification by preventing testing of unconnected / asymptomatic people. no biggie.
The point of the memo was to gather and surface disparate information already public separately un-worrisome but that together might be able to be paid enough attention to for a (positive) governmental reaction.
It was to force agencies to connect dots that the authors believe were not being connected. (Maybe it just wasn’t anybody’s job to connect them)
Perhaps that's on purpose. Perhaps he wants to avoid being sued, or similar things. Patrick has a ton of credibility and I would give him the benefit of the doubt here.
> This is a very different essay than my typical work. It may be judged to very different standards in very different quarters than usual. Please excuse my need to write more reservedly and participate less in subsequent commentary than I usually would. Some truths have social consequences, acknowledged or not.
The purpose of the overall evasiveness could be to prevent personal retaliation of some kind - that would be understandable. But why avoid mentioning the word Olympics and instead call it "the sporting event" repeatedly? Especially now when your connection to the white paper is public.
Maybe because the virus and Olympics are both sensitive topics of national pride in a country that has turned increasingly nationalistic.
Japan has a conviction rate of over 99%. If a prosecutor decides you're guilty of something, it's basically a done deal. You don't want to get on the wrong side of authorities in a country like that.
Japan has a conviction rate of over 99%. If a prosecutor decides you're guilty of something, it's basically a done deal. You don't want to get on the wrong side of authorities in a country like that.
> Japan has a conviction rate of over 99%. If a prosecutor decides you're guilty of something, it's basically a done deal.
I thought that was because the prosecutors are very conservative about choosing what cases to prosecute in the first place, only going after effective slam dunks.
I thought that was because the prosecutors are very conservative about choosing what cases to prosecute in the first place, only going after effective slam dunks.
Long pre-trial detention in some rather uncomfortable situation and social isolation might help you obtain more "confessions" than in a different system.
Probably because you could end up losing your visa and get sued by the Olympic Committee if you say 'Shinzo Abe is suppressing covid-19 research because of the Olympics.' Maybe even jail time.
That's not how Japanese immigration or prosecution work. What law or immigration requirement would he be breaking?
Also, tons of people have been saying that for months, both native and foreign.
Also, tons of people have been saying that for months, both native and foreign.
> That's not how Japanese immigration or prosecution work
Please enlighten us. How does public defamation work in Japan then? I don't know much but I did just google it right now[0] and to my layman eyes it looks bad:
> “(1) A person who defames another by alleging facts in public shall, regardless of whether such facts are true or false, be punished by imprisonment with or without work for not more than three (3) years or a fine of not more than 500,000 yen.”
[0]: https://kellywarnerlaw.com/japan-defamation-laws/
Please enlighten us. How does public defamation work in Japan then? I don't know much but I did just google it right now[0] and to my layman eyes it looks bad:
> “(1) A person who defames another by alleging facts in public shall, regardless of whether such facts are true or false, be punished by imprisonment with or without work for not more than three (3) years or a fine of not more than 500,000 yen.”
[0]: https://kellywarnerlaw.com/japan-defamation-laws/
Japan has a conviction rate of 99.9%.
There is a difference between someone with a big internet presence and someone without one saying something.
There is a difference between someone with a big internet presence and someone without one saying something.
He may be afraid of non-official censure. He may be afraid of his employer getting publically crapped on for the bad behaviour of it's employee. (In this case, the bad behaviour is causing waves.)
If you have direct knowledge of how Japanese official process works in practice, could you relate it along with this observation? Because a thing not in much doubt on HN is that Patrick does have some significant experience with it.
Sure happy to share. I guess most people would be surprised, but Japan has very straightforward and easy immigration if you meet the right conditions, of which Patrick is a shoe-in. He probably already has permanent residency, but if not, he could either be on a work visa or a spousal visa. None of those are going to get rejected because he did some amateur pandemic modeling.
Assuming someone at immigration would take the time to look into his background (not just his paperwork), find out that he wrote a Covid-19 white paper with higher projections than the government at the time and then blacklist him for it is such a mischaracterization of Japanese process, I don't know where to start. It's not like there's a source I can reference, but I also have a lot of knowledge of Japanese immigration through knowing plenty of foreigners on different visas in Japan and have never heard of anyone getting rejected if they meet the conditions.
I can share one interesting anecdotal counter-example to show how easygoing Japanese immigration is. Someone I knew was on a fraudulent work visa "working" for a friend. He was actually creating a startup. By the time immigration found out, he had the necessary scale to sponsor his own work visa, so he wrote an apology letter and then switched to his own work visa even though the foundation of the company was built on a fraudulent visa.
Assuming someone at immigration would take the time to look into his background (not just his paperwork), find out that he wrote a Covid-19 white paper with higher projections than the government at the time and then blacklist him for it is such a mischaracterization of Japanese process, I don't know where to start. It's not like there's a source I can reference, but I also have a lot of knowledge of Japanese immigration through knowing plenty of foreigners on different visas in Japan and have never heard of anyone getting rejected if they meet the conditions.
I can share one interesting anecdotal counter-example to show how easygoing Japanese immigration is. Someone I knew was on a fraudulent work visa "working" for a friend. He was actually creating a startup. By the time immigration found out, he had the necessary scale to sponsor his own work visa, so he wrote an apology letter and then switched to his own work visa even though the foundation of the company was built on a fraudulent visa.
I cofounded a company with Patrick several years ago and have known him for a long time, and in that entire time he has lived full time in Japan. I don't know the particulars of his immigration situation, but if I had to hazard a guess, yes, he's a PR.
I don't know anything in particular about his concerns about his own status. I have, on the other hand, known many LPRs in the US who were extraordinarily careful about their engagement in public matters out of concern about their status.
If your argument is that protection for PRs in Japan is stronger than that of US LPRs, I'm going to go ahead and call that an extraordinary claim. At some point, though, probably rapidly approaching, litigating this point becomes ghoulish. I haven't heard Patrick say he's specifically concerned about his own status, but he's clearly concerned about some of the people he worked with.
I don't know anything in particular about his concerns about his own status. I have, on the other hand, known many LPRs in the US who were extraordinarily careful about their engagement in public matters out of concern about their status.
If your argument is that protection for PRs in Japan is stronger than that of US LPRs, I'm going to go ahead and call that an extraordinary claim. At some point, though, probably rapidly approaching, litigating this point becomes ghoulish. I haven't heard Patrick say he's specifically concerned about his own status, but he's clearly concerned about some of the people he worked with.
known many LPRs in the US who were extraordinarily careful about their engagement in public matters out of concern about their status.
That has to be a function of knowing a particular variety of (however reasonably) paranoid LPR's, though, no? I can't imagine it being a core concern for the vast majority of LPRs.
That has to be a function of knowing a particular variety of (however reasonably) paranoid LPR's, though, no? I can't imagine it being a core concern for the vast majority of LPRs.
I assume most LPRs aren't really in a position to have to think about being engaged with public policy, and the LPRs I tend to know work in a field that intersects a bit more with policy.
Maybe I'm misreading something but do you mean their status as a person engaged in public policy? There's obviously a lot one can sensibly worry about while an LPR but I have a hard time seeing how even the most ill-advised engagement in public policy (short of things like fomenting insurrection) would lead to loss of the actual LRP status. Like, what would even the mechanism be?
I think your anecdote only shows how much discretion the immigration department has in enforcing the law. That same discretion could easily go the other way if someone were to embarrass Japanese authorities.
reverse SEO?
aikinai(1)
> Over a roughly 2 week period, we would expect approximately 64,000 passengers to fly from Japan to Singapore. 3 infections in that population is a rate of approximately 47 basis points, which is 5X the 9 basis points rate of infection in Japan. If one believes the government, the rate with surveilled clusters backed out be a tiny fraction of 9 basis points.
This argument is a bit flawed. People that travel from Japan to Singapore are not a perfect sample of Japan's population - they might be more likely to be infected, as they might travel more than the average Japanese person.
This argument is a bit flawed. People that travel from Japan to Singapore are not a perfect sample of Japan's population - they might be more likely to be infected, as they might travel more than the average Japanese person.
Three is way too few samples to draw any statistics from anyway. It does suggest untracked transmission in Japan. And that's about it.
When I read that part I was disappointed to have been lured into reading another iteration of "I multiply numbers without tracking associated uncertainty". Sigh. That stuff runs rampant at the moment.
When I read that part I was disappointed to have been lured into reading another iteration of "I multiply numbers without tracking associated uncertainty". Sigh. That stuff runs rampant at the moment.
This is just my 2 cents but according to https://www.worldometers.info/coronavirus/#countries Japan has only done 923 tests for 1M of their population. That's much lower than any developed nation. One thing the article claims is the spread of the virus by asymptomatic infected people. Given this low level of testing - it's hard to gauge the true level of infection in the country - although the continuous decrease on daily cases is good, it doesn't mean it cannot spike back up. We just have to wait and see what happens.
What I find confusing though is Japan's low death numbers. I was assuming that spikes in mortality couldn't be hidden, but recent comments from inside sources in Japanese hospitals are starting to make me doubt this assumption. Still, there is not a crisis on Lombardia-level going on, which one would expect given the relative inaction of Japanese government. I'm guessing the truth is somewhere in the middle - Japan's reported numbers are underestimating the issue, but at the same time Japanese society is as a whole more resistant than at least Southern Europe.
I mean, look at the comorbidity data - heart disease, hypertension, diabetes - aren't the Japanese one of the healthiest people in the world?
Yes, but the population is even older than in Italy, which is also a big factor.
One theory is that people are dying but it hasn't been discovered yet because of people staying inside. see https://en.wikipedia.org/wiki/Kodokushi
Having just ridden the Yamanote today though, it's unreal how empty it is.
Having just ridden the Yamanote today though, it's unreal how empty it is.
I doubt there's much overlap in people who have so little human contact that no one knows they're dead and people who catch viruses that are still present in only a tiny fraction of the population.
Oh, and a third condition that these people be such recluses that they don't even call a doctor when deathly ill.
Oh, and a third condition that these people be such recluses that they don't even call a doctor when deathly ill.
Even people with little human social interaction need to get groceries from somewhere...
Dude, you're talking about the country that christened the hikikomori phenomenon...
There are undoubtedly recluses, but do they also have frequent contact with people to catch diseases from?
You can catch covid in many ways, it lives on hard surfaces for days.
Japan is a country where at the best of times, a lot of people die at home and are not discovered for some time. If you remove social contacts thanks to lockdown, this is going to become more common.
See https://en.wikipedia.org/wiki/Kodokushi for more.
See https://en.wikipedia.org/wiki/Kodokushi for more.
Yes, that happens sometimes, but no, there are not thousands of unnoticed dead people in their apartments in Japan.
Occam’s razor in this case is that the pandemic in Japan isn’t as bad as the author projected. It’s not a conspiracy or coverup and there aren’t dead bodies hiding everywhere, the author was just wrong.
Occam’s razor in this case is that the pandemic in Japan isn’t as bad as the author projected. It’s not a conspiracy or coverup and there aren’t dead bodies hiding everywhere, the author was just wrong.
Here are the facts as we have them.
From https://www.worldometers.info/coronavirus/country/japan/ Japan admits to about 10,000 cases now, with a doubling time of about 11 days so they will admit to 20,000 cases by the end of the month.
If you read https://www.who.int/bulletin/online_first/20-254565.pdf you will find credible reasoning for 90% of COVID-19 cases not being tracked in official numbers, with a wide uncertainty. That correction would make it 200,000 cases in Japan by the end of the month. If you update that argument with the lower IFRs suggested in https://www.cebm.net/covid-19/global-covid-19-case-fatality-... then you get to a projection of 500,000 cases in Japan. (The admittedly problematic Stanford study came up with a suggestion of similar underreporting factors in both Santa Clara and Los Angeles.)
Alternately we could arrive at a similar conclusion if you assume that Japan is doing less testing than average. And there is considerable evidence that this is true.
We therefore do not have reason from the officially reported figures that he is wrong.
Now let'd deal with the dead bodies argument.
Deaths trail infections with roughly a 3 week lag. (A week to get sick, 2 weeks to die.) Let's go back to the simple model of 90% of infections are not reported and the true fatality rate is 1%. On March 31 there were 1700 official cases. On that model there were 17,000 infected of which 170 should die. Guess what? Today there are officially 263 dead bodies.
We. Don't. Even. Have. A. Shortage. Of. Known. Bodies.
The stated conclusions only look absurd to anyone who HASN'T tried to understand the dynamics of exponential growth, and the problems with the official data. He might or might not have been correct. But directionally he was clearly a lot more right than the official government position at the time.
From https://www.worldometers.info/coronavirus/country/japan/ Japan admits to about 10,000 cases now, with a doubling time of about 11 days so they will admit to 20,000 cases by the end of the month.
If you read https://www.who.int/bulletin/online_first/20-254565.pdf you will find credible reasoning for 90% of COVID-19 cases not being tracked in official numbers, with a wide uncertainty. That correction would make it 200,000 cases in Japan by the end of the month. If you update that argument with the lower IFRs suggested in https://www.cebm.net/covid-19/global-covid-19-case-fatality-... then you get to a projection of 500,000 cases in Japan. (The admittedly problematic Stanford study came up with a suggestion of similar underreporting factors in both Santa Clara and Los Angeles.)
Alternately we could arrive at a similar conclusion if you assume that Japan is doing less testing than average. And there is considerable evidence that this is true.
We therefore do not have reason from the officially reported figures that he is wrong.
Now let'd deal with the dead bodies argument.
Deaths trail infections with roughly a 3 week lag. (A week to get sick, 2 weeks to die.) Let's go back to the simple model of 90% of infections are not reported and the true fatality rate is 1%. On March 31 there were 1700 official cases. On that model there were 17,000 infected of which 170 should die. Guess what? Today there are officially 263 dead bodies.
We. Don't. Even. Have. A. Shortage. Of. Known. Bodies.
The stated conclusions only look absurd to anyone who HASN'T tried to understand the dynamics of exponential growth, and the problems with the official data. He might or might not have been correct. But directionally he was clearly a lot more right than the official government position at the time.
"Sometimes" is doing a lot of heavy lifting during a viral pandemic which hasn't been matched in severity for the last century.
You are correct that official coronavirus deaths are low. But official influenza deaths (blue diamonds) were almost double their baseline value (green line) and above a threshold value (purple line, but I don't know enough Japanese to know what threshold) back in week 8 of this year (late Feb, early March, depending on how you count it.)
https://www.niid.go.jp/niid/ja/flu-m/2112-idsc/jinsoku/1852-...
I wonder if there are other, non-coronavirus causes of death that are significantly above their normal values?
https://www.niid.go.jp/niid/ja/flu-m/2112-idsc/jinsoku/1852-...
I wonder if there are other, non-coronavirus causes of death that are significantly above their normal values?
To give an indication of how low that testing is, on that site Japan is ranked #119th country in the world in terms of testing.
We often conflate asymptomatic and presymptomatic people: my understanding is that asymptomatic people aren't very infectious, but presymptomatic people are. I can't find a solid citation for this, though.
The mechanistic basis for that is simply viral load: asymptomatic people have some virus, but not enough to ever make them really ill, whereas presymptomatic people have loads of virus, but it hasn't made them really ill yet.
The mechanistic basis for that is simply viral load: asymptomatic people have some virus, but not enough to ever make them really ill, whereas presymptomatic people have loads of virus, but it hasn't made them really ill yet.
With this disease it appears asymptomatic people are equally infectious.
That was very much not my understanding. Do you have a proper technical source for that? I don't, and i wish i did!
https://jamanetwork.com/journals/jama/fullarticle/2762028
TL;DR contact tracing shows numerous cases of asymptomatic people that have introduced the disease to people near them.
TL;DR contact tracing shows numerous cases of asymptomatic people that have introduced the disease to people near them.
There is a world of difference between "asymptomatic people are infectious" and "asymptomatic people are AS infectious".
I saw early estimates based on detailed modeling from Chinese data that asymptomatic people were about half as infectious as symptomatic ones. I have not seen any such estimates for some time though, nor ones based on more recent data samples.
Given the widespread distrust of the Chinese reporting on what happened in January, and the fact that estimates of how infectious this is have approximately doubled from early estimates, I don't trust that early reporting. I would also love to see an estimate of how much more or less people are infectious when they are asymptomatic.
Given that I don't doubt that they can be infectious, research showing that they can be is not answering the question that I have.
I saw early estimates based on detailed modeling from Chinese data that asymptomatic people were about half as infectious as symptomatic ones. I have not seen any such estimates for some time though, nor ones based on more recent data samples.
Given the widespread distrust of the Chinese reporting on what happened in January, and the fact that estimates of how infectious this is have approximately doubled from early estimates, I don't trust that early reporting. I would also love to see an estimate of how much more or less people are infectious when they are asymptomatic.
Given that I don't doubt that they can be infectious, research showing that they can be is not answering the question that I have.
Assuming the ratio of cases with symptoms to cases without symptoms usually remains the same, I must admit I don't immediately understand why it would be important to determine the amount of asymptomatic cases to determine the risk. It seems to me the growth rate of (symptomatic) cases would be the major indicator for that. (Obviously it would be of general interest, but I mean specifically with respect to gauging the risk).
It all seems to hinge on the assumption that with the implemented "strategy A", nobody with pneumonia would be tested for Covid19 unless they have a known connection to a symptomatic case. That of course would be a mistake. But were people really that complacent that it would never occur to them to test for Covid19, even as the rest of the world is talking about nothing else? (Availability of tests is of course a factor here, but should only be a temporary impediment).
I am interested in it, because here in Germany there also is currently a discussion of the virus spreading silently, only to come back in full force in fall if we become complacent. I must admit I don't fully understand the logic behind that, as surely when it spreads silently, it also has a proportion of symptomatic cases in its wake, so that in the end, it doesn't spread silently after all.
It all seems to hinge on the assumption that with the implemented "strategy A", nobody with pneumonia would be tested for Covid19 unless they have a known connection to a symptomatic case. That of course would be a mistake. But were people really that complacent that it would never occur to them to test for Covid19, even as the rest of the world is talking about nothing else? (Availability of tests is of course a factor here, but should only be a temporary impediment).
I am interested in it, because here in Germany there also is currently a discussion of the virus spreading silently, only to come back in full force in fall if we become complacent. I must admit I don't fully understand the logic behind that, as surely when it spreads silently, it also has a proportion of symptomatic cases in its wake, so that in the end, it doesn't spread silently after all.
The asymptomatic cases can also spread the disease, and a single individual is enough to trigger another outbreak if they slip through the cracks, so for contact tracing and everything you need to know how many asymptomatic cases there might be and where they might be. And the wake might not be spread evenly throughout the population, you could end up with younger individuals being asymptomatic and creating a breeding ground for the virus to spread and mutate in a college town before, even though it seems to be under control, it spreads back to vulnerable populations where everyone is symptomatic. That's one extreme of this but we don't know without random testing how bad it is towards that end
It's not important to determine the amount of asymptomatic cases, but it's important to detect asymtomatic individuals so that their contacts can be traced and tested as well.
This was not done, and "strategy A" failed because of that.
This was not done, and "strategy A" failed because of that.
It would be exceptionally difficult—if not outright impossible—for me to write something like this and not once make even a passing attempt to imply blame or culpability for a core dishonesty that may well end up causing thousands of deaths.
Patrick, I admire your professionalism and restraint in service of your goals.
Patrick, I admire your professionalism and restraint in service of your goals.
Must the conclusion be all one way or the other?
Maybe cluster containment was a bad strategy, but not horrible? Maybe masks and voluntary distancing had a little effect, but not enough? Maybe cases were undercounted, but not to the tune of 90-99%?
Maybe cluster containment was a bad strategy, but not horrible? Maybe masks and voluntary distancing had a little effect, but not enough? Maybe cases were undercounted, but not to the tune of 90-99%?
Near the top patio11 writes: "Our choice to be anonymous was a considered one and is discussed in more detail below.".
I cannot find where it's discussed in more detail below. Can someone point me to it?
I cannot find where it's discussed in more detail below. Can someone point me to it?
> There are few conspiracies in the world. There are many systems with complicated decision-making processes, internal data flows, and incentive structures for actors within them.
The second sentence here is absolutely correct, but it directly contradicts the first one. Because a "conspiracy" is nothing more than having a group of those actors, with aligned incentives, coordinating to work together while hiding that coordination with other actors whose incentives are in opposition.
The second sentence here is absolutely correct, but it directly contradicts the first one. Because a "conspiracy" is nothing more than having a group of those actors, with aligned incentives, coordinating to work together while hiding that coordination with other actors whose incentives are in opposition.
I disagree. The second sentence is about uncoordinated actors making decisions, without anyone conspiring together. The emergent behaviour may look like a conspiracy, which is what he is pointing out.
What is the difference between "looking like a conspiracy" and "being a conspiracy"?
The actors' intent.
Actual conspiracies involve deceit, misdirection, and ill will.
"Never attribute to malice that which can adequately be explained by incompetence."
It's not a perfect rule, but it is a helpful idea to keep in mind.
Actual conspiracies involve deceit, misdirection, and ill will.
"Never attribute to malice that which can adequately be explained by incompetence."
It's not a perfect rule, but it is a helpful idea to keep in mind.
This seems a bit over-the-top. Sure, maybe Japan isn't testing and is just treating pneumonia cases as pneumonia cases instead of the cornavirus cases they actually are, but if that is allowing society to function mostly normally and isn't changing death rates all that much I don't see the harm. Arguably that is a better response than shutting down your economy and creating massive debt problems that will need to be resolved later.
The death rate from COVID-19 is a constant: about ~1% of all cases, so far as is currently known.
If the R0 of the virus is about 2 (which from evidence is about the case for uncontained spread, possibly higher) then half of your entire case load is discovered in the last increment.
That period is (roughly) 14 days from infection to the onset of symptoms. We cannot build a hospital, nor train doctors and nurses, in 14 days.
But here's the thing: the hospitalization rate - which is what keeps the death rate at 1% - is around 10 - 15%. And both those numbers are constants, multiplied against an exponential factor. And hospital stays are around 3 to 4 weeks long.
By the time your hospital beds are 50% full, you're already out of capacity - the next wave is going to be being denied treatment. And in fact, anyone else who has an otherwise treatable but potentially life-threatening condition is also going to be denied treatment. At which point a lot of your deaths aren't going to be directly due to COVID-19...but that's really not going to matter.
If the R0 of the virus is about 2 (which from evidence is about the case for uncontained spread, possibly higher) then half of your entire case load is discovered in the last increment.
That period is (roughly) 14 days from infection to the onset of symptoms. We cannot build a hospital, nor train doctors and nurses, in 14 days.
But here's the thing: the hospitalization rate - which is what keeps the death rate at 1% - is around 10 - 15%. And both those numbers are constants, multiplied against an exponential factor. And hospital stays are around 3 to 4 weeks long.
By the time your hospital beds are 50% full, you're already out of capacity - the next wave is going to be being denied treatment. And in fact, anyone else who has an otherwise treatable but potentially life-threatening condition is also going to be denied treatment. At which point a lot of your deaths aren't going to be directly due to COVID-19...but that's really not going to matter.
Okay, but this appears to not be happening in Japan. Why not? If your answer is, it's going to happen, then why hasn't it happened already if things are truly as dire as the original essay is saying?
Edit: It also appears to not be happening in Sweden. I think a lot of the modeling of this is flawed.
Edit: It also appears to not be happening in Sweden. I think a lot of the modeling of this is flawed.
I'll be a lot more interested when it hasn't happened 2 weeks from now.
[deleted]
Random comments in this frame of context:
- I've seen/heard some doctors saying publicly, on Japanese TV, mid-March, "I think there are 10 times more cases than reported"
- There's an average of 270 deaths per day from pneumonia on a normal year in Japan (100k).
- The largest number of deaths announced from COVID-19 in a single day was, I think, yesterday, and it was 20.
- Deaths from pneumonia that aren't tested could very well appear to be in the noise of normal pneumonia deaths, easily hiding the real death toll. It doesn't take malicious intent for this to happen, just people following the rules (see below).
- Generally speaking, Japanese institutions have a very difficult time moving outside the box. If they have a written plan that is to be followed, that is what happens.
- The plan was to test people who had 4 consecutive days of fever (2 for older people) and close contact with people already diagnosed, and that's what happened.
- It took prefecture governors starting to do things on their own for the central government to start moving. That happened for school closures (Hokkaido leading the way, then Osaka, IIRC), and sending mild cases to hotels or making them stay at home, rather than occupy beds in hospitals (started in Osaka, IIRC)
- Hospitals have a shortage of equipment, and beds. Some prefectures have ramped up the number of available beds for infectious diseases. The government finally changed the rules to allow mild cases to be isolated out of hospitals (I think about a week ago, but it's hard to keep track of time these days).
- Some hospitals have closed their doors completely. The reason? Clusters of COVID-19 in staff and patients. Not because they were treating COVID-19 patients as COVID-19 patients. But because they were treating patients that turned out to have COVID-19. Or people with COVID-19 going there for consultations. Which is not all that surprising when you know people are reportedly going from hospital to hospital to try to be tested for COVID-19. If anything, I'm surprised there aren't more clusters in hospitals.
- There have been reports of ambulances having to try a large number of hospitals before finding an ER able to attend to their non-COVID-19 patient.
I wrote this on April 4: "the political response to covid-19 in Japan is pissing me off now. It now feels like watching a 100 km/h car running into a wall in slow motion, and the car is already in contact with the wall and absorbing kinetic energy."
Almost 3 weeks later, I think we're seeing the engine entering the passenger cabin.
- I've seen/heard some doctors saying publicly, on Japanese TV, mid-March, "I think there are 10 times more cases than reported"
- There's an average of 270 deaths per day from pneumonia on a normal year in Japan (100k).
- The largest number of deaths announced from COVID-19 in a single day was, I think, yesterday, and it was 20.
- Deaths from pneumonia that aren't tested could very well appear to be in the noise of normal pneumonia deaths, easily hiding the real death toll. It doesn't take malicious intent for this to happen, just people following the rules (see below).
- Generally speaking, Japanese institutions have a very difficult time moving outside the box. If they have a written plan that is to be followed, that is what happens.
- The plan was to test people who had 4 consecutive days of fever (2 for older people) and close contact with people already diagnosed, and that's what happened.
- It took prefecture governors starting to do things on their own for the central government to start moving. That happened for school closures (Hokkaido leading the way, then Osaka, IIRC), and sending mild cases to hotels or making them stay at home, rather than occupy beds in hospitals (started in Osaka, IIRC)
- Hospitals have a shortage of equipment, and beds. Some prefectures have ramped up the number of available beds for infectious diseases. The government finally changed the rules to allow mild cases to be isolated out of hospitals (I think about a week ago, but it's hard to keep track of time these days).
- Some hospitals have closed their doors completely. The reason? Clusters of COVID-19 in staff and patients. Not because they were treating COVID-19 patients as COVID-19 patients. But because they were treating patients that turned out to have COVID-19. Or people with COVID-19 going there for consultations. Which is not all that surprising when you know people are reportedly going from hospital to hospital to try to be tested for COVID-19. If anything, I'm surprised there aren't more clusters in hospitals.
- There have been reports of ambulances having to try a large number of hospitals before finding an ER able to attend to their non-COVID-19 patient.
I wrote this on April 4: "the political response to covid-19 in Japan is pissing me off now. It now feels like watching a 100 km/h car running into a wall in slow motion, and the car is already in contact with the wall and absorbing kinetic energy."
Almost 3 weeks later, I think we're seeing the engine entering the passenger cabin.
I really appreciate this post. It's hard to read, but this seems very intentional. There are a number of salient points that are very specifically not stated. Some questions deliberately not answered:
Who was on the Working Group, other than Patrick? Dr. Tyler Cowen spread the results, but no one is mentioned as working in the group other than Patrick. This seems designed to limit potential social fallout to other parties. The whole "Someone read between the lines" section would be much easier to read with the relevant person named. Also consider that Patrick may be limiting fallout to himself here, with the bold statement early on that "I instigated the Working Group and I was the primary author of its white paper."
Did the NYT article writer correspond with the Working Group? The white paper was published with plenty of time before the article was written, and the explicit goal of the Working Group was to "leverage a news organization." Also consider that the NYT article was published on Thursday. And when discussing the goals of the working group, "This implied a publication deadline of Thursday. We assumed media organizations would need our work by Wednesday to check it and produce reporting informed by it." Note that Dr. Cowen's quick post was also published on Thursday, possibly to increase deniability when referring to that goal date.
What Japanese organizations failed to respond to this crisis? The most damning prose in the entire article is "May all judgments be just and merciful." Patrick does not identify any Japanese organization or government by name, but says that the Working Group spoke to many of them. Also, both memos are listed in the timeline immediately before a announcement by Governor Koike. Patrick even convolutes his prose to the point where he never mentions the Olympics. I wouldn't be surprised if he had another sporting event in mind that also matched the specifics of what he wrote.
How much influence did the Working Group have in Japan's response? The NYT article is definitely one potential point of influence, but it seems that the memo itself was shared widely. Consider the difference between this humble ending to the article: "I am a responsible professional. I have no relevant expertise or authority. I have avoided unproductive criticism. I might have made some guesses, during a year when many people were guessing on many topics. I quietly told some people about them. Some guesses may, perhaps by happenstance, align with official guidance and credible published reporting." and his tweet confirming the memo (option 1): "I am materially wrong about the most consequential thing I've had to have a view on in 15 years. You should probably degrade your estimate of my ability to think through complex problems."
Interpreting things through an aggressive lens, I read this as a scathing diatribe against the Japanese government, where a non-expert foreigner living in Japan has to get the Western media involved before the government would admit to there being a problem. Props to the governor of Tokyo for being more on top of this than anyone else (perhaps with the Working Group's involvement), but the national government completely dragged its feet until it was forced by international pressure to start asking real questions.
But I'm probably reading too much into it. Patrick's too humble of a guy to say all of that.
Who was on the Working Group, other than Patrick? Dr. Tyler Cowen spread the results, but no one is mentioned as working in the group other than Patrick. This seems designed to limit potential social fallout to other parties. The whole "Someone read between the lines" section would be much easier to read with the relevant person named. Also consider that Patrick may be limiting fallout to himself here, with the bold statement early on that "I instigated the Working Group and I was the primary author of its white paper."
Did the NYT article writer correspond with the Working Group? The white paper was published with plenty of time before the article was written, and the explicit goal of the Working Group was to "leverage a news organization." Also consider that the NYT article was published on Thursday. And when discussing the goals of the working group, "This implied a publication deadline of Thursday. We assumed media organizations would need our work by Wednesday to check it and produce reporting informed by it." Note that Dr. Cowen's quick post was also published on Thursday, possibly to increase deniability when referring to that goal date.
What Japanese organizations failed to respond to this crisis? The most damning prose in the entire article is "May all judgments be just and merciful." Patrick does not identify any Japanese organization or government by name, but says that the Working Group spoke to many of them. Also, both memos are listed in the timeline immediately before a announcement by Governor Koike. Patrick even convolutes his prose to the point where he never mentions the Olympics. I wouldn't be surprised if he had another sporting event in mind that also matched the specifics of what he wrote.
How much influence did the Working Group have in Japan's response? The NYT article is definitely one potential point of influence, but it seems that the memo itself was shared widely. Consider the difference between this humble ending to the article: "I am a responsible professional. I have no relevant expertise or authority. I have avoided unproductive criticism. I might have made some guesses, during a year when many people were guessing on many topics. I quietly told some people about them. Some guesses may, perhaps by happenstance, align with official guidance and credible published reporting." and his tweet confirming the memo (option 1): "I am materially wrong about the most consequential thing I've had to have a view on in 15 years. You should probably degrade your estimate of my ability to think through complex problems."
Interpreting things through an aggressive lens, I read this as a scathing diatribe against the Japanese government, where a non-expert foreigner living in Japan has to get the Western media involved before the government would admit to there being a problem. Props to the governor of Tokyo for being more on top of this than anyone else (perhaps with the Working Group's involvement), but the national government completely dragged its feet until it was forced by international pressure to start asking real questions.
But I'm probably reading too much into it. Patrick's too humble of a guy to say all of that.
> Who was on the Working Group, other than Patrick?
An interesting question—but if they wanted to be publicly known, they would be. I’d rather leave that to them.
> Patrick even convolutes his prose to the point where he never mentions the Olympics. I wouldn't be surprised if he had another sporting event in mind that also matched the specifics of what he wrote.
The NPB season was originally scheduled to start March 20 but has been postponed, with the original postponement decision announced March 9. The Olympics were postponed on March 24; the hash dates from March 25th.
An interesting question—but if they wanted to be publicly known, they would be. I’d rather leave that to them.
> Patrick even convolutes his prose to the point where he never mentions the Olympics. I wouldn't be surprised if he had another sporting event in mind that also matched the specifics of what he wrote.
The NPB season was originally scheduled to start March 20 but has been postponed, with the original postponement decision announced March 9. The Olympics were postponed on March 24; the hash dates from March 25th.
I love Patrick's posts but this is long, even for his standards. Can someone summarize the main points?
No. It's well worth your time to read the whole piece.
lalaland1125(5)
Cool. Did you trade on it?
> I felt, while my subjective confidence was 90%, that I was likely miscalibrated. The likelihood that one non-expert, doing casual sleuthing in his spare time, had scooped not just any expert but almost all the experts and almost all the parties in formal authority felt infinitesimally small.
So...was it just a coincidence that the results seem vindicated? Or is the above statement just too much modesty? Or both?
So...was it just a coincidence that the results seem vindicated? Or is the above statement just too much modesty? Or both?
There's a whole section at the end with his theories about why you could expect someone like him to get this better than the experts (the experts were too busy managing the intricacies of Plan A instead of constantly rigorously checking that its assumptions still held and whether it was time to give up and switch to Plan B, etc), and he makes a point against having too much modesty like he did if you have good data.
There is no way Japan's faux-success is due solely or even dominantly to asymptomatic cases, they had to be turning a blind eye to symptomatic ones as well and attributing them to pneumonia, flu etc.
The fact that the reported rates began rising only after the Tokyo Olympics were announced cancelled is almost a USSR-era farce.
Japan has a leading hospital-bed-per-capita capacity in the OECD which could help them conceal this but I believe if occupancy of those beds was graphed for the last two months we'd see a curve indicating an epidemic comparable with US and Europe.
Japan has a leading hospital-bed-per-capita capacity in the OECD which could help them conceal this but I believe if occupancy of those beds was graphed for the last two months we'd see a curve indicating an epidemic comparable with US and Europe.
Then where are the overwhelmed hospitals? Where are the bodies?
They're not overwhelmed yet because they have capacity (NYC hospitals are struggling but are not over capacity either), deaths happen all the time especially in a country with aging population like Japan and are just not counted as covid19, like the author says it will probably be visible in excess deaths statistics once those are published.
Oh my. The Japanese government should feel ashamed to have hidden all of this from the public (edit: I mean the real data and the real gravity of the situation, of course). I, for one, fled the US to come to Japan for a few weeks because I mostly believed these numbers.
I hate this. I really hate that politicians (all over the world, in this specific case in Japan) can afford to treat us like this, and usually not face any significant consequence.
I hate this. I really hate that politicians (all over the world, in this specific case in Japan) can afford to treat us like this, and usually not face any significant consequence.
>I, for one, fled the US to come to Japan for a few weeks because I mostly believed these numbers.
SARS-CoV-2 thanks you for your efforts to help it find new populations to replicate in.
SARS-CoV-2 thanks you for your efforts to help it find new populations to replicate in.
Yeah, considering that you can be asymptomatic for quite a few days that was an extraordinarily selfish act. Fear made them a vector. Feels like the guy in a zombie movie who tries to break the door down to get into the safe room.
Or like Charles Campion in The Stand.
The prior 3 weeks I was in a remote area with essentially no contact with anyone. I came back to SF, stayed at home for one night, and left.
Also, if I feel endangered, I have every right to decide where to go. You might see it as selfish, I see why. At least I am paying my useless and expensive health insurance in the US (out of my own pocket, because you know what? I'm unemployed right now) to support the system, even if I am not taking advantage of it.
Sometimes things are a bit more complicated than "SARS-CoV-2 thanks you for your efforts...".
Also, if I feel endangered, I have every right to decide where to go. You might see it as selfish, I see why. At least I am paying my useless and expensive health insurance in the US (out of my own pocket, because you know what? I'm unemployed right now) to support the system, even if I am not taking advantage of it.
Sometimes things are a bit more complicated than "SARS-CoV-2 thanks you for your efforts...".
If you can't see the why we're incredulous at the idea of intercontinental travel at the height of a pandemic where an often asymptomatic and incredibly infectious disease is running rampant ... then I honestly do not know what to tell you.
Please tell me this is a joke comment
The current count is ~21,000 with the number of confirmed daily cases declining for 6 days straight, from 741 to 338 yesterday. So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society.
Japan's response seems commensurate with the problem, and this reads to me like an excessively verbose illustration of how one can spin even pre-registered falsifiable claims whichever way you want regardless of outcome. 'See? We were mostly right'.
Maybe that's too harsh.