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October 18, 2023

Liberal Democracies Finally Let the Mask Slip

Posted by faustusnotes under Meat Life, off-topic ranting | Tags: , |
[3] Comments 

Have you noticed things seem to be getting a little worse in the developed world? Australia voting a resounding No on the weakest, most milquetoast concession to acknowledging and amending its colonial crimes, the Middle East’s Only Democracy(TM) going on a wild killing spree, unprecedented global heat at the same time as governments of the world’s richest nations are canceling basic infrastructure plans, reneging on carbon reduction commitments, and getting into weird culture war battles about how to define a woman? Things seeming a little desperate? It appears we have reached the stage just after the “and” in the famous phrase “scratch a liberal and a fascist bleeds”.

Canada’s Liberals Applaud a Nazi

The mask really slipped a few weeks ago when Ukraine’s president Zelensky visited Canada to beg for weapons. The war in Ukraine isn’t going well, and the much-vaunted wunderwaffen donated by the west – German tanks rolling into Eastern Europe for the first time in 80 years – have failed to advance the promised counter-offensive, though Ukraine’s leadership has made sure that the offensive achieves the US’s goal of fighting Russia to the last Ukrainian. With video of NATO’s supposedly superior “kit” (ugh) getting wasted on the battlefield proliferating, no progress in the war, and the US house getting skittish about signing more blank checks, Zelensky needed to shore up his support among his allies. After Zelensky’s speech to the Canadian parliament, an apparently well-meaning Canadian speaker introduced a 98 year old man who he told everyone “had fought for Ukrainian independence against the Soviet Union in world war 2”, with Liberal PM Trudeau leading Zelensky and the parliament in two rounds of standing ovations for this stalwart of freedom.

Apparently nobody bothered to think what kind of man might have “fought against the Soviet Union” for Ukraine in world war 2, and of course it turned out very quickly that the man in question was a member of the Waffen SS. Canada’s parliament somehow tricked a Jewish head of state (Zelensky is Jewish) into giving a standing ovation for an Actual Nazi, just because he fought the Soviet Union.

This is a kind of treason, of course: the Soviet Union were Canada’s allies in world war 2, fighting the Nazis, and suffered horrifying losses during their retreat from and recapture of Ukraine. Applauding someone who fought them makes a mockery of their sacrifice, shows the ignorance of all assembled towards their own history, conflates modern Russia with the Soviet Union (a common mistake among liberal apologists for our ridiculous support of Ukraine), and – most importantly – means applauding a nazi.

The 14th Waffen SS division of which Hunka was a member wasn’t an innocent bystander in the war either. They did partisan suppression duties in Poland and Ukraine, freeing up regular SS and Wehrmacht units to kill Soviet soldiers, and in some instances destroyed whole villages. They probably helped with round-ups of Jews, and of course by providing support services they freed up regular units of the SS in Ukraine to speed up their activities in the Holocaust. Himmler himself visited the unit, and said some pretty horrifying things indicating he knew full well where their racial solidarity lay. The knowledge of this unit’s activities isn’t dead in Ukraine, either, far from it – you might recognize their symbol on the Wikipedia page as a common symbol on Ukrainian soldiers uniforms, and in the year before the war started the unit was celebrated in Kyiv. It’s likely that in that horrific display of Nazi solidarity in the Canadian parliament Zelensky, at least, knew about the unit’s history, since it’s a matter of public celebration in certain sectors of Ukraine’s political class, including the people who surround Zelensky.

When Nazis aren’t Nazis

There’s a joke going around the internet that since the Ukraine war began western media have slid through stages of Nazi-denialism, from “there are no Nazis in Ukraine” to “Oh, there’s just a few” to “they aren’t so bad” to, finally “Being a Nazi isn’t always wrong anyway”. It appears we’ve reached stage 4, because within a few days Politico EU published an article arguing that being in the SS didn’t make you a Nazi. Now there’s a reversal on the Nuremberg Trials, eh! Then there was a lot of talk about well how could they have known that these guys fighting in Ukraine against the Soviet Union were Nazis, and he probably wasn’t a volunteer anyway (he was). Then it began to become clear that the Canadian government had courted these Nazis after the war, and a whole bunch of horror stories began to emerge about monuments to the Nazis in Edmonton, an endowment in this Nazi’s name to a Canadian university, and, well, a generally sordid past of encouraging these treacherous villains to contribute to culture and history in Ukraine.

It should be noted that Canadian scholarship on Ukraine was an important contributor to the development of the contested theory of the Holodomor, the idea that Stalin deliberately starved Ukraine. This idea was not new in Ukraine, but the word itself appears to date from the 1980s or 1990s, and it’s likely a fabrication of these Canadian Ukrainian scholars, many of whom were former Nazis. One person who has contributed to the popularization of this claim is Anne Applebaum, who is a regular contributor to liberal publications like the Atlantic and has been a vociferous proponent of the idea that Russia is committing genocide in Ukraine. Her book Red Famine, which contributed to the popularization of this genocide myth, is no doubt heavily influenced by these Canadian-Ukrainian scholars, but she has been perfectly silent about the revelation that they were all Nazis. This body of recent work on the Holodomor feeds into a wider anti-semitic current, known as “double-genocide theory“, which holds that Stalin was as bad as Hitler and is often implicitly or explicitly cited as a justification for Ukrainian (and other countries’) support for the Nazis. This dangerous elevation of a high-school debate bro fetish to the level of serious legal and scholarly work is dangerous, particularly for anti-fascists in Eastern Europe, but it’s a surprise to see it bubbling to the surface in such a grotesque way in Canada.

Russians, of course, have no illusions about this double-genocide nonsense, the evils of Nazis or the nature and persistence of Ukrainian Nazism. Here is what Vassily Grossman had to say about the looming threat of Nazi collaboration in Ukraine in his famous book Stalingrad:

This is the background to the growth of Red Sector, the Azov battalion and the neo-Nazis who humiliated Zelensky in 2019 and forced Ukraine down the road to the war. This is the reason that to get to Baby Yar – the site of the infamous 1941 massacre – and the memorial erected there by the Soviet government, traveling from the Eastern side of Kyiv your quickest route will be along Stepan Bandera avenue. But all this history has been wiped from liberal memory in the west, in the post-war scramble to redefine the Soviet Union as the Enemy, and to rewrite the history of the war so that the allies’ relatively small contribution – and much smaller sacrifice – could be raised above the great and catastrophic suffering of the Soviet Union, obscure the allies’ failure to rescue the Jews, and airbrush the Soviet Union’s central role in saving Jews from the Holocaust out of our history. And how is that working out, now?

The West’s guilty conscience lashes out

Some simple facts about the West’s culpability for the Holocaust should be well known but are relatively underplayed in Western history lessons. From 1939 when the Nazis started the war to the middle of 1944 there is almost no evidence of significant resistance against the Nazis west of the Danube. In Poland and Ukraine yes, there is a well-known history of both collaboration and resistance, but go west and you see a bunch of complacent nations that were largely happy to be pinned under the Nazi boot, with the sacrifice of their Jewish populations considered a small price to pay for their relative peace after they were conquered. The Western nations also resisted refugees, taking only a small number of rich Jewish emigrees and even, famously, turning away shiploads of children. In contrast Jews fleeing east were welcomed into the Soviet Union, and it was the Red Army that liberated Auschwitz, discovered Treblinka, and rescued the Jews of Poland from Nazi violence. The West stood by and waited, taking far more interest in the recovery of their colonial possessions in Africa than in helping the desperate Jews of western Europe, and it was only when the Soviet Union began to roll over Europe itself that they suddenly conceived an urgent need to fight back against the Nazis. If Hitler had cut a deal with Poland to march his armies through for a direct attack on the Soviet Union in 1939, would the west even have bothered going to war with him? I suspect that they would not, and would have stood by while the fate of the Soviet Union’s Jewish population was determined.

This is a stain on Europe’s post-war liberal conscience, so how did they endeavour to wash out this stain? They handed one of their stolen colonial lands to the Zionist project, which immediately unleashed the Nakba on the people of Palestine and established an apartheid state on the shores of the mediterranean. Every time the people of Palestine attempted to peacefully resolve this conflict the Israeli state responded with violence and destruction, and so we find ourselves at the present state, where 2 million Palestinians languish in an open-air prison camp constructed with western money. When Hamas finally respond with a successful attack on Israel’s military, that blood-drenched state unleashes a wave of violence – first indiscriminately killing their own hostages, making up a 21st century blood-libel about beheaded babies, and then attempting to starve and bomb the population of Gaza into oblivion.

In response to this savagery the same liberal democracies and media outlets that were just two weeks ago giving a standing ovation to a confirmed Nazi, or defending that same action, or steadfastly looking away, suddenly rushed to condemn every unsubstantiated lie put out by the Israeli Defence Forces, and publicly announced their unconditional support for “the World’s Most Moral Army” as it enacts the first mass murder of the 21st century. They have nothing to say except “more!” as the IDF slaughters thousands of children, cuts off electricity from hospitals, and forces civilians to drinking from puddles. None of this is kept secret either – in contrast to the “genocide” of Uyghurs that the western media and intelligence agencies invented from whole cloth, and have presented to us constantly over the last 3 years without a shred of evidence, within minutes of the unfolding bombardment of Gaza our social media feeds are flooded with videos of dying children, bombed ambulances, buildings collapsed on civilians, reports of entire families wiped out. The Palestinian ambassador to the UK reports 6 of his own family killed; the Scottish first minister’s own mother-in-law is trapped in Gaza and he cannot even get a response to inquiries from the foreign office, while the media drill him on whether he has sufficiently condemned Hamas. Meanwhile France bans rallies in support of the Palestinian people, MSNBC bars its muslim anchors from reporting, a Muslim child is stabbed to death in the USA, and Germany stops a protest by Jewish opponents of the slaughter on the grounds it might be anti-Semitic.

This is the “liberal” response to the mass murder by starvation and bombing of 2 million muslims. Meanwhile liberal blogs – those bastions of interventionism back in the Iraq war days – remain stunningly silent. Balloon Juice, which has run a daily post on the invasion of Ukraine, headed with a graphic accusing “Ruzzians” of genocide, declared “there’s no there there” about the shameful Canadian ovation of a Nazi, and is in full support of the Israeli military. Lawyers, Guns and Money have barely mentioned it, and Crooked Timber have put up a single, weak post about how they don’t know what to say, which has degenerated into a condemnathon and some complaints about Jeremy Corbyn – the only politician of any note in the UK who was willing to publicly support the Palestinian people.

It’s often said that the single defining feature of liberalism is that liberals never, ever learn. They constantly watch the same things happening, hear the same lies from the same criminal gang, absorb the same excuses from the same people, and respond in the same way without any adaptation to the circumstances. We know that the Israeli Defence Forces lie – they lied about Shireen Abu Akleh, they lied about the Gaza Flotilla Raid, they lied about Rachel Corrie – but of course every person in the western media, political and public elite accepts everything they say without question, knowing it’s all a lie and knowing their history of killing children. Journalists, of course, don’t even have object permanence, but this singular property of liberal politicians and political commentators generally is that they cannot, under any circumstances, learn from what constantly surprises them, because if they developed any theory of the structural underpinnings of the social forces at work it would become simply impossible to remain a part of the liberal establishment.

Our failing economy

The last part of this collapse in the coherence of the western social order is our failing economy. We are constantly told – by political leadership, by economists, by journalists and by pundits and “think” tankers – that capitalism is the best system available to us, that capitalism has made us the richest people in the history of the world, that any other system would leave us impoverished and embittered. Yet at the same time they tell us that they have to cancel even the shortest high speed rail line because they can’t afford it; that university fees must remain too expensive for most people to attend without going into a lifetime of debt; that it is simply impossible for people to have affordable housing; and that paying you more than $7.25 an hour is beyond their power. You must remain poor, squatting in sub-standard housing surrounded by decaying infrastructure and scrabbling to get together enough money just to stay housed and pay off the exorbitant price of your university loans – all in the richest countries in the history of the world. Whose wealth? Whose benefit? They couldn’t even control a simple respiratory disease, you had to go back to work as soon as possible or the best, most efficient system of allocation of resources in the history of the universe would collapse around you; and they absolutely cannot afford to pay for you to get a booster vaccine if you’re under 50, because … well, because how could the 6th richest country in the world afford it?

And where did this money go? The USA spends a huge percentage of its income on weapons, is a thoroughly militarized society; the UK and France are nuclear powers. But together the entire economy of the NATO countries – some 500 million people, including most of the top 10 richest countries in the world – ran out of ammunition and weapons to give to Ukraine after just 600 days of war with a country having not even a third of their population. Where did all that money they took from you go? What were they spending it on, while they were telling you they can’t afford high speed rail, schools that don’t collapse, COVID protections, universal health coverage, gun control or a raise in the minimum wage? After 600 days they’re scraping the bottom of the barrel, right down to munitions they promised they wouldn’t use because they’re borderline illegal (and won’t work in Ukraine anyway). And worse still the wonder-weapons they sent have all failed, proven to be worse than the cheapest material the Russians can throw at them. All the Leopard tanks are burnt out husks, the Challengers – “never defeated in battle” – abandoned on the side of the road next to ditches filled with the corpses of Ukrainian men, the Bradleys and Bushmasters and Marders all toast and the troops they were slated to carry forced to slog through the long grass where mines and drones are slaughtering them. That’s what your money was spent on, while you were being told 10% annual inflation was inevitable and no you can’t have a pay rise, and if you try striking we’ll make it illegal because the best system of allocating resources ever invented – the only one that works – can’t make food affordable and can’t produce enough ammunition to fight a small war in a distant country.

So, this is the promise of liberalism as we enter the third decade of the 21st century. No freedom of speech, no money for you and no investment in public services, and if you dare to speak up while we throw money into the mass murder of civilians living in the poorest place on earth we will throw you in jail. In America we’ll throw you in jail anyway, but not until we’ve stripped you of your assets without trial and only if you’re lucky enough not to get shot on arrest. In defense of this you need to stand by and watch – you must not speak, or you’ll lose your job! – as we commit warcrimes and cheer the bombing of hospitals and the starving of citizens and throw all our resources into defending a criminal, corrupt gang of Nazis as they grind an entire generation of men into meat, only to find those resources aren’t enough because our economies are running on empty.

But if you talk about any of this you’re a wild-eyed idealist, a “tankie” (who paradoxically doesn’t want to send German tanks into Eastern Europe!), an anti-semite, and – worst of all – naive, unable to understand that this is the only way things can be. Nothing can ever ever be better, and anyone who tries to make it better is a fool and a trouble-maker.

This is liberalism in the 21st century.

 

February 5, 2023

Do Journalists Understand Object Permanence? A case-study with a balloon

Posted by faustusnotes under China, Meat Life, off-topic ranting, Science | Tags: , |
[14] Comments 

If you haven’t been living under a rock since the beginning of February you’ll be aware that a Chinese “surveillance” balloon has drifted over the continental USA and even hovered over some dustbowl in the centre where the USA keeps its missiles. This has led to that weird kind of 24 hour cable news coverage that gets Americans hysterical, in which they cover a perfectly normal event as if it were a catastrophe, and get terrified of shadows. In this case the media were tracking the balloon across its entire path, defense experts were being interviewed, and every armchair expert on twitter was weighing in with their opinion of the real significance of the thing. An entire country sent into a state of unhinged uncertainty by a balloon. Ultimately Antony Blinken, the US secretary of state, canceled a visit to the USA which the Americans (but not the Chinese) claimed was going to lead to high-level meetings.

Of course this is transparent nonsense. Nobody can control the path of a balloon, though some people tried to speculate that some moderate degree of control could be achieved by changing heights, and the balloon covered a track across the USA that is already widely covered by military and commercial satellites. Why would the country that has its own fancy-shmancy space station, a cloud of satellites powering its own mapping service, the world’s largest high-speed rail network, and a lander on the dark side of the moon, need to use a balloon to spy on the continental USA? And why would it particularly want to hover over a missile site that has been so extensively mapped by the USA’s “adversaries” that all activity there has to be done underground? And why would they risk this provocation on the eve of a supposedly historic visit by a senior US diplomat?

The balloon took its strange path just after the USA experienced a huge cold snap across much of the contiguous states, and just as the north east of the USA and Canada were expecting a secondary cold snap. These cold snaps are caused by the jet stream slowing and weakening, so that its path sags southward and cold air from the pole is allowed to escape across the continental USA. These jet-streams flow from west to east, and are the reason for example that a Canadian weather balloon ended up over Russia in 1998. Indeed, after the Chinese government finally noticed US panic they issued a statement that it was a weather balloon gone wild, which is completely consistent with its strange looping pathway. It drifted north east until it hit the jet stream, diverted eastward, and then was dragged down over the continental USA by the sagging jet stream that was simultaneously producing the coldest ever recorded temperatures in New Hampshire.

None of this obvious counter-evidence led the US media or various twitter commentators to question the Pentagon’s claims, which is unsurprising but depressing, because these claims were being aired by not just the same institution that brought us the invasion of Iraq, but the very same people. The current Pentagon press spokesman, Brig Gen Pat Ryder, who gave press conferences about the balloon, has a storied history of propaganda for the US military, and in particular was in charge of “strategic communications” for the Coalition Provisional Authority in 2004. He was the chief of propaganda for the most corrupt military occupation in history, and in particular he was in charge of “strategic communications” when the Abu Ghraib scandal happened. He was also in charge of public affairs for an air force wing during the NATO bombing of Yugoslavia, when one US airplane (not from his wing) blew up the Chinese embassy – something that required a bit of spin at the time! The guy currently providing information about this balloon to the press never saw a truth he wasn’t willing to hood and electric-shock to death. If this guy said the sky was blue you would need stick your head out the window and check. If he asked for the salt at dinner you’d best pass him the pepper, and if he claimed he wasn’t the father you wouldn’t need to waste money on a paternity test – you could be sure it was him. This man is a liar, he is paid to lie for his government, and he has spent at least some of his life lying to cover up some of the most corrupt and incompetent mistakes and crimes of the US military.

Why would you believe this man when he tells you that a balloon is being used for spying?

It gets worse, of course. On February 4th the US department of defense released a statement about the shooting down of the balloon (which cost at least $1 million, but finally gave the F-22 jet a confirmed air-to-air kill). In the statement they noted that

Chinese balloons briefly transited the continental United States at least three times during the prior administration

and of course the media and various idiots in the commentariat went wild about how “spy balloons” had been regularly sent over the USA. Media reported this as spy balloons entering US airspace, dropping all ambiguity, as did the usual talking heads on the internet. But note that the DoD statement nowhere says that they’re spy balloons – it leaves that for the media to do. It also states they “briefly transited” the USA. It is not physically possible for a balloon to “briefly transit” the continental USA from China unless it passes over the tip of Alaska – standard behavior for a weather balloon launched from China and blown out to sea, on occasions when the jetstream is functioning properly. But all of this nuance and the obvious implications were left out by commentators, who went off the deep end at the suggestion that balloons might have been used for spying and Trump just let them.

This is particularly ridiculous posturing, because it is also attempting to rewrite history to suggest that Trump – who led a trade war against China and sparked a wave of both official and unofficial retaliation against Chinese living in the USA – was somehow soft on China during his time in office. And it is also trying to conjure up some grand conspiracy in which the country that controls satellites, a space station, and half the marketshare of the world’s cellphones, is sending balloons it can’t control across the Pacific in the hope that one day one of them will just randomly luck onto a top secret site that they couldn’t photograph better from orbit. This is thoroughgoing nonsense. But it has the entire press pack and liberal intelligentsia doing the Pentagon’s propaganda work for it, and baying for blood. These people aren’t even paid, and they’re taking subtly misleading information from the most dishonest organization on earth – straight from the mouth of the man who was in charge of “strategic communications” during the Abu Ghraib scandal – and adding the extra panic the Pentagon wants, without even being directed to.

This is how we got the invasion of Iraq, the murder of a million Iraqis, the displacement of four million more, and the creation of ISIS: because the Pentagon lied to journalists, and journalists just repeated everything they were told as if it were god’s own truth. Josh Marshall (whose tweet is pictured above) wrote lots of essays about the Iraq war that he has scrubbed from his blog, so I can’t tell if he supported it or not, but it is clear he wrote extensively about it at the time, so if he has any sense he would be aware that the Pentagon lied us all into that atrocity. Is he aware that the people he is quoting now were lying to him then? Do other journalists reporting on this ever stop to think that maybe they shouldn’t listen to people who lie to them consistently?

No, they don’t. Journalists are like a baby playing peekaboo, or like Bart Simpson in Lisa’s cupcake experiment – they just can’t think that the same thing would happen twice, because they cannot, under any circumstances, analyze the structural factors driving the news they report on. They just keep reporting the things they are told and even if they are being told the same lies with the country name changed, by the same people, working for the same institution, they are unable or unwilling to question whether there is any level of trust they should assign to that person. Even if they know that the last time around these were shown to be lies, and they know who spouted those lies.

They just don’t have object permanence. And these babies are going to help the Pentagon lie us into a war with China.

 

November 23, 2022

How Much do SpaceX Rocket Launches Really Cost?

Posted by faustusnotes under Crime Fiction, Meat Life, Nerd Culture, off-topic ranting, Science, Science Fiction | Tags: , |
[12] Comments 

Recently in conversation with one of my players I was led to ponder whether or not SpaceX is revolutionizing space travel, and whether it has driven costs down to new record levels. My initial response was skeptical, but upon reflection I thought there should be data on this, and it should be possible to make some judgements about whether SpaceX is really doing what people claim. This post is an attempt to understand whether SpaceX rockets, in particular the Falcon 9, really are as cheap as people say, whether SpaceX has revolutionized space travel, and what we can expect in the future from this country or from rocketry in general. The key objectives are to:

  • Determine the truth of the claims about the cost of SpaceX rockets
  • Compare these claims with historical trends in rocket prices
  • Examine the role of reusable rockets in these trends

I hope by the end of this post to penetrate some of the hype around this company’s work, and understand a little more about the economics of space travel generally. A warning: this post is likely to be long, involves lots of dry figures, and is predicated on the assumption that Musk is a dishonest businessman.

Why do this?

First of all, why do this at all? Partly because it’s a rainy public holiday here and I have nothing better to do, but mostly because I think Elon Musk is an utter and complete fraud, who lies about all his companies’ activity, over-hypes his products, delivers dangerous, over-priced or poor quality goods, and wrecks the companies he runs. This is obvious for Tesla, Solar City and (now) Twitter, so it doesn’t seem unreasonable that the same would be true of SpaceX. But unlike Tesla and Twitter, SpaceX does seem to be delivering an actual usable product to high performance standards, so maybe its achievements buck the general Musk trend towards hyperbole and failure? However, on the flip side, Musk has spent a lot of time hyping his plans to go to Mars with SpaceX and everything about that project is obvious vapourware, hype and bullshit. The Youtube Common Sense Skeptic channel goes through this in great detail, showing how every aspect of everything Musk says about his Mars plans is completely and insanely untrue. So why should we assume the rest of his SpaceX plans are anything different? Remember, the first rule about liars is that if you know someone has lied repeatedly and consistently in the past, you should not trust anything they tell you now.

So actually I think it is possible SpaceX is burning money hand over fist, lying about the price of its launches and losing money on them. It’s a “disruptive start up” and it’s not uncommon for this kind of business to over-hype its product while burning through huge amounts of venture capital money. They do this either because they’re built on a completely unrealistic business model and refuse to admit it (Uber, Wework, and Theranos are examples of this); or they hope to smash regulatory hurdles to reduce costs and become profitable (AirBNB, Uber, Lyft); they’re straight-out fraud and hoping to burn through the money and no-one will notice (Theranos); they’re hoping to drive down the price so far that their competitors go bust and then they can ramp up prices before the venture capital runs out (Uber); they’re a business idea that depends on hype and people not noticing how awful the actual product is (AirBNB); or they’re hoping for a breakthrough that will suddenly render their business model profitable, or is the secret reason they’re doing it all (Uber’s self-driving taxi idea). It’s possible that this is what SpaceX is doing – keeping prices low and burning through venture capital in hopes of pushing out its opposition so that it can start charging monopoly rates, and/or hoping for a breakthrough in tech that will lower prices so much it can actually compete.

The history of rocket prices

Launching stuff into space doesn’t come cheap, and getting stuff up there is a big technological challenge. Humans have been launching rockets into space since 1957, and the general trend has been to see lower costs over time, with a noticeable hiccup in costs during the Space Shuttle era when the price of re-using the vehicle itself considerably inflated costs. Figure 1 shows the long-term pattern of prices for major rockets, and is divided into approximately four stages of development, characterised as Vanguard (when the first rockets were developed), Saturn V (when non-reusable rocket technology matured), Shuttle (when prices rose for the use of this orbital vehicle) and Falcon, when SpaceX started dropping prices. I took Figure 1 from a paper by Harry Jones, entitled The Recent Large Reduction in Space Launch Cost. I will recreate figure 1 with some changes later in this post.

Figure 1: Historical trend in rocket launch prices

Rocket launch prices are typically given in dollars per kg; figure 1 shows them in current 2018 prices (so early prices have been adjusted for inflation) but not, as far as I know, in purchase-power-parity prices (a few of the data points in the picture are from non-US sources; we’ll come back to that). Most rockets last for long periods of time, and the prices given in the figure are for the first launch date, not for example the last date, or tracking price over time. A good rule of thumb for a rocket launch is to assume it might cost about $10,000 per kg, and a typical rocket will launch 4000 – 20000 kg into space at a cost of between 50-200 million dollars. It’s not cheap to get shit up there!

But note the extremely low price of Falcon 9: it is listed as $2,700 per kg in Figure 1, which is enormously cheaper than the nearest competitor. Figure 2, which I took from a reddit post, shows different prices alongside the price of other rocket companies currently in operation – there are now a lot of startups in the commercial space industry, since Obama deregulated it in 2010, and these have been pushing their own prices down. In Figure 2 you can see a different set of figures for Falcon 9, with the reusable having a price of $4,133 per kg, and Falcon 9 divided into two kinds of launch (reusable and expendable). Figure 2 puts Falcon 9 prices to low earth orbit in a similar range to the Russian Proton M, or the US Vulcan rocket.

Figure 2: Launch prices for various rockets from a Reddit SpaceX forum

But as I will show, the prices listed in these figures are dishonest, and we will discuss the true price of launching Falcon 9. We will also analyze the data from Figure 1 in a little more detail, and see what we can learn from it.

Claims about SpaceX

The common claims made about how SpaceX has “revolutionized” space travel are available at booster sites like Space.com, which lists 8 mostly bullshit ways in which SpaceX has completely transformed space travel. For an example of bullshit consider their claim that it has made the uniforms fashionable … also note the uncritical reference to “German-American” rocket pioneer Werner von Braun (spoiler: he was a Nazi). In amongst the various nonsense we can find two main claims:

  1. SpaceX has reduced the cost of space travel, typically people giving unsourced claims that it has driven prices down, or using phrases that Musk himself constantly uses but clearly doesn’t understand like “by an order of magnitude”.
  2. SpaceX has developed completely new technology like reusable rockets which have both helped to push down the price of star travel and opened up new fields

Neither of these claims, as we will see, has any basis in reality. Incidentally, during this search for claims about SpaceX, I learnt that Musk claims to have spent 350 million dollars developing Falcon 9 and 750 million developing Falcon Heavy. I will use these numbers even though I don’t believe anything Musk says.

Methods

For this post I have performed three main analyses:

  • Analysis of SpaceX funding sources and costs
  • Analysis of SpaceX launch activity and prices
  • Analysis of the history of rocket launch prices

Here I briefly describe the methods I used for each of these analyses.

SpaceX Funding and costs

SpaceX obtains funding from launching rockets, Starlink subscriptions, government contracts, and venture capital. For launch prices I used the stated prices on the SpaceX website and associated forums, generally given at 62 million for a new Falcon 9 rocket and 50 million for a recycled one. Data on Starlink subscriptions I obtained from a website called nextbigfuture, for what that’s worth. I obtained contract information from a search on the govconwire.com website, which lists contracts and funding. Venture capital information I obtained from crunchbase.com. I put this data in mostly for 2017 onward (government contracts), 2010 onward (launches), 2016 onward (Starlink) and 2002 onward (venture capital). Note that some contract data is for “potential” contracts, which may vary in detail on delivery, but I wasn’t able to work out exactly how and when the money was delivered. For some obvious future contracts I did not include them as a funding source, but my numbers on government contracts are definitely shaky because of this.

For costs I used information on the total number of Starlink satellites launched from Wikipedia, cost of a satellite from nextbigfuture, and vague reports on Falcon 9 launch costs sourced around the web – about 50 million dollars for a launch of a new rocket, and 15 million for a reused rocket (these figures are attributed to Musk in interviews but seem dodgy to me). I used google to get the total number of current employees and their average salary (11,000 or so, at an average salary of $90,000) and assumed on-costs of 30%.

Note that SpaceX is not a public company and it is difficult to identify exactly how much money it has or is using. I do not know if it pays dividends on the shares it sold, what its rental or real estate costs are, how much money it is burning in fines and compensation, and any interest repayments on loans. This is only a blog post, after all!

SpaceX launch activity and prices

I obtained Falcon 9 launch data from Kaggle, though I think it’s just a scrape from the Wikipedia website. This data contains the date of the launch, the booster used, the client, the payload and its weight, whether the booster was new or used, and the result of both the launch itself and the attempt to recycle the booster. A small number of launches were classified launches for US government defense contractors, with no information on the weight or type of payload.

I also visited the SpaceX website and put in data on small payloads for their Rideshare plan, which confirmed that for all payload weights up to 800kg SpaceX charges $6000/kg, much higher than the sticker price and generally consistent with the prices in Figure 2 for other mature competitors. Not quite revolutionary is it …

Once I downloaded this data and did some unpleasant work importing it to Stata I produced some basic summaries of the data, such as mean payload weights, maximum weights, proportion of flights that were government contracts, etc. I also calculated a price/kg for each flight based on the sticker price of 62 million for a new rocket or 50 million for a recycled one, and also attempted to identify rockets that were new on launch and were not recycled (these would be “expendable” rockets).

Analysis of the history of rocket prices

I imported data from the Jones paper (it is provided in the Appendix) and added some additional information: I categorized rockets as communist or non-communist, and added some additional data for Falcon 9 launches based on the analysis of launch prices to give some more reasonable numbers for these launch prices. I deleted Falcon Heavy (which I don’t have launch data on and which seems largely to be vapourware at the moment) and made a fake data point for Communist launches in 2018 (these are still happening – China has a whole communist space station now!).

I then fitted a regression model of natural log of launch price per kg by year, with a term for communist/non-communist, generated the predicted values of price per kg from this model, and plotted curves for communist and non-communist launches. I plotted these against the observed price data and added Falcon 9 data separately. I ran the models and plotted for launches after 1961, because the first 4 years of the rocket program were, obviously, slightly special.

This gives a reproduction of Figure 1 with a little more detailed statistical analysis, with very different implications.

Results

The first thing I want to say before we get into details is that the sticker price everyone reports for Falcon 9, of $2700 / kg to launch into low earth orbit, is a lie, or at least very dishonest. This is taken from the SpaceX website description of Falcon 9, which states that it has a payload of 22,800 kg, and the common price of 62 million dollars for a launch of a new rocket. This is dishonest because it gives the payload for a fully expendable Falcon 9 rocket, but this rocket does not exist. No Falcon 9 is intended to be fully expendable, and if such a rocket existed it would need a separate production line to the current Falcon 9s in use. Reusable rockets need to be more robust and stronger than expendable ones, which means they have a different frame and fairings. This discussion of reusability makes clear that up to 40% of the payload can be lost in a reusable rocket due to the need to have a stronger structure and to keep some fuel for re-entry. You can’t just build a reusable rocket and use it as if it were expendable! This is backed up by the data – in 165 flights on which I have data, no flight ever flew at full payload, but there are multiple flights at a maximum value of 16,250 kg. The true maximum payload of the Falcon 9 rocket is 16,250 kg, not 22,800kg, and it will never fly at this value. In case you doubt me, note that all the max payload flights were Starlink deliveries, and it is just inconceivable that SpaceX would never use the full payload of their rockets to deliver their own satellites to orbit. The hard limit on a Falcon 9 rocket is 16,250kg, and the website is lying.

As we will see, this sticker price is also dishonest because in reality the rockets only ever fly fully laden when they are delivering Starlink satellites, and often the price paid by commercial buyers is much higher than 62 million. We will explore this below.

SpaceX funding and costs

SpaceX has been burning through money at a staggering rate. Here are my estimates of its income streams:

  • Approximately $7.5 billion in venture capital since 2017
  • Approximately $15 billion in government contracts since 2016
  • Approximately $3 billion in commerical launch fees since 2016
  • Approximately $3.75 billion in Starlink subscriptions since 2016

This amounts to about $4.8 billion in income per year. Its annual costs over the same period appear to be about $3.7 billion if we assume a recycled rocket costs 15 million to launch, a new rocket 50 million, and a starlink satellite costs $250,000 to build.

From this we should assume that SpaceX is making $1 billion per year in profit, if it has no dividend payment, interest or other expenses. Obviously this isn’t true (someone probably has to buy some stationery!) and maybe its other operating costs overrun this spare billion. But I think the story is likely dire. Why is SpaceX raising venture capital worth a billion a year if it is also getting enormous amounts of money in government contracts? I would suggest it is because it is losing money hand over fist on launches, which actually cost a half billion more than Musk is letting on, and/or rocket development (particularly Falcon Heavy and the Starship project) are costing an enormous amount more than he has let on.

Let’s also note that more than half of SpaceX’s revenue is government contracts. Without those government contracts, it would be dead in the water. Note that some of these contracts cover specific launch tasks, and almost always pay much more per launch than the SpaceX sticker price. For example, the Heliosphere contract pays 109 million to launch a satellite for NASA in 2024, while the cargo resupply mission to the ISS covers 32 flights for $14 billion (about $400 million per flight). Nobody in NASA seems to believe that the cost of a single mission is a mere $50 million!

SpaceX launch costs

The data on SpaceX launches covers Falcon 9 launches from 2002 to mid-2022, for a total of 165 launches. Of these 45 (26.5%) are aerospace/military contracts, and 52 (30.6%) are SpaceX flights, mostly delivering starlink satellites to low earth orbit (LEO) were they can vandalize the night sky in service of a poor-quality internet supply. Most of the flights (80.6%) used recycled boosters, and only in 12 flights (7.1%) was a new rocket used with no attempt to recover the booster – these 12 flights are the only ones that potentially used an “expendable” rocket. Of these 12 flights, seven were to GTO, which has a sticker payload of 8,300 kg. The maximum payload in those 7 flights was only 5600 kg, well below the sticker payload.

In fact most flights of the Falcon 9 have been far below its maximum payload. Figure 3 shows the mean, median, minimum and maximum payload by orbital destination for the 153 launches on which this data is available. No GTO flight has reached the sticker payload of 8300 kg, and the largest payload for LEO is 16250kg (all these flights were starlink deliveries, when the incentive and opportunity to use the maximum payload was greatest). Note the LEO(ISS) weights – these are deliveries to the International Space Station. Under the contract linked above, these flights are being paid for at somewhere between 100 and 400 million dollars per flight, giving a ludicrously high cost of – on average – between $20,000 and $85,000 per kg. This is potentially more expensive than the space shuttle, depending on the content and nature of the contract.

Figure 3: Mean, median, minimum and maximum payload weights by orbital destination, Falcon 9 flights to mid-2022

Figure 4 converts the values in Figure 3 to price/kg, assuming a price of $62 million for a new rocket or $50 million for a reusable rocket and ignoring higher prices for NASA or NRO contracts. These are to the best of my ability to tell the minimum price charged by SpaceX – in reality it is probably charging a lot more. For example on 30th June 2021 a Falcon 9 was launched that carried 88 rideshare payloads – this probably cost $6000/kg, judging from the website, and so the whole flight could have cost as much as $98 million. Even then, this figure is low compared to some of the low earth orbit launches, which could have cost as much as $360,000 per kg.

Figure 4: Mean, median, minimum and maximum price per kg, in thousands of dollars, for Falcon 9 launches to 2022

Figure 4 makes very clear that the sticker or theoretical price of rocket launches has almost no relationship to the actual costs, which can be much larger depending on the type of cargo shipped and the nature of the orbit it is sent to. This should be borne in mind in the next section.

Analysis of the history of launch prices

Figure 5 shows the price/kg of rocket launches from 1962 to 2018, with launches coloured blue for non-communist and red for communist states. Corresponding lines of best fit from the regression model are shown in the same colour, and some indicative Falcon 9 launch prices are plotted at the end in green. For indicative Falcon 9 prices I chose a) the median LEO price of $3210/kg; b) the optimum true LEO price of $3030/kg; c) a likely ISS supply price of $7,880/kg based on a $134 million contract; and d) the dishonest website price everyone quotes of $2,700/kg. We could also include $6000/kg, which is cited on the website for rideshares, but I forgot to, and can’t be bothered making this figure again.

Figure 5: Historical launch prices and modeled trends for communist and non-communist states, 1962 – 2018

As can be seen, the Falcon 9 optimum and some of its median launch costs are on the curve for communist systems, while the optimum ISS launch contract price lies just above the historical trend for US rockets. In fact, the predicted price for 2022 for the US system would be about $6000/kg, which is exactly the rideshare price that SpaceX cites on their website.

So in fact, far from revolutionizing the cost of launching rockets, SpaceX’s Falcon 9 is exactly consistent with the long-term historical decline in prices observed for launches from the US or its allies (mostly Japan). SpaceX have done nothing to advance the price of launches except to be there, commercializing a mature technology.

Conclusion

The final conclusion of all of this is that SpaceX are lying about the price to launch stuff into space on their rockets, and the media are uncritically repeating their fabricated price without checking its validity, comparing it with other prices available on the SpaceX website, comparing it with the prices that would be implied by SpaceX’s government contracts, or looking at the evidence from actual SpaceX flight data. The true price of launching stuff into space on a SpaceX rocket is likely more like $6,000/kg, more than twice the number they are citing.

Furthermore, this price is not a revolutionary drop in the cost of launching, and is in fact entirely consistent with the historical trend in US rocket launch prices. The best prices Falcon X manages to achieve are also not unusual, being simply normal prices for a Chinese or Russian rocket. The claim that SpaceX is doing anything special to drive down rocket prices is just more Muskrat hype, with no basis in reality at all.

It is also clear that reusability has not driven down the price of launches. Reusability incurs a payload penalty, since the rocket needs to be stronger and some fuel needs to be reserved for re-entry. Reusability is also not a radical new idea: the space shuttle’s booster rockets were reusable, and SpaceX’s sole advance on this 1980s technology has been to land them on a barge rather than beside one. This likely speeds up the time to return them to use, and slightly reduces the penalty incurred for robustness (since the rockets don’t need to resist the crash into the water) but it also significantly increases the amount of reserve fuel needed for re-entry. In fact United Launch Alliance (ULA), a SpaceX competitor, analysed reusability and found that it does not necessarily deliver much cost benefit for these reasons. There are formulae for the calculation of how many re-uses are needed for a recyclable rocket to be cheaper than an expendable one, available at the documents linked in this discussion board, and they suggest that in general it only reduces costs in the long-run by about 5%. So no, SpaceX has not revolutionized anything in this regard either.

So in conclusion, SpaceX is not revolutionizing space travel, it has not driven prices down at all relative to the long-term trend, launches with SpaceX cost considerably more than their PR suggests, and SpaceX is essentially a low-quality internet service provider with a side-hustle in military contracting, being heavily propped up by murky venture capital. Elon Musk is not, and never will be, anything except a scammer, and in future decades people will look back on how he was viewed in this period with confusion, scorn and disbelief.

 

August 20, 2022

Of the Crooked Timber of liberalism, no straight thing will ever be made

Posted by faustusnotes under Meat Life, off-topic ranting | Tags: , |
[37] Comments 

I wrote a comment under this post at the left-wing academic blog, Crooked Timber, and it was deleted during pre-approval. This has been happening a lot recently, so this time I saved it and present it here, with some additional discussion below:

I guess JohnQ hasn’t heard of the insect apocalypse, or thinks it’s a good thing. It’s weird he thinks that pesticide use is down since he supports GMOs that are specifically intended to allow increased use of herbicides. There isn’t any evidence that their use is going down anyway, this is just wishful thinking. Furthermore, dismissing deforestation in low-income countries as due to “the need for firewood” is really something else. Did you really mean to reduce the entire structure of post-colonial appropriation of ecosystem services in poor countries to “they use too much firewood”??

There is a democratic pathway out of this disaster but enabling it requires choices that aren’t easy reading for the liberal left. That pathway was on clear display in the UK between 2015-2019, and the response of the liberal left was to move heaven and earth to destroy it – first by the action of Starmer and his clique of class traitors in undermining the 2017 election, and then when that failed to dislodge radical democracy from the labour party, enlisting the entire liberal left elite (from octopus Cohen in the Guardian to various enablers in the US blogosphere) to destroy the project with a fake campaign of “anti-semitism”, which allowed an actual anti-semite to win a crushing victory for capital in 2019 and usher in the greatest impoverishment of the British working class in generations. A simple search of past posts at CT will show where its liberal left members stood on this – one of them continued to support Starmer after the revelations of his treachery. 

If we want a democratic path out of this we are going to need the liberal left to accept that their ideas have failed, and the campaign to deradicalize leftism in western democracies has hollowed it out and led to a 30-year long string of defeats, while the right has consistently grown more and more radical. This is going to involve throwing away some of the most cherished ideas of the centrists and the liberal left, like “free speech” and “british values” and also it’s going to require recognizing that liberalism has always served as the intellectual and political handmaiden of fascism. It’s going to require a proper commitment to decolonization, recognition that the western left has been complicit in the colonial project, and along with that a far greater tolerance of “authoritarian” and “illiberal” regimes, along with a recognition that the entire concept of “authoritarian” is an empty nonsense intended to hold back national liberation and progressive movements.  This is going to require recognition that fascism is an entirely western political movement that is constantly at risk of returning, it wasn’t put to bed at the end of world war 2 and it is our duty as leftists to oppose it everywhere and stridently. This means fantasies like those sometimes put forward here and elsewhere that Trump wasn’t special, or that Ukraine is a liberal democracy, need to be ruthlessly dealt with. We don’t have time for liberal wet dreams anymore. 

This is also going to require that the liberal left and its elite allies in media, academia and politics recognize some hard truths about their own disconnection from the realities of political struggle. This can start with a recognition that the entire discipline of economics is a failed joke that exists solely to support the propagandistic needs of capital. We can follow that with a hard look at exactly which political and organizing principles much of the western left has thrown out because of the taint of leftism associated with them rather than any real intellectual or ideological problem with them – e.g. nationalization, which should absolutely be at the centre of every political program in the west, proudly and with force, along with unionism. Pacifism – both locally and internationally – needs to go in the bin. The idea that we can sell out some small parts of our movement to win hearts and minds in “the mainstream” needs to go – trans women is the current vogue for under-bussing in the UK, but they’ve already thrown the entire cis female community in the US under the bus so they can slightly increase their chances of winning a couple of milquetoast senate seats. It’s going to require that the elite left and its remaining institutions – the Guardian, the left wing university departments and organizations that remain – recognize that all the best ideas and action are in the gritty, embarrassing corners of our society, amongst environmentalists and uncool allotment-working grandpas and not the suits and spivs of the Blairite movement.

It’s also going to require a return to the cynicism about western media, intelligence and military sources that we had before and after the Iraq war. They’re lying to you – about everything. This means that you need to reject all their narratives, not just the ones that are politically convenient. This is going to mean asking some hard questions about your own complicity in the ridiculous, facile, and openly far right propaganda campaigns of the past 10 years that too many liberals have supported. That means being full-throated in support of Palestine, putting a Yemen flag in your Twitter profile pic in place of the blue-and-yellow, and listening to the voices of ordinary people in low and middle income countries, not whatever fashionable cipher or white representative the western media have currently chosen to parade about.

I don’t see any of this happening anytime soon, and we’re running out of time. If we don’t re-energize a real left there will be no democracy of any kind within a decade, and no pathway – democratic or not – out of this ecological crisis. But as a first step to that rejuvenation it would be nice to see it start with a few mea culpas here.

The collapse of Crooked Timber (CT) over the past 7 years from a relatively well-subscribed, combative and intellectually engaged blog to a liberal vanity project that serves primarily to recycle Economist talking points and American mainstream propaganda is a microcosm for the collapse of left-liberal thought in the west more generally. The liberal order has completely failed, and while right-wing liberals have largely accepted this and shifted so far to the right that they’re indistinguishable from the fascists who are going to eat them, there remains a rump of “centrists” and leftist liberals who haven’t got the message yet, and somehow think that a political system of moderate leftist democracy with mildly regulated capitalism, coupled to the “rules-based international order” is going to save us from the catastrophes that are coming. It isn’t, and while these left-liberals fiddle with electoral politics through the machinery of empty suits like Starmer’s labour, vapid clown shows like the Liberal Democrats, or hollowed out fund-raising machines like the US Democratic Party, the world is shambling faster and faster towards the inevitable mid-game crisis of full-blown environmental collapse coupled with the demise of late-stage capitalism. The material conditions in which democratic countries attempt to manage their politics are not getting any easier from here, and from now until we find a radical solution to our problems every year of your life is going to be the best year of the rest of it. In the face of this we can see what left liberals and their scammy political parties are doing: nothing, coupled with useless propaganda.

So it is that on the same day that the Uvalde mass shooting occurred Matt Yglesias tweeted out some pro-American bullshit about how America is the greatest country on earth; or on the same month that we learnt about Keir Starmer’s treachery the authors at CT were admitting they voted for him as leader and would do so again; or in another week of multi-thousand COVID deaths in the USA the democrat-appointed leader of the CDC’s covid response proudly stated that he wanted to privatize vaccine provision and testing as soon as possible; or as we learn as many as two thirds of Britons face fuel poverty this winter the Starmer-led “Labour” party refuses to consider nationalizing the bandits that are driving the British population into poverty. We have resource economists like John Quiggin of CT still breezily confident that technology plus free markets will avert climate change disaster even as half of the world is struggling to deal with actually-existing climate change disaster – and dismissing deforestation in poor countries as “too much firewood” (see above my point about leftists having to grapple with their role in the colonial project!)

Ordinary people can see this and are voting with their feet. The UK Labour party recently revealed it lost some 90,000 members after its betrayal of Corbyn and is now millions of pounds in the red, which puts it even more in hock to the corporate donors who wanted Corbyn out. UK unions are considering removing funding from that same party while a wave of strikes rolls across the country, and union leaders demand Labour return to its roots, but Starmer bans his frontbench from being seen near them. The gulf between the beliefs and aspirations of left-liberal public intellectuals, political leaders and organizations grows wider and wider, while the political leadership that represents this political tendency tries to convince itself that it can assemble winning electoral coalitions from the shrinking number of ordinary people who can still convince themselves that this is working – in the face of obvious evidence that it isn’t, and can’t, and most people know it.

The political endpoint of this will be fascism. We can see it in the USA, where this tendency is at its most advanced: ordinary voters have checked out in the face of the Democratic party’s ridiculous oblivious optimism, refusing to engage with either the party itself or the ballot box, as the Republican party carefully and consistently dismantles democracy everywhere it can. There is some hope that the Democratic Party – on the back of a wave of cruelty unleashed on women by the outlawing of abortion – will recover a bare majority of seats in the Senate this Autumn (though they may lose the House!) but no sign that they’ll do anything remotely useful with them, because they value the “institutions” of liberalism far more than the actual political goals they claim to pursue. After they fail to capitalize on even that small gain (or can’t, if they lose the House), and with their liberal blindness paralyzing them in 2024, what hope that they will retain the White House or that they will survive the fascist uprising that follows a Dem victory? And what hope that in the face of Starmer’s prevarications in the UK, the Tories will lose the next election? We can already see that the strategy for UK Labour is going to be a continued rightward shift, that will fail to satisfy anyone and alienate everyone who cares about our future, while the Tories continue to advocate openly fascist ideas. In order to prevent climate disaster we need an active, strong and committed left wing political leadership in every major western economy within the next 5 to 10 years, even sooner in the case of the USA, but we’re going to see nothing short of fascism.

This is the end of the liberal project. It’s not going to win anything anymore, and when it does it will achieve nothing of any good anyway, because there is nothing left within its ideology that is able to stand up to the pressures of these times. We need a return to radical leftist democratic parties, or there will be no democracy left. So no, CT, there is no democratic pathway to civilization survival, until we all give up on the petty little daydreams of liberalism and return to a real left-wing politics that prioritizes the needs of ordinary people over glib liberal shibboleths.

UPDATE (2022/8/25): There is some doubt being expressed in comments as to whether this is a real issue outside of some anonymous commenters on CT, so I present here a screenshot of a tweet from Andrew Harrop, general secretary of the Fabian Society, an important left-wing organization in the UK that forms the intellectual underpinnings of the labour party there. It is a simple, categorial dismissal of a bill strike in the UK, not on the basis that it wouldn’t work, but that it is simply too radical for ordinary British people. There are serious concerns being expressed by some left-wing people about the dangers of acting on the Enough is Enough campaign’s suggestions, but that is not Harrop’s concern. No, his concern is that a payment strike is “far left” politics that ordinary British people wouldn’t be able to support. See how far British left-wing politics has been enervated by this kind of liberal drivel!

 

August 16, 2020

Assessing the Benefits of Online Teaching and Supervision

Posted by faustusnotes under Education, Meat Life, Nerd Culture, Science, Travel | Tags: |
[3] Comments 

We are now eight months into the coronavirus pandemic with little sign that most countries will be able to get it under control without a vaccine, which means that many countries are now attempting to return to normal while managing the virus. For most countries I predict this is going to be disastrous, and even countries that have not yet fully reopened – like France and the UK – are seeing resurgence in cases with the potential for a return of a major epidemic. But some of these countries are planning to reopen schools and universities in the Autumn, despite the risks, on the assumption that personal protective measures can contain those risks. I have expressed before my discomfort with personal protective measures, which will never be as effective at containing an infectious disease as good policy and robust treatment access, but this seems to be the dangerous path most countries have chosen to take. Given this, many universities are now trying to figure out how to return to in-person classes in Autumn, and many professors seem to want to do this. However, after a full semester of teaching entirely online I am unsure why there is so much pressure to return to in-person teaching and supervision. If we are going to move to a new normal I think we should consider the possibility that for some (many?) classes online is better than in-person, and here I would like to outline some of the benefits of online teaching and supervision.

Brief background

I teach classes in basic statistics, basic statistical programming, and some advanced statistics courses, to graduate students who are primarily mature age students working in health and studying part time. Here in Japan the first semester starts in April and in February I pushed for us to go entirely online, because I was working with Chinese colleagues on the coronavirus response in China and I knew how bad it was going to get. Our university already had a partially online component of teaching, to enable working people to take classes – basically students can choose to take an online or physical class for all of our required and many of our elective classes, and those who take the online component get to view recordings of the lectures, along with pre-recorded slides, and a slide set translated into Japanese. We have an online forum for asking questions and students can also join the physical class if they are taking the online component but able to get free time (this doesn’t happen much). Given our university already had this experience with online teaching it was very easy to switch entirely online and the faculty agreed, so we had about 6 weeks to prepare. This was a very good decision: many of our students are clinicians and some work directly in covid-19 treatment and care, so having them gather physically in a room is extremely high risk.

I originally planned to just switch the physical classes to the online component, upload last year’s recordings and use the lectures as a Q&A, but students don’t always have time for this, so I started teaching the classes in zoom (using slide sharing and so on), and I have found many aspects of lecturing in zoom to be superior to physical lecturing. I also reconfigured the statistical programming class to be done in zoom using breakout rooms. The statistical programming class was traditionally taught entirely physically, with me and two teaching assistants (TAs) running around the class answering questions and then reproducing errors on the teacher’s computer to explain specific problems that are relevant to everyone’s education. I could not physically do this anyway this year because I dislocated my kneecap in mid-February and had surgery in mid-April, but even if I had been able to, I found ways to make this work better in zoom. My students this year are learning more and better than last year, using zoom.

Benefits of online teaching

In my experience of first semester there are many aspects of holding classes online that are superior to holding them physically. In no particular order, here they are.

Reduced commuting: Some of my students join the lecture from their workplace, or from locations that vary weekly depending on their schedule. They don’t have to commute, so physically it’s much easier for them. Commuting in Japan is obviously high-risk for coronavirus, but it also reduces pressure on students if they don’t have to bounce from work to school to home. I think surveys in Japan have shown an overwhelming desire for normal workers to continue working from home and commuting is a part of the reason for this.

Better quality lecture materials: Nobody has to squint from the back of the room, or worry about audibility, or any of that stuff. They can see the slides clearly when I share them and can hear my voice clearly, plus can control the audio when they need to. The lecture recordings are also better quality, because instead of recording me standing there against a white screen in a dark room with dubious audio the students can clearly see the high quality of the slides and hear my voice directly in the microphone. This is especially useful for the programming class because it was very hard for students to read the Stata code on the lecture screen but in the zoom lectures it’s very clear

Disability friendly: We have one student who has mobility issues and would find getting into class very exhausting and time consuming, but none of this is a problem for them with zoom. Students also don’t have to suffer a one-size-fits-all computer arrangement for the programming class, and can use whatever ergonomic keyboard or weird screen setup they want. They can also learn in their native operating system and now I can teach in both – I have a mac and one of my TAs has a PC, so we can share screens to show differences (plus we can share students’ screens so we can learn how to work in their setup).

Full computer access: In the past I taught on a shared work laptop in a lecture theatre, or on the bodgy old PC in the computer room, with no access to my own full suite of materials. But now I have my entire setup available, so I can dig back through old files to show code I wrote years ago, or data examples that respond directly to a question rather than being prepared ahead. Obviously I could do this if I brought my laptop to the class but it’s so much more convenient to do this in my own office with all my stuff already set up (and it also means I can access external hard drives connected to my office desktop, etc). Students, too, can share the data they’re working with for their projects if they need to.

Shy and quiet students win: Asian students are generally shy and retiring and don’t like to ask questions but it is much easier for them if their face is not shown or they can do it in a chat window. Questions asked in chat can also be shelved and returned to later (since they’re written down where they can’t be forgotten) or answered by TAs in chat or by other students – in the programming class if someone asks a question we aren’t sure about one of the TAs can google the solution (or dig around in help files) and post the answer in chat while I continue managing the class. I think this makes Q&A better, and also encourages more class involvement by shy or quiet students. In my main stats class this isn’t a huge problem (since it’s just straight lectures) but even there being able to hide your face and/or voice helps shy, insecure, uncertain or scared students, all of whom can be found in a stats class. Also note that in a more interactive class a lecturer could strictly control students’ speaking time using the mute button, and I think in some systems can monitor how much students have spoken so that they can see directly if they’re allowing one student to dominate the class.

Convenience: Students can eat while they watch the lecture, can drink things other than water, can use their own bathroom when they want to, and can even sleep if they need to, knowing they won’t be caught out, won’t be embarrassing themselves in front of peers or lecturers, and won’t miss the class, since it’s recorded. Students are in general more comfortable in their own home or study or in the environment they chose for study, than in a lecture theatre with students they don’t know.

Recorded classes: My older students in particular find the recording of the programming classes very helpful. They have told me they review the same sections over and over while they try to figure out what to do for certain problems and tasks. Also for mathematics they can simply rewind and play again, which is a huge benefit for the slower or less confident students. I think the security of knowing they can’t miss anything makes it easier for students to take in the class, especially since it’s in their second language

Overseas and traveling students can participate: Three of our students were unable to enter Japan because the borders slammed shut the week before they were scheduled to arrive, and one more just slipped through. Given that most of our students are basically self-quarantining to avoid infection, two of our students are eager to return to their home country early so they can take these protective measures in a better environment. Online classes enables these students to continue studying even though they’re overseas. It enables us to maintain a diverse class even though we have pandemic border closures, and potentially in future to extend our classes to students who cannot get a scholarship and cannot afford to study in Japan. This is good!

Given these benefits, I’m not sure why people are eager to return to in-person teaching.

Online supervision and anti-harassment countermeasures

For me, supervising students usually involves working through statistical problems, often on a computer in my office. Last year I investigated ways to set up a shared, easily-accessible screen in my office so that we didn’t have to hunker around a laptop and more than two people could see a person’s work at a time, but the administrative details made me give up. This year of course that’s not a problem – it’s easy for me to supervise groups of students and share screens between them if I want. Nonetheless I still find in-person supervision preferable to online – visual and body-language cues are helpful for understanding whether someone understands what you’re saying, and somehow I feel something missing in online supervision that I don’t feel in online teaching. Also, in-person supervision can mean having a student down the hall who drops in and pesters you with the next stage of a problem on the regular, and this can be a very convenient way to get through difficult parts of a project quickly, but you can’t do this so well online. (You could, of course, just set your zoom on at 9am with your students logged in and working quietly and just use it when you need to, like a shared office – but we haven’t got there yet). So I still somehow prefer in-person supervision. However, there is one way in which I think online supervision is going to radically change the way professor/student and professor/staff relationships work, and that is its use in preventing harassment.

There are many forms of harassment in universities but one of the commonest is power harassment (pawahara in Japanese), in which a senior figure uses their power and authority to ruin the lives of students and junior staff. This is done through straightforward bullying – yelling, threats, insults and the like – as well as through things like taking authorship, demanding excessive work, refusing to share connections, giving unfair assessments, and so on. Things like sharing connections are the sorts of subtle power relations that can never be fought effectively, but the bullying aspects of power harassment take on a very different tone when all meetings need to be conducted online. I was myself bullied by a boss for years, and when I made a formal complaint against him a big problem I had was that much of his behavior – the threats to sack me, the unreasonable demands, the unfair statements about my work and personality, the threats towards my students – was verbal and not recorded, so in the formal complaint this became a case of my word against his. I won that complaint but it was a long slog and the outcome was not as good as I had hoped because the entire part of my complaint about his manners and inter-personal behavior could not be confirmed. This isn’t a problem when your relationships are done through zoom, and it will completely change the balance of power, for the following reasons.

The bully cannot get the same pleasure online: Bullies do what they do for personal pleasure and to bolster their own fragile personalities, so they need a reaction. Sure they do a lot of stuff that has no visible response – threatening emails, yelling over the phone, bitching about you to others – but none of this means anything to them if they can’t also hurt you visibly and viscerally enjoy the pleasure of watching you collapse. This pleasure is obviously going to be reduced if it’s done through a camera but worse still, on zoom you can turn off your own camera and mute yourself and they simply cannot get any pleasure from their words at all. They can try and force you to turn your camera and mic on but you are the one who controls your computer’s settings, and they cannot enjoy bullying as much. If it doesn’t make them feel better they’ll still do it – bullies are bullies after all – but they will have less personal incentive to do it and maybe, just maybe, as a result they won’t do it as much. Also, obviously, the bully cannot do the physical things bullies love – throwing small office objects, throwing paper at you, pushing you or touching you.

Bullies hate to be recorded: This is the real killer for a bully. Bullies always know how power works and are very aware of the risks of power being used against them. This is why the threats and insults are much more commonly and forcefully delivered in person, away from witnesses and not in writing. If you can record your meetings with your boss then he or she is going to have to be super careful about what he or she says, and even if the bully can stop you from recording the zoom session itself they cannot stop you putting your phone next to the speaker and hitting record. The threats to sack me always happened in unplanned ad hoc meetings where I did not have time to surreptitiously bring in my phone and hit record, and in any case it is hard to surreptitiously record people when they can see what you’re doing. But online they cannot guarantee they aren’t being recorded, and this means they will have to be careful. Furthermore, one of the responses a university might consider to bullying is to have a witness present at meetings, but the university cannot do this for ad hoc meetings, hallway interactions and the like. But zoom eliminates those meetings – all meetings need to be scheduled and can be recorded. So you can simply request during mediation to have all meetings recorded, and you already have your bully on a leash. It’s worth noting too that universities are going to be much, much more careful about dismissing bullying claims if they are aware that the recordings of the situation they determined was “not bullying” could end up going viral on twitter. I am aware for example of one famous economist who has a terrible reputation, but no one has ever recorded his rants. Good luck to him supervising online!

Witnesses: One of the great things about zoom is that you don’t know what’s going on on the other side of the computer. Even if the video is on and mute is off, a quiet witness can sit on the other side of the computer listening to the behavior of your bully, and stand as a witness in a complaint. Bullies often gaslight their victims, making sure they say derogatory things in private and then either denying them or saying that they didn’t mean it that way or that you misinterpreted their tone. They can’t get away with that if someone you trust is listening in and can tell what they really meant, and give you feedback later. This is a protection for strict or unreasonable senior staff who are not bullies, because that witness will potentially tell their subordinate that the behavior is unpleasant or unreasonable but not bullying. But for bullies this is a disaster. They can’t break your confidence in your own judgment if there are witnesses to dispute their gaslighting, and they can’t even know the witnesses are there. Also it’s much easier for a victim to strike back verbally if they have a person there offering emotional support, even silently – especially if the conversation is muted and the camera off so that the victim can consult with the witness about what to say. And of course you can have that witness occasionally drift by in the background, so that the bully suddenly discovers that the last 30 minutes of bad behavior may have been heard by an outsider.

Bullies love chaos and unstructured interactions: One thing my boss was fond of doing was barging into my office and yelling at me, or calling me into an impromptu meeting and demanding answers to things I hadn’t prepared for, or catching me after group meetings with unreasonable and unrealistic requests plus insults. Bullies love to have everyone on edge, never sure when they’re going to make demands or suddenly turn foul. Of course they can be erratic and chaotic in zoom meetings but they cannot just barge into your work and yell at you over zoom – they need to schedule appointments by email, and that means telling you what it’s about so you can prepare, or at least leaving a paper trail of failed information. Also when meetings are organized like this you can try to rustle in co-supervisors, colleagues and collaborators to diffuse the aggression – and of course you can schedule a witness to hover behind your computer.

Given these reasons I think online supervision actually takes a lot of power away from senior staff and puts it in the hands of their victims. With tele-working and home-based teaching and research becoming the new normal, I think there is a strong chance that even after the pandemic people will be able to manipulate the new normal to allow for greater amounts of online meetings and supervision, with the ability to get greater control over the environment in which bullying happens. If you are being bullied by your supervisor now, I recommend finding ways to turn the zoom meetings and lack of physical meetings into a tool to collect evidence on your mistreatment, and to gather support from partners and friends to help weather it. A couple of recorded zoom sessions with a powerful bully could transform a workplace harassment case, and especially the implied threat of viral attention will really serve to focus the minds of campus administrators on what to do about bullying senior staff. It is my hope that online supervision and telework in the new normal will revolutionize the way academics work and in particular will enable students and junior staff to better manage the misbehavior of unruly and unpleasant senior faculty.

Online conferences and virtual meetings

One thing I really hate about academia is the conference world. I think it’s a scam that was developed by a previous era of academics to enable international travel for free, and for a while it was great – people could go to exotic locations and take a break on the government’s money. But now that administrators have become aware of the scam and the grant money is getting more competitive conferences are a drag. Even very senior staff now are not allowed to fly business, are required to turn up the day of or the day before a conference and are not allowed to take time off before they fly home, and often have to present certificates of attendance or reports. I find conference attendance exhausting and distracting, and I don’t think it enhances my academic life at all. Shlepping halfway across the world to present a 5 minute presentation at a conference where 90% of the material isn’t relevant to my work, then going straight from the final day to the airport to shlepp all the way back, arriving the day after I left and having to go back to work the next day – it’s just an exhausting and tedious waste of time. The fact that it is relevant to our careers – that junior staff have to take time out from all the other stuff they’re doing to faff on the other side of the world without any pleasurable side benefits in order to pad their CV – is incredibly infuriating. And on so many occasions it is completely unproductive – if you’re not the keynote speaker at an international conference you’re likely to be presenting a 5 minute speech in a windowless room to 5 or 10 other people (3 of whom are from your work anyway) who won’t have any questions and may not even care about your work (5 of them are the other presenters!) It’s very rare that there is any significant interaction or anything productive arises from it. What a waste of time!

Online conferences, on the other hand, are great! You only have to attend the presentations that are interesting, you can do it as part of your day job, and because nobody needs to blow half their grant money on a plane ticket many more people will attend. My Chinese colleague recently attended one where she presented her work to 300 people, rather than the 10 people she would expect at a physical conference – and she did it from her bedroom! This means that way more people see your work, there is much more interaction as a result, time limits can be strictly adhered to, people without grant money or from poorer universities can attend, students can attend … it’s a huge win. I hope that in the new normal conferences will become a thing of the past, and will be recognized as the wasteful scam that they were. Let’s make all our conferences online and save physical work travel for actually meaningful trips to do real work!

Conclusion: Online teaching is great

I have been raised to think of online learning as a scam, a way for unscrupulous universities to fleece low-quality students for second rate degrees. But in the modern world of high connectivity and good quality shared work apps, I think we can move past this and begin to see a way to improve our teaching using the online tools available to us. We can make our classes more inclusive, more interactive and more engaging, and we can find new ways to teach hard topics, using the online tools available to us. We can also change the nature of workplace meetings and hopefully even begin to make real progress on eliminating bullying. And we can finally do away with the ludicrous scam of physical conferences, which will enable us to use our grant money more effectively and get our work out to a wider range of people than we have in the past. Let’s embrace this new normal and use it to make our teaching genuinely inclusive and higher quality!

 

May 28, 2020

Why Was Japan’s COVID-19 Response Successful?

Posted by faustusnotes under Health, Japan, Meat Life, Science | Tags: , |
[26] Comments 

On Tuesday 26th May Japan’s COVID-19 state of emergency ended, five days earlier than expected and with deaths down to low double digits every day. The state of emergency was accompanied by a voluntary lockdown that started on 8th April for Tokyo and six other prefectures, extending to the rest of Japan a week later and ending in the rest of Japan a week before the lockdown ended in Tokyo. This means that the lockdown affected Tokyo for just 7.5 weeks, and the rest of Japan for about 6 weeks. At its peak the epidemic generated about 1200 cases in one day (on 17th April), dropping from 1200 to 30 in just 5 weeks.

In contrast, the UK essentially introduced its lockdown on 23rd March and is still slowly relaxing the lockdown. The UK lockdown was stricter than that in Japan, with enforceable restrictions on movement and activities[1], it involved the complete closure of many businesses, and it effectively lasted 3 weeks longer than Japan’s. At its peak the UK saw 8700 cases in one day (on 10th April, a week before Japan’s peak) and dropped much slower, only going below 2000 cases on 25th May – the same day Japan reached 30 cases. This is a quite remarkable difference in pace of decline: dropping by 97.5% in 5 weeks for Japan, compared to 75% in 6 weeks for the UK. These differences show very starkly when plotted, as I have done in Figure 1. This figure shows daily new cases in the two countries by day since the 10th confirmed case, using data obtained from the Johns Hopkins School of Public Health coronavirus tracker[2]. From this figure it is clear that Japan saw its 10th case much earlier than the UK (on 30th January compared to 24th February) yet experienced a much more gradual increase and a much more rapid decline than did the UK.

Figure 1: Daily new COVID-19 cases in the UK and Japan by day since the 10th confirmed case

Why was Japan’s response to the coronavirus so much more effective than that of so many other high-income countries? In this post I will explore a little the key factors that affected the Japanese response, what made the numbers grow so slowly and why the lockdown was more effective than in many other countries. In particular I will compare Japan with the UK, as a model of the differences between an effective and an ineffective response.

Figure 2: Health education materials are essential to good pandemic prevention

A timeline of interventions

Japan saw its first case on the 16th January, compared to 31st January in the UK. However, Japan took action sooner and more aggressively. Here are some key actions and when they were taken by each country.

The difference in public response to the issue of mass events is a key example of the quality of the response in the two countries. While the UK was faffing about with discussion about which responses to take, Japan was already canceling and closing events. My own work events began to be postponed in the last week of February, but so did major public events:

  • J league (soccer) halted all games on 25th February (170 cases)
  • Japan National Pro Baseball league held all preseason games without an audience from 26th February (189 cases)
  • Japan boxing commission and pro-boxing association canceled or postponed all bouts from 26th February
  • Rise kickboxing was canceled on 26th February
  • Sumo was held without an audience from 8th March (502 cases) (5 days after Boris Johnson bragged about “shaking hands with everybody” (51 cases))

In contrast in the UK:

  • An England-Wales Rugby match was held on 7th March with a live audience and the PM in attendance (206 cases)
  • Premier league events were held on 8th March with a live audience (283 cases)
  • Cheltenham races were held on 10th – 14th March (382 – 1140 cases)
  • League one games were held on 10th March (382 cases)
  • UEFA champions league games were held on 12th March (in Scotland) (456 cases)

The UEFA champions league match brought a large number of German fans to Scotland, and a week earlier I think Liverpool visited Spain and another team visited Italy, where the epidemic was already booming. These events had huge numbers of fans – 81,000 people attended the England-Wales rugby match, and many soccer games host tens of thousands of fans. In contrast, the only major event to be held in March in Japan that I know of, with an audience, was K1 on 22nd March, which attracted 6500 fans who were all given a mask at the door (and this event still attracted huge controversy and anger in Japan).

Because of the slow growth of the epidemic the lockdowns also happened at different stages of the epidemic. Japan’s lockdown came on 8th April, when there were 5120 cases; the UK’s, on the 23rd March, when the UK had reached 6600 cases and was already on a much more rapid upward trajectory. It took 4 days from the announcement of lockdown for the UK’s case load to double, whereas it took Japan 8 days. The next doubling took the UK another 4 days, and never happened for Japan.

Finally of course there is the attitude of the leadership: on 3rd March Sadiq Khan announced no risk of catching coronavirus on the London Underground, the same day that Boris Johnson was bragging about shaking everyone’s hand at a hospital (and thus caught coronavirus himself).

It should be clear from this that while in some cases the UK government acted with about the same speed as the Japanese government, in general the Japanese government acted when it had much lower numbers of cases than the UK, and implemented more far-reaching and aggressive strategies that were likely to have greater impact. But beyond basic actions on mass events and action plans, there was one additional major difference in the Japanese government’s response: case isolation.

Contact tracing and case isolation

From the very beginning of the epidemic, Japan introduced a system of “test, trace and isolate” that follows WHO guidelines for emerging infectious diseases. Under this system, once someone was identified as a likely COVID-19 case and tested positive, they were immediately moved to a nominated hospital into a special management ward designed for highly infectious diseases, to have their condition managed by specialist medical teams. This case isolation reduces the risk that they will infect their family, and prevents them from spreading the disease through basic daily functions like shopping if they live alone and cannot be helped by others. This strategy was also used in China and Vietnam, and it is a core part of the reason why the lockdowns in these countries were so much more effective than they were in the UK, USA or much of Europe. When a confirmed case of COVID-19 self-isolates at home they are highly likely to infect family or housemates, who will then continue to spread the virus amongst themselves and to others. This is particularly bad in cities with high levels of inequality like London, where essential workers live in cramped share houses and lack the resources to stop working even if infected. These people infect their housemates, who must continue working as bus drivers, cleaners, care workers or shop assistants, and cannot help but infect others. If the first case is quickly isolated, this reduces the risk that subsequent cases will be infected. As stressed by the WHO, case isolation is key to cracking this highly infectious virus. Case isolation early in the epidemic slows the growth of the epidemic and buys more time to scale up testing and other responses, while case isolation once the lockdown is in place helps to push down the number of infections more rapidly, reducing both the severity and length of the lockdown.

Case isolation was key to Japan’s successful management of this epidemic, but many people have suggested that the epidemic was controlled also because of cultural and social factors that make Japan more successful at managing infectious diseases. I do not think these played a major role in Japan’s response.

Japan’s “unique” social and cultural factors

Some have suggested that Japan’s culture of hygiene, its long-standing mask-wearing habits, and high quality public infrastructure might have played a role in slowing the growth of the epidemic. It is certainly true that Japanese people have a tradition of washing their hands when they get home (and gargling), wear masks when they are sick, and have remarkably clean and hygienic public spaces, with readily available public toilets throughout the country. The trains are super clean and stations are also very hygienic, and it is never difficult to find somewhere to wash your hands. Japanese people also don’t wear shoes in the house (and in some workplaces!) and often have a habit of changing out of “outside clothes” when they come home. But I think these cultural benefits need to be stacked against the many disadvantages of Japanese life: Japan’s trains are incredibly crowded, and everyone has to use them (unlike say California, which was much worse hit than Japan); Japanese shops and public accommodations in general are very cramped and crowded, so it is not possible to socially distance in e.g. supermarkets or public facilities; because Japan’s weather is generally awful and its insects are the worst things you have seen outside of anime specials, most of Japan’s restaurants and bars are highly enclosed and poorly ventilated; and Japanese homes are often very cramped and small. When viewed like this, Japan is a disease breeding facility, a veritable petri dish for a rapidly spreading and easily-transmissible disease. Japan’s population is also very much older than the UK’s, which should suggest further high rates of transmission, and from mid-February we have terrible hay fever which turns half the country into snot cannons. Not to mention the huge outdoor party that is held at the end of March, where everyone gets drunk and nobody socially distances. Japan’s work culture also does not support home working, in general, and everyone has to stamp documents by the hour and we still use fax machines, so I really don’t think that this is a strong environment to resist the disease. I think these social and cultural factors balance out to nothing in the end.

Differences in Personal Protective Equipment

I do not know what the general situation for PPE was in Japan, but certainly the hospital attached to my university, which is a major nominated infectious disease university, sent around a circular in mid-February describing our state of readiness, and at that time we had 230 days’ supply of COVID-rated gowns at the current infection rate, as well as ample stocks of all other PPE and plans in place to secure more. There was a shortage of masks for public use in March, which was over by April, but I do not get the impression that there was such a shortage in the designated hospitals. Japan also has a very large number of hospital beds per capita compared to other high-income countries, but this figure is misleading: most of these beds are for elderly care and not ICU, and in fact its ICU capacity is not particularly large. However, by keeping the new cases low and moving isolated patients to hotels once the hospitals became full, Japan managed to mostly avoid shortages of ICU beds (though it was touch and go for a week or two in Tokyo). I think in the Japanese hospital system the lack of ventilators and ICU beds would have become a major problem long before the country ran out of PPE.

Inequality and disease transmission

One way that Japan differs from a lot of other high-income countries is its relatively low levels of inequality. In particular it is possible for young people to live alone in Tokyo even if they do not have high incomes, which means share housing does not really exist here, and all the young people who move to the big cities for work mostly live by themselves where they cannot infect anyone. Although it is a very densely-populated country and houses are much smaller than in the UK, there is less overcrowding because housing is affordable and there is a lot of it. Most people can afford health care and have ready access to it (waiting times are not a thing here). This low inequality plays an important role in elderly care homes, where staff are better paid and treated than in the UK care sector, and less likely to move between facilities on zero-hour contracts as they do in the UK. There is a higher level of care paid to basic public facilities like hospitals, railway stations, public toilets and other facilities which ensures they are relatively hygienic, and cleaning staff here tend to be paid as part of a standard company structure rather than through zero-hours contracts, with good equipment and basic working rights. Also there is a much lower level of obesity here, and obesity is not as class-based, so there is less risk of transmission and serious illness through this risk factor. There is a very high level of smoking, which is a major risk factor for serious illness and death from COVID-19, but it is the only risk factor that is comparable to or higher than those in the UK. In general I think Japan’s low level of inequality helped in the battle against this disease, by preventing the country from developing communities where the disease would spread like wildfire, or having strata of the population (like young renters) at increased risk, or forcing increased risk onto the poor elderly as we saw in the UK.

A note on masks

I think masks are a distraction in the battle against this disease. I think most people don’t know how to wear them properly and use them in risky ways – touching them a lot, reusing them, wearing them too long, storing them unsafely, and generally treating them as part of their face rather than a protective barrier. I think that this can create a false sense of security which leads people to think that opening up the economy and dropping lockdown can be safely done because everyone is protected by masks. This is a dangerous mistake. That is not to say one shouldn’t wear them, but one should not see them as a solution to the more basic responsibility of social distancing and isolation, and one definitely should not drop one’s hand hygiene just because one is wearing a mask: hand hygiene is much more important for protecting against this disease. It’s worth remembering that on the days that Japan was seeing 300 or 500 or 1000 cases a day everyone was wearing masks, but somehow the disease was still spreading. They are not a panacaea, and if treated as an alternative to really effective social measures they may even be dangerously misleading.

Conclusion: Early, sensible action and strong case isolation are the key

Japan took an early, rapid response to the virus which saw it screening people at airports, educating the population, and implementing sensible measures early on in the epidemic to prevent the spread of the disease. The first measures at airports and in case isolation were taken early in February, major events were cancelled and gatherings suspended from mid- to late-February, and additional social distancing measures introduced in March. Throughout the growth of the epidemic the Japanese response focused on the WHO guideline of testing, tracing, and isolating, with case isolation a routine strategy when cases were confirmed. This case isolation slowed the growth of the epidemic and once lockdown was in place helped to crush it quickly. This in clear contrast to the countries experiencing a larger epidemic, which typically reacted slowly, introduced weak measures, and did not implement case isolation at all or until it was too late. Lockdowns with self-isolation will work, but as Figure 1 shows, they are much less effective, causing more economic damage and much slower epidemic decline, than lockdowns with case isolation.

Finally I should say I think Japan ended its lockdown a week early, when cases in Tokyo were still in the 10s, and we should have waited another week. I fear we will see a resurgence over the next month, and another lockdown required by summer if our contact tracing is not perfect. But it is much better to end your lockdown prematurely on 10 cases a day than on 2000 a day, which is where the UK is now!

fn1: With certain notably rare exceptions, of course…

fn2: I have had to do a little cleaning with the data, which contains some errors, and I think the JHSPH data doesn’t quite match that of national health bodies, but it is much more easily accessible, so that is the data I have used here. All case numbers are taken from that dataset, unless otherwise stated.

 

May 20, 2020

What is the Best Metric for Judging When to End Lockdown?

Posted by faustusnotes under Health, Meat Life, Science | Tags: , |
[16] Comments 

As I write this many countries are beginning to end their lockdowns and make plans to reopen. The UK has already begun to reopen, the US is opening state by state and much of Europe is beginning to return to work and play. Japan has ended its state of emergency in 40 prefectures, leaving the 7 hardest hit prefectures another two weeks of lockdown before they can resume normal activity. Different countries and states have different guidelines and rules about how to reopen, and are reopening at different stages of the epidemic. Let’s look at the circumstances in some of them.

  • United Kingdom: 2,400 new cases on 19th May, down from a peak of about 6,000 a day. A major epidemic still seems to be raging in elderly care homes, but people have begun returning to work. There is debate about whether to reopen schools, but some universities have decided to conduct the entire 2020/21 academic year online. Quarantine rules will be introduced for inbound overseas travelers from early June. Still recruiting staff to do contact tracing.
  • Germany: 513 daily cases on 19th May, down from a peak of 6,000 a day. Shops have reopened, Bundesliga has restarted without crowds and schools will soon reopen. The end of lockdown began on about May 10th, when there were about 670 cases a day
  • USA: 19,662 daily cases on 19th May, down from a peak of about 35,000 a day. States are reopening at their own pace with some being strict and some being very relaxed. Most states have ongoing daily cases in the hundreds, and there are signs that the decline in daily cases has stopped in states like New Jersey and Washington, or that case numbers are rising in states like Maryland, after seeming to plateau. In some states like Texas the number has been constantly increasing and the state is reopening after completely failing to stop the growth of the virus. Major problems with the testing infrastructure and large state-by-state differences in public health infrastructure.
  • Japan: 31 daily cases on 19th May, down from a peak of about 700 cases, with 5 in Tokyo. Only some prefectures are reopening, rules remain regarding mass events, schools have not yet reopened, and things aren’t going straight back to normal. Full reopening of the country is currently planned for 31st May but could be postponed if the trajectory changes

New Zealand, of course, began to reopen only when there were 0 cases. These countries seem to have starkly different ideas about when and how to reopen, with the USA and UK really nowhere near the bottom of their incidence curves, and still huge numbers of cases being discovered every day. Most of these countries claim to have pushed the reproduction number of the virus below 1, which means that they think the epidemic is under control. But what is the best metric for determining when to end a lockdown?

Metric 1: Daily number of cases

One way to judge whether to exit lockdown is the daily number of cases. You can calculate this as a percentage of your total active cases and from that estimate the amount of time it takes to double the number of cases, and if you think this is low enough you can reopen. Under this metric New York is ready to reopen, since it saw 1,474 new cases yesterday out of 353,000 total cases, which suggests a growth rate of 0.4%, which in theory should mean it will take another 100 days or more for case numbers to double.  By this metric Arkansas should be okay too – it had 110 new cases yesterday out of 4,923 existing cases, giving a 2% growth rate that suggests about a month or more to double. You need to show a little caution with this calculation though, because many states that have experienced slow growth in long epidemics have a large number of recovered cases. In fact in Arkansas there are only 1,184 active cases, so basically yesterday it saw a 10% increase in case numbers, which means the number of cases will double in a week. It should probably stay closed by that metric! But a lot of states don’t seem to be recording or reporting recovered cases. Also if we use the metric of not opening if your cases will take a week or less to double (say, a 10% increase per day), then New York now could open even if it had 30,000 daily cases, since that is less than 10% increase a day. But I think everyone would agree a single city opening when it still has 30,000 cases a day would be a bit silly.

Metric 2: Reproduction number

Everyone is becoming familiar with the effective reproduction number, Rt, now that the epidemic is all the news we can read about. Rt is the number of cases that will be generated by a single infected person. Rt measures this number over time, so it can change as policies change, and is slightly different to R0, the basic reproduction number. R0 measures Rt at the beginning of the outbreak, when there is only 1 new case and the population has no special measures in place. I estimated R0 for COVID19 to be 4.4, meaning that each case will generate 4.4 new cases. Because the disease has an incubation period when people are asymptomatic of about 4-5 days, we can expect those 4.4 new cases to occur between 4 days and two weeks after the initial infection, so we might expect that an approximate rule for this virus is that 100 cases today will generate 400 cases after a week, suggesting that unrestrained it doubles every 3-4 days. That’s nasty! But after policies are put in place we can drive Rt down to 1, and once it’s below 1 we should expect that the epidemic will begin to die out. This seems to be the primary metric the UK government is using – their politicians are always on TV talking about “the R number” and everyone is eager to get it below 1. The big problem with using Rt is that if you have enough daily cases, an Rt below 1 will still mean you generate a lot of new cases. For example, the US has 20,000 cases a day and most Rt values are near 1. If Rt is 0.8 then given the incubation time we should expect 16,000 daily cases after a week, 12,800 after two weeks, and so on. That suggests a half-life for the disease of perhaps 2-3 weeks, and it will take another two months to disappear. A lot of deaths will happen in that time.

Another problem with Rt is that once the economy opens we should expect it will go up. If Rt keeps fluctuating above and below 1, are we to keep closing and opening the economy? What if it’s 0.8 for a week, then goes up to 1.2? Do we close down? Or wait as the epidemic begins to spread again? If it is fluctating like this we may end up with an epidemic that is constantly varying around 20,000 cases a day: one week it’s 15,000 a day, then we loosen our measures and it’s 22,000 a day, and so on. Also there is a lot of uncertainty in estimates of Rt – if it’s 0.9 then in theory we are in epidemic elimination territory, but actually if the confidence interval is 0.7 to 1.1 there’s some chance we aren’t there at all.

Metric 3: Health system capacity

Unless we do as NZ has done and exterminate the virus completely before we reopen, we can be confident there will still be some cases when we reopen. In this case we will need to deal with them by testing, contact tracing, and if possible isolating the cases. Contact tracing one case when they’re in lockdown is easy – you just test the people they live with. But once they’re working and socializing one positive case will likely mean tracking down and testing 5 or 10 more people. This is hard work and it needs to be done quickly with a disease like this, especially if even a small number of people are asymptomatic but able to spread. Basically you need to find and test all 10 contacts and get their results back to them – and if necessary isolate them – within 4 days of the onset of symptoms in the index case, and even less time if the index case delayed presentation to hospital. This means if you have 500 cases a day you need to track 2500 to 5000 people daily, and potentially have to isolate 2000 of them. To do this requires a lot of boots on the ground and a lot of hotel rooms. Furthermore, the more cases you have the less room there is for error. If you have 5 cases a day and a 10% error rate in contact tracing you’ll miss 5 people, 1 of whom might be infected. With 500 cases a day you’ll miss potentially 500 people, of whom 100 might be infected. Those slip ups will help the virus continue to spread until it finds a super spreader like the Korean bar scenario (or in America, a meat packing plant).

To me this is the best guide for when to open: do you have the logistics to cope with cases as people begin to socialize and spread the disease again? If you have 50 cases a day and 500 contact tracers then you can probably handle it; if you have 500 cases a day and 500 contact tracers then it’s not going to work, and you’re going to lose control of the epidemic. Rather than judging by the rate at which the virus might double, or the reproduction number, you should look at whether you can rigorously and effectively stamp out every single case that could be generated after you reopen, and not ease your lockdown until you’re well within the logistic capacity to do so. That means looking at testing capacity, the number of people able to contact trace, your population’s willingness to share contacts and engage with health workers, your hotel capacity for case isolation, and your hospital bed capacity (and in-hospital infection risk!) for those you miss. If any aspect of that process could break, you need to wait.

Unfortunately, a lot of policy makers and politicians have been focused on the reproduction number, as if crossing the reproduction threshold will automatically end the epidemic. It’s an easy number to focus and gives an easy story to tell the press and the public, and it’s nice to have a target to aim for, but although a scientifically valid measure of the epidemic’s dynamics it is of little use in deciding how to deal with the epidemic. Much more important is the ability to control the cases you have, and a long term plan for getting rid of them, than a spot judgment about whether you “have the epidemic under control” based on a number that is both uncertain and ultimately not very practically informative.

The consequences of losing control a second time

The big problem with losing control of the epidemic a second time is that you have a lot more cases floating around than the first time it happened. It took the UK two weeks to rise from 152 cases a day to 4,500 cases[1], so if the UK opens up on 2,500 cases and loses control the consequences will be dire. If the week after opening up there are 2,000 cases, and the contact tracing misses 152 of them (<10%!), then in theory within two weeks the UK will be back to 4,500 cases a day. Furthermore, it will be much harder to go back into lockdown a second time, because the population will no longer see it as an effective strategy and it will be political suicide for any government contemplating it. Socially and politically, you can’t let this genie back out of its bottle. And although we like to hope that the population will observe social distancing rules and other niceties, in reality this will slide quickly, and if the cases aren’t under control by the time people return to their normal ways, another explosion will follow. This is without considering unknown and potentially catastrophic risks, such as school openings. The UK government is pushing to reopen schools because they say there is little risk of spread among children, but the ONS survey found much higher proportions of young people with antibodies in the community than are recorded in confirmed hospital cases. If the virus was quietly spreading in young people when it started at 1 case, how explosive will its growth in this cohort be if it starts from 2000 cases? These low-risk groups are highly likely to have many social contacts and to be an excellent infection vector for high-risk groups such as their parents and teachers.

Watching the data from the USA, I think this is already happening in some states in the USA now. Texas, Maryland, Minnesota, maybe New Jersey, North Carolina, maybe Tennessee are already beginning to see either growth or a distinct flattening of previous downward curves, and other states that are reopening like Florida and Wisconsin will likely see this in a week or two. I don’t think any of these states have the contact tracing capacity for the cases they are currently seeing, and they don’t have any plan to isolate cases, nor do they have well-functioning or affordable health systems. The same is true in the UK, which is nowhere near having its contact tracing infrastructure in place, and is playing with all kinds of deadly scenarios (like reopening schools and soccer games). I think this is partly because they’re fixated on Rt as the metric for reopening, partly because they’re incompetent, and partly because of political and economic pressure, but regardless, a disaster is in their near future if their health system capacity is not ready – and I think it’s not. In two weeks we are going to see the second wave hit these unready countries, and it’s going to make the first wave seem like a bad cold.

fn1: But it has taken 5 weeks to get from 4,500 back to below 4,000. This shows the incredible urgency of stopping this epidemic during its upward rise, not once it has really spread. The government’s faffing in the early days has made every subsequent decision harder, less effective and more deadly. The entire crew should resign immediately and hand government over to some adults to manage the place properly.

 

April 25, 2020

The Dangerous Consequences of Poor Quality COVID-19 Tests

Posted by faustusnotes under Health, Meat Life, Science | Tags: , |
[3] Comments 

There is a lot of pressure at present for the expansion of testing for COVID-19 to enable better understanding of the spread of the virus and possibly to help with reopening of the economy. Random population surveys have also been conducted in many countries, with a recent antibody survey in California, for example, finding 50 times more people infected than official estimates report. The WHO recognizes testing as a key part of the coronavirus response, and some countries are beginning to discuss the idea of “immunity passports”, in which people are given an antibody test and enabled to return to work if they test positive to antibodies and are well (since this indicates that they have been infected and gained immunity). The WHO advises against this approach because there is no evidence yet that people who have experienced COVID-19 and recovered are actually immune. But in addition to this virological concern, there is a larger, statistical concern about COVID-19 tests (especially antibody tests) and the consequence of widespread use of these tests as a policy guide: how reliable are they, and what are the consequences of deploying poor-quality tests?

My reader(s) may be familiar with my post on the use of Bayesian statistics to assess the impact of anti-trans bathroom laws on natal women. This study found that, since being transgender is a very low prevalence phenomenon, if we tried to actually enforce birth-gender bathroom laws almost everyone we kicked out of a woman’s toilet would actually be a cis woman. This is a consequence of Bayes’ Law, which basically tells us that when a condition has very low prevalence, any attempt to test for that condition will largely produce false positives unless the test is a very very accurate test. This applies to any attempt to discriminate between two classes of things (e.g. trans women vs. natal women, or coronavirus vs. no coronavirus). It is a universal mathematical theory, and there is no escaping it.

So what happens with testing for coronavirus. There are a couple of possible policies that can be enacted based on the result of testing:

  1. People testing positive are isolated from the rest of the community in special hospitals or accommodation, to be treated and managed until they recover
  2. People testing positive self-isolated and all their potential contacts are traced and tested, self-isolating as necessary
  3. People testing negative are allowed to return to ordinary life, working and traveling as normal
  4. People testing positive to antibodies with no illness are issued an “immunity passport” and allowed to take up essential work
  5. Health workers testing negative are allowed to return to hospital

Obviously, depending on the policy, mistakes in testing can have significant consequences. This is why the WHO has quite strict diagnostic criteria for the use of testing, which requires multiple tests at different specified time points with rules about test comparison and cautionary notes about low-prevalence areas[1]. Now that some antibody tests have achieved marketing status, I thought I would do a few brief calculations using Bayes’ rule to see how good they are and what the consequences will be. In particular let’s consider policy options 1, 3 and 4. I found a list of antibody tests currently being marketed or used in the USA here, and information on one PCR test, from Quantivirus. I assumed a testing program applied to a million people, and for each test under this program I calculated the following information:

  • The number of people testing positive and the number who are actually negative
  • The proportion of positive tests that are actually positive
  • The number of people testing negative and the number who are actually positive
  • The estimated prevalence of COVID-19 obtained from each of these tests

I used the current number of cases in the USA on 24th April (870,000), multiplied by 10 to include asymptomatic/untested cases and a US population of 330 million to estimate the true prevalence of coronavirus in USA at 2.6%.  Note that with 2.6% prevalence the true situation is 26,000 cases of COVID-19 and 974,000 people negative. I then compared the estimated prevalence for each test against this. Here are the results

Beckton-Dickinson/Biomedomics Covid-19 IgM/IgG Rapid Test

This test has 88.7% sensitivity and 90.6% specificity, and has been given emergency use authorization by the FDA. If used to test a million people in the context of disease prevalence of 2.6%, we would find the following results:

  • 114,906 people testing positive of whom 91,521 are actually negative
  • Only 20.4% of tests positive
  • 885,903 people testing negative, of whom 2,979 are positive
  • An estimated coronavirus prevalence of 11.4%

This would mean that under policy 1 (isolation of all positive cases) we would probably increase prevalence by a factor of 5, since 80% of the people we put into isolation with positive cases would be negative (and would then be infected). If we followed policy 3 or 4, we would be releasing 2,979 people into the community to work, get on trains etc., and infect others. We would also recalculate the case fatality rate of the virus to be 50 times lower than the actual observed estimate, because we had observed deaths among 870,000 cases (prevalence 0.26%) but were now dividing the confirmed deaths by a prevalence of 11.4%. This would make us think the disease is not much worse than influenza, while we were spreading it to five times as many people. Not good! Curing that epidemic is going to need a lot of bleach injections.

Cellex qSars-CoV-2 IgG/IgM Cassette Rapid Test

This test has also received emergency use authorization, and has 93.8% sensitivity and 95.6% specificity, which sounds good (very big numbers! Almost as good as Trump’s approval rating!) But if used to test 1,000,000 Americans with prevalence of 2.6% it still performs very poorly:

  • 67,569 people testing positive of whom 42840 are actually negative
  • Only 36.5% of tests positive
  • 932,430 people testing negative, of whom 1,635 are positive
  • An estimated coronavirus prevalence of 6.8%

This is still completely terrible. Isolating all the positive people (policy 1) would likely increase prevalence by a factor of 3, and we would allow 1,635 people to run around infecting others blithely assuming they were negative. Not a good outcome.

CTK Biotech OnSite Covid-19 IgG/IgM Rapid Test

This test has not yet received emergency use authorization, but has 96.9% sensitivity and 99.4% specificity. With this test:

  • 31,338 people test positive of whom 5,841 are actually negative
  • About 81% of tests are actually positive
  • 968,611 people test negative, of whom 817 are positive
  • An estimated coronavirus prevalence of 3.1%

This is much better – most people testing positive are actually positive, we aren’t releasing so many people into the wild to infect others, and our prevalence estimate is close to the true prevalence. But it still means a lot of people are being given incorrect information about their status, and are taking risks as a result.

Conclusion

Even slightly inaccurate tests have terrible consequences in epidemiology. As testing expands the ability to conduct it carefully and thoroughly – with multiple tests, sequenced tests, and clinical confirmation – drops, and the impact of even small imperfections in the testing regime grows rapidly. In the case of a highly contagious virus like COVID19 this can be catastrophic. It will expose uninfected people to increased risk of infection through hospitalization or isolation alongside positives, and if used for immunity passports significantly raises the risk of positive people returning to work in places where they can infect others. In comparison to widespread testing with low-quality tests, non-pharmaceutical interventions (e.g. lockdowns and social distancing) are far more effective, cheaper and less dangerous. It is very important that in our desire to reopen economies and restart our social lives we do not rush to use unreliable tests that will increase, rather than reduce, the risk to the community of social interactions. While testing early and often is a good, strong policy for this pandemic, this is only true when testing is conducted rigorously and using good quality tests, and not used recklessly to end social interventions that, while painful, are guaranteed to work.

 

fn1: It’s almost as if they know what they’re doing, and we should listen to them!

 

April 1, 2020

COVID19 Begins to Slip Out of Control in Japan

Posted by faustusnotes under Health, Japan, Meat Life, Science | Tags: , |
[7] Comments 

Tokyo Zombie Movie

The novel coronavirus (COVID-19) continues to spread globally, and at this point in its progress very few high-income countries have escaped its grip. On a per-capita basis Spain has 38 times the rate of infection of China, the US 10 times and Australia 3 times, but plucky Japan has only 0.3 times the infection rate of China. Until now the rate of growth has been low, with only tens of cases per day being recorded over much of February and March, but since last week the alarm has been sounding, and the government is beginning to worry. We had our first lockdown on the weekend, a voluntary two days of 自粛 in which everyone was supposed to stay inside, and this week discussion of lockdown began. This is because the previous week was a bright, sunny weekend with the cherry blossoms blooming, and all of Tokyo turned out to see them despite the Governor’s request for everyone to be cautious. Over the two weeks leading up to that weekend, and for perhaps two days afterwards, the train system returned to normal and Tokyo was being its normal bustling, busy uncaring self. But then on the week after that event the numbers began to climb, and now the government is worried as it begins to watch the numbers slide out of control. I am also now hearing for the first time stories of doctors having to find alternative ICU beds for COVID patients – still not a huge deal, because any one hospital does not have a large supply, but enough cases are now appearing to force doctors to seek empty hospitals elsewhere.

It is possible to see the effect of this party atmosphere in the data, and it offers a strong example of how important social distancing is. Using the data from the Johns Hopkins Coronavirus tracker (and making a few tiny adjustments for missing data in their downloadable file), I obtained and plotted the number of new cases each day, shown in Figure 1 below. Here the x axis is the number of days since the first infection was identified, and the y-axis is the number of new cases. Day 70 is the 1st April. The red line is a basic lowess smooth, not a fancy model.

Figure 1: Daily new cases by time since the first case

It is clear from this figure that things changed perhaps a week ago. New case numbers were up and down a lot but generally clustered together, representing slow growth, but since about a week ago the gaps between each dot are growing, and more dots are above than below the line. This is cause for concern.

However, it is worth remembering that each day the total number of cases is increasing, which means also that if you add the same number of new cases on any day, it will have a proportionately smaller effect on the total. We can estimate this by calculating the percentage change each day due to the new cases added on that day. So for example if there are 10 cases in total and 10 new cases are detected we see a 100% change; but 10 new cases with 100 existing cases will lead to only a 10% change. From this we can calculate the daily doubling time: the time required for the number of cases to double if we keep adding cases at the same percentage increase that we saw today. So, for example, if there are 100 cases on day 9 and on day 10 there are 10 more cases, the percentage change is 10%, and from that I can estimate that the number of cases will double after 7.2 days if that 10% daily change continues. This gives a natural estimate of the rate at which the disease is growing, adjusting for its current size. Figure 2 shows the doubling time each day for Tokyo, again with the number of days since the first infection on the x-axis. I have trimmed the doubling time at 20 days, so a few early points are missing because they had unrealistically high doubling times, and added a lowess smooth to make the overall pattern stand out. The vertical red line corresponds with Friday March 20th, a national holiday and the first day of the long weekend where everyone went cherry blossom viewing.

Figure 2: Daily time required for case numbers to double in Japan

Since the infection hit Japan the doubling time has been growing slowly, so that in February it would take almost two weeks for the number of cases to double. The doubling time dropped in March[1], which was also the time that the government began putting in its first social distancing guidelines (probably about late February); work events were being canceled or postponed by early March, probably in response to government concern about the growing number of cases, and this appears after two weeks to have worked, bringing the doubling times back up to more than two weeks. And that was when the sunny weather came and everyone went to hanami, marked on the red line, at which point the doubling time dropped like a stone. Back in the middle of March we were seeing between 10 and 40 cases a day, slow changes; but then after that weekend the number of cases exploded, to 100 or 200 a day, pretty much 4-6 days after the long weekend started. The following weekend was when the government demanded everyone stay in, and the city shut up shop; but we won’t begin to see the effect of those measures until tomorrow or this weekend, and right now the number of new cases is still hovering around 200 a day.

It’s worth noting that not all of these cases are community transmission. About 10% are without symptoms, and another 20% are having symptoms confirmed (probably because they’re very mild), which indicates the effectiveness of contact tracing in tracking down asymptomatic contacts. A lot of these cases are foreigners (something like 20-25%), and this is likely because they’re residents returning from overseas, and likely identified during quarantine/self-isolation (so not especially risky to the community). But still, even 70% of 200 is a lot of cases.

It’s instructive to compare this doubling time with some heavily-affected countries. Figure 3 shows the smoothed doubling times for Japan, the US, Italy and Australia. It has the same axes, but I have dropped the data points for clarity (I make no promises about the quality of these hideous smooths). The legend shows which country has which colour. Italy and Australia start slightly later in this data because their first imported case was not at day 0.

Figure 3: Doubling times for four affected countries

As you can see, Italy’s doubling time was almost daily in the first week of its epidemic, but has been climbing rapidly since they introduce social distancing. Australia’s doubling time was consistently a week, but began to increase in the last two weeks as people locked in. The US tracked Japan for a couple of weeks and then took a nose dive, so that at one point the daily doubling time was 3 days. Italy provides a really instructive example of the power of social distancing, which was introduced in some areas on February 28th and nationally in increasingly serious steps from 1st March to 9th March. Figure 4 shows Italy’s doubling time over the epidemic.

Figure 4: Doubling time for Italy

 

It is very clear that as measures stepped up the doubling time gradually increased. In this figure day 40 is the first of March, the first day that national measures were announced. Despite this, we can see from Figure 3 that it took Italy about a month and a half from the first case to slow the spread enough that further doubling might take a week, and early inaction meant that a month of intensely aggressive measures were needed to slow the epidemic, at huge cost.

It is my hope that Japan’s early measures, and aggressive investigation of clusters at the beginning of the outbreak, will mean that we don’t need to go into a month-long lockdown. But if Japan’s population – and especially Tokyo’s – don’t take it seriously now, this week and this weekend, Tokyo will go the same way as London and Italy. It’s time for Tokyo to make a two week sacrifice for its own good. Let’s hope we can do it!

fn1: Which the smooth doesn’t show, by the way, it’s an awful smooth and I couldn’t improve it by fiddling with the bandwidth[2]

fn2: A better model would be a slowly increasing straight line with a peak at the hanami event and then a rapid drop, but I couldn’t get that to work and gave up[3].

fn3: Shoddy jobs done fast is my motto!

 

March 26, 2020

Is Japan really not Testing Enough for Coronavirus?

Posted by faustusnotes under Health, Meat Life, Science | Tags: , |
[2] Comments 

Conspiracy theories about Japan’s approach to the coronavirus (COVID-19) are beginning to spread online, as people find it very difficult to believe that the country still has only 1000 cases of the virus even though it has not been testing a great deal. This has led to suggestions that Japan is covering up the true number of cases, and the epidemic is out of control in Tokyo.

This isn’t true: Japan has actually tested quite a lot of people, the epidemic is not out of control here as it is in so many other countries, there is no cover up, and what is happening in Japan is an example of what can be achieved with careful, early interventions. I will explain this here a little.

What is Japan’s epidemic situation?

According to the Ministry of Health, Labour and Welfare there were 1193 confirmed cases of COVID-19 on 25th March, of whom 272 had recovered,  43 had died and 57 required ventilator support. Japan’s first death from COVID-19 occurred on 13th February, about 41 days ago, a lot earlier than in other countries such as Germany (15 days ago), Italy (34 days ago) or the USA (25 days ago). For a disease as infectious as this one, these small differences in number of days should lead to huge differences in case numbers: Japan has had 16 days more than the USA to see this epidemic grow, but on day 9 the USA had only 645 cases – now it has 64,661 cases. It is obviously mystifying to many people that the US could see a 100-fold increase in the number of cases in the same time period that Japan saw only a two-fold increase. The obvious suspicion is that since Japan hasn’t tested that many cases, they must be hiding something. There are two reasons this theory doesn’t work: 1) Japan is actually testing more than people recognize and 2) you would definitely be able to tell if there was a 50-fold undercount of cases.

What is Japan’s testing situation?

Testing data can be obtained here. Japan has tested about 22,000 people, of whom 1193 have been confirmed positive. In contrast Germany has tested 167,000 and the UK has tested 65,000. This certainly seems like a lot of missed tests in Japan, but it is worth bearing in mind that the number of tests per positive person is actually about the same in these countries: 18.4 per positive in Japan, 19.7 per positive in the UK, and 25.5 per positive in Germany. In South Korea the number is unusual: 350,000 tests for about 9,000 cases, or 38.9 tests per positive case, but South Korea was dealing with a unique situation where a particular population group was known to be at risk (the weird religious group) and an aggressive testing policy could be targeted based on a social identity. In other countries the number of tests has approximately mapped the scale of the epidemic. This strangely stable ratio of tests to positive patients arises from the limitations on the test: it can only work on people who currently have the virus (it’s a PCR test) and it is expensive and still limited, so population-level testing cannot yet be conducted, and if done partially would miss cases. Basically every country is using passive case-finding to identify the disease, and only using the test where the symptoms suggest it, in order to conserve tests and avoid the social consequences (isolation and clinic shutdowns) associated with false positives. Japan is doing no differently here than Germany or the UK, it’s just that there are less people with symptoms, and less people to test as a result.

It’s worth noting that Japan set up a call centre for people with COVID-19 concerns on the 28th January, and since the middle of February it has been receiving about 3000 calls a day (also, somewhat cutely, 0-2 faxes per day: don’t ever change, Japan!), so there have been about 150,000 calls over the period of testing. In a country of 120 million this doesn’t seem to be a sign of a massively out of control epidemic. I can’t find statistics on the NHS 111 line but there are many stories out there about how it is congested with calls.

Why is Japan following this policy?

There are several levels of testing that can be conducted for any disease, ranging from population screening (seen in breast cancer programs) through voluntary testing (seen in HIV prevention programs), active case finding (where community health organizations target particular groups known to be at risk of a disease, usually used for TB) to passive case finding, which is used in almost all non-fatal sexually transmitted infections, influenza, and other infectious diseases. Screening is usually only conducted if the disease course can be changed by early detection. Passive case finding is useful when there is no identifiable group to target, or the disease prevalence is low so the chance of a positive test is low, or the test is rare/expensive/invasive. In this case the test is still restricted in availability, and the disease prevalence is low so you need to use a lot of tests to find one case. This is complicated in the case of COVID-19 by the possibility that the testing process itself will infect the tester, and so it’s better not to go charging out into the community exposing testers to large amounts of potentially infected people. South Korea conducted a kind of active case finding program, but that is because they knew where to look.

In this sense Japan’s policy is really no different to that in other countries. Japan has focused its efforts up until now on finding cases through cluster investigation: a lot of cases in Japan up until recently have arisen from cluster’s connected to specific events, and finding the people connected to these clusters and isolating them is super important. A single live music event in Osaka, for example, was responsible for 48 cases (about 5% of all the cases in Japan!), and had those cases not been tracked they would have turned into a huge outbreak. You can see the effect of this cluster approach in the statistics: often new cases (particularly in rural Japan) are asymptomatic, which indicates they were caught as part of a contact tracing effort; and even today with 40 new cases in Tokyo about half have a known contact already, which suggests they were tracked down (or their contacts will be). Quite a few cases are also imported: 5 of today’s 40, for example, have an overseas travel history. Focusing on clusters means targeting testing at people who need it, which avoids clogging up testing facilities and ensures that the test follow up is good quality.

Another reason for Japan’s low number of tests is its basic advice to people with suspected COVID-19. The advice from the government to citizens and medical institutions alike is: don’t come in for a consultation unless you have a fever >37.5C and coughing/chest tightness for at least 4 days (unless you’re pregnant or otherwise at risk). Until then you should self-isolate and avoid travel. This advice is super important in Tokyo, where most people travel by public transport, and ensures sick people aren’t infecting others on the train, and it avoids over-burdening health facilities with people who just have a cold. Two of my role-playing group have gone through this process; one went to the doctor after 4 days and was diagnosed with a cold based on x-ray and influenza tests, and the other self-isolated until her symptoms faded after 3 days. We’ll never know if she is immune to the virus now, but it doesn’t matter because she wasn’t at risk and she did not infect anyone else by getting on a train. Given that a lot of cases in Italy are now being  reported as hospital-acquired, this is good advice – but it also leads to the use of less tests.

So how do we know the size of Japan’s epidemic?

If we aren’t testing, how do we know what’s happening? First, we can assume given the ratio of positive results to tests is the same as in other countries that the process is working the same way here, and less tests are needed because less people have the virus. Second, though, we can look at the state of hospital emergency and intensive care wards, and make a judgment about the epidemic from the burden those wards are facing. In New York, for example, we now have horrifying accounts of emergency wards overflowing with cases and doctors working without breaks as their hospitals become basically COVID zones. In Italy new triage guidelines are being released for rationing ventilators. I am sure that is not happening (yet) in Japan, for two reasons: I work with doctors at a major hospital, and I am regularly visiting that hospital for medical care.

I have worked in and around hospitals for my whole career, doing data management and research, including in Japan, and I am familiar with how a hospital feels when it is working well and when it isn’t. You can tell from the way the doctors and nurses are working, the state of the physical environment, and what they complain about when they talk to you during your work day, whether they are struggling. Doctors are often wrong about epidemiology but they have an eye for when things are changing in their case load, and when they talk to you about it you can tell if things are going wrong. I don’t get that impression from my day job, or from any of my research colleagues from other hospitals here. There is not yet any pressure on emergency or intensive care services. I also receive the circulars for the medical staff in my work email, and so I can see how they are preparing for a surge that has not yet happened (today for example I received reassuring news about the stockpile of emergency equipment that my hospital has, the kind of news that would probably make an American very angry at how ill-prepared their system was). It’s not complacency or a lack of care: the wave just hasn’t hit yet.

The second reason I know this is that I have had to visit a lot of different parts of this hospital for medical care for my stupid knee, which I dislocated at kickboxing four weeks ago and have subsequently discovered has been missing some major components for the past 30 years. I only discovered this through multiple x-rays, MRIs, and CT scans (which I guess Aussie doctors didn’t feel I deserved over the first 30 years of my life!) As we all know, X-rays play a very important role in COVID-19 care since they enable doctors to see what kind of damage is going on. There is no way I would have sat just 10 minutes in the x-ray queue, watching orthopaedic patients hobble in and out calmly, if my hospital were overrun with COVID patients – I would probably be sent off to an external private provider or forced to wait all day. There’s also no way the CT scanner would be available for me to use 15 minutes before my appointment.

Unless Japanese people are uniquely able to resist this virus, the surge isn’t here yet, which means the epidemic is still in its infancy here – but that may all be about to change.

Japan’s prevention policy and what is coming soon

Japan has avoided major lockdowns yet, because it acted early and sensibly in light of warnings from China. The Japanese government listened to China, sent help early on, and paid careful attention to what was happening. The first advice from the Ministry of Health, Labour and Welfare was sent early – probably in early February – and the first restrictions on public behavior were instituted probably two weeks after the first death in mid February. My work events were being canceled by the end of February, and instructions were being disseminated throughout Japan to avoid large events. New advice about self isolation was issued early, and the National Institute of Infectious Diseases began its epidemiological investigations early. Japanese companies already have seasonal flu policies in place, and it is quite common for people to self-isolate if they have influenza, and those who don’t self-isolate will wear masks and behave responsibly with their disease. Japan is also not a touchy-feely huggy kind of country, and bowing is the standard greeting. In contrast, the UK was still considering what to do about large events in early March, and hand-shaking was still being discussed. It’s incredible that the day before the UK experienced its first coronavirus death, when Italy was starting to go pear-shaped, and in light of China’s experience, the British government still had no opinion on large events or shaking hands, one of the most disgustingly unhygienic ways you can greet someone.

This early action has served Japan well – even though it at no point closed its border to China! – but it may not be enough. Yesterday there were 40 new cases in Tokyo and 95 new cases in the whole country, and the Tokyo governor asked people to stay inside all weekend and not travel at all unless it was an emergency. There has been general uproar that a large kickboxing event (K1) was held on Sunday, and also consternation at the large numbers of people still going to parks and gardens for ohanami (it’s the season). If counter-measures aren’t stepped up it’s likely that Japan will lose a grip on this. It’s my expectation that by next weekend the Ministry of Health, Labour and Welfare will announce a lockdown, at least of the major cities, and an extended closure of restaurants and bars (to be clear, I have no inside knowledge of this – it’s just my judgment). The 40 cases we saw in Tokyo today were at least partly a result of last weekend’s ohanami madness, and we won’t know the effect of a weekend shutdown until next week, so my guess is the government will increase the restrictions next weekend. Given the small number of cases at present and the slow daily growth they probably only need to maintain a couple of weeks’ shutdown, not the extended horror we have seen in some cities, but my guess it is coming. If the Japanese government does what it’s very good at and dithers, expect Tokyo to become a zombie survival game show within a month. But so far the Japanese response has been measured and careful and effective, so I hope they will continue this and will get this right.

A note on conspiracy theories and racism

It’s worth recognizing that the European and Anglosphere countries (except perhaps for New Zealand) had two months’ warning of what was coming, they watched everything that was happening in China and they basically ignored it. Even Boris Johnson’s rapid turnabout on his irresponsible and inhumane “herd immunity” policy wasn’t driven by the clear knowledge available to the whole world from China; he waited until some white dudes at the University for Killing People and Stealing their Shit had had time to update their model with the Italian experience before he realized what a disaster he was unleashing. It seems that no one in the west at any point considered Chinese experience, Chinese struggle or Chinese lives worth anything, and ignored all the warnings they were being given until it was too late. Japan, on the other hand, listened to China and bought itself a month of slow growth as a result.

The conspiracy theories you see online about China and Japan are grown in the same fertile racist soil as the European policy mistakes. There is a long-standing image of Asians as shifty, untrustworthy, authoritarian and narcissistic, and that is exactly the racist image that drives these conspiracy theories. It’s not possible for white people to imagine that Asians could be doing something better than them, so they simply imagine that Asians are lying and covering up the truth. Inscrutable, untrustworthy and impenetrable societies are hiding the numbers and pretending everything’s okay for their own nefarious ends (or to “save face”).

Needless to say, it’s all bullshit. There is no conspiracy, and nobody is covering anything up. Asia is just doing it better, and the west needs to start listening to what’s happened over here, if they want to escape this with any of their grandparents alive.

 

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