8 ms·

Ioannidis continues to push this evidence-based approach, but I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam. They a

by jtsnow 7y ago

Ioannidis continues to push this evidence-based approach, but I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam. They argue that one doesn't need raw evidence to act if the statistical evidence shows that the risks are catastrophic. They published a paper on January 26th which lays out arguments for why conventional risk management approaches are inadequate in these situations. [1] This paper was met with disregard on HN [2], but the persistent reach of Ioannidis shows why Taleb's arguments have value. Some on Twitter argue that the WHO statement on January 14th shows where Ioannidis' approach fails: "Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission..." [3] Authorities were looking for evidence before taking any action. [1] https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathogens-coronavirus-a-note https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathog... [2] https://news.ycombinator.com/item?id=22154333 https://news.ycombinator.com/item?id=22154333 [3] https://twitter.com/WHO/status/1217043229427761152 https://twitter.com/WHO/status/1217043229427761152

ellyagg 7y ago
It's weird because I'm just as afraid of a black swan of unforeseen, runaway financial collapse due to pandemic countermeasures. People seem awfully glib about how many will die from the pursuant depression.
- rootusrootus 7y ago
  I'm becoming considerably more afraid of the social and economic consequences from the pandemic countermeasures than of the virus itself.
  - amiga_500 7y ago
    My main fears: 1. They find it does effect kids, it just takes longer 2. They find reinfection is common
    - rapidslowness 7y ago
      Do not fear. 1. All evidence shows children have very low risk of severe illness. It can happen but is very very unlikely. 2. Immunity for corona viruses lasts months or years. Why should it be different for this one? Opposing news stories are mixtures of early discharges from hospitals and false negatives test results. Studies that test also asymptotic cases from Italy and Heinsberg (Germany) (e.g. https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/neue-corona-symptome-entdeckt-virologe-hendrik-streeck-zum-virus-16681450.html https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavi...) indicate a R0 much higher than 2 or 3 (more between 5 and 10). We do not know infected people(!!!). We just know cases. My belief and hope is that virus is so infectious live can return to normal in weeks not months because almost everybody already has or had it (in areas with community spreading). Don't panic. Distance and wait.
  - wwweston 7y ago
    We had our chance to get this together years beforehand. We even had a chance to have lower impact interventions be effective 2-3 months ago. There are no chances for light economic impacts now. Use lighter mitigation methods and productivity and demand will get hit by the illness and death itself, both the first order effects that hit those infected (which would be wider), and the second order effects as people improvise their own rightly fearful responses. The main difference you can count on is that the timing would move closer to the peak. AFAICT nobody has a clear model of whether it would be better or worse.
  - ClumsyPilot 7y ago
    You do realise that, given no countermeasures, there will be deaths of millions of people, plus half the country I'll. It will collapse the economy. Tou cant save money by ignoring the disease.
    - klmadfejno 7y ago
      I don't argue for no countermeasures due to moral reasons, but I think this is highly misleading. More than half of the deaths from this disease are from people over 80. The majority of people over 80 contribute nothing to the economy, but do receive social services, take up housing, have expensive healthcare, etc. If thanos snapped away everybody over 80, I think the economy would IMPROVE because we suddenly have an enormous chunk of resources that can be used for more useful things than care for the elderly.
guscost 7y ago
> I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam. Is that even necessary? Taleb's school argues that empiricism has fundamental shortcomings because it must be "incomplete" in a world of imperfect (read: statistical) evidence. I agree it's a big problem, one that we are not likely to solve. But they go on to say "therefore, we must apply the precautionary principle to XYZ" which is frankly nonsense. Instinct might be important in Taleb's world of non-ergodic black swans, but that absolutely does not prove that his instinct is better than mine or yours!
- acqq 7y ago
  Taleb's point is that high uncertainties which can result in catastrophic loss are worth of spending money to protect against. In our present case, the real nonsense is US allocating funds for a 1.5 trillion dollar plane, but totally avoiding investing in the response of pandemics... before it can be too late. https://www.newyorker.com/news/news-desk/how-long-will-it-take-to-develop-a-coronavirus-vaccine https://www.newyorker.com/news/news-desk/how-long-will-it-ta... "science can meet the challenges, but there is lots of attrition” before any vaccine gets to the point of licensure. The problem is twofold. First, there may never be a market for a vaccine at the end of the development process, because the epidemic is contained, or never comes to pass. Then, traditionally, if there is an epidemic, it may take hold in a developing country where the costs of research and development cannot be recouped. “The resources and expertise sit in biotech and pharma, and they’ve got their business model,” Grant said. “They’re not charities. They can’t do this stuff for free." Were there early enough proper funding (surely insignificant compared to 1.5 trillion dollar) this pandemic could have been avoided and, additionally, in the case it couldn't have, the vaccine produced faster. (Bill and Melinda Gates tried to motivate others to do something about that, for years). Once the virus spreads, it is totally irrelevant where it started. Edit: and to answer to the message below: I don't have to prove anything. The exponential spread will do its work, independently of all of us. That exponential spread is not something that happens just with coronavirus, it was for decades a known fact. That's the nature of pandemics. The humans in charge ignored the fact at the humanity's peril. There's nothing that can disappear because your political beliefs are different. Even more directly, we're where we are exactly because the political beliefs resulted in the ignorance of the facts.
rumblecat 7y ago
Risk management is the correct way to go when uncertainty is high. Containment was the correct approach at the time. When evidence starts coming in, then you can start applying evidence based approaches. > Mortality rate: Mortality and morbidity rates are also downward biased, due to the lag between identified cases, deaths and reporting of those deaths [1] > Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 (Figure 1). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died (8) . . . As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years) [2]. Based on the second source, who can still seriously believe that the naive death rate is too conservative, because all the people in intensive care just have not died yet? Look at the deaths/recoveries in Singapore and Hong Kong for more evidence [3][4]. Whereas, if you compare fatality rates reported by Germany, SK, HK, Singapore and other high testers vs China, Italy and Spain, it's pretty clear the latter are under-diagnosing mild/asymptomatic cases, which increase their fatality rate by a factor of 10 or more. [1] https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathogens-coronavirus-a-note https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathog... [2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm6912e3_w https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm... [3] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Hong_Kong https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_H... [4] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Singapore https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...
- joe_the_user 7y ago
  Whereas, if you compare fatality rates reported by Germany, SK, HK, Singapore and other high testers vs China, Italy and Spain, it's pretty clear the latter are under-diagnosing mild/asymptomatic cases, which increase their fatality rate by a factor of 10 or more. South Korea has 1% fatality rate at the end of their epidemic, they showed .5% in the middle of this. Germany has .2% rate but it has crept up to .4% and I suspect it will continue to creep to 1%, and if they get overwhelmed it could go higher. China has a less than 1% rate outside of Wuhan, since outside that area, the health care system wasn't overwhelmed [1]. The extra deaths in Wuhan could be attributed to the health care system getting overwhelmed rather than under counting - 20 or 10% of those infected require intensive care. You quote 10% of the infected on the Diamond Princess as requiring hospitalization. With an overwhelmed health care system, that might be the death rate. Which is to say that we have more evidence but that evidence seems to point to a desperate need for containment. [1] You can compare all the statistics at: https://covid19info.live https://covid19info.live
avsteele 7y ago
I find Taleb's argument specious. The risk inherent in a reaction can be pretty catastrophic as well; for example we are now seeing some project 20%+ unemployment in the next quarter. In addition, we do have data on the possible harms from Coronovirus, since we have more CFR data at this point. This puts bounds on possible harms. For more detail see John's other article in statnews. The results of the Diamond Princess cruise ship also are telling [1]. It looks like Iceland has about 1% of its people infected [2]. This didn't happen overnight, and Iceland is doing OK. [1] https://twitter.com/maximlott/status/1241718453700038658?s=20 https://twitter.com/maximlott/status/1241718453700038658?s=2... [2] https://www.government.is/news/article/2020/03/15/Large-scale-testing-of-general-population-in-Iceland-underway/ https://www.government.is/news/article/2020/03/15/Large-scal...
- natalyarostova 7y ago
  Well, consider if we reacted late January when he wrote that article it would have been very cheap to contain...
  - Barrin92 7y ago
    Then the immediate question is, the next time we react early and it turns out we overreacted, is that something you're going to register as well? In particular in authoritarian countries like China which actually have a history of vast overreaction based on a 'security-first' mindset. Ioannidis actually points to one other example in the article. There are several corona strains already in circulation with fatality rates as high as 8% among the elderly. If this reaction is rational, are we irrational not locking down everything every winter?
    - natalyarostova 7y ago
      Maybe we can just lock things down when we sport extremely dangerous new viruses. It doesn’t seem that tricky to me. I was following this from late December, and it was clear it was a potentially huge risk.
- ttul 7y ago
jhanschoo 7y ago
Taleb's note was probably more relevant back when it was published. It's clear that current measures are measures devised against epidemics, and not "conventional risk-management approaches" for everyday business, which he seems to be criticizing. There's a lot to criticize about the note [1] but its conclusion was appropriate in that a response tailored to the particular epidemic based on conventional risk-assessment can't properly evaluate the harm of an epidemic until it is too late. But today, governments are responding in the typical fashion of responding to pandemics. Closing borders and quarantines are precisely the measure that dampens the more frequent so-called "superspreader" events, and social distancing is the exaggerated response that decimates the potential impact of these "superspreader" events. It's obvious and unfortunate that the authors didn't do their research on public health policy, since public health advisors and experts actually already knows the right measures to take; it's a matter of convincing the decision-makers that this is the right way to respond to a new pandemic rather than the risk-assessment models that were tailored to more frequent events. > Ioannidis' approach fails: "Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission..." [3] Authorities were looking for evidence before taking any action. I don't think this is the right conclusion. I think many flu strains occasionally transmit from animal to humans, but fail to spread from human to human, and imposing drastic measures upon this is too much of an overreaction, since they aren't usually much worse in public health impact than the seasonal flu. On the other hand, as soon as there is a spike of cases in a local area, that is enough evidence to be wary. That tweet just reads like a poor excuse by Chinese officials that doesn't make sense, something that the rest of the world have come to expect from them. You also have a misreading of what Ioannidis is trying to push for. He isn't advocating against taking action before good evidence comes out. Rather, he is highlighting that our current lack of good evidence about the epidemic is necessitating a greater reaction than may actually be necessary if we had better evidence. He is advocating for better evidence to be published with higher standards, so that if this pandemic is actually less dangerous than it actually is, decision-makers would continue to trust the public health experts to make decisions should a worse pandemic come about. [1] e.g. > Standard individual-scale policy approaches such as isolation, contact tracing and monitoring are rapidly (computationally) overwhelmed Computationally ???
- 7y ago

by jtsnow 7y ago

ellyagg 7y ago

It's weird because I'm just as afraid of a black swan of unforeseen, runaway financial collapse due to pandemic countermeasures. People seem awfully glib about how many will die from the pursuant depression.

rootusrootus 7y ago
I'm becoming considerably more afraid of the social and economic consequences from the pandemic countermeasures than of the virus itself.
- amiga_500 7y ago
  My main fears: 1. They find it does effect kids, it just takes longer 2. They find reinfection is common
  - rapidslowness 7y ago
    Do not fear. 1. All evidence shows children have very low risk of severe illness. It can happen but is very very unlikely. 2. Immunity for corona viruses lasts months or years. Why should it be different for this one? Opposing news stories are mixtures of early discharges from hospitals and false negatives test results. Studies that test also asymptotic cases from Italy and Heinsberg (Germany) (e.g. https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavirus/neue-corona-symptome-entdeckt-virologe-hendrik-streeck-zum-virus-16681450.html https://www.faz.net/aktuell/gesellschaft/gesundheit/coronavi...) indicate a R0 much higher than 2 or 3 (more between 5 and 10). We do not know infected people(!!!). We just know cases. My belief and hope is that virus is so infectious live can return to normal in weeks not months because almost everybody already has or had it (in areas with community spreading). Don't panic. Distance and wait.
- wwweston 7y ago
  We had our chance to get this together years beforehand. We even had a chance to have lower impact interventions be effective 2-3 months ago. There are no chances for light economic impacts now. Use lighter mitigation methods and productivity and demand will get hit by the illness and death itself, both the first order effects that hit those infected (which would be wider), and the second order effects as people improvise their own rightly fearful responses. The main difference you can count on is that the timing would move closer to the peak. AFAICT nobody has a clear model of whether it would be better or worse.
- ClumsyPilot 7y ago
  You do realise that, given no countermeasures, there will be deaths of millions of people, plus half the country I'll. It will collapse the economy. Tou cant save money by ignoring the disease.
  - klmadfejno 7y ago
    I don't argue for no countermeasures due to moral reasons, but I think this is highly misleading. More than half of the deaths from this disease are from people over 80. The majority of people over 80 contribute nothing to the economy, but do receive social services, take up housing, have expensive healthcare, etc. If thanos snapped away everybody over 80, I think the economy would IMPROVE because we suddenly have an enormous chunk of resources that can be used for more useful things than care for the elderly.

guscost 7y ago

> I have not yet seen an adequate response to critics such as Nassim Taleb or Yaneer Bar-Yam. Is that even necessary? Taleb's school argues that empiricism has fundamental shortcomings because it must be "incomplete" in a world of imperfect (read: statistical) evidence. I agree it's a big problem, one that we are not likely to solve. But they go on to say "therefore, we must apply the precautionary principle to XYZ" which is frankly nonsense. Instinct might be important in Taleb's world of non-ergodic black swans, but that absolutely does not prove that his instinct is better than mine or yours!

acqq 7y ago
Taleb's point is that high uncertainties which can result in catastrophic loss are worth of spending money to protect against. In our present case, the real nonsense is US allocating funds for a 1.5 trillion dollar plane, but totally avoiding investing in the response of pandemics... before it can be too late. https://www.newyorker.com/news/news-desk/how-long-will-it-take-to-develop-a-coronavirus-vaccine https://www.newyorker.com/news/news-desk/how-long-will-it-ta... "science can meet the challenges, but there is lots of attrition” before any vaccine gets to the point of licensure. The problem is twofold. First, there may never be a market for a vaccine at the end of the development process, because the epidemic is contained, or never comes to pass. Then, traditionally, if there is an epidemic, it may take hold in a developing country where the costs of research and development cannot be recouped. “The resources and expertise sit in biotech and pharma, and they’ve got their business model,” Grant said. “They’re not charities. They can’t do this stuff for free." Were there early enough proper funding (surely insignificant compared to 1.5 trillion dollar) this pandemic could have been avoided and, additionally, in the case it couldn't have, the vaccine produced faster. (Bill and Melinda Gates tried to motivate others to do something about that, for years). Once the virus spreads, it is totally irrelevant where it started. Edit: and to answer to the message below: I don't have to prove anything. The exponential spread will do its work, independently of all of us. That exponential spread is not something that happens just with coronavirus, it was for decades a known fact. That's the nature of pandemics. The humans in charge ignored the fact at the humanity's peril. There's nothing that can disappear because your political beliefs are different. Even more directly, we're where we are exactly because the political beliefs resulted in the ignorance of the facts.

rumblecat 7y ago

Risk management is the correct way to go when uncertainty is high. Containment was the correct approach at the time. When evidence starts coming in, then you can start applying evidence based approaches. > Mortality rate: Mortality and morbidity rates are also downward biased, due to the lag between identified cases, deaths and reporting of those deaths [1] > Among 3,711 Diamond Princess passengers and crew, 712 (19.2%) had positive test results for SARS-CoV-2 (Figure 1). Of these, 331 (46.5%) were asymptomatic at the time of testing. Among 381 symptomatic patients, 37 (9.7%) required intensive care, and nine (1.3%) died (8) . . . As of March 13, among 428 U.S. passengers and crew, 107 (25.0%) had positive test results for COVID-19; 11 U.S. passengers remain hospitalized in Japan (median age = 75 years), including seven in serious condition (median age = 76 years) [2]. Based on the second source, who can still seriously believe that the naive death rate is too conservative, because all the people in intensive care just have not died yet? Look at the deaths/recoveries in Singapore and Hong Kong for more evidence [3][4]. Whereas, if you compare fatality rates reported by Germany, SK, HK, Singapore and other high testers vs China, Italy and Spain, it's pretty clear the latter are under-diagnosing mild/asymptomatic cases, which increase their fatality rate by a factor of 10 or more. [1] https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathogens-coronavirus-a-note https://necsi.edu/systemic-risk-of-pandemic-via-novel-pathog... [2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm6912e3_w https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm?s_cid=mm... [3] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Hong_Kong https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_H... [4] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Singapore https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

joe_the_user 7y ago
Whereas, if you compare fatality rates reported by Germany, SK, HK, Singapore and other high testers vs China, Italy and Spain, it's pretty clear the latter are under-diagnosing mild/asymptomatic cases, which increase their fatality rate by a factor of 10 or more. South Korea has 1% fatality rate at the end of their epidemic, they showed .5% in the middle of this. Germany has .2% rate but it has crept up to .4% and I suspect it will continue to creep to 1%, and if they get overwhelmed it could go higher. China has a less than 1% rate outside of Wuhan, since outside that area, the health care system wasn't overwhelmed [1]. The extra deaths in Wuhan could be attributed to the health care system getting overwhelmed rather than under counting - 20 or 10% of those infected require intensive care. You quote 10% of the infected on the Diamond Princess as requiring hospitalization. With an overwhelmed health care system, that might be the death rate. Which is to say that we have more evidence but that evidence seems to point to a desperate need for containment. [1] You can compare all the statistics at: https://covid19info.live https://covid19info.live

avsteele 7y ago

I find Taleb's argument specious. The risk inherent in a reaction can be pretty catastrophic as well; for example we are now seeing some project 20%+ unemployment in the next quarter. In addition, we do have data on the possible harms from Coronovirus, since we have more CFR data at this point. This puts bounds on possible harms. For more detail see John's other article in statnews. The results of the Diamond Princess cruise ship also are telling [1]. It looks like Iceland has about 1% of its people infected [2]. This didn't happen overnight, and Iceland is doing OK. [1] https://twitter.com/maximlott/status/1241718453700038658?s=20 https://twitter.com/maximlott/status/1241718453700038658?s=2... [2] https://www.government.is/news/article/2020/03/15/Large-scale-testing-of-general-population-in-Iceland-underway/ https://www.government.is/news/article/2020/03/15/Large-scal...

natalyarostova 7y ago
Well, consider if we reacted late January when he wrote that article it would have been very cheap to contain...
- Barrin92 7y ago
  Then the immediate question is, the next time we react early and it turns out we overreacted, is that something you're going to register as well? In particular in authoritarian countries like China which actually have a history of vast overreaction based on a 'security-first' mindset. Ioannidis actually points to one other example in the article. There are several corona strains already in circulation with fatality rates as high as 8% among the elderly. If this reaction is rational, are we irrational not locking down everything every winter?
  - natalyarostova 7y ago
    Maybe we can just lock things down when we sport extremely dangerous new viruses. It doesn’t seem that tricky to me. I was following this from late December, and it was clear it was a potentially huge risk.
ttul 7y ago

jhanschoo 7y ago

Taleb's note was probably more relevant back when it was published. It's clear that current measures are measures devised against epidemics, and not "conventional risk-management approaches" for everyday business, which he seems to be criticizing. There's a lot to criticize about the note [1] but its conclusion was appropriate in that a response tailored to the particular epidemic based on conventional risk-assessment can't properly evaluate the harm of an epidemic until it is too late. But today, governments are responding in the typical fashion of responding to pandemics. Closing borders and quarantines are precisely the measure that dampens the more frequent so-called "superspreader" events, and social distancing is the exaggerated response that decimates the potential impact of these "superspreader" events. It's obvious and unfortunate that the authors didn't do their research on public health policy, since public health advisors and experts actually already knows the right measures to take; it's a matter of convincing the decision-makers that this is the right way to respond to a new pandemic rather than the risk-assessment models that were tailored to more frequent events. > Ioannidis' approach fails: "Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission..." [3] Authorities were looking for evidence before taking any action. I don't think this is the right conclusion. I think many flu strains occasionally transmit from animal to humans, but fail to spread from human to human, and imposing drastic measures upon this is too much of an overreaction, since they aren't usually much worse in public health impact than the seasonal flu. On the other hand, as soon as there is a spike of cases in a local area, that is enough evidence to be wary. That tweet just reads like a poor excuse by Chinese officials that doesn't make sense, something that the rest of the world have come to expect from them. You also have a misreading of what Ioannidis is trying to push for. He isn't advocating against taking action before good evidence comes out. Rather, he is highlighting that our current lack of good evidence about the epidemic is necessitating a greater reaction than may actually be necessary if we had better evidence. He is advocating for better evidence to be published with higher standards, so that if this pandemic is actually less dangerous than it actually is, decision-makers would continue to trust the public health experts to make decisions should a worse pandemic come about. [1] e.g. > Standard individual-scale policy approaches such as isolation, contact tracing and monitoring are rapidly (computationally) overwhelmed Computationally ???

7y ago