Two articles from Bill Gates about Covid19 that are worth reading

The first is an AMA:

A therapeutic could be available well before a vaccine. Ideally this would reduce the number of people who need intensive care including respirators. The Foundation has organized a Therapeutics Accelerator to look at all the most promising ideas and bring all the capabilities of industry into play. So I am hopeful something will come out of this. It could be an anti-viral or antibodies or something else.

One idea that is being explored is using the blood (plasma) from people who are recovered. This may have antibodies to protect people. If it works it would be the fastest way to protect health care workers and patients who have severe disease.

And speaking of convalescent blood therapy, this is also worth reading:

A simple and medically feasible strategy is available now for treating COVID-19 patients, transfuse blood plasma from recovered patients. The idea is that the antibodies from the recovered patients will help the infected patients. The idea is an old one and has been used before with some success.

And this is the second article by Bill Gates, worth reading in full, and so I will not provide an excerpt. Consistently applied restrictions on movement across the entire country, a clear strategy on how to prioritize testing, and a clear plan on developing a treatment and a vaccine are the key takeaways. Applicable mostly to America, or written with America in mind, but really works across the entire planet. India has applied the first of these as well as she could have.

 

Some Really Simple Questions about the Supply of Vaccines

  1. Do we have enough vaccines for India to roll out doses to everybody who is 18+?
    No.

  2. Will increasing the price at which these vaccines are purchased increase the supply?

    Yes. I teach this for a living, as do thousands of economists the world over, and there is no way our answer to this question ought to be anything except a resounding “Yes”.

    An increase in the price at which we’re willing to buy a good will increase the supply of that good.

  3. Is that the only way to increase the supply of these vaccines?

    No. Murali Neelakantan and I outlined some of the possible ways in this article. A fuller explanation is available here, but it is behind a paywall, alas.

  4. But… aren’t we suggesting nationalization, or something like that? It doesn’t sound free-market-ish.

    And indeed it isn’t. Price based market mechanisms are, under normal circumstances, infinitely preferably to other mechanisms. I strongly disagree with anybody who states otherwise.

    Growth maximization above all, subject to the right to live and climate considerations is a philosophy that is hard to argue against. And growth maximization happens best with market based price mechanisms.

    But I also strongly disagree with people who will say that these are normal circumstances!

    And under these circumstances, I think it makes sense to ask if other options have the ability to increase supply. Especially in the short run. A 350,000 daily caseload number with a CFR of even 0.1% is reason enough for me.

    Put another way, if the opportunity cost of sticking to only market-based price mechanisms is lives lost because of insufficient vaccines, is it worth the trade-off?

    To me, no. This is that one year out of a hundred where you do what it takes, no matter what.

  5. So what do we do next?

    Run the numbers! If we adopt the solutions that have been outlined in the Scroll piece, how much does vaccine production go up by? And by when? If we find out that it goes up by only 1% against the baseline (do nothing) scenario, and that only after six months, then it is not worth it.
    But, on the other hand, if we find that it is possible to increase supply by 25% by the end of May as against the do-nothing scenario, then sign me up for this plan.
    Again, run the numbers.

  6. So have we run the numbers?

    As best as I can tell, no. There is no analysis that I can find online (published by the government or otherwise) that has run these scenarios.

    Running the numbers is complicated, I appreciate that. It is not just a simple question of saying “x” is the monthly capacity of plant “y”. There’s supply chain bottlenecks, efficiency considerations, learning curves, technology transfers and much more involved. But is developing this model necessary? For reasons answered in questions 1-5, I think so, yes.

  7. So why don’t I run the numbers?

    Why not indeed? But before I try, if any of you have…
    …any information about whether or not this has already been done by somebody
    …arguments for why this should not be done…
    Please, do let me know.

    Also, if any of you have any links that will be helpful in this analysis, please, do let me know.


The Contours of the NCDVP

That’s the Nationalized Centrally Driven Vaccination Programme.1

The article in Scroll that I linked to yesterday was the easy part. The much more difficult part is to work out what might come in its place.

We (Murali Neelakantan and I) attempt to outline such a plan in this document. (PDF version 1.0 here)

It is a document written literally on the fly, and there are bound to be errors. Equally, there are bound to be aspects we have not thought of at all, or not thought out well enough. That’s the point of this post: please, read and let us know what we’re missing, and how it can be made better. If it is the most hare-brained thing you’ve ever read, let us know that too – but please, also do tell us why you think so.

Please note that we will continue improving upon the Google doc as we go along, so it will naturally keep on changing.

Finally, if you find merit in the arguments we have made, please, help it reach a wider audience.

Thank you!

(@ashish2727 for me on Twitter, and @grumpeoldman for Murali Neelakantan on Twitter)

  1. As you can tell, marketing is not our forte[]

The Vaccine Responsibility by K. Sujatha Rao

I and a friend have been exchanging messages about the idiocy that was the European Super League (or whatever the name was. I’m not even going to bother looking it up). He asked me if I would post anything here about the economics behind the league, either defending the idea or refuting it.

Here’s one paragraph from a previous post of mine that I would want to base that essay (if I ever write it) on:

When David Perell says that we have made the world cheaper, what I think he is saying is that we have figured out ways to cheapen the effort that we are willing to put into the act of consuming something. That something could be a meal, but it could also be extended to reading, viewing, or listening as well – and more besides.

https://econforeverybody.com/2021/03/08/maximizing_soul/

To me, the ESL is based on the assumption that a large number of us fans are willing to cheapen the effort that we are willing to put into the act of consuming football matches – that we are not looking to maximize soul. Thankfully, so far, that assumption seems to have been ever-so-slightly off the mark.1

Anyways, he wrote a post about it, and we’ve been sharing stuff about it on and off. I sent him one written by Jonathan Wilson, and he sent me this response: “I seem to have covered largely the same points with way less finesse.”

To which my response was, that is my middle name.


Now, I didn’t need to write any of that, and any half-decent editor would have lopped off that whole bit – and quite rightly too. But hey, this is my blog, I had fun writing it, and it was a welcome break from you-know-what.

But “I seem to have covered largely the same points with way less finesse” is all too applicable in my case when reading K. Sujatha Rao’s excellent article in the Indian Express today on India’s vaccination drive. It is worse in my case of course, because I haven’t even covered largely the same points, forget the finesse.

I won’t excerpt from it, because it deserves to be read in its entirety.

But I will reiterate (in my won words) points that I thought were especially crucial, and also list out some questions that I had after I finished reading it.

  1. The point about the utilization of the vaccines that will be procured by the Government of India (GoI) is really a request for clearer communication. You simply cannot overstate the importance of clear communication.
  2. If SII has received grants from GAVI and from the Central government, would a publicly available dashboard about capacity, supply chain bottlenecks, vaccine allocation by states/countries and specific timelines for capacity expansion be possible? I’m not trying to be snarky, I am genuinely asking. What are the reasons against such a dashboard being made publicly available?
  3. I’ll ask again: Imagine a good with large positive externalities. Let’s call this good a vaccine. Let’s say that the supply of these vaccines is going to be tight. Let’s say that demand is very inelastic. Would you recommend fragmenting total market demand into smaller constituent curves? If yes, why?
    K. Sujatha Rao makes the legal argument in her article, and then makes the economic argument. Read both (and again, not being snarky), please tell me why we are choosing to do what we are doing – in this year of all years, and for this good of all goods.
  4. She speaks of halving the estimated cost of INR 60,000 crores by invoking compulsory licensing and expanding production through the 18 manufacturing facilities in India. These must be back of the envelope calculations, obviously. But if anybody reading this has information on how one might create such an estimate (and an estimate of how much production will go up by via this route), please let me know.

Please, do read the article.

  1. Sarcasm alert: the evil idiots who dreamt up that monstrosity have gotten exactly what they deserved. Not enough of it, if you ask me.[]

On Conducting Examinations, Especially in 2020

This is less a blogpost, and more of a rant. Consider yourself warned! 🙂

This past Saturday, I cam across a most excellent Twitter thread:

The author, Carl Bergstrom (Wikipedia article here, University profile here) makes a detailed, reasoned argument against online proctoring of examinations, especially in 2020. In my blogpost, I’m going to riff on this Twitter thread, and some related points, and build an argument against the way we conduct examinations in Indian Universities.

To begin, watch this Sugata Mitra TED talk about education:

Just the first five minutes or so is enough for the argument I will be making today, but you really should watch the full thing. There was, as it turns out, a case for rote memorization at one point of time. But today, as Mitra says in the video, it is the computers that are the clerks. They do (and to be fair to them, they do it much better than we ever could) the job of remembering everything, so that we don’t have to.

To every single professor reading this blogpost: when was the last time you yourself spent a day working without looking up something on the internet? When was the last time you researched something, wrote something, without using your computer, or the internet on some device?

Then why do we insist on examining our students for their ability to do so, when we ourselves don’t do it? And for those of our students who are not going to get into academia, they wouldn’t last in their organizations for even an hour if they tried to work without using computers and the internet.

They would (should!) be fired for being Luddites!

And yet, to land up in that firm, they must spend the last week of their lives as a college student cooped up for three hours in a classroom without a computer, without the internet, and use pen and paper to write out the important features of xyz in abc lines.

I can’t possibly be the only one that spots the incongruity, surely?

Here, from the Twitter thread I spoke about earlier, is a picture of Bloom’s taxonomy:

Image

Read the Wikipedia article about Bloom’s taxonomy, or look carefully at the picture above. At best – and I think I am being charitable here – our question papers in higher education in India reach the evaluate stage, but certainly not create. And even that is a stretch.

Moreover, even if we somehow agree that we do indeed reach the evaluate stage, we are effectively asking students to evaluate based on their memory alone. Why?

One, won’t students write a better evaluation of whatever theory we are asking them to write about if we give them the ability to research while writing? Second – and I know this is repetitive, but still – are they ever going to write an evaluation without having access to to the internet?

In plain simple English: We train students for 25 years to get awesome at memorizing stuff, and then expect them to do well in a world which doesn’t value this skill at all.

(To be clear, some things you should remember, of course. Think of it as a spectrum – and I am not suggesting that we move to the end of the spectrum where no memorization is required. I am suggesting, however, that we are at the end of the spectrum where only memorization is required. Close enough, at any rate).

Coming specifically to this year, the year of online examinations, here’s a tweet that was quoted in Bergstrom’s thread:

There really isn’t much to say, is there? All universities the world over have sent out variations of this nightmare this year, and in some cases, repeatedly. It’s the whole null hypothesis argument all over again – we assume all students to be guilty until proven otherwise. That is, we assume everybody will cheat, and therefore force everybody to comply with ridiculously onerous rules – so as to prevent the few who might actually cheat.

And cheating, of course, being looking up stuff on the internet. The argument itself is pointless, as I have explained above, and we go to eye-popping lengths to enforce the logical outcome of this pointless argument.

Prof. Bergstrom makes the same points himself in the Twitter thread, of course:

This year, especially, is a good opportunity to turn what is otherwise a disaster of a situation into meaningful reform of the way we conduct examinations.

Students, parents – indeed society at large – will spot the incongruity of learning online, but being examined offline. If we, in higher education in India do not spot this incongruity and work towards changing it – well then, we will have failed.

And finally, the last tweet in the thread is something we would all do well to remember:

Forecasting The Future

All forecasting models are fun to learn about, and to tinker with in your software of choice. But it is equally true that all forecasting models are problematic.

First, they’re based on the assumption that the future will look like the past. Eventually, that will not be the case – this is a guarantee.

Second, even if they are based on the past, there is the problem of survivorship bias to consider in your sample of choice (my thanks to Aadisht for helping me realize this better).

And third, your predictions cannot – I repeat, cannot – account for all the underlying complexities. Forecasting is a ridiculously risky thing to do, and kudos to those who try, for this very reason.

I’d done a round-up of posts I had read in January 2020 (remember January 2020? Those were the days) that tried to predict what the world would look like when it came to India, technology and the world. I bring this up to re-emphasize the point I was trying to make in the previous paragraph: no matter how sophisticated your model, no matter how careful your sampling, and no matter however many dots you connect: reality will always have you beat.

That’s just how it is. Forecasting models work well until they don’t, and that one time they don’t can often be more costly than all the times they did.


And that brings me to this tweet:


What should you take away from this tweet (and the rest of the thread)?

My primary audience when I write here is, in a sense, myself back when I was an undergrad/post-grad student. So what advice would I want to give to myself after having read that Twitter thread?

  1. As Nitin Pai himself goes on to say in a subsequent tweet, this is a useful principle to have: Don’t try to predict the future.
  2. Respect skin in the game. Did he get it wrong? Sure he did. But hey, it takes courage to put your reasoning, your thoughts and your conclusions in the public domain. Feel free to disagree with the conclusions, but accord people who write in public the respect they deserve for having done so.
  3. Have the courage to admit you were wrong. We have two examples in front of us. One is the usual “I was misquoted/misunderstood” weasel talk. The other is an admission of error, straight up, and without qualifiers. Like the tweet above.
  4. Work at getting better. A publicly available record of your thoughts is invaluable, because it forces you to write after thinking carefully. It is also invaluable because you can outsource the “where can I get better” to the internet. And there are enough (trust me) people on the internet who will enthusiastically point out where you’re wrong. Use that advice constructively. By that I mean this, specifically: continue to write in the public domain, and that will mean making mistakes. Try not to make the same ones twice.

Like Nitin, I have written about what we’ve been going through, and how we might get out of it. All of it is available here on this blog. Some of it might turn out to be wrong – in fact, there’s a guarantee that if I write enough, some of it will be wrong. And given the pandemic that we’re going through, the stakes are impossibly high.

But it is the process of writing in public, and giving feedback on what other people write in public that drives our thinking forward.

So again, if you’re a student reading this: write. Write in the public domain. Make mistakes. Develop a thick enough skin to take on the criticism. Learn the (almost impossible to acquire) skill of figuring out when you’re wrong, and develop and hone the courage it takes to admit it.

And then, write again.


(Quick note: posting will be sporadic for some time.)

Help Me Understand This, Somebody…

A fellow Puneri citizen sent out this tweet yesterday:

It was hard not to be snarky, and I didn’t even bother trying to resist:

But in my day job, I try to be an economist, and so I have questions. Just two of them, and they’re fairly simple ones. Here they are:

  1. He (or SII) was free to set the price, correct? Free market economics: let the seller decide the price, and let the buyer decide if she wants to buy at that price.


    So the price now stands reduced by a whopping 25%. Does that mean that it was set too high in the first place?


    That is, let us assume that SII is able to increase capacity expansion at a price of 300 per dose. Also assume that it can make a normal or “super” profit at this price – then was 400 not too high?


    If we assume that he was going to earn an extra 100 rupees per vaccine sold, and that he was going to sell say 200 million vaccines to the states, that’s 200 million into 100 rupees.1

    I don’t want to do the math, but were we ok with at least that much “extra” money going into the Poonawalla coffers until yesterday?

    If yes, why?


  2. Unless, of course, that was not the case, and capacity expansion will suffer at a price of 300. A raise in the minimum wage will mean switched-off air-conditioning, correct? Well, in that case, is it not our moral duty to ask him to take the price back up to 400? Because if the opportunity cost of his philanthropy is reduced capacity expansion, isn’t that worse?

(By the way, all this is taking the assumption that SII “needs” the proceeds from the sale of this one vaccine alone to fund capacity expansion. That may or may not be true. And this also assumes that this is the only vaccine that SII will be producing and selling, which is obviously not true. Even in this “best-case” scenario, my questions hold up – if we do a full reckoning, they become even more important!)

If it is the first point above, us economists must explain why we think it is ok for those 100 rupees (per dose) to go into SII’s coffers.

If it is the latter, there ought to be a stream of op-eds beseeching Mr. Poonawalla to roll back his offer, for that would be truly philanthropic.

Which will it be?

And I know I said only two questions, but forgive me my greed, and let me ask one more: what is the definition of “transparent pricing”?

  1. Where do I get that number 200 million from? Who knows? I assumed that for the 960 million people in total who become/continue to be eligible on the 1st of May, he gets to sell only 200 million doses to the states. And yes, I am assuming only a single dose for these 200 million. Since nobody knows what the quantities are actually going to be, this is as reasonable an assumption as any other. If anything, this is a very conservative estimate. No?[]

It is difficult, this economic theorizing business

One of my favorite questions to ask in classes on introductory economics is this one:

“By a show of hands, how many of you have a BSNL sim-card?”

The answer is rarely more than five percent, if that, and my little stunt works every time. For obvious reasons, of course: even passionate defenders of the public sector often reveal their preference through action, if not always through their statements. Free markets work, the private provisioning of goods is demonstrably efficient and the price mechanism is a wonderful, wonderful thing.

Until, every now and then, when it is not.

April 2021 is one of those times.

And to make sure we could then produce those vaccines at scale, “X” brought up an idea that came from the Biomedical Advanced Research and Development Authority when Rick Bright was its director. The authority proposed subsidizing the construction of private manufacturing facilities as long as the government has the authority to take them over in times of pandemic.
If all of this sounds as if it’ll require a lot of government action, well, it will.

https://www.nytimes.com/2021/04/01/opinion/covid-vaccine.html

Pop quiz, particularly for those of you who follow economists online. Identify “X”.

“X” is, of course, that well known pro-government socialist, Alex Tabbarok.

Sarcasm alert: Prof. Tabbarok is as much of a pro-government socialist as Rahul Dravid is a goonda. But as with Rahul Dravid and goondagiri, so also with Alex Tabbarok:

“Ninety-nine years out of 100, I’m a libertarian,” Tabarrok said with a laugh. “But then there’s that one year out of 100.”

https://www.nytimes.com/2021/04/01/opinion/covid-vaccine.html

And it is that kind of a year, 2021 – for both Alex Tabbarok and Rahul Dravid. It is a year in which the role of the government is more important than perhaps ever before, given what is at stake: public health. Public health is, by definition, a public good:

And the role of the government in this case is to do all it can to ensure the provisioning of that public good – in this case, the vaccine.

Hold on to this thought, and we’ll come back to it.


Here’s a hypothetical scenario: a joint family is considering ordering in dinner this coming Saturday, and mutton biryani is the unanimous choice1.

The restaurant this family is considering ordering from will deliver a jumbo family pack (serves 8) for two thousand bucks. Single serves of the same dish are also available, at three hundred each. There are eight family members.

Should the family order a family pack, or single serves?

Here’s another (not so) hypothetical scenario: Until a couple of years ago, Holi celebrations in our housing society would always mean having the neighbourhood chaatwala set up shop in the lobby. Anybody and everybody who was here playing Holi was welcome to have as many plates of chaat as their hearts desired. No payment was involved, of course, because the payment was made in advance, in bulk.

Does this make sense, or would we be better off paying for each dish as we had ’em?

Hold on to this thought too, and we’ll come back to it.


Final thought experiment (I promise!): let’s say this chaatwala is the stuff of legend. Mindblowing panipuris, outstanding bhelpuri and tokri chaats that have the potential to rule the world. We would like to have this demi-god of chaat set up shop in our society, but so would ten other housing societies in our neighbourhood.

If you were this maestro of a chaatwala, which society would you choose to shower with your culinary blessings? The housing society with the cutest kids, or the kindest grandparents, or the prettiest flower-beds? Or the one with the most number of lived-in apartments – that is, the one that was likely to give you the most business?

And conversely, if you were part of the largest housing society in the area, and you and everybody else including the chaatwala knew this to be a fact, could you maybe get a bit of a discount on the deal? Would you, at the very least, want to try?


Can I cheat a little bit and include one final thought experiment? What if eating that chaat wasn’t just good for your palate? What if it also, somehow, conferred upon you the mystical, magical ability to not infect your neighbours with some disease – say, a virus?


Now let’s combine all of the above, and resort to econo-speak where the vaccines are concerned:

When faced with a largely inelastic supply curve for a good, fragmenting demand into separate constituents means you lose out on bargaining power. When the good in question is one with large positive externalities, procuring as much as possible as quickly as possible becomes a moral imperative. The best way to do that is to have the central government procure centrally, and that right away.

In fact, if it is a question of conferring those mystical, magical abilities upon as many citizens as quickly as possible, maybe the largest housing society the government should get that chaatwala to share the recipe with other chaatwalas in the market.

All housing societies should get as many plates of chaat as quickly as possible, but the negotiating should be left to just one extremely large entity. That negotiating should include potentially sharing the recipe for that delicious, life-saving chaat.

Or, to close the loop on the metaphors:

Every state should get as many vaccines as quickly as possible, but the negotiating should be left to the central government. That negotiation should include the possibility of sharing the patent for the vaccine (and more besides). And oh, remember that the truth lies somewhere in the middle. There is indeed a role for the private sector here: distribution and last mile delivery can and needs to be an all-hands-on-deck affair. Procurement? Not so much.

Is this a free-market solution? No.

Does a non-free-market solution stand a chance of being an optimum solution?

As Prof. Tabarrok points out, every hundred years or so, the answer is yes indeed.

Very much so.

  1. It’s a hypothetical scenario, so we’ll assume away Arrow’s Impossibility Theorem[]

Vaccinations: Quantity and Pricing

I and Murali Neelakantan have a piece out today in Scroll about the economics of the vaccination programme that is due to start in May ’21. Feedback most welcome – in particular, points we may have missed. Please, I’d love to hear your thoughts.

But it isn’t enough to talk about how current policy isn’t the best way of going about it. You also need to be thinking about what is the best (or at the very least, the least bad) way of going about it.

So, well, ok, let’s assume for the moment that the states will cough up the amount, one way or the other. But which way (or the other)?

Here are some ideas:

His back of the envelope calculations peg the tab for West Bengal at Rs. 8000 crores (do read the thread for his assumptions). As he says, that’s 2.6% of the state’s budgeted expenditure, and given the large positive externalities spillovers, subsidization wouldn’t be a bad idea.1

You could do similar exercises for each state – but for the moment, let’s just assume that it’s around 2.5% of each state’s budgeted expenditure.2.

What might that do to state finances?

The covid-19 pandemic disrupted the finances of India’s states in the ongoing fiscal year. Expense needs grew and public debt swelled, while revenues shrank. While most states could return to pre-pandemic output levels next year, their fiscal indicators are likely to remain strained for much longer, projections by the 15th Finance Commission (15-FC) show.
States’ combined fiscal deficit is likely to have risen to 4.5% of their total gross state domestic product (GSDP) in 2020-21, from 2.5% in 2018-19, the panel said. The commission’s fiscal roadmap puts the figure at 3% by 2025-26. Debts by that year could still be 32.5% of the total GSDP, against 27.3% in FY20, the estimates show.

https://www.livemint.com/news/world/states-may-not-return-to-pre-covid-debt-levels-by-fy26-finance-comm-roadmap-11612765562078.html

The kicker? That article is from the 8th of February, 2021. Things have, um, changed since then. The “while most states could return to pre-pandemic output levels next year” bit, in particular, now looks a bit iffy.


Next, Arvind Chari ran the numbers, and he comes up with a number of INR 50,000 crores for free universal vaccination:

He also advocates direct monetizing of state government vaccination programs via the RBI:

Niranjan Rajadhakshya refers us to an article in which Maitreesh Ghatak and Tarun Jain recommend the issuance of public health bonds (not that this is from 2020):

Issuing bonds for 30 years’ duration matches the decades-long returns from investments in healthcare, and is about the time taken for a young child who benefits from health investments to become an active taxpaying adult. Very short-duration bonds mean that the repayment schedule will not match the boosts in tax revenue.

https://m.economictimes.com/news/economy/policy/view-state-governments-can-be-better-armed-financially-to-fight-covid-19-by-issuing-public-health-bonds/amp_articleshow/76202188.cms?__twitter_impression=true

And they thankfully answer the obvious question in the very next paragraph:

Arguably, GoI could raise the same money at lower cost and then transfer to states. But, recently, GoI held up disbursing states’ share of GST collections at precisely the point that states needed those funds the most. Market borrowing limits by states have been raised subject to administrative conditions, and GoI could possibly impose conditions for health funds as well. Finally, borrowing directly allows each state government to prioritise its unique healthcare expenditure needs.

https://m.economictimes.com/news/economy/policy/view-state-governments-can-be-better-armed-financially-to-fight-covid-19-by-issuing-public-health-bonds/amp_articleshow/76202188.cms?__twitter_impression=true

Note that the last sentence in the second excerpt doesn’t apply in today’s context.


What else could be done? I’ll try and update this post with articles as I read them – feel free to keep sharing them we go along.

  1. Truer, if anything, at the central level, but let’s not go there right now[]
  2. By the way, any GIPE student reading this: I have a fun project just waiting to be launched[]

Variants of Concern

I didn’t do so well last year in terms of posting regularly around this time onwards, and it was because thinking about Covid overwhelmed me. I’ve studiously tried to avoid writing about it since then as much as possible, but this post is an exception to that self-imposed rule.


First, about the “second” wave in India. We’ve been here before, about a century ago. I’d written down notes from Laura Spinney’s excellent book, The Pale Rider in March of last year, and there was this bullet point:

The flu struck in three waves, and the second wave was by far the deadliest.

https://econforeverybody.com/2020/03/18/notes-from-pale-rider-by-laura-spinney/

There are many possible reasons for why the second wave is likely to be much worse than the first, and I do not know enough to be able to even speculate which one is the most likely. But both a century ago and now, the second wave was by far and away the worst:

Please, read the whole thread.


And here we are, a century down the road. Via the excellent, indefatigable Timothy Taylor, this little book. And from that little book, this not-so-little excerpt:

Manaus, a city on the Amazon River of more than 2 million, illustrates the dangers of complacency. During the first wave of the pandemic, Manaus was one of the worst-hit locations in the world. Tests in spring 2020 showed that
over 60 percent of the population carried antibodies to SARS-CoV-2. Some policymakers speculated that “herd immunity”—the theory that infection rates fall after large population shares have been infected— had been attained.

That belief was a mirage. A resurgence flared less than eight months later, flooding hospitals suffering from shortages of oxygen and other medical supplies. The pandemic’s second wave left more dead than the first.

Scientists discovered a novel variant in this second wave that went beyond the mutations identified in the United Kingdom and South Africa. This new variant, denominated P.1, has since turned up in the United States, Japan, and
Germany. Scientists speculate that a high prevalence of antibodies in the first wave may have helped a more aggressive variant to propagate. The hopes for widespread herd immunity may be dashed by the emergence of more infectious
virus variants.

Since the outbreak in Manaus in January 2021, P.1 has now spread throughout Brazil. The variant is much more transmissible than those that had been circulating previously in the country. High transmissibility and the absence of
measures and behaviors to stem the dissemination of the virus have led to the worst health system collapse in Brazilian history. The country has been on the front pages of major news outlets around the world not only due to the dramatic
situation that is currently unfolding but also because of the global threat posed by a major country with an uncontrolled epidemic.

https://www.piie.com/sites/default/files/documents/piieb21-2.pdf

The point is not to read more about the P1 variant. That is a worthy exercise, and you can see this, this and this for starters. But the point that I want to make is this – well, the points I want to make are these:

  1. The one other instance we have of a global pandemic tells us that the second wave was deadlier.
  2. That seems to be the case this time around as well, because the same virus has mutated into a variety of different forms over the past year in different parts of the world.
    1. Each of these so-called “variants-of-concern” will have different impacts, both in their countries of “origin” and (inevitably) elsewhere.
    2. How variant x affects individual y in region z is down to a long list of potential factors.
  3. And therefore 2021 already is, and will continue to be, worse in many ways compared to 2020.

And again, not just because of the P1 variant. That is simply one (worrisome, to be sure) variant – there are many more, and there will be more still to come.


Bottomline: we’re just getting started with the second wave. It isn’t the beginning of the end – it is the end of the beginning.