Angel in an Astra | COVID patient survival characteristics | Do we need more David Chapelle | Steamed fish, wok style | Bigly Online
I thought I’d start on the non-COVID related blogs and flag World Autism Awareness Week. Welcome new readers, do check out my micro grants programme (any applicants reading, sorry I’m very behind in reviewing) and feel free to Follow me on Twitter @benyeohben.
Being at home hasn’t particularly impacted my productivity. I save some time on commuting, although I lose on day-dreaming/thinking time. I’m cooking more, which is healthy, except I’m eating more too. Of course, my working practice has had to "pivot" - as the startups like to say. I am extremely lucky that my job can be done remotely, especially after years of practice and with established relationships with information providers and companies.
I’ve also connected by video call, video meetings, video workshops (not quite as effective, although the chat can work), video interviews….
Discussions with my theatre friends have been much harder. There’s no work. There is little creation happening, as creating is typically for in-person events. The charitable theatre company I chair is grappling with it and emergency meetings are happening around the country. The Arts Council is responding but, as we’ve seen, institutions struggle to act with the necessary swiftness. Crisis and isolation can be a creative time for some artists (cf Pushkin). It’s feeling grim for many though. I’m offering small loans as an extension of my grants programme for those in my network. Reply to me.
One pivot we made was for Thinking Bigly, which went online. Chat provided the interaction. We still had polls. Some games. We had a child cameo. Laura Kressly reviewed it. The show is part lecture, so tilting to this format was fairly easy and the tech pretty simple to test out as well. It is not going to replace in-person theatre. But, I think there is enormous opportunity in high quality, engaging, interactive “webinar” style learning. There is really only a smattering out there (cf. Khan Academy) and colleges etc. have not yet fully embraced the possibilities. The current restrictions may accelerate what has started. I have a recording of Bigly. Reply if you’d like a copy (or of my solo performance).
My non-COVID related thoughts were how happy I was to choose a whole fish with my son and steam it in a wok for dinner.
"...We arrange the chopsticks to form a hash tag # shape (or use wooden spoons!) on the base of the wok, so it can raise the fish a few centimetres off the bottom where the boiling water sits. We lay the fish on the chopsticks, when the water is boiling and cover the wok...." 2 min blog here.
I managed to watch some offensive comedy by David Chappelle, while hiding out in Boston in early March. Reflecting on it, I ended up on the side of thinking we do need to protect offensive comedy.
Poking fun at others is not as generous as poking fun at yourself (which David Sedaris does) but jokes are not only about laughing. They are a reflection of humanity and politics.
“Jokes aren’t only about laughing” Tyler Cowen
“I make fun of poor people because I see myself in them” David Chappelle
"When you make jokes about Trans people, doesn’t that normalise us?” Daphne (trans)
David Chappelle was offending everyone. A 4 min blog on our right to offend and if we need more David Chappelle?
A few quick hits before we get to COVID.
My friend, Michael Baptista on Fintech + open letter to chancellor on how to fund FinTech.
Folky singer-guitarist Laura Marling teaches guitar on instagram / twitter. It feels like a personal teach-in, a sort of concert / glimpse into practise / rehearsal. Seedlings growing in the background, an accidental little drawing caught on her hand (see Tutorial no. 5). Fascinating and wow for me.
250 Things an architect should know (in praise of Michael Sorkin ).
I like lists.
1. The feel of cool marble under bare feet.
2. How to live in a small room with five strangers for six months.
3. With the same strangers in a lifeboat for one week.
4. The modulus of rupture.
5. The distance a shout carries in the city.
6. The distance of a whisper.
7. Everything possible about Hatshepsut’s temple (try not to see it as ‘modernist’ avant la lettre).
8. The number of people with rent subsidies in New York City.
9. In your town (include the rich).
10. The flowering season for azaleas.
11. The insulating properties of glass.
12. The history of its production and use.
13. And of its meaning.
14. How to lay bricks.
And for World Autism Awareness Week (Anoushka’s new blogs):
Part 2. The Angel in her Astra
There’s a huge amount out there on COVID, so pick carefully what to weight. I also assembled some early blogs looking at a few less covered aspects.
A recent blog was on COVID and climate(1), another was the Imperial College model which forms a key piece of UK government advice (2), another on how people (44% as of early March) ) were believing the media are overhyping COVID, and the brutal maths of how bad it will get in the UK (3) and another on thinking about how to speed up drug development. I developed that blog and submitted a policy paper to George Mason University (Mercatus Center) which is now published.
And now this week’s COVID thinking if you haven’t had enough:
➳Key UK epidemiologist, Neil Ferguson, notes and video
➳Michael Liebreich on climate post-COVID
➳UK critical care patient characteristics
➳My policy thoughts (echoing Bill Gates?!)
➳Bill Gates to build vaccine manufacturing (video on daily show)
-Current England strategy = <20K Deaths from COVID (vs 500k no strategy)
-Peak ICU demand in 2.5 to 3 weeks
-With current strategies + recent surge in NHS capacity = ICUs will have enough capacity though may get close on local level.
-Testing needs significant ramp for strategy shift in 3-4 weeks
-Current strategy => 5 - 10% London is infected, will vary across country.
-Without suppression/current strategies, Ferguson et al model still suggests 500K deaths and overwhelmed health service
-Original modelling did not include much on testing + contact tracing as Public Health England made clear that testing was not going to be anywhere near sufficient in Feb/March.
UK epidemiologist, Neil Ferguson, notes and video (3 min blog + link to video)
Michael Liebreich (climate/energy thinker) on climate post-COVID "...Epidemics are not the only systemic risks to which we have been oblivious. In the run-up to the Great Financial Crisis we were oblivious to the systemic risks to our financial system posed by extreme levels of leverage and risky, opaque derivatives. And most people are still complacent about the systemic risks to our planetary environment posed by thoughtless economic development. Is it fanciful to hope that that as a result of Covid-19 the world pays a bit more attention to those urging us to respect our planetary boundaries, and a bit less to those pretending they do not exist?
In summary: Covid-19 is causing a massive drop in emissions this quarter, perhaps as much as 20%; after that, emissions will rebound, but remain significantly down until a vaccine enables a full recovery; even after that, they may well remain depressed for some years by an economy again hobbled by a colossal mountain of debt; and in the longer term, the stickiness of some of the new behavior, business models and technologies will certainly accelerate the transition to a low-carbon economy. Out of this terrible period, some good will come..." 4 min op-ed piece for BNEF here.
➳UK critical care patient characteristics
Mechanical ventilation: 79% of COVID vs 43% (viral pneumonia, VP)
Survival: 52% (COVID) vs 78% (VP)
Of those who received advance respiratory support 34% survived still low
My paper was accepted by the Mercatus Center at George Mason University:
Quickly developed therapeutic, prophylactic, and vaccine treatments will be essential to defeat the COVID-19 pandemic. Standard regulatory and development protocols typically yield drug development in 6 to 11 years. However, experimental vaccines and prophylactics against COVID-19 are in development and currently in trials, making deployment after safety trials feasible within months. Though efficacy of these treatments is uncertain, with probability of success, on average, at just 16 percent, efficacy can still be tested in real-world settings by adopting an approach that allows patients to begin drug treatments earlier in the regulatory process.
After phase I trials have been completed and data have been gathered, an expert committee should be convened to advise on the risk, benefit, and chance of success of the novel agent with a view toward distribution to the public through patient choice. There is limited downside risk and a good chance of a positive outcome with this approach. The US Food and Drug Administration (FDA) has the authority to approve pharmaceuticals requiring further trials, but the success of this approach will depend on coordination between sponsoring research organizations, trial designers, and regulators. International pharmaceutical regulators, such as those in the United Kingdom, Europe, or Japan, can also adopt this approach.
At this point, a clear indication of regulators’ openness to this approach would provide certainty for organisations and accelerate development of possible vaccines and treatments. When adjusting for probability, this approach may save hundreds of thousands of lives in the United States and more globally.
Under a traditional approach, a 50 person phase I trial might not be considered enough data to make strong judgments on safety and efficacy. It’s considered exploratory. However imagine…
10 separate Phase I trials (or trials with adaptive design) start in April 2020 across multiple countries. Patient numbers and characteristics (eg age, presence of COVID-19 antibodies, sex) are careful considered. The statistical power of multiple trials is stronger than one or two trials. 10 trials of n = 50 (say, up to 100) could be run in US, China, Italy, UK, Germany, France, South Korea to name a few countries with R&D capabilities with either commercial or non-profit led organisations that could run such trials. Results could be available in July. These data would include safety data, and preliminary measurements of efficacy such as COVID-19 antibodies.
Each interested country could convene its own expert and stakeholder committee. That committee could vote on if tentative approval should be given based on a benefit and risk assessment of the data. This meeting should be held in public and take submissions from stakeholders potentially replicating FDA advisory committee meeting processes or similar. A citizen’s jury process could run given the state of public interest.
In an optimistic scenario of no safety signals and strong efficacy signals, this would allow a September 2020 launch with high risk populations such as over-65s and healthcare workers prioritised. This is subject to commercial scale up of manufacturing. Funding for this should be given in April in hope of a positive scenario. In a pessimistic scenario, negative safety signals would not warrant tentative approval. The downsides would be limited to the volunteer trial participants and the investments taken.
The cost of running 10x phase I/II trials now is perhaps between $200m to $1bn. Given that this could solve the problem - it seems to be something that governments should be doing or incentivising. Especially vs fiscal bail outs wheich are 1000x this amount.
It echoes what Bill Gates is suggesting in this video ( 5 mins with Trevor Noah) and more extended with CBS. (25 mins)
Stay safe, stay well.
Graphics and links:
3 https://www.thendobetter.com/investing/2020/3/13/covid-brutal-maths-and-counter-factuals - The alarming maths and the reluctance of many
4 From Dalio's commentary on COVID and hitting 0% interest rates. https://www.linkedin.com/pulse/implications-hitting-hard-0-interest-rate-floor-ray-dalio/
5 https://www.thendobetter.com/investing/2019/8/23/forecasting-primer. On forecasting drug success
6 https://www.thendobetter.com/investing/2019/7/13/superforecasting-tips. On Superforecasting tips
7 Form for my small loans scheme. https://forms.gle/JYpNJCpHXxm83z7u7
8 Non-standard advice: https://www.thendobetter.com/investing/2018/12/14/non-standard-financial-advice
9 https://80000hours.org/covid-19/. On one page COVID links
11Imperial College modelling again: https://www.thendobetter.com/investing/2020/3/17/covid-uk-imperial-college-team-modelling-scenarios
I've had 100+ submissions and have backlog of 50+. Sorry if you are waiting for a response, I'm caught up to approx end Jan. Micro-grants. £10K for positive impact people.