> It seems to resonate a bit here, when Marc speaks of things like regulatory capture. I heard a few years back that a US health insurance startup had to provide on the order of 6000 pages of documentation to be approved. No wonder that there hadn't been another provider for twenty years or so. It seems like some things are hard to build mostly because some people want it that way.
Sure, but is this actually a high order blocker? I'd argue that it's not even a first order effect. The problem here is not that we don't have enough insurance capacity; the problem is that we don't have enough ventilators. And it turns out, actually building those things to spec is hard. Intellectual property and regulatory capture are bad things to be reduced, IMO, but they're only part of our current equation.
The moneyed classes of America don't like redundancy and they don't like long term investments. Since they hold such a huge chunk of wealth compared to the rest of America, their preferences (which I might note, Marc represents professionally) make these decisions long before patent troll lawsuits or building inspectors can rain on any parade.
> Point being, why not write simpler laws and regulations and leave it to the courts to interpret what adheres to the spirit of it? With the barriers of entry gone, I think we'd see a renewed vitality to many ossified sectors.
Litigation is the most costly way to settle these things. Your idea would require even more startup capital per small business to overcome the legal obstacles you seemed eager to abolish.
We’re not necessarily talking about litigation here. Like another commenter pointed out, other legal system allows you to ask the courts for decisions without an opposing party.
We're actually not running out of ventilators anywhere. Existing installed base is sufficient and moreover, it turned out the federal government had a large stockpile anyway, which rather invalidates the central thesis of the article re: lack of preparedness.
The claim about ventilators was one of the first dodgy claims I noticed but really the entire first part of the article is a pack of lies. Andreessen says:
"We see this today with the things we urgently need but don’t have. We don’t have enough coronavirus tests, or test materials — including, amazingly, cotton swabs and common reagents"
This isn't amazing. The amount of testing being performed has scaled exponentially over the space of just a few months, from a standing start. In fact there's a lot of evidence that the supposedly exponential growth of the virus was really due to an exponential growth in testing, when positives are viewed as a proportion of overall tests done. It's not an indictment of "the West" that materials run out after such a vast acceleration - if anything I'm amazed it didn't happen earlier!
"We don’t have enough ventilators, negative pressure rooms, and ICU beds"
All three are in plentiful supply. Even in localised hotspots like New York problems are limited to a handful of hospitals.
I've been reading about the near deserted state of most hospitals for over a week now. I don't understand where Marc is getting his information from if he isn't aware of this.
"We also don’t have therapies or a vaccine — despite, again, years of advance warning about bat-borne coronaviruses"
Vaccines can't be created for a virus that doesn't exist yet regardless of how many vague warnings there are, so this isn't remarkable: it's inevitable. As for therapies, that's what ventilators and CPAP are.
"then we may not have the manufacturing factories required to scale their production"
Given the data appearing in a flood of new papers, showing that the virus is not dangerous enough to warrant current policy, no unusual rates of manufacturing scale-up will be required.
"it took scientists 5 years to get regulatory testing approval for the new Ebola vaccine after that scourge’s 2014 outbreak, at the cost of many lives"
I'm actually on Marc's side on this one, in that I suspect current FDA approval processes are overkill. But this claim is also nonsense. FDA allows fast-track approval bypass for cases where someone is going to die without treatment anyway, and Ebola disappeared after 2014 - according to CDC the next time it was spotted was Zaire in 2018 with a grand total of 8 cases. That's not even close to "many lives".
"A government that collects money from all its citizens and businesses each year has never built a system to distribute money to us when it’s needed most."
Tax credits, quantitative easing, loan subsidies. The government has many ways to distribute money to people.
"At least therapies and vaccines are hard! Making masks and transferring money are not hard"
In fact making medical masks is hard. It requires special materials and machines, the supply of which can't be rapidly scaled up.
Headline is literally "Factories are scrambling to make 20 times more face masks a day to keep up with demand amid coronavirus outbreak, but the masks are surprisingly difficult and expensive to make"
As for money, transferring money is easy. Figuring out the right amounts and the right people to send it to, without creating an explosion of fraud and waste - that's not so easy.
The number of tests done so far is about 4 million. Aren't you surprised to find we didn't have 4 million cotton swabs? Barely 1 swab per 100 people?
For reference, Q-tips come in packages of 500 for about $5 at your local pharmacy. They sell around 20 billion per year. Test swabs are somewhat more special and individually wrapped, but 4 million shouldn't cost a lot.
I want to make sure you know that this post is full of bizarre falsehoods. New York and Seattle definitely have ventilator shortages. California had a shortage and that federal reserve of ventilators netted us a small number of broken devices that had to be repaired. Lucky us, the State had a corporate partner that could do it.
I especially want to take issue with this falsehood:
> All three are in plentiful supply. Even in localised hotspots like New York problems are limited to a handful of hospitals.
ICU beds are definitely in short supply. It doesn't matter if a bed exists in another state, folks who need ICU beds aren't usually fit to travel. That's part of why their care is intensive.
But also, only large hospitals have significant ICU capacity. So saying it's only limited to hospitals that have ICU capacity seems very disingenuous to me. It's like saying, "There is no shortage of ICU beds at local clinics." That's true, because no one expects substantial ICU capacity at local clinics. If they had it, it'd be welcome right now.
> I've been reading about the near deserted state of most hospitals for over a week now. I don't understand where Marc is getting his information from if he isn't aware of this.
Where are you reading this? I have relatives in healthcare in NY. They do not relate your story to me.
> Vaccines can't be created for a virus that doesn't exist yet regardless of how many vague warnings there are, so this isn't remarkable: it's inevitable. As for therapies, that's what ventilators and CPAP are.
Who would CPAP machines be for? Why bring them up?
> Given the data appearing in a flood of new papers, showing that the virus is not dangerous enough to warrant current policy, no unusual rates of manufacturing scale-up will be required.
The medical literature is in fact saying the opposite. But now I'm morbidly fascinated what the "reopen the economy" and "it's just the flu" crowd are circulating as "scientific literature."
> Tax credits, quantitative easing, loan subsidies. The government has many ways to distribute money to people.
None of which are actually effective in the face of historic unemployment.
> In fact making medical masks is hard. It requires special materials and machines, the supply of which can't be rapidly scaled up.
Making masks which reduce individual aerosol dispersal is easy. N95 masks are harder. We definitely could scale them up rapidly if we wanted to. This is the territory where things like IP law do matter and do cost lives.
New York doesn't have a ventilator shortage and never did. It had a predicted shortage based on bad simulations, but never a real one. In fact it's now sending ventilators elsewhere:
"On April 2, Cuomo predicted the state would run out of ventilators in six days “at the current burn rate.” But on April 6, Cuomo noted, “We’re ok, and we have some in reserve.” Now New York appears to have passed the apex. Deaths, a lagging indicator, crested at 799 on April 9 and hit 606 on April 16, the lowest figure since April 6. Hospitalizations are also declining, and on April 16 also hit their lowest level since April 6. Cuomo today has so many ventilators he is giving them away: On April 15, he said he was sending 100 of them to Michigan and 50 to Maryland. On April 16, he announced he was sending 100 to New Jersey."
I'm morbidly fascinated by what you're reading that has led you to this belief.
Re: ICU beds: I was talking about the world generally rather than New York specifically. For example in New Jersey on April 8th only 3 hospitals were load balancing to others:
"the field hospital constructed inside the massive Jacob K. Javits Convention Center in Hudson Yards, had 340 patients as of Tuesday afternoon ... The facility has a maximum capacity of 2,500 hospital beds. As of Tuesday afternoon, the Javits Center hospital had treated about 700 patients"
Even on April 1st, the New York Post visited an ICU and found it was only handling double the normal case load, well within capacity (13 patients normally, 26 then):
Certainly there are cases where single hospitals ran out of space and started load balancing onto nearby hospitals. But, that happens during normal times too.
Where are you reading this? [empty hospitals]
The essay isn't only about New York, it's trying to generalise not only to America but the whole western world. And across the world hospitals are laying off staff due to underload:
Who would CPAP machines be for? Why bring them up?
CPAP - the pressure type, not the sleep machines - is now a common therapy for treating COVID-19. For example the British Prime Minister wasn't put on a ventilator but rather given only CPAP (basically, a mask connected to the hospital oxygen supply). This is because there's a growing belief in the medical world that ventilators can cause more harm than good for COVID patients.
None of which are actually effective in the face of historic unemployment.
That's not a rebuttal. Systems to distribute money exist. The idea they've never been built, as the essay argues, isn't right.
If you want to argue they aren't designed for sustaining a world under house arrest, by all means do so, but no country on earth has created schemes specifically for that.
Making masks which reduce individual aerosol dispersal is easy. N95 masks are harder
Andreessen was talking about medical-grade masks designed to protect doctors from patients, not ad-hoc home made things. And for those masks the point stands: it's hard to make them but he says it's easy.
As for medical literature, go read the links to papers and studies here:
There are many links to papers, comments and articles by doctors and other specialists who are arguing that the virus is clearly not as deadly as feared. For example, the serology survey that's in the first link under the April 18th update was discussed here on HN just recently.
That's good news, by the way! Don't you hope they're right? My experience is that some people posting on HN don't actually want to study what people bringing good news are saying.
Sorry, I already have decided in another post your "Swiss Doctor's" summary isnt't very credible and that National Review article seems to have an awful lot of hedging in it.
Thank you for the effort, but I don't believe there is much more to say on the subject.
I'm sorry, you're right. There was a narrow window where there were concerns, but that passed. New York DOEs face ICU bed shortages.
My response here was mostly dismissive because the poster above is clearly trying to downplay the crisis for reasons I can only speculate on. After taking a lot of time to read through the poster's previous links, I'm quite frustrated with how much time I wasted on disingenuous garbage links.
But yes, I lumped Seattle (which briefly did have a ventilator shortage) in with New York on ventilators. This is pretty much the only thing I was wrong about and I'll take this opportunity to own up. But I won't engage earnestly with the previous poster any further.
Please could you link some of the papers you mention on the scale of the coronavirus problem? I'm not doubting they exist, I'd just be interested to have a read.
"A swiss doctor on COVID-19," huh? Well since it's written by a doctor we should give it the benefit of the doubt and read the page and the links. But I confess, upon doing so I find that this is a page full of good (and in some cases, familiar) resources presented in a way that reminds me of a well-produced climate science denial websites.
That's an incendiary claim, so please let me provide an example. Here's point 4 on the overview:
> The age and risk profile of deaths thus essentially corresponds to normal mortality. Up to 60% of all Covid19-related deaths have occurred in particularly vulnerable nursing homes.
"Nursing homes" is highlighted and links to an article talking about mortality in nursing homes and long term care facilities. It is both cautious about its claims (pointing out data is not very good yet) an doesn't make the point that nursing homes are in fact the fatality concentration point. It's not clear how we'd draw a larger conclusion from this.
Another example, next point:
> Many media reports of young and healthy people dying from Covid19 have proven to be false upon closer inspection. Many of these people either (did not)[1] die from Covid19 or they in fact had (serious preconditions)[2] (such as undiagnosed leukaemia).
Firstly, I'm not sure anyone has disputed that young people are much less likely to die of the virus. But there are two links in this point, one to a Daily Mail article about how a coroner is waiting for a toxicology report before ruling the cause of death is COVID-19. This is probably the right call, but an infant testing positive for COVID-19 appears to have died over respiratory distress. It's difficult to just shrug and go, "Oh well that's SIDS not the virus even though the nature of the death is identical."
Really, these points read like someone with an agenda trying to make a lot of cites for legitimacy. But there isn't a lot of evidence of a larger pattern here, just a lot of data which is then presented in a leading way to facilitate a narrative.
Another example of this:
> The often shown exponential curves of “corona cases” are (misleading)[3], since the number of tests also increases exponentially. In most countries, the ratio of positive tests to total tests either remains constant between (5% to 25%)[4] or increases rather slowly.
This is another really misleading bullet point. Looking at [4], we see indeed that the over-time ratio of tests has remained at an average of 25% positive by country (this is of course averaged, hotspots see totally different numbers). But the author has previously pointed out that testing administration has risen exponentially, so this is a constant proportion of an exponential population. If we decline to extrapolate from this, the author cannot make their point. But if we do, we see an exponential growth in COVID-19 cases.
I see more examples but I won't further belabor the point. This resource is written by someone with an agenda they want to execute on. It doesn't appear to be someone honestly engaging in inquiry and arriving at a data-driven conclusion.
> I really can't help but appreciate the irony of alleging agenda in the above poster's sources, while simultaneously citing the Daily Mail, Yahoo Sports, and Twitter.
The post you're replying to did not use those as sources. They were criticizing the website for using those sources (and including them here for reference). Look at the locations of [1] thru [4] in their comment: they're all in the body of quotes.
> I'm actually on Marc's side on this one, in that I suspect current FDA approval processes are overkill.
As I understand it FDA didn't approve Pandemrix, while EU regulators did give it fast track appeal.
Pandemrix causes narcolepsy in 1 in 60,000 people who take it. (so, for the entire US that's about 5000 with a life long debilitating illness that requires constant care.) The risk is very low, but it's there and we need to be careful about exposing a population of hundreds of millions to these risks just because we have an ideological opposition to any form of government regulation.
It's hard to form an opinion on that case without knowing more about Pandremix. How many people did it help? Is the illness it treats worse than narcolepsy? How many people are wrongly prescribed it?
I also wonder what kind of study found such a tiny effect size. 1 in 60,000 would require a staggeringly powerful study to successfully link it to Pandremix.
Not saying you're wrong about any of that, and I suppose I could go research these questions myself. But based solely on what you wrote I don't think there's any way to tell if that decision was good or bad.
> The moneyed classes of America don't like redundancy and they don't like long term investments.
This class denigrating language does nothing to elevate the discussion and it is absolutely false (in the sense that it is only a "truth" within your worldview and the worldview of others who share it), and it is false in the sense that it doesn't accurately describe the behaviors of individuals in the "moneyed class".
The "moneyed classes" as you call it if anything have more redundancy and longer term investments that most other classes. It is incredibly rare for anyone in the "moneyed classes" to not have a balanced portfolio of investments that add in fiscal redundancy in case one investment goes bad. The portfolios are also balanced insofar as balancing short term and long term growth depending on their investment horizon.
The problems you've identified have far more to do with a coordination problem than the vices of individuals.
The "moneyed class" is not one coordinated hive mind mass that all conspire with one another to avoid redundancy and eschew long term investments.
The "moneyed class" like the "unmoneyed class" are all individual actors each acting in their own self interest and trying to figure out an optimal solution given limited imperfect information and handicapped by many cognitive biases.
Any system that is going to solve the issue of redundancy and long term investments needs to acknowledge the reality of limited imperfective information and cognitive biases and the impact these have on human reasoning and the subsequent actions of individuals.
Sure, but is this actually a high order blocker? I'd argue that it's not even a first order effect. The problem here is not that we don't have enough insurance capacity; the problem is that we don't have enough ventilators. And it turns out, actually building those things to spec is hard. Intellectual property and regulatory capture are bad things to be reduced, IMO, but they're only part of our current equation.
The moneyed classes of America don't like redundancy and they don't like long term investments. Since they hold such a huge chunk of wealth compared to the rest of America, their preferences (which I might note, Marc represents professionally) make these decisions long before patent troll lawsuits or building inspectors can rain on any parade.
> Point being, why not write simpler laws and regulations and leave it to the courts to interpret what adheres to the spirit of it? With the barriers of entry gone, I think we'd see a renewed vitality to many ossified sectors.
Litigation is the most costly way to settle these things. Your idea would require even more startup capital per small business to overcome the legal obstacles you seemed eager to abolish.