Six Deaths in King County, U.S. Mistakes, Paywalls and Pandemics

Good morning,

I am, gingerly, wading back into the COVID-19 waters. I remain extremely cognizant about the fact that I am not an expert; at the same time, I am increasingly worried about the Seattle area in particular, which is not only a place I used to live — and would love to one day return to — but is also an area where Stratechery has a lot of readers.

On to the update:

Six Deaths in King County

From the Seattle Times:

Six people in Washington have now died from COVID-19, the illness caused by a new coronavirus, state and King County officials announced Monday, as they said that an extraordinary effort to contain and manage the health crisis is moving toward a new stage. While stressing most people will experience mild symptoms, the officials say more cases are inevitable and they will soon stop intensively following up on each one. Rather, they will focus on outbreaks and giving individuals, schools and other institutions the best advice on how to minimize illness…

As of noon Monday, 18 people in King and Snohomish counties had been diagnosed with COVID-19, the illness caused by the coronavirus, according to the state Department of Health (DOH). Six people have died.

That last paragraph should raise a massive red flag: I noted yesterday that the actual case fatality rate (CFR) is likely closer to 0.5% than it is to 2.5%, but that means the range of cases, given 6 deaths, is closer to 1,200 if the CFR is 0.5%, and 240 if the CFR is 2.5%. That, though, understates the situation: those numbers apply approximately four weeks ago, since fatalities take a while; it is safe to assume that the coronavirus has been spreading in Washington for weeks, and there are likely thousands of infections. This is a perfect example of my good news/bad news summary from yesterday: the bad news is that SARS-CoV-2 is very viral; the good news is that it is probably less fatal than originally feared. That, though, means that 6 deaths is a pretty big deal in terms of the overall rate of infection.

There are countervailing factors; four of the deaths were residents of a nursing home in Kirkland, and the elderly and those with underlying health issues are the most susceptible to COVID-19. That suggests that the number of cases may be somewhat less than the death toll indicates; at the same time, it is noteworthy that the strain in Washington does appear to be one that has been present for a while. From the New York Times:

Researchers who have examined the genomes of two coronavirus infections in Washington State say the similarities between the cases suggest that the virus may have been spreading in the state for weeks. Washington had the United States’ first confirmed case of coronavirus, announced by the Centers for Disease Control and Prevention on Jan. 20. Based on an analysis of the virus’s genetic sequence, another case that surfaced in the state and was announced on Friday probably was descended from that first case.

The two people live in the same county, but are not known to have had contact with one another, and the second case occurred well after the first would no longer be expected to be contagious. So the genetic findings suggest that the virus has been spreading through other people in the community for close to six weeks, according to one of the scientists who compared the sequences, Trevor Bedford, an associate professor at the Fred Hutchinson Cancer Research Center and the University of Washington.

Dr. Bedford said it was possible that the two cases could be unrelated, and had been introduced separately into the United States. But he said that was unlikely, however, because in both cases the virus contained a genetic variation that appears to be rare — it was found in only two of the 59 samples whose sequences have been shared from China, where the virus originated.

At first glance, this is comforting in a way: the virus has probably been circulating for weeks and no one has noticed! In truth, though, that understates the impact of exponentiality: it seems likely that the virus was circulating in Wuhan for weeks as well, and only exploded into a crisis 6~8 weeks after its introduction. In other words, the situation in King County may be on the verge of getting very bad very suddenly.

The issue is not necessarily stopping the virus’ spread; to repeat what I said yesterday, the opportunity to do that likely passed in late December or early January. What is important now is slowing the speed in order to prevent our health care system from being overwhelmed. As Elad Gil, whose blog post I linked to yesterday put it to me, COVID-19 is like a denial-of-service attack on health care infrastructure; the risk is in hospitals being overwhelmed with cases that, in a vacuum, could be overcome.

U.S. Mistakes

As an aside, this is where the U.S. has fallen short in its response; I criticized China a month ago for the effect censorship had on containing the virus, and I stand by that. The U.S., though, has struggled with testing in particular. Again, from the New York Times:

The coronavirus has found a crack in the nation’s public health armor, and it is not one that scientists foresaw: diagnostic testing. The Centers for Disease Control and Prevention botched its first attempt to mass produce a diagnostic test kit, a discovery made only after officials had shipped hundreds of kits to state laboratories. A promised replacement took several weeks, and still did not permit state and local laboratories to make final diagnoses. And the C.D.C. essentially ensured that Americans would be tested in very few numbers by imposing stringent and narrow criteria, critics say.

On Monday, following mounting criticism of the federal response, Trump administration officials promised a rapid expansion of the country’s testing capacities. With the help of private companies and academic centers, as many as a million diagnostic tests could be administered by the end of this week, said Dr. Stephen Hahn, commissioner of the Food and Drug Administration.

There is a really important point here: as I have repeatedly argued, the U.S. is not going to compete with China with Chinese tactics. From a Daily Update last fall:

I firmly believe that when it comes to longterm geopolitical competition — and I think that is exactly what the United States and China are embarking upon — the United States’ most important advantage vis-à-vis China is liberty. I know that sounds horribly cliché, but the fact of the matter is that not only is that the point where these two countries core ideologies most profoundly differ, I also believe it is core to innovation — and innovation is exactly where the U.S. needs to win.

Note that the U.S. is going to go from basically no tests to millions of tests, not because the government finally got its act together, but because regulations were finally loosened and the private sector was asked to step in. Figuring stuff out at scale in a distributed nature is what the U.S. is good at; it is a mistake to think that a top-down response is the only answer.

That noted, there is one top-down response that I think is appropriate — and again, I put this forward with a great deal of trepidation, given that I am not an expert, but also with the burden of responsibility, given my readership: I think that Amazon and Microsoft should work-from-home for the next few weeks, with the hope of not only limiting the spread of the virus within their ranks, but also setting an example for the rest of the Seattle area. Again, this isn’t something that is going to be stopped, but the rate matters, and severely restricting how often people come in contact is the best way to slow things down.

Paywalls and Pandemics

You probably didn’t notice this, but I linked to the Seattle Times above, which is usually paywalled:

From a certain point of view, this doesn’t make sense: why would you make a particular resource free at the time it is of highest demand? This, though, is a misunderstanding of what the Seattle Times is selling. I wrote in The Local News Business Model:

It is very important to clearly define what a subscriptions means. First, it’s not a donation: it is asking a customer to pay money for a product. What, then, is the product? It is not, in fact, any one article (a point that is missed by the misguided focus on micro-transactions). Rather, a subscriber is paying for the regular delivery of well-defined value.

Each of those words is meaningful:

  • Paying: A subscription is an ongoing commitment to the production of content, not a one-off payment for one piece of content that catches the eye.
  • Regular Delivery: A subscriber does not need to depend on the random discovery of content; said content can be delivered to to the subscriber directly, whether that be email, a bookmark, or an app.
  • Well-defined Value: A subscriber needs to know what they are paying for, and it needs to be worth it.

This last point is at the crux of why many ad-based newspapers will find it all but impossible to switch to a real subscription business model. When asking people to pay, quality matters far more than quantity, and the ratio matters: a publication with 1 valuable article a day about a well-defined topic will more easily earn subscriptions than one with 3 valuable articles and 20 worthless ones covering a variety of subjects. Yet all too many local newspapers, built for an ad-based business model that calls for daily content to wrap around ads, spend their limited resources churning out daily filler even though those ads no longer exist.

In this particular case, were I a paying subscriber of the Seattle Times, I would be very happy about this decision: what I am funding is not exclusivity of zero marginal cost content, but rather the means by which content that is valuable to me is produced, and, in the case of a pandemic, that content being spread broadly is particularly valuable to me personally.

To that end, as long as I am urging companies to do things that appear at first glance to be against their interest, I encourage publishers broadly to make all COVID-19 content freely available. I am doing the same: both yesterday’s daily update and today’s are free to share.

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