Thursday, March 26, 2020

Japan vs. Italy: Why is the virus exploding in one but not the other? (Demographic Doom Podcast #36)

This is the script for my Demographic Doom podcast episode (#36) released on 26 March 2020. It may differ slightly from the final broadcast. This episode is available on major podcast platforms, including PodbeanApple Podcasts and a video version on YouTube. See the description on the YouTube version for annotations, links and corrections. You can also comment on this episode there. (If you leave comments on this blog post, I might not see them.) The main website for this project is DemographicDoom.com


PODCAST AND VIDEO COMING SOON

I’m Glenn Campbell. I call myself a demographic philosopher. I’m looking at life and trying to predict the future through the lens of demography, or the study of human populations.

Today is Thursday, March 26, 2020, and we're in a time of great cultural insanity. The world is facing two simultaneous calamities: the COVID-19 epidemic and the collapse of the world economy, and in general, people and governments handling things porrly. Far and away the biggest threat today is the global economic collapse, much bigger than the one in 2008. This is certain to cause more human misery than any virus, but as of today, the world seems to be treating the virus in isolation, as though it was the only thing that mattered. In this episode, I'm going to follow pretty much that same path, focusing mostly on the virus, but I assure you the economic collapse will consume many future episodes.

The biggest insanity of the moment is the current obsession with lockdowns. This is the emotional solution to every threat: Just lock everything down. Everyone stay home. Hide under you pillows. No one in or out. A lockdown is when a whole country, state or region is ordered to shut down. Transportation is restricted, and all supposedly "nonessential" businesses are told to close. All those workers are expected to go home, hunker down and wait for some kind of All-Clear signal from the government. It is seen as your patriotic duty to sit on your couch, watch TV and not leave home.

To put this podcast into historical perspective: As I record this, there have been roughly 800 coronavirus deaths in the USA. (It is senseless to talk about the number of coronavirus cases because the US doesn't have anywhere near the capacity to test all the people who are suspected to have it.) At present, some two dozen states have enacted lockdown restrictions requiring non-essential businesses to close. What constitutes "nonessential" is a matter of debate, but it's fair to say that half the states have shut down half their businesses, and the situation is roughly similar in Europe.

There a multiple absurdities in this. The biggest one is that any lockdown assures a rapid and brutal economic decline, much faster and harder that would otherwise happen. No matter how you measure human misery, the economic collapse is certain to cause far more it over its lifetime than any virus—over the course of years, not just months—yet politicians don't seem to be factoring in how these lockdowns are making the economic crisis far worse. Everyone's running around yelling, "The ship is sinking! We got to save everyone!" but in the process they're just blowing more holes in the ship.

In popular rhetoric, the economy doesn't matter right now. All that matters is saving lives. If even one life is saved by these measures, it's worth it. What these speakers don't understand is that all of human well-being ultimately rests on the economy. If you deliberately nuke it, like a lockdown does, ultimately people are going to starve. They may survive the virus, but they'll be living in a world more horrible than you can imagine—a Venezuela or North Korea world—where nothing works, including medicine, because you don't have the economic underpinnings to support it.

Many of the workers who are being told to go home today will never go back, because their jobs will be gone. This is a sudden, brutal layoff of a major portion of the workforce, instead of gradual waves of layoffs as in previous crashes. Make no mistake, an economic collapse was destined to happen with or without any virus, but lockdowns assure that it is happening faster and harder.

Another great absurdity is that these lockdowns aren't accomplishing what they intend to. They aren't actually saving any lives. I understand the desire to "flatten the curve", but there a deep fallacy here. I'll get into later, but really you don't want to flatten the curve; you want reduce it altogether. Lockdowns are like trying to kill a mouse with a sledgehammer. Sure, you might get the mouse eventually but you're causing so much collateral damage to your home that the mouse doesn't matter anymore.

The main focus of this episode is figuring out what works and what doesn't in the fight against the disease. Hygiene works. Changing contact behavior works. Lockdowns don't work. They're a disaster in the making. To illustrate this, I'm going to focus on the current epidemic in two countries: Japan and Italy.

You may not have heard much about the coronavirus epidemic in Japan, and for good reason. It seems to have fizzled. Even though Japan was one of the first outside China to receive the virus, cases have not spiked exponentially. In the current official accounting, there are about 1200 diagnosed cases and about 45 deaths, for a population of 127 million, and the numbers are rising only slowly. Compare this to Italy with less than half the population, 60 million, which was exposed to the virus later than Japan. There have been about 7000 deaths in Italy and at least 80,000 cases.

Interestingly, Italy is in full lockdown mode, while Japan is not. In Italy, transportation has essentially stopped; non-essential businesses are closed; people are ordered to stay in their homes under threat of fines. The whole country is essentially in a wartime blackout, yet cases continue to climb.

In Japan, it's basically business as usual. The subways and trains are still running, still packed with sardine commuters. Most businesses are still open and operating as usual. Big gatherings and entertainment events have been cancelled. Theme parks for have closed, but clubs are still open. Sit-down restaurants are still open. I confirmed this with a friend who lives in Japan. Not mjch is shut down, yet we have a feeble 45 deaths in Japan vs. 7000 in Italy.

So on one side we have Italy, in full lockdown mode, where the epidemic is raging. In Japan with no lockdown, it seems to be petering out.So what gives here? Why is there so much difference in how the virus attacks each country. Understand this, and you'll understand what really works and why lockdowns are such a grievious mistake.

You can't blame the medical systems. In Japan and Italy, they are roughly equivalent. You also can't say the Italy has more coronavirus deaths because it has so many old people, because Japan has even more. So what is it that makes Japan essentially immune to coronavirus, at least so far?

So here's my theory: Japan has been largely spared by the virus because it is full of.... Japanese!

I don't mean there's a racial component. There is no real evidence that the virus prefers one race over another. I mean there's a cultural component. To put it crudely, the Japanese are obsessed with hygiene, while the Italians are not.

Now it's unfair and bigoted to apply such stereotypes to individuals. You shouldn't call someone a "dirty Italian" because, on an individual basis, it may not be true, but it is not unfair to acknowledge measurable statistical differences between populations. That's called "culture" and it's a real thing. The Japanese, as a culture, place a high value on personal hygiene—on being and appearing clean. This is the home of electronic toilet seats to thoroughly clean and sanitize your bum. Electronic toilet seats are doing nothing to prevent the spread of Covid-19, but they reflects the mindset of the Japanese people. This was a very clean culture long before the virus hit. This is also not a touchy-feeling culture—not a lot of hugging and social kissing. In Japan, you keep your distance.

Italy, on the other hand, is a very touchy-feely culture. Lots of warm embraces and kisses on the cheek. When you talk to someone, you come up close to them. I can't say that I know Italian culture very well, but it's obviously different than Japanese culture. Statistically, Italians and Japanese interact with each other differently, and these differences are going to change how COVID-19 moves through the population.

So here what I think is the single biggest difference between Italians and Japanese: It's how they greet each other. In Italy, they shake hands, maybe they embrace; they are physically close. In Japan, they bow from a respectable distance. It is considered rude for anyone to touch anyone else without a justifiable purpose.

Just eliminating handshakes could be the biggest coronavirus prevention measure short of a vaccine. No one knows yet how big a vector handshakes are, but I suspect it's huge. Have you wondered why so many Western politicians are getting the virus, far more than than the statistics suggest? Politicians shake a lot of hands! Shaking hands is a solid viral connection between one individual and another, and Japanese culture has almost completely eliminated this vector.

Then there are all the other ways the Japanese try to be clean. I spent two weeks in Tokyo in 2012, and one thing that struck me is how many people were wearing surgical face masks in the street. Initially, I thought this was because people were paranoid about catching something. This may in fact be true, but there's another side of it: If you have a cold, it is considered impolite to cough without a mask. It is not yourself you are trying to protect but others. If you coughed in public and weren't wearing a facemask, people would look at you askance, which is the Japanese equivalent of yelling at you loudly.

A Japanese government report on March 9 found that 80% of the people who got the disease didn't pass it on to others, which is the sort of R-nought you can live with. This virus is supposed to be passed to between 2 and 3 people on average—That's the generally accepted R-nought.—but Japan is showing only a fraction of that, and I think it's because of their culture, their way of interacting.

So if this is true—that Japan has licked the virus just by being Japanese—it suggests that the best solution for other countries is simple behavior change. Americans and Europeans need to be more Japanese in their hygiene behavior—and they're doing it! They've stopped shaking hands. Coughing in public is now a no-no. There are all sorts of easy and cheap changes that can be made by individuals and businesses to emulate the Japanese model. If a society does enough of these high-value things, then it pushes its R-nought below one, and the virus expires.

In an earlier podcast, I talked about herd immunity. That's the notion that if a certain percentage of people in a population get a virus, it helps protect the others, because the virus now has no way to get to those uninfected people, but I'm now wondering whether herd immunity is a red herring, distracting us from something more important: the R-nought, or the reproduction rate within a population. That's the number of people, on average, that each carrier of the disease infects. If the R-nought is above one, it spreads through the population. If it is less than one, the virus eventually expires.

If you can push the R-nought below one, then herd immunity never become relevant, because the virus expires after only a couple of hops. One person might give it to another who might give it to a third, but it eventually stops, not very far from where it started.

The media have been treating the R-nought as a fixed number that is a characteristic of the virus itself. It's not. It is a characteristic of the human culture that carried the virus. One virus may be more inherently transmissible than another, but the actual transmission is still done by humans, so it's totally dependent on human behavior. Change the behavior, and you change the R-nought.

What the Japanese seem to have done is pushed the R-nought close to one just by being Japanese. They just aren't giving the virus enough opportunities to reproduce itself, so it's dying off before it reaches the broader population. Yes, the Japanese are still riding in packed subway cars and going out to clubs, and it's probably true that some people are catching the disease in these places, but if it's not a major source of transmission, it doesn't push the R-nought over one.

Sure, the R-nought may have been 2-3 in Wuhan, China—maybe even higher—but that was Wuhan China, an entirely different culture from Japan. Different hygiene standards. Different ways of interacting. In every culture, the R-nought is going to be different, but our culture-blind thinking means that we've been treating it as a fixed number. We're saying, "Boy, if the R-nought in the USA is the same as it was in China, then we're all screwed!" Well, it won't be the same as in China, because America is a different culture with different ways of interacting.

Furthermore, the R-nought is highly malleable. People can be quickly trained to change their behavior, especially if they know their lives depend on it. Just by not shaking hands anymore, an entire culture can reduce it's R-nought by a significant factor. I have not idea what that factor it, but I bet it's big.

An important thing to note is that you don't need to eliminate every conceivable source of transmission to push the R-nought below one. You only need to target the biggest forms of transmission. If you can neutralize the things that contribute most to transmission—like handshakes and door knobs and getting directly coughed on—then you may not need to sweat over the minor ones like riding in the subway or going to a club. You just need to suppress the major vectors to the total R-nought is below one. You don't need 100% sterile containment. You just need a "good enough" reduction of the main sources of transmission.

Lockdowns don't acknowledge any of this. They are intent on nothing less than full containment. Everyone is supposed to lock themselves in their homes so there's no possibility of transmission. And it's true: People are locked away from each other can't spread the virus, but you've also disabled your whole society and economy for no good reason. A lockdown is carpet-bomb attack on all forms of in-person social interaction, most of which have little chance of spreading the virus. In many states, you can't even go to the beach anymore, because there's a possibility, however slim, that the virus might jump from one beach-goer to another. If that's possible, but it's probably a one in a million chance compared to, say, a 1 in 10 chance of spreading the virus with a handshake.

The trouble with blanket lockdowns is they have no sensitivity, no perspective. They are treating highly unlikely sources of transmission exactly the same as a likely ones. In the philosophy of lockdowns, no risk of transmission is acceptable. Only total containment will do.

Much attention has been focused on two sources of transmission that may be possible with COVID-19: asymptomatic transmission and aerosolization. Asymptomatic transmission means that someone who shows no symptoms of the disease can still give it to others. Aerosolization means the virus can be transmitted though the air for long distances, not just within a meter or two of someone who coughs. Taken together, these two factors mean you can't trust anyone or any place. If you walk into an airport terminal and breath the air, the virus can get you. If you come within 6 feet of someone who show no symptoms, you're gonna die.

While these vectors may be real, they're probably not significant enough to change the R-nought, yet lockdowns treat all these risks as the same. We're going to close all the airports and keep everyone at least six feet away from each other, because nothing less than perfect protection will do.

A sensible epidemiological approach is, "Let's address the main factors." The stupid approach is, "Let's address every conceivable factor." The first approach is manageable. The second approach is both impossible and unsustainable, and you are absolutely killing your economy in the process.

I spoke about lockdowns in a previous podcast. I called them national suicide. One you start down this road of seeking absolute protection at any cost, how do you call it off? Right now, we've got millions of people hunkering down in their homes waiting for the All-Clear from their government on when to come out. So when will this All-Clear be given? Two weeks from now? Six months? How will conditions in six months be any different than they are today? The virus will still still exist, but no one will have learned how to manage it in real-world settings.

Lockdowns are like "curing" a drug addict by throwing him into prison or a locked rehab facility. Yes, if you deprive him of access to drugs, he will get off them. He will detox. At the end of his stay, the addict will be "clean", but he hasn't learned anything about how to stay off drugs, and he'll go right back to his old behavior as soon as the drugs are available again. You haven't cured him all.

So what are the justifications for this current lockdown obsession in America and Europe? There are several of them, and I think they're all pretty damn stupid.

First, there's this notion of "flattening the curve". If a certain number of people are destined to get the disease anyway, then you don't want them all hitting your hospitals at once. Services will be overwhelmed and most people won't get treatment. It would be better, the reasoning goes, to spread those cases out over a long period of time, so more people get treated.

The main fallacy here is the assumption that there are destined to be a fixed number of cases, like 10 million requiring hospital care, and there's no way to to change this number. The experience in Japan says otherwise. You can change the number of people infected by changing human behavior. The Japanese don't have to worry about flattening the curve, because their curve already seems manageable. Instead of flattening the curve, we should be reducing the curve so that fewer people get the disease. Lockdowns don't really help with this, because they aren't training people how to reduce their exposure.

Another reason lockdowns are taking off right now is that they're both popular and easy to promote. Politicians love lockdowns because it gives them an easy way to show that they're doing something.  They're taking charge. Lockdowns give them a chance to project themselves as strong, decisive leaders, not waffling, nuanced bureaucrats. The populace, in turn, seem to appreciate this apparently bold leadership. They think this one simple solution is going to save them.

Most of the lockdowns in the USA have been in place for only a couple of days. So far, the average citizen seems to be on board, largely supportive of their leaders. Let's see how sentiments evolve as one week turns into two or three and all the hidden costs of imprisonment begin to sink in. Because that's what lockdowns really do: They imprison people without a trial. They force them into house arrest, which gets harder and harder the longer it goes on. I can't even begin to describe the huge toll this is going to take on people's finances, social life and sanity. Many of the activities you used to engage in are simply not available anymore.

So today is March 26, and many of the signs I've seen on businesses say, "Reopening April 6." That's about 12 days away, plenty of time for people to learn how horrible house arrest can be. They may also begin to see that the politicians who advocated the lockdowns don't really have a plan at all. They're just responding to public hysteria with the illusion of a plan that's in no way workable. Personally, I don't think these lockdowns can go on for very long, but by the time they end, the damage is done. Sure, people may be allowed to go back to work, but many won't have jobs to go back to. It's hard to start up the glue factory once you shut it down.

Another reason I think lockdowns are popular is that the Chinese did it. They were the first to experience the virus, and they responded in a massive totalitarian way, and it would appear on the surface that these efforts have been successful. For example, China has been claiming almost no new cases for the past couple of weeks. The number of confirmed cases is stuck at around 81,000, and any new cases are supposedly brought into China by foreigners. This supposed "success story" is cited by Western politicians as proof that lockdowns work.

But is any of this real? Has China really cured its coronavirus problem? Or is this just an incredibly effective propaganda effort. China has been manipulating its statistics for decades, claiming, for example, that it was achieving consistent economic growth of 6% year after year. In this totalitarian state, only the Chinese government knows what is really going on in China, and it's entirely within their power to suppress all new cases and deaths.

But even if the Chinese numbers are accurate, what have been the costs? If the lockdowns continue to this day, then they can hardly be considered a success story, because the ultimate goal is to let people out so they can pursue normal life again. I'm not sure whether this is happening in China. Are the Chinese people still semi-free, like they were a year ago, or is everyone living under house arrest?

In any case, China is not a good role model for the West. They can do things that other countries can't and shouldn't, like trample human rights. You don't want to follow them down that path even if it saves a few lives.

Listening to the rhetoric of politicians, I hear two contradictory philosophies: One is that this is a war. We are fighting an external enemy, the virus, and we all have to make sacrifices for the war effort. The other things I hear politicians say is that every life is precious. Even if this lockdown saves only one life, it'll be worth it. Well, which is it? When you're at war, you don't worry about a single life. You don't try to protect everyone from everything. In a war, commanders have to make cold, calculated decisions about who to kill, essentially. They are going to put some soldiers at risk to protect others and the country they're trying to save. They're balancing the good of one group of citizens with the good of the whole. They're making hard triage decisions about how to save and who to let die.

Any responsible commander is going to kill a lot of his own troops. It's part of the job. But politicians and businesses can't do that. Every life is precious, and every life must be saved. No one may be submitted to any kind of definable risk. If you're a business in America, and one of your customers suffers any kind of injury in your business, you're going to get sued. If you're a politician and you make any kind of decision that inflicts harm on one person, the victims and their family are going to be all over the media crying about it. In a liberal democracy, the only acceptable solution is a perfect one. Protect everyone regardless of the costs. Unfortunately, this won't win you any wars.

Winning a war required having a strategy, and lockdowns don't involve any. It's just pure impulse. Pure fight or flight. Right now, people are in flight mode. They're running away to their bunkers without thinking about the consequences. In a modern economy, everyone running for the bunkers at the same time is a recipe for disaster, because and economy needs people to be doing things. They need to go out and buy things, and if everyone stops at once, it becomes a doom loop that just goes on and on.

At this point, I think we're already well into the doom loop. There's really no escape. We're being sucked down the vortex, and I shudder to think what's on the other side.


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For annotations, links and corrections, see the description on the video version of this podcast. You can also leave comments there.

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