Some Thoughts on SARS-CoV-2 / COVID-19 “Coronavirus”

I pulled my first all-nighter in a long time diving deep into the SARS-CoV-2 / COVID-19 affectionately known as “coronavirus”. 

The virus is called SARS-COV-2 and the disease it causes is called COVID-19. Think HIV = virus, AIDS = disease.

Here are some facts that I have taken seriously:

1. Initial mortality estimates from the WHO ~2% skewed heavily to the elderly. This chart was from preliminary data out of China.
2. The countries that have done a good job of containing the virus Hong Kong, Singapore, and S. Korea, all have amazing health care systems and have managed containment through a combination of proactive measures, scenario planning, mass population testing, and luck.
3. The countries that have been slower to act, such as Iran and Italy have fared much worse. Current mortality rates in Northern Italy are exceeding 5% and rising… Members of the Iranian parliament have died.
4. Most people have no or moderate symptoms, some people get a bad cold/flu /indigestion symptoms. Current estimates suggest that ~15-20% of cases require hospitalization and some fraction of those are critical. Meaning, severe pneumonia managed via a ventilator and experimental anti-viral medications.
5. A woman in Japan tested positive and received hospital care, then after testing negative and being released, she got sick again, and again tested positive for COVID-19. Was the second test a false negative? Does the virus recur like Malaria? Do we not develop immunity and therefore, can we get sick an infinite number of times? Did the virus mutate that rapidly? Can we ever develop immunity? or was the woman just an outlier with a weak immune system?
6. So far we know that the virus SARS-COV-2 like influenza can be spread via droplets and can live on surfaces. Unlike Influenza, however, SARS-COV-2 appears to also live in the digestive tract and spread by fecal transfer. In affected areas where people have had symptoms of indigestion, diarrhea, and vomiting, it appears that the virus can also spread by way of fecal plumes also. Some evidence suggests the virus can live outside the body for longer than standard influenza.
7. COVID-19 has, even under the most optimistic scenarios a 10x death rate to the flu. Some epidemiologists estimate that 30-70% of the USA will get infected. Quick math says a 2% death rate times 30 – 70% of America’s 329 million people, means if our healthcare system continues to function properly and IF the death rate is only 2% then we are looking at 1.9-4.6 Million Deaths in the USA alone, plus an order of magnitude more people requiring hospital care.
8. Quick estimates of the number and availability of hospital beds at various locations around the USA suggest that we don’t have nearly enough if these estimates are true. What has happened in Italy is that the medical system is starting to fail. Hospitals are full and can’t take more patients, doctors are getting infected, burned out and exhausted. Thus ALL CAUSE mortality is spiking in Italy in addition to COVID-19 since physicians are now forced to triage heart attack and stroke patients along the long line of infected virus holders.
9. Americans w/o health insurance and ~70%+ of Americans live paycheck to paycheck. It seems that social and healthcare disruptions are the problem in most developed countries. Some people on the west coast of the USA are starting to panic, and are making a run on Costco and Walmart to stock up on non-perishable food, water, and medical supplies. This will be a time for us all to remember that we are in this together and that we might need to help our neighbors, friends, and family while staying calm and avoiding panic.
10. I spoke with a contact doing work overseas and the situation in Asia on what I had considered paranoia, he considered prudent precaution. Mortality numbers seem low (which is good!) in the first wave of the virus, but as hospitals around the world start to fill up and run short on beds, ventilators, and PPE, the mortality rate seems to rise, making the virus deadlier than the 2% on the average.

At the time of this writing, there many unknowns about COVID-19. Here are a few questions that I have:

1. What are the long term health effects in people who contract COVID-19, and are hospitalized, but then who recover?
2. Can we build immunity or is the virus immune-suppressive?
3. How infectious is it? Models suggest case count doubling every 3-8 days. In an exponential, that’s a huge difference.
4. What is the actual mortality rate?
5. What health consequences does the virus cause?
6. Which antiviral therapies have proven effective? What medical interventions can we use?
7. What will be the short, medium, and long term economic, political, and social disruptions of this disease?
8. What will happen to our doctors, nurses, caregivers, and primary care / mental health professionals?
9. What is the likelihood that this virus mutates into one with an even higher mortality rate?
10. What fraction of our drugs, PPE and medical equipment comes from China? Will we face global supply disruptions due to this shortage?
11. What else should we be asking?

How I am getting prepared?

I’m taking a ‘belt and suspenders’ level of precaution for the next 3-6 months. I canceled all travel. group activities, and live meetings for the next 2+ months. It pains me to say this includes martial arts training sessions, the gym, and various social occasions, events, and conferences that I had planned to attend. Here are a few good articles I found for how to think about preparation here and here.

In short, I agree with this tweet by Balaji Srinivasan:

” Don’t let anyone shame you out of talking about the virus, preparing for it, or reallocating resources accordingly. The time for winning internet points via above-it-all sarcasm and condescension towards people who took this seriously has now officially drawn to a close.”

After speaking with friends currently living in Asia, I am taking this thing seriously. Epsilon Theory has some thoughts on The Fall of Wuhan and the build-up of incentives that might lead to governmental irresponsibility similar to the negligence in the aftermath of Katrina, The 08 Financial Crisis, etc.

It’s hard to separate fact from fiction when watching the news. Here are scientific sources + some good follow on Twitter:

Situation Updates from the CDC
Situation Updates from the WHO
John’s Hopkins COVID-19 Tracker
Harvard University’s School of Public Health COVID-19 Updates

Twitter:
@balajis
@webdevMason
@ScottGottliebMD
The WHO

Here’s what journalists, business leaders, and media commentators are saying: 

Virologist interviewed on Fox https://www.foxnews.com/world/how-coronavirus-stacks-up-to-other-coronaviruses-sars-and-mers
Updates from the New York Times: https://www.nytimes.com/news-event/coronavirus
Updates from Al Jazeera: https://www.aljazeera.com/news/2020/01/coronavirus-symptoms-vaccines-risks-200122194509687.html

Possible Long-Term Social, Technological and Economic Impacts of CoVID-19 by Azeem Azar
Bill Gates has a talk from 2016 that now seems prescient.
Elad Gil on Advice for Startup Founders on (COVID-19)

Here’s a good synopsis from Last Week Tonight with John Oliver

Update 3/10/2020: I have decided to reformat this post to make it more clear. I have gained a lot of new information since I wrote this two weeks ago. I will continue adding to this post and publishing revisions to the extent that the information might be valuable to my friends and family.

General Problem Solving Rules

I found a paper with these notes on it stuffed into my copy of Poor Charlie’s Almanac. Below is a list of super-simple rules for good problem solving:

  1. Ask: Should I be working on this? or What if I did nothing?
  2. Resolve the big ‘no-brainer’ questions first.
  3. Apply the 80/20 Rule.
  4. Separate the core problem from the minutiae
  5. Invert – Think through the problem in reverse
  6. Apply numerically fluency (probability, statistics, algebra, basic calculus)
  7. Apply elementary, interdisciplinary wisdom.
  8. Never rely entirely on others.
  9. Watch for combinations of factors – The Lollapalooza Effect

Two-Track Analysis:

  1. What are the factors that really govern the interests involved, rationally considered?
  2. What are the subconscious influences? Where is the brain automatically forming conclusions at the sub-conscious level?

Charlie Munger’s Investing Principles Checklist

This checklist is from Poor Charlie’s Almanac, and if of course incomplete. I’m adding to this list all the time, and updating my thinking. Disclaimer: I’m not a professional investor, or an investment advisor, nor do I play one on the internet. The information below does not constitute investment or financial advice.

I retyped this this checklist by hand to help switch my brain from ‘busy mode’ to ‘rational investor mode.’ I therefore won’t make an investment decision without first grounding my perspective in this series of principles. From there, I run a few additional filters including if I use the product or service, if I think it’ll grow with time, and if I understand the company. Only then and after consideration will I place my long term money in an investment.

Risk — All investment evaluations should begin by measuring risk, especially reputational.

  • Incorporate an appropriate margin of safety.
  • Avoid dealing with people of questionable character.
  • Insist upon proper compensation for risk assumed.
  • Always beware of inflation and interest rate exposures.
  • Avoid big mistakes; shun permenent capital loss.

Independence — “Only in fairly tales are emperoros told they have no clothes”

  • Objectivity and rationality require independence of thought.
  • Remember that just because other people agree or disagree with you doesn’t make you right or wrong — the only thing that matters is the correctness of your analysis and judgement.
  • Mimicking the herd invites regression to the mean.

Preparation — “The only way to win is to work, work, work, work, and hope to have a few insights”

  • Develop into a lifeling self-learner through voracious reading; cultivate curiousity and strive to become a little wiser every day
  • More important than the will to win is the will to prepare
  • Develop fluency in mental models from the major academic disciplines
  • If you want to get smart, the question you have to keep asking is “why, why, why?”

Intellectual Humility — Acknowledging what you don’t knwo is the dawning of wisdom

  • Stay within a well-defined circle of competence
  • Identify and reconcile disconfirming evidence
  • Resist the craving for false precision, false certainties, etc.
  • Above all, never fool yourself and remember that you are the easiest person to fool.

Analytic Rigor — Use of the scientific method and effective checklists minimizes errors and omissions.

  • Determine value apart from price; profress apart from activity; wealth apart from size.
  • It is better to remember the obvious than to grasp the esoteric
  • Be a business analyst, not a macroeconomic, market, or securities analyst.
  • Consider the totality of risk and effect; look always at potential second order and higher level impacts.
  • Think forwards and backwards
  • Invert, always invert

Allocation — Proper allocation of capital is an investor’s number one job

  • Remember that the highest and best use is always measured by the next best use (opportunity cost)
  • Good ideas are rare — when the odds are in your favor, bet (allocate) heavily
  • Don’t “fall in love” with an investment — be situation-dependent and opportunity-driven

Patience – Resist the natural human bias to act

  • “Compound interest is the eighth wonder of the world” (Einstein); don’t interrupt it unnescessarily
  • Avoid unnescessary transactional taxes and frictional costs; never take action for its own sake
  • Be alert to the arrival of luck
  • Enjoy the process along with the proceeds, because the process is where you live

Deciciveness — When proper circmstances present themselves, act with deciciveness and conviction

  • Be fearful when others are greedy, and greedy when others are fearful
  • Opportunity doesn’t come often, so seize it when it does
  • Opportunity meeting the prepared mind; that’s the game

Change — Live with change and accept unremovable complexity

  • Recognize and adapt to the true nature of the world around youl don’t expect it to adapt to you
  • Contunually challenge and willingly amend your “best-loved ideas”
  • Recognize rality even when you don’t like it — especially when you don’t like it

Focus — Keep things simple and remember what you set out to do

  • Remember that reputation and integrity are your most valuable assets — and can be lost in a heartbeat
  • Gurad against the effects of hubris and boredom
  • Don’t overlook the obvious by drowning in minutiae
  • Be careful to exclude unneeded unformation or slop: “A small leak can sink a great ship”
  • Face your big troubles; don’t sweep them under the rug

Preparation, Discipline, Patience, Decisiveness

“We’re partial to putting out large amounts of money where we don’t have to make another decision. If you buy something because its undervalued, then you have to think about selling it when it approaches your calculation of intrinsic value. That’s hard. But, if you can buy a few great companies, then you can sit on your ass. That’s a good thing.” -Charlie Munger

 

Naval Ravikant on Wealth Creation

Here is a list of ideas from Naval’s now-famous Tweetstorm, elaborated in this blog/podcast. I turned this into a checklist to avoid errors in judgment when evaluating business opportunities and how to spend my time.

  1. Seek Wealth, Not Money or StatusWealth is assets that earn while you sleep
  2. Make Abundance for the World Wealth isn’t about taking something from somebody else
  3. Free Markets Are Intrinsic to HumansWe use credits and debits to cooperate across genetic boundaries
  4. Making Money Isn’t About LuckBecome the kind of person who makes money
  5. Make Luck Your DestinyBuild your character in a way that luck becomes deterministic
  6. You Won’t Get Rich Renting Out Your Time You can’t earn non-linearly when you’re renting out your time
  7. Live Below Your Means for FreedomPeople busy upgrading their lifestyles just can’t fathom this freedom
  8. Give Society What It Doesn’t Know How to GetSociety will pay you for creating what it wants and delivering it at scale
  9. The Internet Has Massively Broadened Career PossibilitiesThe Internet allows you to scale any niche obsession
  10. Play Long-Term Games With Long-Term PeopleAll returns in life come from compound interest in long-term games
  11. Pick Partners With Intelligence, Energy and IntegrityYou can’t compromise on any of these three
  12. Partner With Rational OptimistsDon’t partner with cynics and pessimists; their beliefs are self-fulfilling
  13. Arm Yourself With Specific KnowledgeSpecific knowledge can be found by pursuing your genuine curiosity
  14. Specific Knowledge Is Highly Creative or TechnicalSpecific knowledge is on the bleeding edge of technology, art and communication
  15. Learn to Sell, Learn to Build If you can do both, you will be unstoppable
  16. Read What You Love Until You Love to Read You should be able to pick up any book in the library and read it
  17. The Foundations Are Math and LogicMathematics and logic are the basis for understanding everything else
  18. There’s No Actual Skill Called ‘Business’ Avoid business schools and magazines
  19. Embrace Accountability to Get LeverageTake risks under your own name and society will reward you with leverage
  20. Take Accountability to Earn EquityIf you have high accountability, you’re less replaceable
  21. Labor and Capital Are Old LeverageEveryone is fighting over labor and capital
  22. Product and Media Are New LeverageCreate software and media that work for you while you sleep
  23. Product Leverage is EgalitarianThe best products tend to be available to everyone
  24. Pick a Business Model with LeverageAn ideal business model has network effects, low marginal costs and scale economies
  25. Example: From Laborer to Entrepreneur From low to high specific knowledge, accountability and leverage
  26. Judgment Is the Decisive SkillIn an age of nearly infinite leverage, judgment is the most important skill
  27. Set an Aspirational Hourly RateOutsource tasks that cost less than your hourly rate $5,000 an hour
  28. Work As Hard As You CanEven though what you work on and who you work with are more important
  29. Be Too Busy to ‘Do Coffee’Ruthlessly decline meetings 
  30. Keep Redefining What You DoBecome the best in the world at what you do
  31. Escape Competition Through Authenticity Nobody can compete with you on being you 
  32. Play Stupid Games, Win Stupid PrizesCompetition will blind you to greater games
  33. Eventually, You Will Get What You DeserveOn a long enough timescale, you will get paid
  34. Reject Most AdviceMost advice is people giving you their winning lottery ticket numbers
  35. A Calm Mind, a Fit Body, a House Full of LoveWhen you’re finally wealthy, you’ll realize it wasn’t what you were seeking in the first place 
  36. There Are No Get Rich Quick SchemesGet rich quick schemes are just someone else getting rich off you
  37. Productize Yourself Figure out what you’re uniquely good at, and apply as much leverage as possible
  38. Accountability Means Letting People Criticize YouYou have to stick your neck out and be willing to fail publicly
  39. We Should Eventually Be Working for OurselvesBut we will have to make sacrifices and take on more risk 
  40. Being Ethical Is Long-Term GreedyIf you cut fair deals, you will get paid in the long run
  41. Envy Can Be Useful, or It Can Eat You AliveEnvy can give you a powerful boost, or it can eat you alive 
  42. Principal-Agent Problem: Act Like an OwnerIf you think and act like an owner, it’s only a matter of time until you become an owner
  43. Kelly Criterion: Avoid RuinDon’t ruin your reputation or get wiped to zero
  44. Schelling Point: Cooperating Without CommunicatingPeople who can’t communicate can cooperate by anticipating the other person’s actions
  45. Turn Short-Term Games Into Long-Term GamesImprove your leverage by turning short-term relationships into long-term ones
  46. Compounding Relationships Make Life EasierLife gets a lot easier when you know someone’s got your back 
  47. Price Discrimination: Charge Some People MoreYou can charge people for extras based on their propensity to pay
  48. Consumer Surplus: Getting More Than You Paid ForPeople are willing to pay more than what companies charge
  49. Net Present Value: What Future Income Is Worth TodaySee what future income is worth today by applying a discount to its future value
  50. Calculating the Hidden Costs of ProductsExternalities let you account for the true cost of products by including hidden costs
  51. Bonus: Finding Time to Invest in Yourself If you have to work a “normal job,” take on accountability to build your specific knowledge

Technology is, by definition, the intellectual frontier. It’s taking things from science and culture that we have not figured out how to mass-produce or create efficiently and figuring out how to commercialize it and make it available to everybody. 

Another good indicator of specific knowledge is when someone can’t give a straight answer to the question: “What do you do every day?” Or you get an answer along the lines of, “Every day is different based on what’s going on.”

The Clocks Have No Hands

“The line separating investment and speculation, which is never bright and clear, becomes blurred still further when most market participants have recently enjoyed triumphs. Nothing sedates rationality like large doses of effortless money. After a heady experience of that kind, normally sensible people drift into behavior akin to that of Cinderella at the ball. They know that overstaying the festivities that is, continuing to speculate in companies that have gigantic valuations relative to the cash they are likely to generate in the future will eventually bring on pumpkins and mice. But they nevertheless hate to miss a single minute of what is one helluva party. Therefore, the giddy participants all plan to leave just seconds before midnight. There’s a problem, though: They are dancing in a room in which the clocks have no hands.”

– Warren Buffett, Chairman’s Letter to Shareholders of Berkshire Hathaway (February 28, 2001)

The Power of Incentives

“Never, ever, think about something else when you should be thinking about the power of incentives.”

-Charlie Munger

This is why I’m taking a break from social media at the time of this writing. The incentives of ad-supported social networks are not aligned with my goals.

Behaviorist BF Skinner understood the power of providing regular, spaced, or random rewards & punishments. I like to remember that the Nazis seemed like everyday people before and after Hitler. Employees of corporations commit accidental atrocities without knowing it. (but sometimes it is on purpose)

Smart people can act dumb, ethical might cheat, and normal people can become sociopathic because of their incentive systems. Like the old saying goes…

“Don’t expect someone to understand something if their salary depends on them being ignorant.”

Here’s Munger’s giving a commencement speech at USC:

You do not want to be in a perverse incentive system that’s causing you to behave more and more foolishly or worse and worse — incentives are too powerful a control over human cognition or human behavior. If you’re in one [of these systems], I don’t have a solution for you. You’ll have to figure it out for yourself, but it’s a significant problem.

If you’re part of an idiotic system, dangerous or unethical system. Get out now.

I try to remind myself that designing the right incentives is probably 95% of leadership. The good news is, you can use incentives to be more ambitious, think bigger, and work out more.

The Virtues of Ben Franklin

Without continual growth and progress, such words as improvement, achievement, and success have no meaning.

-Benjamin Franklin

228 years before The Checklist Manifesto came into vogue, Ben Franklin used a simple checklist to remind himself of his duties. The goal was not unattainable perfection, an open admission of his own weakness and an attempt to improve his character. Some of his famous lines include:

Early to bed and early to rise makes a man healthy, wealthy, and wise.

Never leave that till tomorrow which you can do today.

Either write something worth reading or do something worth writing.

[Make a transition to how this applies to my generation]

The attitude du jour tends to be moral flexibility and ambiguity. I see members of my generation believing in false profits, grasping for meaning, and making calamitous errors of judgment in the absence of a moral code.

I have come to appreciate keeping fewer, better ideas close at hand to remind me of what I should be focusing on, rather than running from one new thing to the next. I have recently tried to review these virtues from time to time with some success.

I’ve started keeping daily logs of my goals, outcomes, how I spend my time, and how I think to gradually refine and improve my way of being.

Here’s a list of Benjamin Franklin’s Virtues. Which others do you practice?

1. Temperance – Eat not to dullness; drink not to elevation.
2. Silence – Speak not but what may benefit others or yourself; avoid trifling conversation.
3. Order – Let all your things have their places; let each part of your business have its time.
4. Resolution – Resolve to perform what you ought; perform without fail what you resolve.
5. Frugality – Make no expense but to do good to others or yourself; i.e. waste nothing.
6. Industry – Lose no time; be always employed in something useful; cut off all unnecessary actions.
7. Sincerity – Use no hurtful deceit; think innocently and justly, and, if you speak, speak accordingly.
8. Justice – Wrong none by doing injuries, or omitting the benefits that are your duty.
9. Moderation – Avoid extremes; forbear resenting injuries so much as you think they deserve.
10. Cleanliness – Tolerate no uncleanliness in body, clothes, or habitation.
11. Tranquility – Be not disturbed at trifles, or at accidents common or unavoidable.
12. Chastity – Rarely use venery but for health or offspring, never to dullness, weakness, or the injury of your own or another’s peace or reputation.
13. Humility – Imitate Jesus and Socrates.

Charlie Munger on Getting Ahead

‘We get these questions a lot from the enterprising young. It’s a very intelligent question: You look at some old guy who’s rich and you ask,

“How can I become like you, except faster?”;

Spend each day trying to be a little wiser than you were when you woke up. Discharge your duties faithfully and well. Step by step you get ahead, but not necessarily in fast spurts. But you build discipline by preparing for fast spurts… Slug it out one inch at a time, day by day, at the end of the day – if you live long enough – most people get what they deserve.’

– Charlie Munger

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