Contact tracing as a component of ending corona pandemic lock-downs

One important idea behind 'flattening the curve' of covid-19 cases is that, if lockdowns reduce the case rate sufficiently, the economy might be able to open up again and leave control of the virus to contact tracing and selective quarantines.  Contact tracing--tracing the contacts of sick people, to see who else they might have infected--was the go to method of trying to control sexually transmitted diseases.  But it's likely that an infected person has an easier time remembering sexual contacts than the much more casual contacts than can lead to covid-19 infection.

And there are lots of ideas about how contact tracing might be conducted (and it isn't clear to me that any of them are being prepared for with sufficient seriousness to be actually put into place anytime soon...). The old fashioned way involves lots of people on the phone, interviewing those who have just tested positive.

Here's one story along that line, from The Hill:
Newsom wants to train 10,000 contact tracers in California

"California Gov. Gavin Newsom (D) said Wednesday that the state is planning to train up to 10,000 contact tracers amid the coronavirus pandemic.

"Expanding contact tracing and testing is one of six indicators Newsom said last week would drive the state’s decision to gradually modify portions of the stay-at-home order. "


And here's another, from Vox:
Contact tracing, explained
The US needs tens of thousands of “disease detectives” to safely reopen the economy.   
By Dylan Scott

"To prevent another spike in cases, public health workers will perform the difficult and sometimes tedious process of interviewing people diagnosed with Covid-19, finding out who they have recently been in close physical contact with, and then informing those people of their potential exposure and advising them to self-isolate and get tested.

“The rapidity with which this work has to be done is really unprecedented,” Jeff Dunchin, who leads the epidemiology division in King County, Washington, the first epicenter of the pandemic in the United States, told me. “If you miss a few cases, those little sparks can set off a forest fire.”
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Another part of the contact tracing discussion involves apps on smart phones. The idea is that your phone can report to a good deal of precision where you have been, and/or who you have been near.  That "and/or" has implications for privacy.  If the contact tracers figure out if you and I have been near each other by looking at our path through the world, then they are recording a lot of information about us besides whether we have e.g. been within six feet of each other.  Alternatively, using blue tooth enabled apps, we could just be recording which phones our phone got close to.

In either case, the idea behind phone apps for contact tracing is that if someone tests positive for covid-19, they record it on their app, go into quarantine themselves, and the apps of everyone to whom they have been close (in the last 14 days?) sound the alarms.

Here's a paper in Science:

Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing
Luca Ferretti *, Chris Wymant *, Michelle Kendall , Lele Zhao , Anel Nurtay , Lucie Abeler-Dörner ,
Michael Parker , David Bonsall1,†, Christophe Fraser1,†‡

Abstract: The newly emergent human virus SARS-CoV-2 is resulting in high fatality rates and incapacitated health systems. Preventing further transmission is a priority. We analyzed key parameters of epidemic spread to estimate the contribution of different transmission routes and determine requirements for case isolation and contact-tracing needed to stop the epidemic. We conclude that viral spread is too fast to be contained by manual contact tracing, but could be controlled if this process was faster, more efficient and happened at scale. A contact-tracing App which builds a memory of proximity contacts and immediately notifies contacts of positive cases can achieve epidemic control if used by enough people. By targeting recommendations to only those at risk, epidemics could be contained without need for mass quarantines (‘lock-downs’) that are harmful to society. We discuss the ethical requirements for an intervention of this kind.
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Here's a skeptical take on that from Brookings Techstream, that focuses on the considerable problem of false positive and false negative conclusions, and also on privacy and security:

Contact-tracing apps are not a solution to the COVID-19 crisis
April 27, 2020 Ashkan Soltani, Ryan Calo, and Carl Bergstrom

"we urge developers of contact-tracing apps, as well the companies enabling their development, to be candid about the limitations and implications of the technology. To be ethical stewards of these new public health tools, they must also provide explicit guidelines and “best practice” recommendations for the development of the apps. These should include recommendations for how back-end systems should be secured and how long data should be retained, criteria for what public health entities can qualify to use these technologies, and explicit app store policies for what additional information, such as GPS or government ID numbers, can be collected. They should adopt commonly accepted practices such as security auditing, bug bounties, and abusability testing to identify vulnerabilities and unintended consequences of a potentially global new technology. Finally, app creators—as well as the platforms that enable these applications—should make explicit commitments for when these apps and their underlying APIs will be sunsetted.

"There is also a role for law and official policy. If we are to use technology to combat coronavirus, it is critical that we do so with adequate safeguards in place. Here we mean traditional safeguards, such as judicial oversight and sunset provisions that guard against mission creep or limitations on secondary use and data retention that protect consumer privacy. We agree with our colleagues at the Civil Liberties Oversight Board that coronavirus surveillance should learn from the lessons of 9/11. But we also see a role of law and policy in policing against an all too plausible dystopia that technological solutions could enable."
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If you are in Australia, here's a government sponsored voluntary contact tracing app that you could try out if you want:
COVIDSafe app
Let's work together to stop the spread of COVID-19
COVIDSafe helps you and all of our communities. Assist health officials to quickly understand and tackle the spread of Coronavirus (COVID-19).
https://www.covidsafe.gov.au/

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And here is (a picture) of the above post in Spanish, in the (gated) 20th anniversary edition of the magazine Capital:  Capital cumple veinte años

Transplants under lockdown (but beginning to pick up)

Since the beginning of pandemic lockdowns, living donor kidney surgeries in the U.S. have almost ceased (partly because living donor surgeries aren't emergency surgeries, and were being cancelled with all elective surgeries as hospitals readied themselves for covid-19 patients, who materialized in large numbers in some places but not others). Deceased donor transplants have also been down, for a variety of corona-related reasons, which means that donor organs are going to waste.

Here's an aggregate graph from https://unos.org/covid/

And here's a story from Statnews.com

Transplants plummet as overwhelmed hospitals focus on the coronavirus
By ELIZABETH COONEY

"Organ transplant medicine is always a high-wire act, balancing too many people’s needs with too few matches. The coronavirus epidemic has only heightened the significant risks and hoped-for benefits of transplant surgery. Organ donations are down by a third and the health care system itself is in full-blown scarcity, triaging elective surgeries to some unknown future date so only emergency cases find their way into precious operating rooms and intensive care beds. As life-saving as they are, even many transplants are being put off.

"For people who need a transplant, their fate depends on the organ and how sick they are. Pancreas transplants are on hold indefinitely, classified as “life-enhancing,” not life-saving because patients can survive on insulin. Kidney patients who can continue to function on dialysis have been taken off waiting lists while still accruing waiting time for the day when non-urgent transplants resume. Heart patients who are not already in the hospital on mechanical heart-assist devices and who may be able to wait a few weeks will do so.
...
"Prospective transplant recipients can’t have Covid-19, either. The immune-suppression drugs they must take to prevent organ rejection would prevent them from fighting off the virus and make them super-shedders of the virus, placing those around them at hugely increased risk of being infected.

Transplant emergencies mean people who can’t wait another week or even another day. But these patients are also balancing on a knife’s edge: They have to be sick enough to be near death but well enough not to need long ICU stays in hospitals overwhelmed by coronavirus patients who need weeks on ventilators so they can breathe.

“Our ability to do a liver transplant is not always just about the [risk of Covid-19] exposure to the patient,” said David Mulligan, chief of transplantation surgery and immunology at Yale. “It’s also, do we have a bed? Do we have a ventilator to take care of the patient? Can we isolate the patient from other Covid-infected patients? Do we have enough time to do this operation, get them through it, keep them away from Covid, and then get them out of the hospital safely? That’s what we’re shooting for.”
...
"The widespread delays in testing people for the coronavirus have also meant delays in testing organs, said Gabriel Danovitch, medical director of UCLA’s kidney and pancreas transplant program. “When the virus was first detected, we didn’t have the capacity to test all potential donor organs. And a lot of organs were wasted because of concern of possible infection.”

Repugnance watch: Hungary moves to roll back legal recognition of transsexuality

The covid-19 pandemic has allowed a consolidation of authoritarian power in Hungary, as also elsewhere, which can take some odd forms.

The Guardian has the story:

Hungary prepares to end legal recognition of trans people
Trans people fear more discrimination as Orbán pushes through law defining gender based on ‘sex at birth’

"Hungary’s rightwing government looks likely to push through legislation that will end the legal recognition of trans people by defining gender as “biological sex based on primary sex characteristics and chromosomes” and thus making it impossible for people to legally change their gender.
...
"“In Hungary, you need to show your ID to rent a bike, buy a bus pass or to pick up a package at the post office. It basically means coming out as trans to complete strangers, all the time. The good version is they are nice about it, but there are situations where people turn quite hostile,” said Ivett Ördög, a 39-year-old trans woman living in Budapest."
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Here's the background story:
Hungary seeks to end legal recognition of trans people amid Covid-19 crisis

"The Council of Europe’s commissioner for human rights, Dunja Mijatović, called on Hungary’s parliament not to adopt the law, and said the measure was in contravention of human rights standards and the case law of the European court of human rights."

Test design and gender gaps in performance--evidence from a national exam in Chile, by Coffman and Klinowski

Here's a recent paper from PNAS:

The impact of penalties for wrong answers on the gender gap in test scores
Katherine B. Coffman and   David Klinowski
PNAS April 21, 2020 117 (16) 8794-8803;

Abstract:
Multiple-choice examinations play a critical role in university admissions across the world. A key question is whether imposing penalties for wrong answers on these examinations deters guessing from women more than men, disadvantaging female test-takers. We consider data from a large-scale, high-stakes policy change that removed penalties for wrong answers on the national college entry examination in Chile. The policy change reduced a large gender gap in questions skipped. It also narrowed gender gaps in performance, primarily among high-performing test-takers, and in the fields of math, social science, and chemistry.

Yelping about restaurant health violations, by Dai and Luca

Online reviews, like Yelp, can play an effective role in disseminating information about restaurant hygiene scores...

Digitizing Disclosure: The Case of Restaurant Hygiene Scores†
By Weijia Dai and Michael Luca*
American Economic Journal: Microeconomics 2020, 12(2): 41–59


Abstract: Collaborating with Yelp and the City of San Francisco, we revisit a canonical example of quality disclosure by evaluating and helping to redesign the posting of restaurant hygiene scores on Yelp.com. We implement a two-stage intervention that separately identifies consumer response to information disclosure and a disclosure design with improved salience—a consumer alert. We find score posting is effective, but improving salience further increases consumer response.

They write:

"The rise of online platforms raises the opportunity to revisit disclosure initiatives and to use a design economics lens to improve decisions about where and how disclosure is delivered.
...
"Our intervention proceeds in two stages. In the first stage, which begins in early 2013, Yelp starts posting hygiene scores on San Francisco restaurants. We analyze the impact of the score posting using a difference-in-differences strategy, comparing differential changes in restaurant demand after the score posting between restaurants with low hygiene scores that are more likely to be affected by the score posting (as predefined by the city) and those with higher scores.2  To shed light on demand,
we drew on purchase intention measures, such as a user calling or seeking directions to a restaurant or clicking on the restaurant’s own website link. We find that hygiene score posting on Yelp leads to a 13 percent decrease in purchase intentions for restaurants with low hygiene scores.
...
"Following the initial hygiene score posting intervention, in the second stage, we worked with Yelp in 2015 to develop a “hygiene alert”—a salient message that appears only on the Yelp pages of restaurants with low hygiene scores. Such low-score restaurants are identified by the city as having “poor” operating conditions with “high-risk” hygiene violations.

"We find a further 7 percent decrease in purchase intentions for restaurants with low scores due to hygiene alerts, and an 11 percent decrease in the number of reviews, nearly doubling the effect of the score posting for these businesses. On the restaurant side, although there is no evidence showing an improvement of restaurant hygiene scores across restaurants, we find suggested evidence of a decrease in the probability that the low-score restaurants will receive low scores again after the alert."

When supply chains break down, brokers make markets

During the Arab oil embargo of the U.S. in 1973, I remember hearing an oil broker discuss his day. He would cold call companies that used oil and ask if they had any to sell. Almost always he was told they were looking to buy oil, because their usual suppliers had gone dry. He'd write that down and go on to the next call.  Sometimes he'd find someone with oil to sell--maybe the general economic slowdown had reduced their consumption, but since they were normally buyers and not sellers they hadn't sold their surplus.  That kept the broker in business, he was able to help them sell their excess.

When well-established supply chains break down (e.g. as factories close in China and hospitals in NY are short of supplies, both because of the covid-19 pandemic), brokers are becoming important. Brokers work to piece together pieces of broken supply chains by connecting buyers and sellers. Even in times of shortages there can be sellers, with stock in their warehouses, who no longer have connection to buyers...

The NY Times has the story:

Marc Benioff’s $25 Million Blitz to Buy Protective Gear From China
A call from a university chancellor set in motion a private-sector effort to procure 50 million masks, gowns and swabs for American medical facilities.
By David Gelles

"The university’s usual suppliers in the United States were short on masks and face shields, and there was no sign that the State of California or the federal government was coming to the rescue. “The supply chain had really dried up,” Mr. Hawgood said.

"So Mr. Hawgood called Marc Benioff, the hyperconnected billionaire who is a founder and the chief executive of Salesforce.
...
"that phone call set off a frenzied effort by Mr. Benioff and his team that drew in major companies like FedEx, Walmart, Uber and Alibaba. In a matter of weeks, the team spent more than $25 million to procure more than 50 million pieces of protective equipment. Fifteen million units have already been delivered to hospitals, medical facilities and states, and more are on the way.

"The relative ease with which Salesforce acquired so much protective gear stands in sharp contrast to the often chaotic government efforts. While states have had to compete against one another for scarce supplies and the strategic national stockpile of protective gear is depleted, Mr. Benioff and his team simply called up their business partners in China and started writing checks.
...
"After Mr. Benioff got off the call with Mr. Hawgood on that Thursday, he called Daniel Zhang, chief executive of Alibaba, the enormous e-commerce marketplace. Last year, Salesforce and Alibaba announced a partnership meant to give Salesforce customers better access to the Chinese market, and teams from the two companies had been working closely.
...
"In San Francisco, Mr. Aytay and his team decided to buy only from companies that someone they knew well could personally vouch for. “Setting up a trust network was very important,” Mr. Aytay said.

"By March 22, the Salesforce team identified the first promising tip. The Jointown Pharmaceutical Group, a large Chinese company, had 500,000 surgical masks in a warehouse in Los Angeles."
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Of course there are perils in dealing with unusual suppliers, so the broker has to be reliable and have reliable connections.  After all, what could go wrong?

Buzzfeed news has the story:

After One Tweet To President Trump, This Man Got $69 Million From New York For Ventilators
The Silicon Valley engineer, who had no background in medical supplies but was recommended by the White House, never delivered the ventilators.

Hoarding and price gouging during Corona troubles

It appears we now have a Federal price gouging law.
Bloomberg has the story:

Accused New York Mask Hoarder Is First Charged Under Defense Act
By Patricia Hurtado

"In response to the Covid-19 pandemic, President Donald Trump on March 18 issued an executive order making it illegal to hoard medical supplies and devices which the U.S. has designated as scarce or sell them at excessive prices.
...
"Singh sold three-ply disposable face masks for $1 each, after having bought them for 7 cents -- a markup of about 1,328% -- Donoghue said, citing records seized from the store. Bulk sales were made to organizations serving vulnerable senior citizens and children battling the virus, according to the records.

"Singh “saw the devastating Covid-19 pandemic as an opportunity to make illegal profits on needed personal protective equipment,” said Craig Carpenito, the U.S. Attorney for the Eastern District of New Jersey who also heads the U.S. Department of Justice’s Covid-19 Hoarding and Price Gouging Task Force.

"U.S. postal inspectors seized 23 shipping pallets containing more than 100,000 face masks, 10,000 surgical gowns, 2,500 full-body isolation suits and more than 500,000 pairs of disposable gloves at Singh’s warehouse."
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And many states have had price gouging laws on the books for a long time. Here's a story from the WSJ:

Texas Attorney General Accuses Largest U.S. Egg Producer of Price-Gouging
Lawsuit alleges Cal-Maine Foods sold eggs at over 300% of their normal cost in coronavirus pandemic      By Rebecca Davis O’Brien

"The lawsuit shows the concern among law-enforcement officials and consumer-protection authorities over price-gouging on essential goods during the pandemic.
...
"Before the pandemic, between December 2019 and February 2020, Cal-Maine’s prices in Texas were around $1.02 for generic eggs and $1.89 for specialty eggs, according to the lawsuit.

"According to the lawsuit, as of 2015, Cal-Maine operated more than 90% of the largest egg-processing facilities in Texas. Nationally, Cal-Maine is the largest producer and marketer of shell eggs in the U.S., with a 19% overall market share, the lawsuit alleges, citing company statements.

"According to the lawsuit, Cal-Maine’s price jumps weren’t justified because its egg supply wasn’t affected—the company has said its facilities have been fully operational, with no disruptions to delivery or its supply chain. “During this pandemic, neither production costs nor contractual obligations forced Cal-Maine to charge exorbitant prices,” the lawsuit alleges.

"The lawsuit also alleges that Cal-Maine has misled the public about its egg prices, citing an April entry on the company website stating that “wholesale shell egg market prices…are outside of our control.” In fact, the attorney general alleges, there is no egg-market exchange, and Cal-Maine can exert control over prices."

AEA Awards: Clark Medal and Distinguished Fellows

Here's the AEA announcement:

2020 American Economic Association Awards
Congratulations to the 2020 John Bates Clark Medalist, Melissa Dell, and to the newly elected Distinguished Fellows: Katharine Abraham, Shelly Lundberg, Paul Milgrom, and Whitney Newey. View the Press Release for all award announcements.

Melissa Dell, Clark Medalist 2020

Distinguished Fellows
The Award of Distinguished Fellow was instituted in 1965. Past Presidents of the Association and Walker Medalists shall be Distinguished Fellows. Additional Distinguished Fellows may be elected, but not more than four in any one calendar year from economists of high distinction in the United States and Canada. The following economists have received this award:

2020

• Katharine Abraham
• Shelly Lundberg
• Paul Milgrom
• Whitney Newey

Mentoring women assistant professors of Economics: an RCT (and some thoughts on the word "mentor")

From the NBER:

Can Mentoring Help Female Assistant Professors in Economics? An Evaluation by Randomized Trial
Donna K. Ginther, Janet Currie, Francine D. Blau, Rachel Croson

"Women continue to be underrepresented in academic ranks in the economics profession. The Committee on the Status of Women in the Economics Profession of the American Economics Association established the CeMENT mentoring workshop to support women in research careers. The program was designed as a randomized controlled trial. This study evaluates differences between the treatment and control groups in career outcomes. Results indicate that relative to women in the control group, treated women are more likely to stay in academia and more likely to have received tenure in an institution ranked in the top 30 or 50 in economics in the world."

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There is probably no appropriate place to bring this up, but the word "mentor" always seemed to me to be faintly inappropriate in the particular context of addressing the difficulties associated with doing economics while female.

In Homer's Odyssey, Mentor is a man. But in fact, it is the goddess Athena who (in Alexander Pope's translation) " took Sage Mentor’s form, and thus like Mentor spoke." That is, often the advice that appears to come from (male) Mentor, in fact came from (female) Athena, disguised as Mentor.

So maybe female mentors of female economists should be athenas?

Corona virus research networks for economists

Corona virus, and the lockdowns and other policies it elicits, are attracting considerable attention from economists.  Below are some efforts to coordinate these research activities.

Stockholm School of Economics (SSE) is sponsoring the:
SSE CORONA ECONOMIC RESEARCH NETWORK

"The SSE Corona Economic Research Network (SSE-CERN) brings together researchers in economics and other disciplines that conduct research or policy work related to the Covid-19 pandemic. The network aims to stimulate research related to Covid-19, for example by communicating research and policy ideas and by organizing webinars. We also provide a list of research questions that we believe need to be answered and links to useful material about Covid-19."

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David Levine at the European University Institute (EUI) is coordinating a site for
COVID 19 RESEARCH 
Researchers collaborating for the endgame of the pandemic.

"Statement of Purpose: The purpose of this group is to draw on the talents and technical expertise of researchers to provide cost benefit analysis of mitigation measures and policy recommendations to be adopted, particularly for the endgame. The aim is to provide a conduit through which research can flow: matching expertise with questions and taking advantage of economies of scale to establish a credible organization that will be taken seriously by policy makers. The disease is international and so are we."

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And the European Economic Association is maintaining a List of Projects on corona virus related topic.

City of Science museum in Naples

Last June I gave some talks in Italy (back when there were airplanes, and in-person talks--remember?) One side trip took me to the City of Science museum in Naples.  I've just now come across a web page that memorialized that visit, with some pictures that reminded me of what a fine science museum it is.  (I still enjoy science museums, even though I'm temporarily out of kids to bring with me...)

Il Premio Nobel per l’Economia 2012 Alvin Eliot Roth in visita a Città della Scienza
19 giugno 2019

More essential services, from the lockdown in New Zealand

The Guardian has the breaking news from New Zealand (and the sub-headline makes you glad for experts..):

Sex toy sales triple during New Zealand's coronavirus lockdown
Speculation rife about an impending baby boom, but experts say uncertain times mean this is unlikely

"New Zealanders are permitted to leave their homes only to access essential services or take walks during the national shutdown, which began a fortnight ago and will remain in place for at least a further two weeks.
...
"The restrictions also prompted a tripling of sex toy sales in the 48 hours before the lockdown was imposed on 25 March
...
"“We’re selling a lot of beginner toys ... all our beginner ranges are very popular,” said Emily Writes, a spokesperson for the business. “It definitely looks like people are saying: ‘I’ve got time, I might try something new.’”

"Sales of condoms, lubricant, and menstrual cups were among the other purchases that spiked after Ardern announced the lockdown, as well as adult board games and – perhaps reflecting a wider trend towards disinfecting behaviour – sex toy cleaner.
...
"Adult Toy Megastore was deemed an essential service by New Zealand’s government and was allowed to continue operating during the shutdown because it sells condoms and medical items."

Rabbi Yeshayahu Haber (1965-2020), who founded "Gift of Life" kidney donor organization

Rabbi Yeshayahu Haber, who founded the Matnat Chaim ("Gift of Life") organization of kidney donors in Israel, has died of coronavirus. He was 55 years old.

YNet has the story:
הרב שהציל חיים נפטר מקורונה (Google Tranlate: The rabbi who saved lives died of corona)

Here's a story in English from Vos Iz Neias? (Yiddish: "What's New?")
Rabbi Yeshayahu Haber, Who Founded “Gift Of Life” For Kidney Donations, Passes Away From Coronavirus

and this from the Jerusalem Post:
'Gift of Life' founder Rabbi Haber passes away at age 55 due to COVID-19

"Haber's funeral will take place at 2 a.m. in Jerusalem. The public is asked not to come to the funeral procession."

GIFT OF Life: Matnat Chaim donors, 2016-2017.

Here are all my posts on Matnat Chaim, which recently recorded its 800th kidney donation.

Gaming organ allocation: Heart failure treatment responds to changes in the priority rules for heart transplants

Recent changes in the allocation of deceased donor hearts for transplantation have focused on what kinds of mechanical interventions a patient has.  And as choice of alternative interventions has changed priorities for donation, cardiologists have responded by changing the interventions they choose.

Several articles in JAMA Cardiology speak to this and related matters, and here's an editorial describing the issue:

Anticipating a New Era in Heart Transplantation
Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
JAMA Cardiol. Published online April 15, 2020. doi:10.1001/jamacardio.2020.0611

The first paragraph gives this capsule history:

"The 50th anniversary of heart transplantation was celebrated in 2018. During those 50 years, heart transplantation as treatment of advanced heart failure evolved from a heroic intervention with uncertain outcomes to a guideline-directed treatment appropriate for selected patients to restore quality of life and to improve survival. Today, 1-year survival after heart transplant is nearly 90%, and the conditional half-life after heart transplant is now 13 years.1 Those robust outcomes reflect myriad breakthrough initiatives, including the definition of brain death; introduction of routine endomyocardial biopsy for rejection surveillance, development of potent immunosuppressive therapies, particularly those inhibiting calcineurin and in turn interleukin 2 production, and advances in therapies to support the failing ventricle, especially mechanical circulatory support devices. For more than 2 decades, the number of heart transplants performed in the United States has been approximately 2000 per year and, having recently increased, was 3551 in 2019.2 Taken together, the observed early and late benefits of heart transplant punctuate an incredible journey from heretical concept to clinical standard of care. The courageous pioneer physicians and especially the early patients who faced overwhelming risks are revered for establishing a foundational pillar in the care of patients with advanced heart failure. It is reasonable to assert that after 50 years, heart transplantation is a well-established success poised for the next era."

They then turn their attention to ways in which cardiologists have responded to changes in the deceased donor allocation system:

"Three articles in this issue of JAMA Cardiology further address new challenges in the process of care improvement for heart transplantation, some of which we think may require urgent attention.

"The first of these articles, by Hanff and colleagues,7 evaluated changes in the use of mechanical circulatory support under the auspices of new organ allocation rules introduced in October 2018 by the Organ Procurement and Transplantation Network. The new system was intended to redirect available donors to those patients of greatest need. The original status IA category was partitioned into 3 categories, and the original status IB category became category 4. A patient with advanced heart failure supported with a left ventricular assist device (LVAD) without LVAD-associated complications became a status 4 candidate. A similar patient with advanced heart failure experiencing manageable LVAD-associated complications became a status 3. Status 2 now captures those patients with LVAD device malfunction who may be facing eminent demise or need for LVAD replacement, whereas status 1 captures patients with life-threatening arrhythmias or patients being supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Evaluating data through June 2019, Hanff and colleagues7 noted an abrupt increase in the use of VA-ECMO support that was temporally associated with implementation of the new system. Concomitantly, LVAD support for advanced heart failure in patients awaiting heart transplant abruptly decreased from 35.1% before implementation of the new rules to 24.5% after their implementation."

Finally, they also consider center variability to understand what happens to patients when a proffered heart transplant is declined:

"In another article in this issue of JAMA Cardiology, Choi et al10 evaluated data in the US National Transplant Registry between 2007 and 2017 with the intention to assess transplant center variability in donor organ acceptance. The evaluable data emanated from 93 transplant centers and encompassed 19 703 donors and 9628 candidates, with 32% of the donors accepted as first-ranked candidates. After adjustment for pertinent donor, candidate, and geographic covariates, the center variability in acceptance rates was quite remarkable at 12% to 62%. For every 10% increase in center acceptance rate, waiting-list mortality decreased by 27%. Those centers with lower acceptance rates experienced higher waiting-list mortality among candidates listed for a heart transplant..."

Surrogacy finally becomes legal in New York

Passed last month, to come into effect next year, New York follows most of the rest of the country into the American consensus on surrogacy, including commercial surrogacy (so very different than in Europe).

The New York Daily News had this account:

Good news for couples who want children and need a surrogate as N.Y. legalizes the process
By DENIS SLATTERY

"New York legalized paid gestational surrogacy Thursday as lawmakers approved a sweeping budget package containing the measure.

"Gay and infertile couples in the Empire State can now enter into a contract and pay a woman to carry a baby to term through in-vitro fertilization.

"Gov. Cuomo made the measure a priority over the past year and a half as New York remained one of only three states that explicitly banned the practice.

"Pushback from an unlikely combination of religious organizations and women’s groups concerned about the potential exploitation of surrogates, particularly those from low-income backgrounds, preceded the bill’s failure to gain enough support in the Assembly during the last legislative session.Assemblywoman Amy Paulin (D-Scrasdale), who first introduced a bill to lift the ban back in 2012, applauded the inclusion in the budget.

“Today, we bring New York law in line with the needs of modern families, while simultaneously enacting the strongest protections in the nation for surrogates," she said.
...
"The measure also streamlines the “second-parent adoption” process by requiring only a single visit to court to recognize legal parenthood while the child is in utero. Once all of the requirements set forth in the law are met, the intended parents can seek an “Order of Parentage” from a court, which becomes effective immediately upon birth."
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Here's an earlier post, about the complicated coalitions involved in last year's failure to pass the bill

Friday, June 21, 2019  Surrogacy in NY...remains complicated

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Here's a link to and snippets of the new statute itself:


TITLE OF BILL:  An act to amend the family court act, in relation to
establishing the child-parent security act; and to repeal section 73 and
article 8 of the domestic relations law, relating to legitimacy of chil-
dren born by artificial insemination and surrogate parenting contracts

PURPOSE OR GENERAL IDEA OF BILL:
To legally establish a child's relationship to his or her parents where
the child was conceived through third party reproduction including those
children born through gestational surrogacy arrangements.
 ...
"JUSTIFICATION:
New York law has failed to keep pace with medical advances in assisted
reproduction, causing uncertainty about who the legal parents of a child
are upon birth. In many cases, the parentage of children created through
donated sperm, eggs and embryos is unsettled or open to attack at the
time of the child's birth and thereafter. Confusion or uncertainty
regarding the parental rights of donors and intended parents (both
genetic and non-genetic) who participate in the conception of the child
through assisted reproduction is detrimental to the child and secure
family relations. Where children are born to a gestational carrier the
parentage of the intended parents may not be recognized under current
law. This is not only detrimental to the child; it also causes confusion
in many critical situations. For example, a hospital does not know who
must give consent when a newborn requires medical procedures.

"The Child Parent Security Act will provide clear and decisive legal
procedures to ensure that children born through third party reproduction
have secure and legally recognized parental relationships with their
intended parents.The law will make it clear that donors do not have
parental rights or obligations and that those rights and obligations
reside with the Intended Parents.

"Importantly, this legislation lifts the ban on surrogacy contracts to
permit enforceable gestational carrier agreements and sets forth the
criteria for such agreements. When all of the requirements set forth in
the law are met, the intended parents can seek an "Order of Parentage"
from a court, prior to the birth of the child, which becomes effective
immediately upon birth. The requirements are designed to ensure that all
parties enter into the agreement on an equal footing and with full know-
ledge of their duties and obligations. For example, all parties must be
represented by independent legal counsel, and the agreement may not
limit the right of the carrier to make her own healthcare decisions.

"Because of existing New York laws, couples facing infertility and same-
sex couples are forced to go out of state in order to have a child with
the assistance of a gestational carrier. This is overly burdensome to
the parents, who have often struggled for many years to have a child.
Having an out-of-state gestational carrier may make it difficult, if not
impossible, for the parents to fully participate in the pregnancy by
attending doctor's appointments, etc. It also requires the participants
to use out-of-state clinics and medical professionals despite the fact
that New York is home to world-class medical facilities and fertility
professionals.

"New York appellate courts have repeatedly called upon the Legislature to
act to provide much needed clarity to the essential question of who is a
parent. The need to answer that call is more important today than ever
as increasing numbers of children are being conceived and born through
third party reproduction. The Child-Parent Security Act clarifies the
issue of who is a parent and establishes clear legal procedures which
ensure that each child's relationship to his or her parent(s) is legally
recognized from birth. As the New York Court of Appeals held in Brooke
S.B. v Elizabeth A.C.0 biology and adoption are not the only touchstones
to determine parentage. The Child Parent Security Act provides a frame-
work for determining the parentage of the large number of children
unprotected under existing New York state law.


...
 PART 5
    34                 PAYMENT TO DONORS AND GESTATIONAL CARRIERS
    35  Section 581-501. Reimbursement.
    36          581-502. Compensation.
    37    §  581-501.  Reimbursement.   (a) A donor who has entered into a valid
    38  agreement to be a donor, may  receive  reimbursement  from  an  intended
    39  parent  for  economic  losses  incurred  in connection with the donation
    40  which result from the retrieval or storage of gametes or embryos.
    41    (b) Premiums paid  for  insurance  against  economic  losses  directly
    42  resulting  from  the  retrieval  or  storage  of  gametes or embryos for
    43  donation may be reimbursed.
    44    § 581-502. Compensation.  (a) Compensation may be paid to a  donor  or
    45  gestational  carrier based on services rendered, expenses and or medical
    46  risks that have been or will be incurred, time, and inconvenience. Under
    47  no circumstances may compensation be paid to purchase gametes or embryos
    48  or to pay for the relinquishment of a parental interest in a child.
    49    (b) The compensation, if any, paid to a donor or  gestational  carrier
    50  must be reasonable and negotiated in good faith between the parties, and
    51  said  payments to a gestational carrier shall not exceed the duration of
    52  the pregnancy and recuperative period of up to  eight  weeks  after  the
    53  birth of the child.
    54    (c)  Compensation may not be conditioned upon the purported quality or
    55  genome-related traits of the gametes or embryos.
        A. 6959--A                         12

     1    (d) Compensation may not be conditioned on actual genotypic or  pheno-
     2  typic characteristics of the donor or of the child.

Residential real estate sales, social distancing, and traditional marketplace institutions

In some places, residential real estate is an essential service (open houses allowed) and in others not.  Virtual, internet showings are becoming more important.
But some of the particular marketplace institutions, of closing and title ceremonies (including notarized signatures) resist social distancing, and in many U.S. states must be conducted in person. Of course, the security of undisputed ownership is of huge importance in real estate, and online security is imperfect (I'm told...), so it isn't clear how to proceed here.

Here's a story from the Washington Post:

With hand sanitizer and elbow bumps, real estate agents are still selling during pandemic
By Kathy Orton

"Now, as nonessential businesses are shuttering to wait out the pandemic, some real estate professionals are carrying on as usual — albeit with masks, gloves and hand sanitizer. Agents were holding open houses until they were prohibited by local officials. Nearly 200 open houses were listed last weekend and more than 600 open houses the week before in the D.C. region on the area’s multiple listing service. Mayor Muriel E. Bower (D) banned open houses as of Saturday; Maryland Gov. Larry Hogan (R) and Virginia Gov. Ralph Northam (D) forbid them as of Monday.

"Home appraisers and inspectors are donning masks and gloves. Settlement companies are putting buyers and sellers in separate conference rooms and opening a new box of pens for each client who comes to a closing.
...
"Illinois, despite being hit hard by the coronavirus outbreak, has said that real estate is an essential service, and therefore is not required to close like retail outlets and restaurants.

"But California, New York and Pennsylvania have said it is not. Seattle’s multiple listing service no longer allows agents to post open houses.
...
"The number of 3-D home tours created on Zillow went up 326 percent on March 20.
...
"Although many aspects of buying a home can be done online, certain parts of the process — inspection, appraisal, closing — typically are done in person.
...
"According to Todd Ewing, chief executive at Federal Title, Fannie Mae and Freddie Mac are reluctant to buy loans without legislation that allows for remote online notarization.

"Some states, including Virginia, permit remote online notarization, but others such as the District and Maryland, do not. Federal legislation was introduced on March 18 that would allow it in all states."

Organ donation after medically assisted dying, in Canada

In the New England Journal of Medicine, with many authors,
Organ Donation after Medical Assistance in Dying — Canada’s First Cases

February 6, 2020
N Engl J Med 2020; 382:576-577
DOI: 10.1056/NEJMc1915485

"In 2016, following the Supreme Court of Canada’s Carter Decision,1 medical assistance in dying (MAID) became possible with individual court orders. However, owing to the lack of a centrally coordinated Canadian response to the requests of some patients for voluntary euthanasia, as well as concern for individual repercussions, many Canadian providers of assisted dying operate largely independently. With 3 years now passed since euthanasia was approved, it is important to ensure our understanding of current practice for the purpose of quality assurance, provider education, and future research opportunities geared to improve patient-centered practice. Among the practices related to the legalization of euthanasia, organ donation raises challenging issues.

"We performed a historical cohort study of completed MAID organ-donation cases using data from three Canadian provincial organ-donation organizations (Trillium Gift of Life Network, Transplant Québec, and British Columbia Transplant) from June 2016 through January 2019 to describe the initial experience with euthanasia-associated organ donation. A total of 56 patients were referred as potentially eligible for organ donation after MAID on the basis of preliminary assessment by one of the three organ-donation organizations. The mean age was 61 years; 39% of the patients were female. The most common diagnosis was amyotrophic lateral sclerosis, followed by end-stage chronic obstructive pulmonary disease and Parkinson’s disease. Although the majority of Canadian euthanasia cases have involved patients with active cancer,1 our data showed that there is a substantial variety of conditions for which organ donation is a viable possibility. Among the 56 patients in the study, 30 were able to become donors and donated 74 organs. Twenty patients were single-organ donors, while 10 were multiorgan donors. 

Bike matching in NYC

Program Matches Bicycles To Essential Workers Who Need Them In New York 

ARI SHAPIRO, HOST: If you're looking for ways that you can help out these days, there's plenty of need. Food pantries need non-perishable food. Hospitals need masks. And lots of people, it turns out, need wheels.

MARY LOUISE KELLY, HOST: Yeah. That is the idea behind a new program from the New York City-based advocacy group Transportation Alternatives.

"SHAPIRO: Danny Harris says they've matched 42 people with bikes so far, and many more are in the works.
...
"SHAPIRO: And Salazar says with car traffic way down, biking in New York City these days is actually quite nice."

HT: Ellen Kominers

Covid-19 is now a leading cause of death in the U.S.

The Washington Post has the story:

Covid-19 is rapidly becoming America’s leading cause of death
By Dan Keating and Chiqui Esteban

Kidney disease is moved down to number 10.

Of course, "cause of death" is a squishy kind of data, since a given death can be recorded in different ways. See yesterday's post on how Covid-19 also contributes to kidney failure, (and how dialysis in crowded clinics can expose kidney failure patients to infections of all sorts, including corona virus).

Covid-19, kidney failure, and dialysis

Corona virus and kidney failure are a bad combination, whichever way you look at it. On the one hand, Covid-19 is causing kidney failure. On the other, if you are already on dialysis, you are exposed to Covid-19 infection whenever you go to spend a few hours at a crowded dialysis clinic.

Frank McCormick points me to this story from Politico:
U.S. races to stock up on dialysis supplies as kidney failure ravages virus patients
Approximately 20 percent of coronavirus patients in intensive care around the city need the kidney treatment, often for weeks.

"Hospitals in New York City are running out of dialysis fluids as thousands of coronavirus patients develop kidney failure, an unexpected development that could presage the next critical supply shortage nationwide.

"Approximately 20 percent of coronavirus patients in intensive care around the city need the kidney treatment, often for weeks, a development that many providers did not see coming. FEMA held a call Monday with FDA and CMS to discuss the possibility of issuing emergency use authorizations to import more dialysis fluids, according to a document obtained by POLITICO.
...
"Gov. Andrew Cuomo recently said that New York’s ventilator needs are beginning to plateau, and he has begun diverting the equipment to states in greater need. But hospital staff say that the extended nature of dialysis treatment means that shortages of fluids, trained personnel and even equipment there could just be starting."
**********

And here's a NY Times story on dialysis patients and clinics:

 Dialysis Patients Face Close-Up Risk From Coronavirus
As the pandemic sweeps the United States, patients needing kidney dialysis and employees of the clinics worry about keeping the virus at bay in such tight spaces.

"As the coronavirus rages from state to state, the 500,000 people whose failing kidneys require them to get dialysis are among the most vulnerable. Each clinic may have dozens of patients during a single shift, often sitting less than the recommended six feet apart for hours.
...
"Infection has traditionally been one of the industry’s biggest problems.

“The second leading cause of death among hemodialysis patients is infections,” said Dr. Alan Kliger, a Yale nephrologist who is leading efforts to control the spread of coronavirus among dialysis patients. As many as one in 10 patients die from complications from an infection, often at the site where a patient has a catheter.

Corona lockdown, and the food supply chain in India, by Matt Lowe and Ben Roth

Matt Lowe and Ben Roth look at the effect of India's corona virus lockdown on the food arriving at the big wholesale produce market in Delhi.  They describe breakdowns in the supply chains.

Arrivals Dropped 50% Post Lockdown. When Will Azadpur Mandi’s Supply Return to Normal?
Since the lockdown has been extended till May 3, it has become all the more crucial for the government to intervene and ensure that the broader food supply chain operates smoothly. 

"The disruption can already be seen in Delhi’s (and Asia’s) largest wholesale fruit and vegetable market – the Azadpur mandi – which has seen a precipitous decline in the volume of fruits and vegetables flowing through the market.

"Relative to the three prior years, the volume of produce arriving at Azadpur fell by about half on March 24, and has hovered at around that level since (Figure 1).

Coronavirus information, mis-information, conspiracy theories, web search, and social media

The coronavirus / Covid-19 pandemic is constantly generating new information, and misinformation.  How to separate them?

A number of social media sites, and Google, have decided not to rely on their organic recommender systems. So e.g. if you search for "coronavirus" in Google, you get what appear to be all curated sites (e.g. government and University sources, and major newspapers), and if you google "coronavirus conspiracy theories" you get news stories about some of the craziness out there, but not the first hand insanity.

The Guardian has this story:

Tech giants struggle to stem 'infodemic' of false coronavirus claims

"Click over to Google, type in “coronavirus”, and press enter.

"The results you see will bear little resemblance to any other search.

"There are no ads, no product recommendations, and no links to websites that have figured out how to win the search engine optimisation game. Government, NGO and mainstream media sources dominate.

"Algorithms and user-generated content are out; gatekeepers and fact checking are in.
...
"Across the social web – on Facebook, Twitter, YouTube, Reddit, Instagram and Pinterest – search results related to Covid-19 are similarly predetermined.

"Instagram delivers a pop-up urging US users to go to the website for the Centers for Disease Control and Prevention (CDC) – or UK users to the NHS – rather than look at the memes and pictures tagged with #coronavirus.

"On Facebook, a dedicated “Information Center” includes a mix of curated information and official medical advice. On Pinterest, the only infographics and memes to be found on topics such as “Covid-19” or “hydroxychloroquine” are those made by internationally recognised health organisations, such as the WHO.
...
"Another complicating factor is that normally trustworthy sources are not providing reliable information.

“We’ve seen the US government, particularly the White House, becoming a significant purveyor of misinformation around the virus,” Bergstrom said.

Facebook and Twitter have removed posts by prominent and powerful people over coronavirus misinformation, including the Brazilian president, Jair Bolsonaro, but the real test of their resolve will be whether they ever take action against misinformation by Trump."
*********

Here's another story, concerning a particular conspiracy theory:

Facebook acts to halt far-right groups linking Covid-19 to 5G

"Facebook has stepped up efforts to stop the promotion of baseless conspiracy theories linking Covid-19 to 5G, after research highlighted a “toxic cocktail” of far-right-influenced groups pushing the idea alongside incitement to attack telecommunications infrastructure.

"Groups in the UK promoting the conspiracy theory on Facebook – often linking it to explicitly antisemitic messages – have been growing at a significant rate, warned the campaign group Hope not Hate.

"The largest group in the UK, Stop 5G UK, added almost 3,000 members in just 24 hours from 6-7 April while another, Direct Action Against 5G, gained more than 1,400 members in its first week after it was created on 31 March"

John Horton Conway (1937-2020)

John Horton Conway, the  John von Neumann Professor in Applied and Computation Mathematics, Emeritus, at Princeton, passed away on April 11, while suffering from corona virus Covid-19.

Readers of this blog likely know him for his theorem that, in Gale and Shapley's marriage model with strict preferences, the set of stable matchings is a lattice with respect to the partial order of the men's common preferences, or the women's, and that these two lattices are the dual of one another. This helped us understand the observation already made by Gale and Shapley that the set of stable matchings included a man-optimal stable matching that every man likes at least as much as any stable matching, and similarly  a woman-optimal stable matching that is  (weakly) preferred by all the women to any other stable matching (and that the best stable matching for the men is the worst for the women and vice versa).

He was a man of wide interests and many theorems. (When I met him once and told him that he was famous in the market design community for his lattice theorem about stable matching, he pretended not to know which theorem I meant.)

Here are some obituaries (which focus on some of his more widely famous accomplishments):

COVID-19 Kills Renowned Princeton Mathematician, 'Game Of Life' Inventor John Conway In 3 Days

""I am sorry to confirm the passing of my colleague John Conway. An incomparable mathematician, a pleasant neighbor, and an excellent coffee acquaintance," Wang tweeted.
...
"Conway's most notable contribution to his field may have been his invention of the Game of Life, leading to the popularization of cellular automaton."
*********

John Conway Dies From Coronavirus

"According to Princeton University Conway's proudest achievement was the invention of new system of numbers, the surreal numbers—a continuum of numbers that include not only real numbers but also the infinitesimal and the infinite numbers, noting:

"When he discovered them in 1970, the surreals had John wandering around in a white-hot daydream for weeks.

"His surreal numbers inspired a mathematical novel by Donald Knuth, which includes the line:

“Conway said to the numbers, ‘Be fruitful and multiply.’”

"He also invented a naming system for exceedingly large numbers, the Conway chained arrow notation."

*******
And this, from Scott Aaronson:

John Horton Conway (1937-2020)
"His The Book of Numbers (coauthored with Richard Guy, who himself recently passed away at age 103) made a huge impression on me as a teenager. I worked through every page, gasping at gems like eπ√163 (“no, you can’t be serious…”), embarrassed to be learning so much from a “fun, popular” book but grateful that my ignorance of such basic matters was finally being remedied."

Teaching online: Singapore, NYC react to Zoombombing of online classes

Some of us are old enough to remember when email didn't come with security concerns.  Things are moving faster these days, so it's no surprise that there are Zoom trolls and scammers.  Singapore and NYC schools have decided not to use Zoom to conduct their online classes any more.

Here's the Singapore story from the Guardian:

Singapore bans teachers using Zoom after hackers post obscene images on screens
‘Very serious incidents’ have forced suspension from online schools as conferencing app faces renewed questions over security

"Singapore has suspended the use of video-conferencing tool Zoom by teachers after “very serious incidents” in the first week of a coronavirus lockdown that has seen schools move to home-based learning.

"One incident involved obscene images appearing on screens and male strangers making lewd comments during the streaming of a geography lesson with teenage girls, media reports said."
**********
Here's the NYC story from CNN:

New York City schools won't be using Zoom anymore because of security concerns
By Nicole Chavez and Sarah Jorgensen

"Schools in New York City are moving away from using the video conference app Zoom after a review of security concerns.
...
"The department does not have a central contract with Zoom, Filson said, and students and staff will be transitioning to Microsoft Teams, which has "the same capabilities with appropriate security measures in place."

"Earlier this week, federal officials began warning of a new potential privacy and security concern called "Zoombombing."
...
"Eric Yuan, the founder and CEO of Zoom, apologized to the video conferencing app's users for the privacy issues earlier this week, saying his team will stop adding new features for the next 90 days and instead focus solely on addressing privacy issues.
...
"Yuan said over 90,000 schools across 20 countries have been using the platform for online teaching since the company offered its services free of charge to schools because of the Covid-19 pandemic."

Behavioral Economics, Computation, and Game Theory, all in Budapest in July, or online...

Here's the (appropriately cautious) announcement:

Behavioral EC '20
2nd Workshop on Behavioral Economics and Computation

The 2nd Workshop on Behavioral EC will be held in conjunction with the 21st ACM Conference on Economics and Computation (ACM EC '20) and will be co-located with the 6th World Congress of the Game Theory Society (GAMES 2020), on July 17, 2020, in Budapest, Hungary. The goal of the workshop is to bring together researchers from diverse subareas of EC who are interested in the intersection of human economic behavior and computation, to share new results and to discuss future directions for behavioral research related to economics and computation. It will be a full-day workshop, and will feature invited speakers, contributed paper presentations and a panel discussion.

...
Submission deadline: May 18, 2020, 11:59pm PDT.
Notification: June 11, 2020
The workshop: July 17, 2020
COVID-19 Updates: We are aware of the severe restrictions across the globe due to the COVID-19 pandemic. The SIGecom board will update with the final plans for the EC 2020 conference on or by May 6. In the event the in-person conference does not happen, we will hold the workshop virtually.  

Market design seminars on Zoom, Monday afternoons in Paris

For those of you missing your local market design seminars, here's a convenient substitute, Monday afternoons if you're in Europe, or before breakfast if you're in California... (The first one was this past Thursday.)

Virtual MD Seminar Series
The Virtual Market Design Seminar is an open online alternative to seminars cancelled due to the COVID-19. Seminars will cover all fields from market design. Talks usually take place bi-weekly on Monday at 4:00-5:00pm (Paris UTC) on Zoom. Please check the schedule below, different days and times are possible.
Registration
If you would like to participate and to stay up to date about upcoming presentations, please join our mailing list. You will receive the Zoom link for each talk. 

Upcoming Presentations
Thursday, April 9, 2:00pm (Paris UTC).
Maarten Janssen (University of Vienna): "Regulating Product Communication". (with S. Roy). [slides]
Monday, April 20, 4:00pm (Paris UTC).
Scott Duke Kominers (Harvard Business School): "Redistribution through Markets" (with P. Dworczak and M. Akbarpour).
Monday, May 4, 4:00pm (Paris UTC).
Renato Gomes (Toulouse School of Economics): "Regulating Platform Fees under Price Parity" (with A. Mantovani).
Monday, May 18, 4:00pm (Paris UTC).
Benny Moldovanu (University of Bonn):"tba".

Organizers
Olivier Bos (Paris II), Nicolas Fugger (Cologne), Vitali Gretschko (ZEW), Helene Mass (Bonn), Marion Ott (ZEW), Martin Pollrich (Bonn), Nora Szech (KIT).

Clearinghouses are hard to organize in a hurry: volunteer medical workers in NYC

Many healthcare workers are willing and able to come to New York to help with the shortages that Covid-19 has created there.  But existing staffing marketplaces seem to be the avenue by which many of them are in fact matched.

The NY Times has the story:

Volunteers Rushed to Help New York Hospitals. They Found a Bottleneck.
When New York called for volunteers to help fight the coronavirus, 90,000 people responded. The hard part? Getting them into hospitals.

"Ms. Strickland, a former pediatric intensive care unit nurse in High Point, N.C., spent hours trying to submit her volunteer application online, and then emailed city and state representatives. She never heard back.

"Frustrated, she reached out directly to Mount Sinai Queens hospital in New York City. A manager told her to use a private recruiting agency, which the hospital had used for years to bring in temporary staff.

"Within two days, Ms. Strickland, 47, received her assignment. She started this week in the hospital’s emergency department, making about $3,800 a week for three 12-hour shifts instead of doing it for free, as she had initially wanted.
...
"As of Wednesday, more than 90,000 retired and active health care workers had signed up online to volunteer at the epicenter of the pandemic, including 25,000 from outside New York, the governor’s office said.
...
"New York City hospitals have only deployed 908 volunteers as of Wednesday, according to city health officials.

"The urgent need for medical personnel is colliding head-on with the immovable bureaucracy of hospital regulations
...
"State officials said the volunteer portal, which was built from scratch, was initially overwhelmed by the response, but has since connected about 10,000 volunteers to hospitals in New York State within two weeks.
...
"The challenge of screening so many medical workers has opened an opportunity for the dozens of established private agencies that place temporary nurses and doctors at hospitals nationwide
...
"The staffing agencies, an $18 billion industry, say that unlike the state, they already have the technology and infrastructure in place to quickly check credentials for health professionals. In normal times, hospitals hire them to fill short-term staffing needs, such as during a regular flu season.

“As great as it is that the state is trying to help, it’s a very complex process to staff a clinician,” said Alexi Nazem, chief executive of Nomad Health, a health recruiting agency based in New York. “There are dozens of documents to verify. Our company has spent years building those systems.”
...
"New York City’s public hospitals had used private recruiters to bring in about 3,600 new medical workers as of late last week and were seeking to hire 3,600 more, according to the mayor and a city spokesman.

"One of those recruiting agencies, NuWest Group, began contracting with the city less than two weeks ago. Since then, the agency has secured hundreds of nurses and respiratory therapists for city hospitals, with some positions paying more than $10,000 a week, a spokeswoman for the agency said.

"Agencies, who negotiate the rates with hospitals, say that without the high pay, there would not be enough qualified clinicians willing to take jobs at the front lines
...
"Hospital staff members say they are grateful for any reinforcements, but some residents and nurses have expressed frustration over the pay disparities."

Medical triage for Covid-19: if/when it comes to that, how should it be organized?

So far I haven't heard of any actual medical triage in the U.S. in which life-saving treatment for Covid-19 is rationed.  There has been a good deal of discussion of how to avoid this, and of the short supply of masks, gowns, sedatives for intubation, and health care personnel.  Much of that discussion  has focused on reallocating scarce resources to where they are needed (from where they are not so scarce (e.g. California Ventilators En Route to New York, Other States), so that rationing of e.g. ventilators doesn't become necessary.  But if the infection curve doesn't flatten enough, triage may well be coming, at least in some places. (Here's an up to date account of a hard hit rural hospital near New Orleans that hasn't yet had to triage, but might be getting close if nearby hospitals were to stop taking transfers of patients.)  

Already in Italy there was a period (maybe still) when patients over age 70 (and later over 65) were not being given ventilators because of an actual shortage of ventilators compared to the number of patients who needed them. So it makes sense that, along with the discussion of how to prevent the need for triage, there is an ongoing discussion of how to manage it, if  there comes a time and place where there aren't enough vents to go around. (I have already heard a somewhat related discussion in the U.S. about whether patients on vents should be resuscitated--given the small chance of recovery, and the exposure of health care workers to Covid-19 during a resuscitation attempt.)

As in discussions of repugnant transactions, discussing allocation of scarce resources provokes lots of debate about who should get what, and what kind of distinctions should and should not be made. 

Here are longish excerpts from several interesting contemporary accounts:

Here's an article in the March 23 New England Journal of Medicine:

Fair Allocation of Scarce Medical Resources in the Time of Covid-19

by Ezekiel J. Emanuel, M.D., Ph.D., Govind Persad, J.D., Ph.D., Ross Upshur, M.D., Beatriz Thome, M.D., M.P.H., Ph.D., Michael Parker, Ph.D., Aaron Glickman, B.A., Cathy Zhang, B.A., Connor Boyle, B.A., Maxwell Smith, Ph.D., and James P. Phillips, M.D.

"Rationing is already here. In the United States, perhaps the earliest example was the near-immediate recognition that there were not enough high-filtration N-95 masks for health care workers, prompting contingency guidance on how to reuse masks designed for single use.2 Physicians in Italy have proposed directing crucial resources such as intensive care beds and ventilators to patients who can benefit most from treatment.3,4 Daegu, South Korea — home to most of that country’s Covid-19 cases — faced a hospital bed shortage, with some patients dying at home while awaiting admission.5 In the United Kingdom, protective gear requirements for health workers have been downgraded, causing condemnation among providers.6 The rapidly growing imbalance between supply and demand for medical resources in many countries presents an inherently normative question: How can medical resources be allocated fairly during a Covid-19 pandemic?

...

"According to the American Hospital Association, there were 5198 community hospitals and 209 federal hospitals in the United States in 2018. In the community hospitals, there were 792,417 beds, with 3532 emergency departments and 96,500 ICU beds, of which 23,000 were neonatal and 5100 pediatric, leaving just under 68,400 ICU beds of all types for the adult population.12 Other estimates of ICU bed capacity, which try to account for purported undercounting in the American Hospital Association data, show a total of 85,000 adult ICU beds of all types.13

"There are approximately 62,000 full-featured ventilators (the type needed to adequately treat the most severe complications of Covid-19) available in the United States.14 Approximately 10,000 to 20,000 more are estimated to be on call in our Strategic National Stockpile,15 and 98,000 ventilators that are not full-featured but can provide basic function in an emergency during crisis standards of care also exist.14 Supply limitations constrain the rapid production of more ventilators; manufacturers are unsure of how many they can make in the next year.16 However, in the Covid-19 pandemic, the limiting factor for ventilator use will most likely not be ventilators but healthy respiratory therapists and trained critical care staff to operate them safely over three shifts every day. In 2018, community hospitals employed about 76,000 full-time respiratory therapists,12 and there are about 512,000 critical care nurses — of which ICU nurses are a subset.17 California law requires one respiratory therapist for every four ventilated patients; thus, this number of respiratory therapists could care for a maximum of 100,000 patients daily (25,000 respiratory therapists per shift).

...

"Previous proposals for allocation of resources in pandemics and other settings of absolute scarcity, including our own prior research and analysis, converge on four fundamental values: maximizing the benefits produced by scarce resources, treating people equally, promoting and rewarding instrumental value, and giving priority to the worst off.24-29 Consensus exists that an individual person’s wealth should not determine who lives or dies.24-33 Although medical treatment in the United States outside pandemic contexts is often restricted to those able to pay, no proposal endorses ability-to-pay allocation in a pandemic.24-33

...

"These ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients."

**********

Here's a Washington Post story with a good summary of much of the discussion and disagreement about how different patients (and groups of patients) might be prioritized if ventilators have to be rationed:

Who gets a shot at life if hospitals run short of ventilators?

States, hospitals scramble to set guidelines that could prioritize pregnant women, health-care workers — and even some politicians

By Ariana Eunjung Cha and Laurie McGinley April 7, 2020 

"Pregnant women would get extra priority “points” in most if not all plans, U.S. hospital officials and ethicists say. This is not controversial. There also has been some discussion about whether high-ranking politicians, police and other leaders should be considered critical workers at a time when the country is facing an unprecedented threat.

...

"Catholic groups have called on hospitals to treat pregnant women as two lives instead of one. AARP, formerly the American Association of Retired Persons, has decried age cutoffs for ventilator access in some plans. Last month, the Arc, a disability rights group, filed multiple complaints with the Department of Health and Human Services objecting to plans that disadvantage those with “severe or profound mental retardation” or dementia.

...

"Bioethicist Brendan Parent, who served on a New York state task force that developed a highly regarded framework for rationing, sees hospitals and states following two paths.

"One group takes a utilitarian view of doing “the greatest good for the greatest number,” giving preference to those with the best chance of surviving the longest. Others are more focused on ensuring social justice and ensuring vulnerable groups have an equal chance.

...

"UCLA’s plan goes to great lengths to avoid possible discrimination, stating that medical teams may not consider a long list of criteria for ventilator allocation including gender, disability, race, immigration status, personal relationship with hospital staff or “VIP status” — an important reminder given the medical center’s proximity to Hollywood.

...

"In UCLA’s plan, front-line health-care workers and administrators may be given priority access to lifesaving treatment, when their return to work means more people are likely to survive the crisis. If all the allocation criteria are applied and there’s still a shortage of medical resources, then care should be allocated on the basis of a lottery, the document says.

...

"One of the most striking differences among plans is how they deal with the elderly and disabled. Some have strict age cutoffs, or explicit criteria that disadvantage those with certain conditions.

...

"Using life expectancy or remaining life years can also be problematic for those with disabilities, civil rights groups say. The typical life expectancy for a person with Down syndrome, for example, is 60 years, as compared to about 78 years for someone without the condition.

...

"Inova’s Motew said ethical principles allow for prioritizing “some individuals who provide more lifesaving opportunities if they could live” — and that this could include “government leaders.” He compared it to military medicine, in which those who are in a position to go back to help win the war are treated first."

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And here are some thoughts on what we might learn about medical triage from considerations that come up in allocating school places among different populations for whom some positions are reserved.  The idea is that different groups of patients would have places reserved for them, through the kind of political process that reserves places in schools for different demographic groups, with priorities within groups, and ordering of reservations among groups. Once those issues are settled by some political process, the problem starts to look like school choice with affirmative action, and in the model proposed by these authors (who are well acquainted with school choice), deferred acceptance algorithms emerge:

Triage Protocol Design for Ventilator Rationing in a Pandemic:
A Proposal to Integrate Multiple Ethical Values through Reserves
Parag A. Pathak, Tayfun Sonmez, M. Utku Unver, M. Bumin Yenmez
April 2020

Abstract: In the wake of the Covid-19 pandemic, the rationing of medical resources has become a critical issue. Nearly all existing triage protocols are based on a priority point system, in which an explicit formula specifies the order in which the total supply of a particular resource, such as a ventilator, is to be rationed for eligible patients. A priority point system generates the same priority ranking to ration all the units. Triage protocols in some states (e.g. Michigan) prioritize frontline health workers giving heavier weight to the ethical principle of instrumental valuation. Others (e.g. New York) do not, reasoning that if medical workers obtain high enough priority, there is a risk that they obtain all units and none remain for the general community. This debate is particularly pressing given substantial Covid-19 related health risks for frontline medical workers. In this paper, we propose that medical resources be rationed through a reserve system. In a reserve system, ventilators are placed into multiple categories. Priorities guiding allocation of units can reflect different ethical values between these categories. For example, while a reserve category for essential personnel can emphasize the reciprocity and instrumental value, a reserve category for general community can give higher weight to the values of utility and distributive justice. A reserve system provides additional flexibility over a priority point system because it does not dictate a single priority order for the allocation of all units. It offers a middle-ground approach that balances competing objectives. However, this flexibility requires careful attention to implementation, most notably the processing order of reserve categories, given that transparency is essential for triage protocol design. In this paper, we describe our mathematical model of a reserve system, characterize its potential outcomes, and examine distributional implications of particular reserve systems. We also discuss several practical considerations with triage protocol design.

And from the conclusion:

"In our formal analysis, we characterize the entire class of reservation policies that satisfy three minimal principles though implementation of the deferred-acceptance algorithm. As such, we also provide a full characterization of affirmative action policies."
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There are of course other models of triage than school choice. In transplantation, there's a shortage of both deceased and living donors, to the extent that many people who need transplants will never get them. The allocation of deceased donor organs is handled not entirely differently than generalized school choice of a particularly dynamic sort (potential recipients of a deceased donor kidney that suddenly becomes available are categorized into groups, not just by blood and tissue types which have immediate feasibility implications, but also by age and by how difficult it will be to find them a feasible match, and prioritized within groups mostly by waiting time and health status, differently for different organs).  Living donors (almost all are donating a kidney) are much less regulated, and through kidney exchange are mostly allocated through an exchange system that is fairly blind to group membership, although the statistics that are collected pay attention to people in a variety of categories.  The point of kidney exchange of course is not just to allocate scarce resources, but to make them less scarce.  That is a goal to think about whenever triage becomes necessary, or starts to look like it might.

Plasma donation, "convalescent plasma" and Covid-19 antibodies

Blood plasma is a big source of antibodies for people who don't make their own, and in these days of Covid-19 pandemic, antibodies are again in the news. As the number of recovering patients grows, can the antibodies they produce be of help in stemming the spread of the disease, or in curbing its intensity?

Here's a just published report of a quite preliminary study from China, in the PNAS:

Effectiveness of convalescent plasma therapy in severe COVID-19 patients
by Kai Duan, ... Xiaoming Yang (46 authors)
PNAS first published April 6, 2020 https://doi.org/10.1073/pnas.2004168117
Contributed by Zhu Chen, March 18, 2020 (sent for review March 5, 2020; reviewed by W. Ian Lipkin and Fusheng Wang)


"Significance: COVID-19 is currently a big threat to global health. However, no specific antiviral agents are available for its treatment. In this work, we explore the feasibility of convalescent plasma (CP) transfusion to rescue severe patients. The results from 10 severe adult cases showed that one dose (200 mL) of CP was well tolerated and could significantly increase or maintain the neutralizing antibodies at a high level, leading to disappearance of viremia in 7 d. Meanwhile, clinical symptoms and paraclinical criteria rapidly improved within 3 d. Radiological examination showed varying degrees of absorption of lung lesions within 7 d. These results indicate that CP can serve as a promising rescue option for severe COVID-19, while the randomized trial is warranted."
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Here's a story from the WSJ:

Coronavirus Survivors Keep Up the Fight, Donate Blood Plasma to Others
National Covid-19 project seeks volunteers to aid the seriously ill; ‘I feel obligated to help’
By Amy Dockser Marcus

"The Mount Sinai Hospital in New York, where Mr. Sherman volunteered to donate plasma, is one of 34 institutions around the country participating in the National Covid-19 Convalescent Plasma Project, which is seeking blood-plasma donations from recovered patients who have a confirmed Covid-positive test and are at least 21 days out from the onset of symptoms.
...
“The biggest problem is not the lack of donors,” said Arturo Casadevall, a professor at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, and one of the organizers of the national project. “It is the logistics of figuring out how people who want to participate can actually donate.”

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And here's a plasma industry press release:

Global Plasma Leaders Collaborate to Accelerate Development of Potential COVID-19 Hyperimmune Therapy

"Osaka, JAPAN, and King of Prussia, PA, USA – April 6, 2020 –  Biotest, BPL, LFB, and Octapharma have joined an alliance formed by CSL Behring (ASX:CSL/USOTC:CSLLY) and Takeda Pharmaceutical Company Limited (TSE:4502/NYSE:TAK) to develop a potential plasma-derived therapy for treating COVID-19. The alliance will begin immediately with the investigational development of one, unbranded anti-SARS-CoV-2 polyclonal hyperimmune immunoglobulin medicine with the potential to treat individuals with serious complications from COVID-19.
...
"Developing a hyperimmune will require plasma donation from many individuals who have fully recovered from COVID-19, and whose blood contains antibodies that can fight the novel coronavirus. Once collected, the “convalescent” plasma would then be transported to manufacturing facilities where it undergoes proprietary processing, including effective virus inactivation and removal processes, and then is purified into the product."

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My other posts on plasma, mostly focused on repugnance to compensation for donors. Here's one that explains some of the underlying medical issues:

Thursday, July 11, 2019

Plasma shortage alert from the IDF--the Immune Deficiency Foundation