Thursday, May 21, 2020

Blood and plasma: a brief history, from 1628

With all my discussion of convalescent plasma for Covid-19 this week*, here's a historical perspective on the technology and changes in medical practice since the discovery of blood circulation in 1628 that allows blood and plasma to be used in medicine.


A history of blood transfusion: a confluence of science—in peace, in war, and in the laboratory
by Kevin R. Loughlin
Hektoen International, Volume 12, Issue 2 – Spring 2020.

"Since 1628 when William Harvey discovered the circulation of blood, there had been hope that blood transfusion would be possible.
...
"After Harvey’s discovery, transfusion attempts began. In 1665 Richard Lower kept dogs alive by transfusing blood from other dogs.2 In 1667 French physician Jean Denys transfused nine ounces of blood from the carotid artery of a lamb into the vein of a young man. He continued the practice until the third patient so treated, died.3 Denys was sued by the wife of the deceased patient, who presumably died from a hemolytic reaction, but was exonerated. However, the French Parliament, the Royal Society, and the Catholic Church subsequently issued a general prohibition against transfusions.4

"It would not be until 1818 when transfusions were seriously considered again. A British obstetrician, James Blundell, performed a human blood transfusion in the setting of a postpartum hemorrhage.5 However, the debate over transfusions continued over the remainder of the nineteenth century. In 1849 C.H.F. Routh reviewed all the published transfusions to date and remarked in the Medical Times that of the 48 recorded cases, 18 had a fatal outcome and concluded that the mortality rate was unacceptably high.5 The next major advance in transfusion therapy would wait until the turn of the century.

"Karl Landsteiner was an Austrian physician and immunologist. While working at the University of Vienna, he became interested in blood serum work, specifically the factors that led to hemagglutination of red blood cells. This resulted in two landmark publications in 1900 and 1901 that described the evidence of blood groups that he named A, B, and C.6,7 These would later be modified to A, B, and O. Two years later, two of his colleagues, Alfred Von Decastelo and Adriano Sturli, would add a fourth blood type, AB.8,9 Landsteiner would be awarded the Nobel Prize in 1930 for his elucidation of the blood groups.

... in 1912, Doctor Roger Lee demonstrated that O blood could be given to a person of any blood type (universal donor) and that a person with AB blood could receive blood from any blood group (universal recipient).
...
"As blood transfusions became more widespread in medical practice, the concept of establishing blood banks became attractive. In the 1930s Bernard Fantus at Cook County Hospital20 and Carl W. Walter at Peter Bent Brigham Hospital started blood banks. In Boston, Walter’s efforts were viewed with such skepticism and disdain that his facility was relegated to a basement room at Harvard because some trustees thought the storage and use of blood was “immoral and unethical.”21 Fifteen years later he invented the plastic blood bag, which greatly facilitated transfusion therapy.21
...
"In 1940 Edwin Cohn developed ethanol fractionation, the process of breaking down plasma into component products. Albumin, gamma globulin, and fibrinogen were isolated to become available for clinical use.

"In 1944 dried plasma became available for the treatment of combat injuries. Component transfusion therapy became more widely used as the war progressed. The Red Cross concluded its World War II blood program in 1945 after 13 million pints had been collected.11

"In 1961 platelet concentrates became recognized for reducing mortality from hemorrhage in cancer patients. In 1964 plasmapheresis was introduced as a means of collecting plasma for fractionation. In 1971 Hepatitis B surface antigen (HbsAg) testing of donated blood began and in 1992 testing of donor blood for HIV-1 and HIV-2 antibodies commenced.
*************

*here's a recap of my earlier coronavirus posts relating to plasma this week:

Sunday, May 17, 2020


Wednesday, May 20, 2020

Convalescent plasma collection and distribution

Efforts to collect and distribute convalescent plasma from recovered Covid-19 patients are ramping up: there are lots of options.


I donate convalescent plasma at the Stanford Blood Center, in their program on
 CONVALESCENT PLASMA FROM RECOVERED COVID-19 PATIENTS
"This exciting initiative involves taking plasma donations from recovered COVID-19 patients and transfusing that plasma into critically ill COVID-19 patients in the hopes that the antibodies present in the donated plasma will help save the lives of the recipients."

Modern plasma collection is a one-arm process: the machine on my right in the photo alternates between taking blood and returning red blood cells through the same needle (in contrast to the old technology which had blood go out of a needle in one arm and red blood cells return through a needle in the other arm).

Collecting convalescent plasma is not regulated as a research activity, it is just ordinary plasma donation. However giving it to patients is done under FDA guidance, either as a research activity or as an emergency intervention for very ill patients:
Recommendations for Investigational COVID-19 Convalescent Plasma
"Because COVID-19 convalescent plasma has not yet been approved for use by FDA, it is regulated as an investigational product."

There are three FDA-approved pathways right now by which convalescent plasma can be administered to patients.
"Pathways for Use of Investigational COVID-19 Convalescent Plasma:
1. Clinical Trials,
2.  Expanded Access "for patients with serious or immediately life-threatening COVID-19 disease"
3. Single Patient Emergency"

Here is a consortium of nonprofit blood centers, there's likely one near you if you're reading this in the States:
America's Blood Centers (association of independent blood centers)
Here's the American Red Cross effort: Plasma Donations from Recovered COVID-19 Patients

My impression is that the nonprofit blood centers don't pay donors, but are able to sell plasma to customers, including the commercial plasma industry, as part of the thriving domestic and international market in plasma. (I blogged Monday about U.S. plasma exports, all over the world, including especially countries in which compensating donors is repugnant.)
*****************
The for-profit plasma industry (which compensates plasma donors) is represented by The Plasma Protein Therapeutics Association (PPTA)
Here's an announcement about their plans for Covid-19 antibodies:
  1. CoVIg-19 Plasma Alliance Builds Strong Momentum Through Expanded Membership and Clinical Trial Collaboration
"The CoVIg-19 Plasma Alliance, an unprecedented plasma industry collaboration recently established to accelerate the development of a plasma-derived hyperimmune globulin therapy for COVID-19, is rapidly building momentum. Its membership has expanded globally to include 10 plasma companies, and now also includes global organizations from outside the plasma industry who are providing vital support to encourage more people to donate plasma.

"In addition to those announced at its inception - Biotest, BPL, CSL Behring, LFB, Octapharma and Takeda - the Alliance welcomes new industry members ADMA Biologics, BioPharma Plasma, GC Pharma, and Sanquin. Together, these organizations will contribute specialist advisory expertise, technical guidance and/or in-kind support to contribute to the Alliance goal of accelerating development and distribution of a potential treatment option for COVID-19."
*******

"In Minnesota, a program coordinated by the Mayo Clinic has collected plasma from more than 12,000 COVID survivors for transfusion into more than 7,000 gravely ill patients, the result of a massive public appeal led by government leaders and nonprofit groups such as the Red Cross.

"Meanwhile, for-profit companies that typically pay $50 per donation of plasma used in other lifesaving therapies are advertising aggressively — and significantly bumping up their rates for COVID donors.

"In Utah, John and Melanie Haering, who contracted COVID-19 aboard the ill-fated Diamond Princess cruise ship, received gift cards worth $800 after making two donations apiece at a Takeda Pharmaceuticals' BioLife Plasma Services center. BioLife runs several of the more than 800 paid-plasma collection sites in the U.S., part of an industry that produces plasma protein therapies used to treat rare, chronic conditions such as hemophilia and in medical emergencies."

Tuesday, May 19, 2020

Surrogacy amidst the corona virus pandemic lockdowns

The coronavirus pandemic isn't only a story about disease, it's also a story about lockdowns, and restrictions on travel (among other things), especially international travel.  This is having a big, unintended effect on surrogacy markets, as surrogate pregnancies begun before the pandemic come to term. Here are two stories about the situation in the U.S. and in Ukraine.

The Guardian has the story about surrogacy in the U.S.:

Surrogates left holding the baby as coronavirus rules strand parents
The US surrogacy business is in turmoil, with parents overseas unable to pick up their baby and others unable to leave America

"Commercial surrogacy is legal in some US states, making it a hotspot for parents looking to have children through assisted reproduction. But the coronavirus travel ban has seen President Trump close the country’s borders to almost all international visitors, while a nationwide US passport office shutdown has made it impossible for parents who do manage to get into the country to obtain the necessary documentation to take their children home.

"As a result, babies are being born without their parents present at the birth (immigration authorities will only let parents in once the surrogate has given birth to the child). In at least one case, a mother flew from France to attend the birth of her child, only to be turned back by border control. Some parents aren’t being allowed in the country at all.

"Surrogates and surrogacy agencies are scrambling to look after babies themselves."
...
"The solution, Brisman says, is for the US immigration authorities to allow parents into the US to collect their children, and expedite the process by which they can leave the country. “I would like to see the government allow these people in quickly, and allow them home quickly,” she says. “We need expedited passports, birth certificates and visas for people whose babies are being born.”"
********

The NY Times has the story from the Ukraine:

100 Babies Stranded in Ukraine After Surrogate Births
Travel bans have prevented the babies’ parents from entering the country. One official says as many as 1,000 babies will be born before restrictions are lifted.

"Dozens of babies born into Ukraine’s booming surrogate motherhood business have become marooned in the country as their biological parents in the United States and other countries cannot travel to retrieve them after birth. For now, the agencies that arranged the surrogate births care for the babies.

"Authorities say that at least 100 babies are stranded already and that as many as 1,000 may be born before Ukraine’s travel ban for foreigners is lifted.

“We will do all we can to unite the children with their parents,” Albert Tochilovsky, director of BioTexCom, the largest provider of surrogacy services in Ukraine, said in a telephone interview.
...
"Ukraine does not tally statistics on surrogacy, but it may lead the world in the number of surrogate births for foreign biological parents, Mr. Tochilovsky said. His company alone is awaiting about 500 births. Fourteen companies offer the service in Ukraine.

"Ukraine is an outlier among nations, though not alone, in allowing foreigners to tap a broad range of reproductive health services, including buying eggs and arranging for surrogate mothers to bear children for a fee. The business has thrived largely because of poverty.

“The cheapest surrogacy in Europe is in Ukraine, the poorest country in Europe,” BioTexCom’s website explains. Surrogate mothers in Ukraine typically earn about $15,000.

"Some members of Parliament who have long opposed the business have renewed their calls for banning surrogacy services for foreigners now that the babies are stacking up without parents.

"Surrogacy is available in Ukraine only if a woman in a heterosexual partnership can demonstrate that she cannot bear children herself.
...
"The babies’ parents are now in the United States, Italy, Spain, the United Kingdom, China, France, Romania, Austria, Mexico and Portugal, the company said.

"Lyudmila Denisova, a human rights ombudsman for Ukraine’s Parliament, said the stranded babies underscore a pressing need for the country to bar foreigners from hiring Ukrainian women as surrogate mothers.

"A human rights official in the presidential administration, Nikolai Kuleba, has also demanded an end to the practice. “Ukraine is just turning into an online store for little ones,” he said."

Monday, May 18, 2020

Qingyun Wu defends his dissertation--remotely

Qingyun Wu successfully defended his dissertation at Stanford today, remotely, as we are all sheltering in place from the coronavirus pandemic.


He presented three papers, the screenshot above is from the third.

1. The lattice of envy-free matchings." Games and Economic Behavior 109 (2018): 201-211.
2 Entering Classes in the College Admissions Model." 
3 "Forbidden Transactions and Black Markets." 

Welcome to the club, Qingyun.

Plasma and plasma products (such as antibodies) are a big business (and the U.S. dominates the international market)

These days I'm thinking about corona virus covid-19 convalescent blood plasma, which I blogged about yesterday, and about which I hope to say more soon. But that has gotten me to think again about blood plasma generally, which is a source of many therapies, including antibodies, immunoglobulins, that defend against a large variety of diseases.

The U.S. is the Saudi Arabia of blood plasma and plasma products, with both a large domestic commercial market and annual exports valued in the billions of dollars. The reason is largely that it is legal in the U.S. to pay plasma donors, so there's ample supply through a big network of hundreds of  for-profit and nonprofit blood and plasma centers (the nonprofits mostly don't pay donors, I think). In many countries, paying their residents for plasma is repugnant and illegal. Fortunately for their citizens, they mostly don't also suffer from severe shortages of life-saving plasma medicines, because it can be bought from the U.S. (See e.g. my posts on Canada's plasma policies.)

Here are some relevant export figures. They make clear that the U.S. exports billions of dollars of plasma, and tens of billions of dollars of plasma products.




For those who would like to study these data, let me explain where they come from.  (They  include some things that aren't plasma products, and may miss some that are...) It's not so easy to find the U.S exports of exactly blood plasma and plasma products (I needed some help).

In Chapter 30 of the U.S. International Trade Commission (USITC) Harmonized Tariff Schedule (HTS),is the code:
HTS 3002: "Human blood; animal blood prepared for therapeutic, prophylactic or diagnostic uses; antisera, other blood fractions and immunological products, whether or not modified or obtained by means of biotechnological processes; vaccines, toxins, cultures of micro-organisms (excluding yeasts) and similar products:
 Antisera, other blood fractions and immunological products, whether or not modified or obtained by means of biotechnological processes"

That sounds good, but it includes (aside from plasma products) things that I don't want to include e.g. Malaria diagnostic test kits, and Fetal Bovine Serum.

On the other hand the subcategory 3002.12.00  is for "Antisera and other blood fractions" which includes sub-subcategories for things I do want to include:
3002.12.10 Human blood plasma.
3002.12.20 Normal human blood sera, whether or not freeze-dried
3002.12.30 Human immune blood sera

And then there are are codes 3002.13.00, 14.00, and 15.00 which cover the promising (very similar) categories in which most of the immunoglobulins are probably found, but maybe some other things too:

Immunological products, unmixed, not put up in measured doses or in forms or packings for retail sale
Immunological products, mixed, not put up in measured doses or in forms or packings for retail sale
and
 Immunological products, put up in measured doses or in forms or packings for retail sale.

The place to go to turn these numbers into export figures is dataweb.usitc.gov  (But getting data there isn't completely straightforward, and I got help from Julia Fabens.)  The table above shows that whole plasma itself has over $2 billion of annual exports from the U.S., and together with plasma products, including those involving antibodies (immunological products) there are almost $20 billion of exports from the U.S.

So, I'm guessing that soon, if clinical trials show that antibodies against covid-19, are useful, they will become readily available, commercially, in plasma and in pharmaceuticals.  A year ago, those human antibodies didn't exist, and so there was no way to use it to help patient zero or the next many thousands.  But now there's a lot of it, more each day, in the blood of recovered patients.  And there's a whole industry devoted to collecting it and purifying the antibodies into "immunological products." 

I hope human antibodies against covid-19 are clinically useful, to help mitigate and cure the disease if not to prevent it, because my sense is that a vaccine is (at least) many months away.
102,597,746 2,627,504 1,586,634
102,597,746 2,627,504 1,586,634

Sunday, May 17, 2020

Cascades of convalescent plasma for Covid-19, and chains of exchanges, by Kominers, Pathak, Sönmez, and Ünver

Covid-19 convalescent plasma is a new thing in the world, that came into existence only when the first human was infected and recovered from the Covid-19 disease that is now pandemic. It isn't clear yet whether it will be clinically valuable, but recovered antibodies have been valuable for some other diseases, so there's excellent reason to hope that will be the case now too.  And as the number of people grows who have recovered from Covid-19, it is likely that the supply of antibodies is growing much faster, since antibody-containing plasma can be donated once a month or so. (There are  ongoing studies of antibody production by recovered patients, examining how long the antibodies remain at high levels, post-recovery). Of course, most of that supply is sequestered in the blood of recovered patients, so there's a non-trivial issue of collection and distribution.

As readers of this blog know, many countries prohibit the sale of plasma. Will Americans continue to support a commercial market for Covid-19 convalescent plasma in the current pandemic?  A distinguished group of market designers has written a paper considering how to apply techniques developed for kidney exchange to the task of collecting convalescent plasma from recovered Covid-19 patients, if it becomes impossible to buy and sell it. In particular, they consider how to create chains of donations, without using money, to overcome the shortages they anticipate.

Here's an easy to read account by Scott Kominers, one of the authors.

Scott Duke Kominers, Bloomberg News  May 11, 2020

"convalescent plasma is in short supply: although it’s hard to estimate precisely, some statistics suggest the U.S. may need twice as much as we have on hand.

"In a new paper, Parag A. Pathak, Tayfun Sonmez, M. Utku Unver and I propose a market design strategy that could help close the gap. Our approach makes use of two special features of the way plasma donation works.

"First, convalescent plasma is collected from recently recovered patients, which means that today’s patients become tomorrow’s prospective donors, assuming they manage to beat the virus. ... That suggests the shortage isn’t from lack of potential supply.

"Second, plasma donation is more than one-for-one: the typical donor can give enough plasma at one time for multiple treatments, and they can potentially donate more than once. As a result, assuming plasma therapy does help patients recover, there is a so-called flywheel effect: the more we use the treatment, the more plasma is available -- provided enough recovered patients are willing to donate.

"Many people would like to donate plasma to help a loved one, but can’t for various reasons:  Their blood types might be incompatible or they might live far away and be unable to travel. To address these sorts of obstacles, my collaborators and I suggest that each plasma donor could receive a voucher that can be used to give a family member or friend priority for plasma treatment. Because donation is more than one-for-one, it’s possible to honor vouchers while still increasing the pool of plasma available to treat other patients.
...
"A similar analysis suggests a role for a pay-it-forward system, where we make a point of treating patients who pledge to donate plasma, assuming they recover and are medically able to do so. Because recovered patients can typically donate more plasma than was needed for their own treatment, this again can help increase the plasma supply in the long run. As a result, my collaborators and I show that, somewhat paradoxically, prioritizing patients who pledge to donate can still end up expanding treatment for the patients who are unable to pledge, or just choose not to.

"Both of these policies are similar to systems we’ve used to expand kidney donation in the U.S.: Priority vouchers are sometimes granted when a living donor gives a kidney to a third-party before one of their family members needs a transplant. And pay-it-forward incentives are used in kidney exchange chains, where a patient with a medically incompatible prospective donor receives a kidney from a third-party donor, and then their donor later gives a kidney to some other patient."
******
Here is the paper itself:

Paying It Backward and Forward: Expanding Access to Convalescent Plasma Therapy Through Market Design
Scott Duke Kominers, Parag A. Pathak, Tayfun Sönmez, M. Utku Ünver
NBER Working Paper No. 27143
Issued in May 2020

Abstract: COVID-19 convalescent plasma (CCP) therapy is currently a leading treatment for COVID19. At present, there is a shortage of CCP relative to demand. We develop and analyze a model of centralized CCP allocation that incorporates both donation and distribution. In order to increase CCP supply, we introduce a mechanism that utilizes two incentive schemes, respectively based on principles of “paying it backward” and “paying it forward.” Under the first scheme, CCP donors obtain treatment vouchers that can be transferred to patients of their choosing. Under the latter scheme, patients obtain priority for CCP therapy in exchange for a future pledge to donate CCP if possible. We show that in steady-state, both principles generally increase overall treatment rates for all patients—not just those who are voucher-prioritized or pledged to donate. Our results also hold under certain conditions if a fraction of CCP is reserved for patients who participate in clinical trials. Finally, we examine the implications of pooling blood types on the efficiency and equity of CCP distribution.

Here's some of the motivation for their model:
"There is an active debate in economics and philosophy on the appropriate role of market-based
mechanisms with compensation for human products used in medicine or medical research like kidneys, blood, blood products, sperm, breast milk, bone marrow, and other.11 Since, as far as we know, there is no current market where infected patients can buy CCP or where recovered patients can sell CCP, we do not consider this possibility as part of our model.
...
"Because CCP is a form of plasma, a natural question is whether a compensated market for CCP will develop. In our model, there is no option to pay to receive CCP or be paid for donating CCP, but a donor can designate the voucher in our model to particular patient in need. As a result, our model of CCP falls between the two extremes described above. We expect that in a crisis moment, there is unlikely to be an active compensated market for CCP (even though it may be impossible to fully prohibit resale of vouchers). If a price-based market does develop, society may deem it unacceptable."
***************

I am more optimistic than they are about the likely available supply of convalescent plasma if it proves useful, through existing commercial channels. My optimism is based on the large thriving commercial market for plasma and plasma-derived antibodies in the U.S., and around the world.  I'll try to blog about the general plasma and antibody (immunoglobulin) market tomorrow, and perhaps more on Covid-19 antibodies later this week.

Saturday, May 16, 2020

Transplants dropped as Covid-19 rose, in France and the U.S.

In France, even more than in the U.S., kidney transplants were considered elective surgery.

In the Lancet:

Organ procurement and transplantation during the COVID-19 pandemic
Alexandre Loupy, Olivier Aubert, Peter P Reese, Olivier Bastien, Florian Bayer, Christian Jacquelinet
Published:May 11, 2020

Here is a set of figures showing "Trends in COVID-19 spread over time in France and the USA and recovery of organs and solid-organ transplantation procedures from deceased donors" (The top two figures are France, the bottom two US)


Here's an updated snapshot of American transplants from UNOS, for all organs:


and for kidneys:

Friday, May 15, 2020

Search and matching models of marriage (with emphasis on search or on matching)

Often when economic theorists (particularly matching theorists) speak of "marriage" we don't mean the real thing, we mean a metaphor embodied in a simple one-to-one model of matching. But marriage is a very real thing, and matching models of various sorts are used to study it.  Here's a survey from the Annual Review of Economics, by one of the leaders of this literature.

The Theory and Empirics of the Marriage Market by  Pierre-André Chiappori

"the economic analysis of the marriage will aim at answering two sets of questions: (a) Who marries whom? and (b) How are the benefits distributed between spouses? Mostly, these questions have been analyzed using either of two different frameworks: frictionless matching theory and search models. The basic distinction between the two is related to the emphasis that is put (or not) on frictions in the description of the market. In search models, frictions are paramount. Typically, each individual sequentially and randomly meets one person of the opposite gender; after such a meeting, both individuals must decide whether to settle for the current mate or continue searching. The latter option involves various costs, from discounting to the risk of never finding a better partner. If both individuals agree to engage in a relationship (which can be marriage or, in some models, cohabitation), then a negotiation begins on the way the surplus is shared.

"Matching models, on the contrary, assume a frictionless environment. In the matching process, each woman (say) is assumed to have free access to the pool of all potential men, with perfect knowledge of the characteristics of each of them—and vice versa. In other words, matching models disregard the cost of acquiring information about potential matches as well as the role of meeting technologies of all sorts (from social media to head hunters and from dating sites to pure luck).
*********

I haven't absorbed the whole paper yet, but the introduction reminded me of the plurality of approaches to studying search and matching (not just restricted to the study of marriage). Chiappori shares the view that the big difference between search models and matching models is that matching models are "frictionless," they assume away all the search frictions that are the subject of search models. 

Search models, on the other hand, concentrate on search effort, and take the actual matching technology to be random meetings. (To my mind, that's vastly different from taking account of the actual technology of matching, which is central to the market design literature on matching.)

The 2010 Nobel prize in Economics went to Diamond, Mortensen, and Pissarides, the founders of the search and matching macro literature "for their analysis of markets with search frictions." I recall that Dale Mortensen expressed the view that one of their big contributions was to notice that matching could be regarded as a "black box," rather than being studied explicitly, i.e. that actual matching didn't need to be incorporated in the model. Here's a 2001 paper from the JEL that discusses that:

Looking into the Black Box: A Survey of the Matching Function
Barbara Petrongolo and Christopher A. Pissarides
Journal of Economic Literature Vol. 39, No. 2 (Jun., 2001), pp. 390-431

" The matching function summarizes a  trading technology between agents who  place advertisements, read newspapers and  magazines, go to employment agencies,  and mobilize local networks that eventually bring them together into productive matches. The key idea is that this  complicated exchange process is summarized by a well-behaved function that  gives the number of jobs formed at any  moment in time in terms of the number  of workers looking for jobs, the number  of firms looking for workers, and a  small number of other variables.

" The matching function is a modeling  device that occupies the same place in  the macroeconomist's tool kit as other  aggregate functions, such as the production function and the demand for money  function."
***********
That work, which is focused on search and which treats matching as a black box, provides some big insights. For example, if search is costly but the benefits of matching are shared equally by the one who searches and the one who is found, then there can be free riding in the form of too little search, and hence unemployment by qualified job seekers at the same time that there are unfilled positions, and unsold houses at the same time as there are people who would actually like to buy them.

But models of matching via aggregate matching functions or via random matching are nowhere near the level of detail that allows the kind of micro-micro economics that market designers practice in analyzing marketplaces or in trying to design them. I'm mostly talking about markets that resemble labor markets more than marriage, but dating sites are marketplaces designed for something related to marriage, and there are some explicitly matrimonial sites. Much of what makes one dating site different from another is how they deal with congestion and other frictions.

A not-atypical market design project begins with an analysis of matching in an existing system,  focused on precisely the details of how matching occurs. A next step is that designers sometimes take responsibility for redesigning those details, or aspects of them, to reduce frictions in marketplaces e.g. for labor, schools,  kidneys, MBA courses, financial exchanges, dating sites themselves, etc.

I think there has been too little intersection between those who study search with random matching and those who study matching without explicitly modeling the costs of search. (That isn't to say that there aren't people working and making progress in that intersection.)  Possibly one barrier is a misunderstanding between these two groups of what the models are good for.


Thursday, May 14, 2020

Does the porn industry provide a model for disease testing and contact tracing to end corona virus lockdowns?

The adult film industry--which produces films in which performers engage in sex with one another--has a testing service called PASS (Performer Availability Screening Services) intended to control the spread of sexually transmitted diseases on film sets.

"Testing facilities screen patients for HIV using the Aptima HIV-1RNA Qualitative Assay test. Other tests on a full performers’ panel also include Chlamydia, gonorrhea, hepatitis B & C, trichomoniasis, and syphilis."
********

Stat provides some detail:
Why the porn industry has a lot to teach us about safety in the Covid-19 era
By USHA LEE MCFARLING  MAY 8

"Since the late 1990s, when an outbreak of HIV infections threatened to shutter the multibillion-dollar industry, the mainstream porn community has implemented procedures that require all performers to be tested for HIV and a host of other sexually transmitted infections every 14 days before they can be cleared to work. Any HIV-positive test leads to an immediate shutdown of all U.S. sets, followed by detailed contact tracing before sets can reopen.
...
"In the 20 years it has been in place, PASS has met, and overcome, many of the same challenges that any large-scale coronavirus testing program might encounter, from issues of keeping databases of private medical information secure, preventing the forging of test results, dealing with false positive results, and educating workers about the need for repeated testing to keep workplaces safe.
...
"“You could imagine TSA verifying someone had tested negative before they were allowed on a flight,” he said. “Testing is particularly important for areas that are high risk, like airplanes or meatpacking plants.”
...
"Mike Stabile, communications director for the Free Speech Coalition, the adult entertainment trade association that runs PASS, said the adult film industry understands “better than most the discussion that has to happen for businesses to reopen.”

"Yet for all of that expertise, it would be hard to imagine the Trump administration, or state politicians, reaching out to the porn industry for guidance.
...
"Repeat testing will be necessary for the coronavirus, too, because — like with HIV — there is so much asymptomatic spread of the coronavirus, said Elizabeth “Betz” Halloran, a professor of biostatistics at the University of Washington who directs the Center for Inference and Dynamics of Infectious Diseases at the Fred Hutchinson Cancer Research Center in Seattle.

“You’ll have to keep testing, maybe every 10 days. We need simpler tests that people can just do at home,” said Halloran, who envisions a low-cost “10-pack” of tests for home use."

Wednesday, May 13, 2020

College admissions, late in the season

Each year, around this time of year, as the main round of college admissions comes to a conclusion, NACAC (the National Association for College Admissions Counseling) publishes a list of colleges that still have positions for qualified students.  Here's this year's listing:

COLLEGE OPENINGS UPDATE: OPTIONS FOR QUALIFIED STUDENTS

"NACAC’s annual College Openings Update: Options for Qualified Students (formerly the Space Availability Survey) is a voluntary listing of NACAC member postsecondary institutions that are still accepting applications from prospective freshman and/or transfer students for the upcoming fall term. Now in its 33rd year, the College Openings Update is designed as a tool for counselors, parents and others assisting students who have not yet completed the college admission process. Typically, colleges will continue to join the update after the May 5 public release date, so check back periodically to see additional colleges still accepting applications."

Tuesday, May 12, 2020

Confusion in NYC high school wait lists

In August, the New York City Department of Education announced a change in the school choice assignment process--without announcing any details.  But the plan was that after the initial run of the deferred acceptance algorithm, they would institute some sort of wait lists. I blogged about it at the time, and was concerned by the lack of detail.

Here's a current story from Chalkbeat that suggests that the details are still opaque, but that families are learning that the waitlist position they were given isn't reliable:

How can you move back on a waiting list?’: NYC’s high school admissions tweaks spark confusion
By Alex Zimmerman  May 8, 2020

"students vying for the city’s most coveted schools are discovering that their position on high school waitlists can worsen over time, a situation that has come as a surprise to some families — adding anxiety to an admissions process that is already famous for its complexity.
...
"Every student who fills out an application and does not get into their top choice is automatically waitlisted. If you get your third choice school, for example, you’ll be on the waitlist for your No. 1 and 2 choices. Nearly 44,000 students did not get into their first choice high school this year, automatically placing them on at least one waitlist.

"The second way is that students can add themselves to any waitlist once the initial matching process is over, even for schools a student didn’t initially apply to.

"In general, students who initially applied to a school but didn’t get in and are automatically added to its waitlist should be ranked ahead of students who add themselves later on, officials said. But there are exceptions.

"The first major exception is if a student is in a higher priority group than someone who is already on the waitlist. Some schools, for instance, give preference to students who live in certain neighborhoods, which can override a student’s position on the waitlist even if they were added first. (Officials said this is the most common reason a student would see their position worsen.)

"Olga Ramos, the admissions director at Bard High School Early College Queens, pointed to a second reason families can move backward — something that surprised her at first.

"If a student got into their first choice school, and listed Bard as their second choice, they could still add themselves to Bard’s waitlist and be considered as if they had been automatically added — potentially bypassing students who were already on the list."

*********
Here's an earlier story in Chalkbeat by Mr. Zimmerman, indicating that the system was still pretty opaque as the school choice process got ready to announce admissions in March:

NYC high school offers are coming this week with a big change: waitlists. Here’s what you should know.  By Alex Zimmerman  Mar 18, 2020

Here's what was known then...

"What are these waitlists, anyway?
"New York City students must apply to high school, listing up to 12 schools they want to attend. A complicated algorithm, developed by a Nobel prize-winning economist, then matches a student to one of their choices.
"That fundamental algorithm is not changing. But for the first time this year, any student who does not get into their first choice school will automatically be added to the waitlist of every single higher-ranked school they didn’t get into.
"Every school that has more applicants than seats will have a waitlist. It’s a similar model that the education department uses for pre-K, kindergarten, and middle schools — something education department officials said is an advantage."
**********
Here's a story from the time of the initial announcement:

Goodbye round two applications, hello waitlists: NYC announces changes to high school admissions
By Christina Veiga and Alex Zimmerman   Aug 15, 2019

"Starting next year, the city will allow students to sit on waiting lists for schools they wanted to attend, but didn’t get into. The city is also eliminating the second round of admissions, which it now uses to for students who aren’t matched to a school they applied to during the typical process.
...
"“It’s like going to a store and getting the ticket, you know what number you are, and you know how many folks are ahead of you, and you’ll be able to watch the process go,” said Deputy Chancellor Josh Wallack. “You’ll also be able to talk with an administrator in a school who can give you a sense of how much waitlists move each year and that varies a bit by school.”
*****

I'm still confused about a different issue that I haven't yet seen addressed. In the original school choice system using the deferred acceptance algorithm, there was a second round in which students unmatched in the first round were asked for additional preferences over schools, so that they could be matched.  How were those unmatched students assigned to schools this year?

Here's my August post:

Friday, August 16, 2019 

Monday, May 11, 2020

Double bubble: Locking up with exactly one other household during lock down

You thought your hard interpersonal decisions ended in high school, or when you married?  Not if you live in parts of Canada, where households will now be allowed to expand their social-distancing radius to include exactly one other household.

The WP has the story:

Canadian provinces allow locked-down households to pair up — threatening hurt feelings all around

"While jurisdictions around the world begin to relax their coronavirus restrictions, a handful are pioneering a novel — and potentially fraught — approach: The double bubble.

"There are rules — and they are not for the commitment-phobic. Each household may join with only one other household. Both sides must agree — for better, for worse — to a mutually exclusive relationship. The decision applies to all members of both households. And it’s final.
...
"The arrangement isn’t unique to Newfoundland and Labrador. New Brunswick has also introduced it. So has New Zealand. And the English Channel island of Guernsey.

Sunday, May 10, 2020

Buying and selling blood plasma, with focus on Canada, continued

Peter Jaworski writes:


"I had a video with Big Think come out recently where I defend paying for plasma against a number of objections. It’s a bit on the long side (17 minutes), but I thought you might be interested in posting it to your blog: https://bigthink.com/videos/paid-plasma-ethics

"I also had an opinion piece on the same topic published in the National Post (with Kate Vander Meer, who is a patient that used plasma therapies): https://nationalpost.com/opinion/opinion-on-covid-19-canada-needs-to-pay-plasma-donors-to-protect-its-domestic-supply?video_autoplay=true"


From the video transcript:


"Out of all the countries in the world only the ones that pay people to make that donation are self-sufficient in plasma therapies. And even the ones that pay not all of them are, in fact, sufficient. So there are only seven countries in the world that legally permit paying people for plasma donations – Germany, Austria, Hungary, Czechia or the Czech Republic, parts of Canada. And I'll talk about Canada in a second. The United States, of course, and China. Those are the seven countries in the world that permit payment. Every other country that does not allow payment for plasma donations imports plasma therapies that make use of plasma primarily from Americans. Germans as well, but primarily Americans. "
***********
And here's the op-ed:

Opinion on COVID-19: Canada needs to pay plasma donors to protect its domestic supply
Kate Vander Meer and Peter Jaworski: In order to ensure that enough people are willing to give plasma to meet the ever-expanding need, we must urgently adopt a pay-for-plasma model here at home

"There’s no evidence that anything other than paying for plasma will work. According to an expert panel formed by Health Canada in 2018, paid donors in countries that permit payment are responsible for providing 89 per cent of the plasma used to make therapies, with the United States alone providing 70 per cent of the global supply. The panel also revealed that no country in the world that forbids paid donations collects enough plasma to meet its needs — not one!"

Saturday, May 9, 2020

Repugnant but legal: can strip shows and payday lenders get Paycheck Protection Program support in the pandemic?

The Washington Post has the story:

Strip clubs, payday lenders, lobbyists fight to get emergency federal loans
In wave of lawsuits, companies battered by coronavirus shutdowns but excluded from aid seek small-business funds

"The Little Darlings strip club in Flint, Mich., was forced to turn off its stage lights and close its doors by the state’s stay-at-home order, but it failed to get a federal small-business emergency loan aimed at softening the financial blow from the pandemic.

"Owners of Little Darlings, along with clubs such as Baby Dolls in Dallas and Cheerleaders Gentlemen’s Club in Philadelphia, said it was wrong that they were excluded from the more than $600 billion Paycheck Protection Program created by Congress and the Trump administration to try to save businesses and jobs during the coronavirus crisis.

"So the strip clubs sued the Small Business Administration. And a federal judge in Wisconsin recently sided with the strip clubs, granting a preliminary injunction to force the government to issue loans to four of them, which government lawyers quickly appealed."

Friday, May 8, 2020

Human Challenge Trials (aka Controlled Human Infection studies) for corona virus vaccines

What do we want?  A vaccine for covid-19.

When do we want it?  After clinical trials and peer review.

How can we get it faster?  By asking healthy young (not at too much risk) volunteers to permit themselves to get infected with covid-19, so we can try out vaccine candidates.

Is that crazy?  Well, maybe not. (But not everyone is sure of that.)

Here's a recent paper considering the proposal.

Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure 
Nir Eyal, Marc Lipsitch, Peter G Smith
The Journal of Infectious Diseases, jiaa152, https://doi.org/10.1093/infdis/jiaa152
Published: 31 March 2020

Abstract: Controlled human challenge trials of SARS-CoV-2 vaccine candidates could accelerate the testing and potential rollout of efficacious vaccines. By replacing conventional phase 3 testing of vaccine candidates, such trials may subtract many months from the licensure process, making efficacious vaccines available more quickly. Obviously, challenging volunteers with this live virus risks inducing severe disease and possibly even death. However, we argue that such studies, by accelerating vaccine evaluation, could reduce the global burden of coronavirus-related mortality and morbidity. Volunteers in such studies could autonomously authorize the risks to themselves, and their net risk could be acceptable if participants comprise healthy young adults, who are at relatively low risk of serious disease following natural infection, if they have a high baseline risk of natural infection, and if during the trial they receive frequent monitoring and, following any infection, the best available care.
*************

Here's another paper, in Science, 07 May 2020, by a big group of authors consisting of medical ethicists and physicians: they think it might be ok.

Ethics of controlled human infection to study COVID-19
Seema K. Shah, Franklin G. Miller, Thomas C. Darton, Devan Duenas, Claudia Emerson, Holly Fernandez Lynch, Euzebiusz Jamrozik, Nancy S. Jecker, Dorcas Kamuya, Melissa Kapulu, Jonathan Kimmelman, Douglas MacKay, Matthew J. Memoli, Sean C. Murphy, Ricardo Palacios, Thomas L. Richie, Meta Roestenberg, Abha Saxena, Katherine Saylor, Michael J. Selgelid, Vina Vaswani, Annette Rid

 Abstract: High social value is fundamental to justifying these studies

 Here are the articles opening lines:

"Development of an effective vaccine is the clearest path to controlling the coronavirus disease 2019 (COVID-19) pandemic. To accelerate vaccine development, some researchers are pursuing, and thousands of people have expressed interest in participating in, controlled human infection studies (CHIs) with severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) (1, 2). In CHIs, a small number of participants are deliberately exposed to a pathogen to study infection and gather preliminary efficacy data on experimental vaccines or treatments. We have been developing a comprehensive, state-of-the-art ethical framework for CHIs that emphasizes their social value as fundamental to justifying these studies. The ethics of CHIs in general are underexplored (3, 4), and ethical examinations of SARS-CoV-2 CHIs have largely focused on whether the risks are acceptable and participants could give valid informed consent (1). The high social value of such CHIs has generally been assumed. Based on our framework, we agree on the ethical conditions for conducting SARS-CoV-2 CHIs (see the table). We differ on whether the social value of such CHIs is sufficient to justify the risks at present, given uncertainty about both in a rapidly evolving situation; yet we see none of our disagreements as insurmountable. We provide ethical guidance for research sponsors, communities, participants, and the essential independent reviewers considering SARS-CoV-2 CHIs."

Kim Krawiec points out to me that, among the things the authors disagree about among themselves is compensation to donors:
"Members of our group disagree about the ethical permissibility of offering payment to CHI participants, and there may be relevant regulatory limits in different jurisdictions. Nevertheless, as SARS-CoV-2 CHIs require confinement and follow-up, fairness seems to demand offering participants compensation for their time. This may total several thousand dollars in the United States, assuming compensation at a fair minimum wage for unskilled labor, as in other CHIs. By contrast, incentives beyond compensation could be avoided, given the number of people already indicating willingness to participate. Concerns that the undue influence of monetary compensation compromises risk judgments are unsupported by the available data, as financial motivations are associated with greater attention to risk (15). Moreover, a rigorous informed consent process could maximize understanding. In case payment tempts participants to withhold disqualifying information, eligibility criteria should be objectively verifiable."
************

And here is a group of activists, at an organization called 1 Day Sooner.
You can sign up here*,

COVID-19 Human Challenge Trials
"Human challenge trials deliberately expose participants to infection, in order to study diseases and test vaccines or treatments. They have been used for influenza, malaria, typhoid, dengue fever, and cholera. Researchers are exploring whether human challenge trials could speed up the development of a vaccine for COVID-19, saving thousands or even millions of lives."

*"Sign up here if you may wish to participate in a human challenge trial for COVID-19 if one were to occur, and, potentially, advocate for safe and rapid vaccine development. "

Thursday, May 7, 2020

Price versus waiting time in a ride sharing market

Here's an interesting paper on ride sharing, with estimates of the tradeoffs that individuals make between price and waiting time. The data come from the Uber-like ride sharing service Liftago in the Czech Republic, which however offers passengers a tradeoff between price and waiting time.

THE VALUE OF TIME: EVIDENCE FROM AUCTIONED CAB RIDES
Nicholas Buchholz, Laura Doval, Jakub Kastl, Filip Matějka, Tobias Salz
Working Paper 27087  http://www.nber.org/papers/w27087

ABSTRACT: We estimate valuations of time using detailed consumer choice data from a large European ride hail platform, where drivers bid on trips and consumers choose between a set of potential rides with different prices and waiting times. We estimate consumer demand as a function of prices and waiting times. While demand is responsive to both, price elasticities are on average four times higher than waiting-time elasticities. We show how these estimates can be mapped into values of time that vary by place, person, and time of day. Regarding variation within a day, the value of time during non-work hours is 16% lower than during work hours. Regarding the spatial dimension, our value of time measures are highly correlated both with real estate prices and urban GPS travel flows. A variance decomposition reveals that most of the substantial heterogeneity in the value of time is explained by individual differences as opposed to place or time of day. In contrast with other studies that focus on long run choices we do not find evidence of spatial sorting. We apply our measures to quantify the opportunity cost of traffic congestion in Prague, which we estimate at $483,000 per day.

In the body of the paper they say:

"We use detailed consumer choice data from Liftago, a large European ride-hailing application. This platform uses a unique mechanism to allocate each ride through a rapid auction process in which nearby drivers bid on ride requests and requesting consumers choose between bids based on various characteristics. Most importantly, bids often involve tradeoffs between price and waiting time, or the time it would take the taxi to pick up the customer. Contrast this with platforms like Uber and Lyft that employ “surge” pricing to equilibrate demand and supply so that consumers do not get to directly express their preferences over prices and waiting times within the platform. We are able to observe both consumers’ individual choice sets as well as their ultimate selection for 1.9 million ride requests and 5.2 million bids.

"The first contribution of this paper is to provide a direct and clean measurement of consumers’ willingness-to-pay to reduce waiting times. We use the variation in choice sets and choices to estimate a demand system that depends both on prices and waiting times. Such measures are of first-order importance for the provision of public transportation infrastructure as well as for the ride hail industry where price and waiting time are the two key variables on which firms compete. Our setting allows us to overcome some of the empirical challenges in measuring preferences over both prices and waiting-time.
"Our second contribution, building on the work of Small (1982), is to provide a conceptual  framework to interpret the disutility of waiting and to demonstrate how the willingness-to-pay for waiting-time reductions can be used to recover the value of time. When consumers choose a shorter wait time over a lower price, they reveal that the value of their time at a particular destination and time-of-day is greater than the value at the original location. Intuitively, the willingness to pay for lower wait times is simply the difference between the value of time at the destination and the value of time at the origin. "
**********
I think the first contribution mentioned above is quite an accomplishment, since I don't know of any equally good measure of consumer preferences for waiting time versus price.

I have some reservations about the value of shorter waiting time being a measure of the value of time at the destination minus the value of time at the origin. That seems to me to be a bit complicated. If I'm at work, ready to go home, and I expect waiting time to be not too long, I might go out of my building before calling a car (and now my value of time where I am is quite low). If I thought the waiting time would be longer, I might call the car from my office, where my value of time could be pretty high.  So the value of time "where I am" depends on whether I'm working or just waiting...and that depends on how long I think I'll have to wait.



Wednesday, May 6, 2020

Testing (for virus and/or antibodies) as a component of ending corona pandemic lockdowns

Yesterday I wrote about how contact tracing could play a big role in relaxing corona pandemic lockdowns.  How about very large scale testing for corona virus? Clearly, it's not one or the other, but one can imagine, and some do, that testing essentially everyone, frequently, could remove the need for indirect methods like tracing contacts.

There are two main things we could test for: virus (infection) and antibodies (indication of past infection).

The main test so far for virus infection, recommended by the CDC, is called a nasopharyngeal swab. It's uncomfortable, but more in a surprising way than a painful one (I am a veteran, and it is surprising how far into your skull your nose goes...). More importantly, it is hazardous for the testers, who could be exposed to the virus while they are probing noses where it lurks.  So they need to be in full hazmat garb, masked and gowned.  And the test I had was not in the hospital or one of the medical office buildings, but on the second floor of the adjacent parking garage (a drive-through test) so that no patients or health care workers or surfaces they might touch would be exposed to infection.

That means the test is hard to administer to many people, or frequently.

Paul Romer argues that the road to ending lockdowns should have every American  tested every two weeks.

It appears that more convenient tests that are also less likely to spread the disease are becoming available.  Here's a story from the WSJ about a saliva test that would allow testees to spit into something and seal it up without exposing the world to possible infection:

Your Spit Could Be the Best Coronavirus Test
As states look for ways to increase their testing capacity, new research suggests that saliva is as effective detecting the virus as swabs

"spitting into a cup appears to be as effective at detecting this virus as sticking a swab into your nose."
******

Another kind of testing involves blood tests for antibodies to Covid-19. The hope is that individuals with antibodies have acquired substantial immunity to the disease (and hence could return to work). But so far little is known about how much immunity for how long follows recovery from Covid-19, so doubts are emerging about how much can be learned from antibody tests at present.

From the NY Times
Italians Find Promise of Antibodies Remains Elusive, for Now
Talk of licensing people with the right antibodies, always ahead of the science, has faded as experts warn that they are still studying what level offers protection and how long it lasts.
By Jason Horowitz


and in the Lancet:

"Individuals in possession of an immunity passport could be exempt from physical restrictions and could return to work, school, and daily life. However, immunity passports pose considerable scientific, practical, equitable, and legal challenges.

"On April 24, 2020, WHO highlighted current knowledge and technical limitations, advising “[t]here is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection…[a]t this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’”.

Tuesday, May 5, 2020

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.”
***************

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.
************

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."
*************

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/

***********
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


Monday, May 4, 2020

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.”

Sunday, May 3, 2020

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."
*********

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."






Saturday, May 2, 2020

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.

Friday, May 1, 2020

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."