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

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

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

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

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.”

*********************

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."

********
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

Allocating and reallocating scarce medical supplies

An op-ed in USA today points out that shortages of critical hospital supplies are occurring and will continue to occur at different times in different states, allowing for increased efficiencies in sharing (which is hampered by a vacuum in leadership at the Federal level).

One of the authors, Dr. Deborah Proctor, is in fact an experienced market designer, who led the (re-)adoption of a fellowship match for gastroenterology fellows.*

National redistribution of hospital supplies could save lives
Taking supplies from less stressed hospitals and sharing them with overwhelmed ones, we could maximize the use of equipment and save more lives.
Diane R. M. Somlo, Dr. Howard P. Forman and Dr. Deborah D. Proctor

"Since we now know more about the predicted peaks in COVID-19 across the U.S., we can see that peak demand will likely occur at different times in different states and cities, starting in early April and extending through May. While some hospitals are already starting to drown, other hospitals that are further from their peak demand have stockpiles of unused equipment lying in wait. 

"What if there was a nation-wide system that allowed hospitals that have equipment but have lower present and predicted demand to lend some reusable (ventilator) and non-reusable equipment (PPE, testing kits) to hospitals that are currently being overwhelmed? Then, as demand in one area rises and the other falls, freed up ventilators could be re-distributed, and manufacturers will have had more time to generate non-reusable equipment for hospitals that lent their equipment. By taking from stockpiles of less stressed hospitals and sharing it with currently overwhelmed ones, we could maximize the use of our national inventory of equipment and save more lives.
...
" redistribution approaches in other settings have enabled vast functional expansions of limited supplies, including kidney transplants and donated food for food pantries across the U.S. Bottom line: Redistribution has the potential to improve the trajectory of COVID-19 mortality in the U.S. Our country is already on track to employ these measures at a state level or voluntarily, so delaying set up of cross-state exchange only means missing out on the maximal benefit of redistribution. In fact, as of this writing, New York’s Governor Andrew Cuomo has just signed an executive order enabling redistribution of medical supplies to struggling hospitals within New York state and Oregon has sent ventilators to New York.

"In these coming trying times, our healthcare system is facing an unprecedented, deadly burden, and we need to make supplies available where they are needed most —independent of state lines. Now is the time to start making the changes, to call on the federal government, national leaders, and private partnerships to coordinate our efforts as a nation, so we can provide the best care possible with our limited supplies. Lives depend on it."

****************

* Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, ''The Gastroenterology Fellowship Match: The First Two Years,'' Gastroenterology , 135, 2 (August), 344-346, 2008.

Transplantation slows in Canada, too...

Ventilators in short supply may be part of the problem (since most deceased donations involve ventilators), but there's also a general risk aversion at play...

Donated organs not being used as hospitals scale back transplants for COVID-19

"OTTAWA — Transplant centres across the country have massively scaled back organ transplants as hospitals try to make sure they are able to accommodate COVID-19 cases.

"Living-donor surgeries have largely shut down across the country, and deceased-donor transplants are happening only when the case is urgent.

"Dr. Atul Humar, past president of the Canadian Society of Transplantation, said that means many organs are not going to good use.

“There’s some donors, deceased organ donors, and we’re not sending teams to procure those organs,” said Humar, who is also the director of the transplant program at Toronto General Hospital.

“It’s quite tragic.”

"Patients who go through certain types of organ donation often require time in the intensive care unit on a ventilator — resources desperately needed by patients with serious cases of COVID-19.

"At Humar’s hospital, organ transplant surgeries have decreased by about 80 per cent, though the numbers vary from province to province."