
An update on a pre-registered result about the coronavirus - balfirevic
https://www.kalzumeus.com/2020/04/21/japan-coronavirus/
======
kspacewalk2
>We project a true count of over 500,000 infections, including more than 5,000
severe cases, and a breakdown in provision of care (“overshoot”) in Nagoya,
Osaka, and Tokyo, before the end of April.

The current count is ~21,000 with the number of confirmed daily cases
declining for 6 days straight, from 741 to 338 yesterday. So... not only wrong
on the numbers themselves, but also on the scale, trajectory and impact on
society.

Japan's response seems commensurate with the problem, and this reads to me
like an excessively verbose illustration of how one can spin even pre-
registered falsifiable claims whichever way you want regardless of outcome.
'See? We were mostly right'.

Maybe that's too harsh.

~~~
panarky
One might argue that a "true count of infections" is not falsifiable -- people
aren't getting tested, causes of deaths aren't properly attributed, officials
are juking the stats.

A more falsifiable claim is "a breakdown of provision of care in Nagoya,
Osaka, and Tokyo, before the end of April".

If patients are in parking lots or bodies are in refrigerated trucks and mass
graves, that evidence is harder to hide.

There are 10 days left in April, but at this point, is there any evidence of
"a breakdown in the provision of care"?

~~~
barry-cotter
Refusing to test, secret testing locations, over two hours on hold on the
COVID hotline. Things aren’t looking great.

[https://www.facebook.com/groups/524159784940511/permalink/52...](https://www.facebook.com/groups/524159784940511/permalink/529891921033964/)

> 4/17 Friday: At noon my friend wakes up and asks if I can call her ward's
> 保健所 and make a PCR test appointment for her. I call them at 12:30.

> It took 2 HOURS to set up a PCR test.

> As I expected, the staff was INCREDIBLY resistant to offer a test, and spent
> 2 hours asking me 100 questions about her symptoms, what treatment she had
> received so far, what hospital she went to the night before, name of the
> doctor who recommended her a test etc. I'm put on hold for an extra hour as
> they sort their things out. They finally call me back and tell me all of the
> information for her test. But here's the kicker. It's a secret location.
> It's a medical facility that's currently closed, but is being used as a
> corona testing site on the downlow. To enter the building, she'll have to
> walk through the parking lot and use the staff entrance. The woman on the
> phone makes me promise not to tell ANYONE other than my friend the name of
> the place where she is being tested. Because if people knew they were doing
> testing there it would "cause a commotion." I really wish I was making that
> last part up. It's absolutely horrific how much they are trying to cover
> this up and keep the official numbers low. I am currently waiting for them
> to call again with her test results. Getting her tested required 1 ambulance
> ride, two visits to the hospital and 5+ hours on the phone. This is
> ridiculous and something needs to change."

~~~
panarky
Ugh, that sounds like a system designed to frustrate and obfuscate at every
level.

But at some point, it's impossible to hide behind bureaucratic procedures to
limit testing.

@patio11's most falsifiable prediction was for a "breakdown of provision of
care" \-- too many sick people for the number of critical care beds, patients
warehoused in hallways, lobbies, parking lots, tents and stadiums.

And if sick people don't show up there, then they eventually show up at the
morgue.

If there's a public health catastrophe in Japan, at some point it must be too
big to hide.

~~~
tptacek
The timeline from Italy shows this can happen in a matter of days.

------
glofish
I found the post to be lengthy, lacking focus and specificity. More compelling
case could be made in a fraction of its length. Hardly worth reading.

The tedious timeline, tweeting hashes as if that meant anything other than:
"do you see how I was right all along".

The whole concept of tweeting a hash of a whitepaper as form of endorsing it
is kind of absurd.

~~~
akavi
I don't think the set of people whose opinions patio11 cares about would
forget about him tweeting that hash (especially given the emphasis he placed
on it).

The hash concept depends on social norms, and it's a fairly strongly enforced
in his corner of the internet.

------
ohazi
Most of this seemed blindingly obvious to me and my peers (in the US) at the
time that Patrick tweeted his hashes. Several of the replies to his tweets
correctly guessed the topic, and most came to similar conclusions. Anybody
with half a brain knew what was going on.

Maybe Japanese culture really is "different" and things really did need to be
done this way, but I find myself agreeing with other comments here that this
whole effort seems puzzlingly labrynthine with relatively little to show for
it, other than providing an opportunity to tweet hashes.

~~~
joe_the_user
Yeah, making a secret prediction seems only justified when your position is in
the extreme minority and when it contains fairly surprising and/or specific
claims. When your claim is just supporting a "strong minority viewpoint",
doing so secretly ridiculous.

~~~
wglb
I think the article points out the justification as a counter point to the
likely official statements everywhere that "Nobody could have known".

------
gregmac
> A long time ago I did a bit of work on disaster alert systems. They’re not
> dissimilar to fire alarms. The engineered purpose of a fire alarm is not
> merely to let people know there is a fire. Many will have already perceived
> the fire. The alarm, buttressing training delivered far before the alarm
> rings, gives you unquestionable and immediate permission to evacuate. We
> know that otherwise some people, smelling smoke and feeling uneasy, would
> look around the room, see other people not moving, and conclude “Who am I,
> to disrupt everything going on by shouting ‘Fire! Fire! Fire!’?” The history
> of humanity has seen far too many rooms where no one shouted ‘Fire!’ early
> enough.

This alone is a pretty interesting point. Can apply to many other systems that
are much less significant than literally "life or death."

~~~
throwawayiouyt
This novella was worth reading just for this gem. It is equally applicable in
"boiling frog" scenarios as in the "fire" cases.

------
rmccue
The clearest communication about the use of hashes rather than direct
publication is laid out quite simply in patio11's original memo:

> I have concerns about saying this loudly because I have an immigration
> status and because Japan has previously shot the messengers in times of
> national emergency, including in the wake of the 2011 disaster. As someone
> who has spent their entire adult life in Japan, who lives here with my wife
> and children, and who has family on the front lines, I pray daily that I am
> wrong.

~~~
sneak
At which URL did you find that text? I can't locate it on his site.

I can confirm, though, as an expat, that there is a special kind of
fear/restraint involved in needing an opt-in, discretionary permission from a
government to be permitted to physically return to your home (which you
already paid for) and your family. It causes a lot of security-conscious
people to err far on the side of caution, which, indeed, may not even be an
error at all.

Immigration policies generally affect a very small minority of people in a
country, so strengthening the rights around them simply isn't a priority in
most societies, and risks/chilling effects like this fall out as a result.

~~~
rmccue
[http://media.kalzumeus.com/covid-19/japan-
covid19-memo-20200...](http://media.kalzumeus.com/covid-19/japan-
covid19-memo-202003221115.md) \- linked from “I did not publish the memo at
the time.” just before the “ Why did you publish the hash and not the memo?”
title.

------
9nGQluzmnq3M
I usually like patio11's writing style, but this is super verbose even by his
standards and oddly evasive/defensive to boot. There's a number of important
messages here, but they make up perhaps 10% of the content, and I _still_
don't really fully understand the rationale behind the cloak and dagger "hash
of report" business.

~~~
simonebrunozzi
Perhaps that's on purpose. Perhaps he wants to avoid being sued, or similar
things. Patrick has a ton of credibility and I would give him the benefit of
the doubt here.

~~~
joebot123
The purpose of the overall evasiveness could be to prevent personal
retaliation of some kind - that would be understandable. But why avoid
mentioning the word Olympics and instead call it "the sporting event"
repeatedly? Especially now when your connection to the white paper is public.

~~~
pavlov
Maybe because the virus and Olympics are both sensitive topics of national
pride in a country that has turned increasingly nationalistic.

Japan has a conviction rate of over 99%. If a prosecutor decides you're guilty
of something, it's basically a done deal. You don't want to get on the wrong
side of authorities in a country like that.

~~~
derefr
> Japan has a conviction rate of over 99%. If a prosecutor decides you're
> guilty of something, it's basically a done deal.

I thought that was because the prosecutors are very conservative about
choosing what cases to prosecute in the first place, only going after
effective slam dunks.

~~~
nico_h
Long pre-trial detention in some rather uncomfortable situation and social
isolation might help you obtain more "confessions" than in a different system.

------
simonebrunozzi
> Over a roughly 2 week period, we would expect approximately 64,000
> passengers to fly from Japan to Singapore. 3 infections in that population
> is a rate of approximately 47 basis points, which is 5X the 9 basis points
> rate of infection in Japan. If one believes the government, the rate with
> surveilled clusters backed out be a tiny fraction of 9 basis points.

This argument is a bit flawed. People that travel from Japan to Singapore are
not a perfect sample of Japan's population - they might be more likely to be
infected, as they might travel more than the average Japanese person.

~~~
lolc
Three is way too few samples to draw any statistics from anyway. It does
suggest untracked transmission in Japan. And that's about it.

When I read that part I was disappointed to have been lured into reading
another iteration of "I multiply numbers without tracking associated
uncertainty". Sigh. That stuff runs rampant at the moment.

------
grosales
This is just my 2 cents but according to
[https://www.worldometers.info/coronavirus/#countries](https://www.worldometers.info/coronavirus/#countries)
Japan has only done 923 tests for 1M of their population. That's much lower
than any developed nation. One thing the article claims is the spread of the
virus by asymptomatic infected people. Given this low level of testing - it's
hard to gauge the true level of infection in the country - although the
continuous decrease on daily cases is good, it doesn't mean it cannot spike
back up. We just have to wait and see what happens.

~~~
m_mueller
What I find confusing though is Japan's low death numbers. I was assuming that
spikes in mortality couldn't be hidden, but recent comments from inside
sources in Japanese hospitals are starting to make me doubt this assumption.
Still, there is not a crisis on Lombardia-level going on, which one would
expect given the relative inaction of Japanese government. I'm guessing the
truth is somewhere in the middle - Japan's reported numbers _are_
underestimating the issue, but at the same time Japanese society is as a whole
more resistant than at least Southern Europe.

~~~
will4274
I mean, look at the comorbidity data - heart disease, hypertension, diabetes -
aren't the Japanese one of the healthiest people in the world?

~~~
lazyasciiart
Yes, but the population is even older than in Italy, which is also a big
factor.

------
sdffdsfdsfsddsf
Assuming the ratio of cases with symptoms to cases without symptoms usually
remains the same, I must admit I don't immediately understand why it would be
important to determine the amount of asymptomatic cases to determine the risk.
It seems to me the growth rate of (symptomatic) cases would be the major
indicator for that. (Obviously it would be of general interest, but I mean
specifically with respect to gauging the risk).

It all seems to hinge on the assumption that with the implemented "strategy
A", nobody with pneumonia would be tested for Covid19 unless they have a known
connection to a symptomatic case. That of course would be a mistake. But were
people really that complacent that it would never occur to them to test for
Covid19, even as the rest of the world is talking about nothing else?
(Availability of tests is of course a factor here, but should only be a
temporary impediment).

I am interested in it, because here in Germany there also is currently a
discussion of the virus spreading silently, only to come back in full force in
fall if we become complacent. I must admit I don't fully understand the logic
behind that, as surely when it spreads silently, it also has a proportion of
symptomatic cases in its wake, so that in the end, it doesn't spread silently
after all.

~~~
vikramkr
The asymptomatic cases can also spread the disease, and a single individual is
enough to trigger another outbreak if they slip through the cracks, so for
contact tracing and everything you need to know how many asymptomatic cases
there might be and where they might be. And the wake might not be spread
evenly throughout the population, you could end up with younger individuals
being asymptomatic and creating a breeding ground for the virus to spread and
mutate in a college town before, even though it seems to be under control, it
spreads back to vulnerable populations where everyone is symptomatic. That's
one extreme of this but we don't know without random testing how bad it is
towards that end

------
sneak
It would be exceptionally difficult—if not outright impossible—for me to write
something like this and not once make even a passing attempt to imply blame or
culpability for a core dishonesty that may well end up causing thousands of
deaths.

Patrick, I admire your professionalism and restraint in service of your goals.

------
scythe
Must the conclusion be all one way or the other?

Maybe cluster containment was a bad strategy, but not horrible? Maybe masks
and voluntary distancing had a little effect, but not enough? Maybe cases were
undercounted, but not to the tune of 90-99%?

------
porker
Near the top patio11 writes: "Our choice to be anonymous was a considered one
and is discussed in more detail below.".

I cannot find where it's discussed in more detail below. Can someone point me
to it?

------
BerislavLopac
> There are few conspiracies in the world. There are many systems with
> complicated decision-making processes, internal data flows, and incentive
> structures for actors within them.

The second sentence here is absolutely correct, but it directly contradicts
the first one. Because a "conspiracy" is nothing more than having a group of
those actors, with aligned incentives, coordinating to work together while
hiding that coordination with other actors whose incentives are in opposition.

~~~
robocat
I disagree. The second sentence is about uncoordinated actors making
decisions, without anyone conspiring together. The emergent behaviour may look
like a conspiracy, which is what he is pointing out.

~~~
BerislavLopac
What is the difference between "looking like a conspiracy" and "being a
conspiracy"?

~~~
NateEag
The actors' intent.

Actual conspiracies involve deceit, misdirection, and ill will.

"Never attribute to malice that which can adequately be explained by
incompetence."

It's not a perfect rule, but it is a helpful idea to keep in mind.

------
jeffreyrogers
This seems a bit over-the-top. Sure, maybe Japan isn't testing and is just
treating pneumonia cases as pneumonia cases instead of the cornavirus cases
they actually are, but if that is allowing society to function mostly normally
and isn't changing death rates all that much I don't see the harm. Arguably
that is a better response than shutting down your economy and creating massive
debt problems that will need to be resolved later.

~~~
XorNot
The death rate from COVID-19 is a constant: about ~1% of all cases, so far as
is currently known.

If the R0 of the virus is about 2 (which from evidence is about the case for
uncontained spread, possibly higher) then half of your entire case load is
discovered in the last increment.

That period is (roughly) 14 days from infection to the onset of symptoms. We
cannot build a hospital, nor train doctors and nurses, in 14 days.

But here's the thing: the hospitalization rate - which is what keeps the death
rate at 1% - is around 10 - 15%. And both those numbers are constants,
multiplied against an exponential factor. And hospital stays are around 3 to 4
weeks long.

By the time your hospital beds are 50% full, you're already out of capacity -
the next wave is going to be being denied treatment. And in fact, anyone else
who has an otherwise treatable but potentially life-threatening condition is
also going to be denied treatment. At which point a lot of your deaths aren't
going to be _directly_ due to COVID-19...but that's really not going to
matter.

~~~
jeffreyrogers
Okay, but this appears to not be happening in Japan. Why not? If your answer
is, it's going to happen, then why hasn't it happened already if things are
truly as dire as the original essay is saying?

Edit: It also appears to not be happening in Sweden. I think a lot of the
modeling of this is flawed.

~~~
XorNot
I'll be a lot more interested when it hasn't happened 2 weeks from now.

------
glandium
Random comments in this frame of context:

\- I've seen/heard some doctors saying publicly, on Japanese TV, mid-March, "I
think there are 10 times more cases than reported"

\- There's an average of 270 deaths per day from pneumonia on a normal year in
Japan (100k).

\- The largest number of deaths announced from COVID-19 in a single day was, I
think, yesterday, and it was 20.

\- Deaths from pneumonia that aren't tested could very well appear to be in
the noise of normal pneumonia deaths, easily hiding the real death toll. It
doesn't take malicious intent for this to happen, just people following the
rules (see below).

\- Generally speaking, Japanese institutions have a very difficult time moving
outside the box. If they have a written plan that is to be followed, that is
what happens.

\- The plan was to test people who had 4 consecutive days of fever (2 for
older people) _and_ close contact with people already diagnosed, and that's
what happened.

\- It took prefecture governors starting to do things on their own for the
central government to start moving. That happened for school closures
(Hokkaido leading the way, then Osaka, IIRC), and sending mild cases to hotels
or making them stay at home, rather than occupy beds in hospitals (started in
Osaka, IIRC)

\- Hospitals have a shortage of equipment, and beds. Some prefectures have
ramped up the number of available beds for infectious diseases. The government
finally changed the rules to allow mild cases to be isolated out of hospitals
(I think about a week ago, but it's hard to keep track of time these days).

\- Some hospitals have closed their doors completely. The reason? Clusters of
COVID-19 in staff and patients. Not because they were treating COVID-19
patients as COVID-19 patients. But because they were treating patients that
turned out to have COVID-19. Or people with COVID-19 going there for
consultations. Which is not all that surprising when you know people are
reportedly going from hospital to hospital to try to be tested for COVID-19.
If anything, I'm surprised there aren't more clusters in hospitals.

\- There have been reports of ambulances having to try a large number of
hospitals before finding an ER able to attend to their non-COVID-19 patient.

I wrote this on April 4: _" the political response to covid-19 in Japan is
pissing me off now. It now feels like watching a 100 km/h car running into a
wall in slow motion, and the car is already in contact with the wall and
absorbing kinetic energy."_

Almost 3 weeks later, I think we're seeing the engine entering the passenger
cabin.

------
timerol
I really appreciate this post. It's hard to read, but this seems very
intentional. There are a number of salient points that are very specifically
not stated. Some questions deliberately not answered:

Who was on the Working Group, other than Patrick? Dr. Tyler Cowen spread the
results, but no one is mentioned as working in the group other than Patrick.
This seems designed to limit potential social fallout to other parties. The
whole "Someone read between the lines" section would be much easier to read
with the relevant person named. Also consider that Patrick may be limiting
fallout to himself here, with the bold statement early on that "I instigated
the Working Group and I was the primary author of its white paper."

Did the NYT article writer correspond with the Working Group? The white paper
was published with plenty of time before the article was written, and the
explicit goal of the Working Group was to "leverage a news organization." Also
consider that the NYT article was published on Thursday. And when discussing
the goals of the working group, "This implied a publication deadline of
Thursday. We assumed media organizations would need our work by Wednesday to
check it and produce reporting informed by it." Note that Dr. Cowen's quick
post was also published on Thursday, possibly to increase deniability when
referring to that goal date.

What Japanese organizations failed to respond to this crisis? The most damning
prose in the entire article is "May all judgments be just and merciful."
Patrick does not identify any Japanese organization or government by name, but
says that the Working Group spoke to many of them. Also, both memos are listed
in the timeline immediately before a announcement by Governor Koike. Patrick
even convolutes his prose to the point where he never mentions the Olympics. I
wouldn't be surprised if he had another sporting event in mind that also
matched the specifics of what he wrote.

How much influence did the Working Group have in Japan's response? The NYT
article is definitely one potential point of influence, but it seems that the
memo itself was shared widely. Consider the difference between this humble
ending to the article: "I am a responsible professional. I have no relevant
expertise or authority. I have avoided unproductive criticism. I might have
made some guesses, during a year when many people were guessing on many
topics. I quietly told some people about them. Some guesses may, perhaps by
happenstance, align with official guidance and credible published reporting."
and his tweet confirming the memo (option 1): "I am materially wrong about the
most consequential thing I've had to have a view on in 15 years. You should
probably degrade your estimate of my ability to think through complex
problems."

Interpreting things through an aggressive lens, I read this as a scathing
diatribe against the Japanese government, where a non-expert foreigner living
in Japan has to get the Western media involved before the government would
admit to there being a problem. Props to the governor of Tokyo for being more
on top of this than anyone else (perhaps with the Working Group's
involvement), but the national government completely dragged its feet until it
was forced by international pressure to start asking real questions.

But I'm probably reading too much into it. Patrick's too humble of a guy to
say all of that.

~~~
philwelch
> Who was on the Working Group, other than Patrick?

An interesting question—but if they wanted to be publicly known, they would
be. I’d rather leave that to them.

> Patrick even convolutes his prose to the point where he never mentions the
> Olympics. I wouldn't be surprised if he had another sporting event in mind
> that also matched the specifics of what he wrote.

The NPB season was originally scheduled to start March 20 but has been
postponed, with the original postponement decision announced March 9. The
Olympics were postponed on March 24; the hash dates from March 25th.

------
weinzierl
I love Patrick's posts but this is _long_ , even for his standards. Can
someone summarize the main points?

~~~
HackOfAllTrades
No. It's well worth your time to read the whole piece.

------
mherdeg
Cool. Did you trade on it?

------
AnonC
> I felt, while my subjective confidence was 90%, that I was likely
> miscalibrated. _The likelihood that one non-expert, doing casual sleuthing
> in his spare time, had scooped not just any expert but almost all the
> experts and almost all the parties in formal authority felt infinitesimally
> small._

So...was it just a coincidence that the results seem vindicated? Or is the
above statement just too much modesty? Or both?

~~~
AgentME
There's a whole section at the end with his theories about why you could
expect someone like him to get this better than the experts (the experts were
too busy managing the intricacies of Plan A instead of constantly rigorously
checking that its assumptions still held and whether it was time to give up
and switch to Plan B, etc), and he makes a point against having too much
modesty like he did if you have good data.

------
seemslegit
There is no way Japan's faux-success is due solely or even dominantly to
asymptomatic cases, they had to be turning a blind eye to symptomatic ones as
well and attributing them to pneumonia, flu etc. The fact that the reported
rates began rising only after the Tokyo Olympics were announced cancelled is
almost a USSR-era farce.

Japan has a leading hospital-bed-per-capita capacity in the OECD which could
help them conceal this but I believe if occupancy of those beds was graphed
for the last two months we'd see a curve indicating an epidemic comparable
with US and Europe.

~~~
twblalock
Then where are the overwhelmed hospitals? Where are the bodies?

~~~
seemslegit
They're not overwhelmed yet because they have capacity (NYC hospitals are
struggling but are not over capacity either), deaths happen all the time
especially in a country with aging population like Japan and are just not
counted as covid19, like the author says it will probably be visible in excess
deaths statistics once those are published.

------
simonebrunozzi
Oh my. The Japanese government should feel ashamed to have hidden all of this
from the public (edit: I mean the real data and the real gravity of the
situation, of course). I, for one, fled the US to come to Japan for a few
weeks because I mostly believed these numbers.

I hate this. I really hate that politicians (all over the world, in this
specific case in Japan) can afford to treat us like this, and usually not face
any significant consequence.

~~~
kspacewalk2
>I, for one, fled the US to come to Japan for a few weeks because I mostly
believed these numbers.

SARS-CoV-2 thanks you for your efforts to help it find new populations to
replicate in.

~~~
SketchySeaBeast
Yeah, considering that you can be asymptomatic for quite a few days that was
an extraordinarily selfish act. Fear made them a vector. Feels like the guy in
a zombie movie who tries to break the door down to get into the safe room.

~~~
Trasmatta
Or like Charles Campion in The Stand.

