>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'.
Yeah, I'm withholding judgement till "the end of April", but given Japan's doubling time is roughly 10 days, you'd expect there to be ~2.5k severe cases right now. Given that Japan's official count is ~11k, is there reason to believe 1/4 of all official cases are "severe"?
Does anyone have up-to-date data on "excess deaths" in Japan for the past few months?
> Although the majority of reported COVID-19 cases in China were mild (81%)
Combine the 19% severe cases number out of China with Japan's aging population (which COVID-19 hits substantially harder), and 1/4 is entirely reasonable.
Is "mild" vs. "severe" dichotomous? I feel like I've usually seen the trichotomy of "mild" => not needing hospitalization, "moderate" => needing hospitalization, "severe" => needing ICU treatment.
Maybe I read that wrong, but wasn't the point that Japan wasn't acting appropriately, and that white paper, along with other research, forced (for lack of a better word) them to own up to the scale of what they were seeing?
Isn't the point that, while the particulars were proved false, the overall thrust of the article that Japan was stalling action which MAY lead to those numbers was true?
Honestly, who has 1-1.5h to read this without skimming through most of the verbiage to tease out the point? I read the "pre-registered" part. It was wrong on a bunch of points, both numbers and impact. I strongly doubt a major world economy of 126 million people with many world-class epidemiologists and doctors and generally non-disastrous political leadership was 'forced' into anything by this.
You’re not a certified expert. Shut up and listen to your betters.
If there were actually the reserves of competence you and others like you believe in; if the authorities actually deserved our trust almost everywhere would have done as well as Taiwan or at least Korea. In the world we actually live in the CDC stopped the Seattle Flu Study from testing for COVID-19 and banned private labs from testing for more than two weeks after fucking up its own tests.
In the world we actually live in the prestige media spent most of February making fun of people who thought this was a real problem that would spread outside China, and later Italy. They didn’t act like they were taking it seriously. They followed the lead of the WHO, which should have been setting the alarm and instead was telling people that the real enemy was prejudice.
Many countries with well credentialed experts failed. You wouldn’t accuse them of hubris. But they failed.
A month ago it was obvious to Patrick that there was a great deal of untracked community spread of COVID in Japan. If the Japanese government was aware of that they would have shut the country down. In reality they only did that four days ago[1]. If they had done that a month ago there wouldn’t be such a shortage of PPE they’re calling for donations of raincoats. There are going to be thousands of excess deaths in Tokyo and they’ll be triaging people leaving the old to die like they did in Lombardy before the month is out.
> One poll shows 75% of people think the prime minister took too long to declare a state of emergency in Tokyo.
After a recent spike in cases in the capital Tokyo, experts warned that the city’s emergency medical facilities could collapse under the pressure. Officials in Tokyo have also urged people to work from home.
Prime Minister Shinzo Abe, centre, declared the state of emergency at a special meeting of medical experts
After the initial state of emergency came into force on 8 April, a number of other regional governors called for the measures to be extended to their areas, saying that cases were growing and their medical facilities were overwhelmed.
Japan’s two emergency medical associations also issued a joint statement warning that they were “already sensing the collapse of the emergency medical system”.
Is patio11 a certified expert? Should he be considered my better? Your better? Should we consider him the better of the actual certified experts in infectious diseases?
If not, then shouldn’t you shut up and listen to those people, who are certified as your betters when it comes to their subject matter? Even the ones who you called out as being wrong in your initial post?
I think maybe you should kick up the leg rest on your La-Z-Boy and relax into your armchair rather than attacking other posters. Unless you’re a certified expert and not just an armchair expert.
Shut up and listen to your betters is kspacewalk’s attitude. Anyone accusing others of hubris for trying to save lives and not assuming competence when the authorities have shown so little is a part of the problem. Anyone who believes that serious problems should be left to experts is a dangerous obstacle to actually solving them in situations of high uncertainty.
The certified experts at the WHO, CDC and FDA failed. Why the hell should they be trusted?
Patrick's entire narrative is sourced from facts generated by experts. His own contributions appear to involve statistical literacy, deep conversance with Japanese language and culture, the ability to locate and comprehend "open source" government documents, and the initiative to do something with those capabilities. We're not asked to take Patrick's word on whether HCQ is an effective treatment or whether procedure masks are effective at combating spread; all we're relying on from Patrick is "yes, these documents produced by the government of Japan do indeed contradict the party line".
While I appreciate what you're trying to say here, your point is orthogonal to the discussion.
The original comment was about the tone of patio11's post and the assertion that an anonymous white paper significantly altered policy decisions of one of the world's most technologically, scientifically, and academically advanced countries. The response the original commenter got from barry-cotter was to "shut up and listen to your betters" because the commenter wasn't a "certified expert" followed by a rant that could have come straight from an episode of Coast to Coast AM. Even his attempts below to walk back his position or re-frame his post as being somehow tongue-in-cheek fail basic logic checks and sound like the ravings of a lunatic bent on exposing some great conspiracy by the learned elite that control the medical-industrial-media complex.
It's just worthless noise. He says we shouldn't trust the experts because they got it wrong, but we should trust patio11 because he didn't get it wrong (or did he? who knows, it's in the future!), but we should trust the "certified experts," but we shouldn't trust the goddamn "prestige media" because all they cared about in February was making fun of people who thought this was a real problem, but wait a minute isn't that media also now taking aim at people who think we should relax social distancing? So is the media going after people who think it's a real problem or are they going after people who don't think it's a real problem?
See what I'm saying? It's just anger and frustration being vented through a keyboard. It's noise and serves no discernible purpose.
We can quibble about patio11's true contribution (we can, but I won't) but, again, that is orthogonal to the point which is that a lot of self-righteous folks have used the coronavirus outbreak as a great way to lash out and/or push their ideology in not so civil manners and through fear-mongering ("THOUSANDS of EXCESS DEATHS in Tokyo!!!"), and we should discourage this behavior as a community.
> The response the original commenter got from barry-cotter was to "shut up and listen to your betters" because the commenter wasn't a "certified expert" followed by a rant that could have come straight from an episode of Coast to Coast AM.
I apologize for a lack of clarity in my writing but not for being very, very pissed off. I assumed it was obvious that I was paraphrasing kspacewalk in the bit about one’s betters, given that it directly followed a quote about the hubris of thinking that a mere peon’s opinion is worth anything or that what they do might matter.
If the people and institutions in which we have placed our trust fail us we have every right to be angry. The populace’s of Taiwan, Korea and Singapore should be showering their ministers, civil servants and CDC equivalents with rose petals. Everywhere else screwed up to varying extents and thousands to hundreds of thousands of people will die because they failed at their job.
> Honestly, who has 1-1.5h to read this without skimming through most of the verbiage to tease out the point?
I’m not trying to flex on you, but it didn’t take me nearly that long to read it. And it really does not demonstrate good faith on your part to come here and tear down patio11 without even doing the basic due diligence of actually reading the damn thing you’re commenting on first.
Everyone with disastrous predictions about the coronavirus can and does make that claim. If my predictions aren't true, give it a few weeks and exponential growth will make them true. If they still aren't true, then they would have been true, but whatever we did a few weeks ago must have been the correct reaction to my predictions.
The very general thrust - that Japan surely had community spread - I agree was true and not widely acknowledged at the time. But I don't think that exempts the more specific projections from analysis.
I understand the problem with some of the claims people make about things being really bad being unfalsifiable.
At the same time, the expected outcome of social distancing is for the outcome to be not as bad... so people will always be able to make this complaint. What exactly do you expect from people who are advocating social distancing?
I expect a degree of epistemic humility. "We don't know how bad it's going to get, but we know that the worst case is very bad, so let's go to extreme lengths to make sure we don't hit it" - no objections to that message. But in my local area, and from what I understand many others, people were saying in mid-March that it was already too late and there would surely be bodies in the streets.
Which hasn't been that bad until now, but it's going to be an increasingly large problem as most countries pass the peak and try to reopen. A lot of people have been convinced that reopening can never happen, that if people are allowed to go to school or restaurants that'll be what tips the health care system over.
"We took the measures that mitigated a disaster, therefore the disaster was never going to happen" is an idiotic opinion.
A virus that spreads from close proximity with infected people, and you're arguing that shoving people back in close proximity is not going to contribute to spreading it? Why? On what basis will this not happen, despite this being exactly what happened?
Spain took about 1 month to go from "hm this coronavirus thing is spreading" to "if you're over 75 we're not going to bother with ventilators because we can't spare the capacity".
Things have to reopen eventually, but if you haven't actually increased your test and tracing capacity, then the effect is going to be exactly what happened in 1918 https://www.popsci.com/story/health/coronavirus-1918-flu-pan... (wherein an experiment with a control was accidentally run at a substantial cost in lives between two US cities).
Sorry, what's the accidental experiment here? The article doesn't suggest any cities in 1918 were doing testing or contact tracing - they couldn't have been, because they didn't even know that the flu was a virus at the time. And I'm not seeing anything about a general closure of non-essential businesses either.
I certainly wouldn't dispute that closing schools and banning public gatherings were good moves.
Quarantine measures were widely implemented in major cities during the 1918 pandemic, but at different times in response to different catastrophes and with a very different result in deaths per capita.
> Around the same time, the city of St. Louis was closing schools, libraries, courthouses, churches, playgrounds as well as limiting the number of people on streetcars and staggering work shifts to minimise contact.
St Louis did relatively well - but they released quarantine measures early and got an unnecessary double peak (see the first source, which shows exactly pretty clearly exactly when they did it, and then quickly reimplemented it).
The lessons of history here really could not be clearer.
Your more wordy source does not describe general business closures and doesn't say the word "quarantine". The lessons of history are clear that we needed to do something, certainly.
> The article doesn't suggest any cities in 1918 were doing testing or contact tracing - they couldn't have been, because they didn't even know that the flu was a virus at the time.
Testing in the modern sense was impossible as a matter of science.
Modern contact tracing could in principle have been done, but it's my understanding that it wasn't. The kind of tracing in the Broad Street outbreak is very different - cholera mostly doesn't spread from person to person, so John Snow had to figure out only where each of the victims spent their time and not an exponential sized web of people they went out drinking with.
i'd love some media humility as well. the self-righteous corona-panic bias of the media i tend to consume (npr, nytimes, etc.) is unwavering and nauseating.
the last couple months of experience tells us (imperfect) physical distancing has done the heavy lifting in flattening the curve, and yet the media orthodoxy is still that stepping one unsheathed toe outside your door is just asking for death. this morning an npr reporter openly mocked a governor for even suggesting a loosening of the lockdown. it's brainless.
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"?
> 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."
This seems like exactly the measures I would institute if I just plain didn't have enough tests to test everyone who wants one (i.e. almost all humans). The secrecy sounds perfectly normal if the goal is to not be swarmed by masses of people who likely just need to stay home.
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.
Exponential growth means fully half of the present population occurred in the last growth cycle (presuming R0 ~ 2).
With a mean time to symptoms of 14 days, depending on what Japan is doing, 10 days is an age (though it's worth noting that severe respiratory symptoms set in in week 3).
The average is 5-6 days to show any symptoms. That is the figure that you are remembering.
If it is going to turn severe, the average to develop severe shortness of breath from first symptoms is another 7-10 days. Which means that the range from exposure to severe shortness of breath is 12-16 days...or an average of 14 days.
Which is exactly what the person that you were responding to said. So your memory was correct in so far as it went, but you were remembering the wrong fact about COVID-19.
Yeah, I don't understand at all what the purpose of publishing this hash was supposed to be. Is it just to be able to say "I told you so!" (or in this case, I didn't tell you so, but I really did think this) at some later date?
> In a world where I was wrong, people who trust me professionally would likely think less of me. That was an acceptable risk.
Yeah, what a hero taking an extremely slight risk to his reputation in the middle of a pandemic.
Sorry, I normally generally like things patio11 writes on here (he's the bingo card guy, right?) but this whole thing reads like a lengthy ego-stroke.
The point of the hash is a marker to force yourself to come to terms with your idea.
You make it public and then act on it.
The author has a visa to stay in Japan, a country with strict rules on the disruption of public order. Spreading unfounded speculation on a pandemic might rule afoul of such rules.
But if you didn't act on it then you're just a shmuck that knew something and didn't help their neighbors, if you did act, you can justifiably _be_ smug because you did something about it.
Posting it and acting on it build a "track record" that is harder to dismiss.
> The current count is ~21,000 with the number of confirmed daily cases declining for 6 days straight
Yes, but all of those 6 days are still higher than 7 & 8 days ago. In fact, all the days you picked are also higher than they were through March 15st-April 4th too - and several days between April 4th onwards as well.
Today's new cases in Japan are many multiples higher than most days in March - but I do hope they continue their recent trend of decline.
> So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society.
Maybe, but they did use the term "true count" which appears to mean: asymptomatic and those who have it but haven't/won't get tested.
As the US has learned, once you start to ramp up testing the case count ramps up too.
Looking at Japan's testing, they are testing more per day now than in March[0] but their total number of people tested is still not very high at almost 117k[1] - given they have ~125m population.
> NHK confirms that coronavirus-appropriate hospital beds are 80%+ filled in Tokyo, Osaka, Ishikawa, Hyogo, Shiga, and Okinawa.
> Experts threshold of concern for imminent impact on medical care is 30%, again per NHK.
> The 28 prefectures which are above that threshold will not fit in this tweet.
> NHK reports that several prefectures which were unable to sustain the prior strategy of hospitalizing all diagnosed cases have begun moving less severely affected patients to hotels/etc or asking them to self-sequester at home, temporarily freeing up bed space.
>!NHK reports that while reprioritization of hospitalization strategy and urgent measures to add more beds may buy some time, the situation risks a collapse in the provision of medical care, and that experts explain we cannot be optimistic.
It's not too harsh. It seems pretty clear to me the blasé conclusion that essentially "things are gonna get much worse in a month" (no duh) was loosely backfilled with numbers after the conclusion was already made.
Writing in a circuitous manner may have been necessary due to the author's immigration status but it's also a very convenient smokescreen that makes his group's results look more dramatic.
For example, the timeline for March 24th, the day before this epic whitepaper was released: "a sporting event is postponed." This "sporting event" was the Tokyo OLYMPICS! But showing that Japan was already starting to take COVID-19 a lot more seriously than some of their public pronouncements may lead you to believe before the whitepaper release date might undercut the article's implication that his whitepaper changed the public narrative and thus the author would be less deserving of asspats and clout.
I've heard people say that this pandemic highlights the (unfortunate) severe lag time of real-life discourse to Twitter's discourse (what is "known" on Twitter versus public narrative).[^1] From that angle this report could be a good thing to try to short-circuit that gap. My opinion is the attempt failed (more accurately their conclusion was already stale), and this writeup brings it right back around to the worst parts of Twitter's discourse - personal brand marketing and clout-chasing.
[^1]: While that's undoubtedly true, Twitter also generates a massive amount of garbage takes which are conveniently forgotten through severe selection bias (looking back with hindsight to see who was right is easy). Online takes also have zero cost compared to reality; you can throw infinite virtual darts at a dartboard but in reality you can steer your meat machine down only one path. Thus there will always be a lag between the two.
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.
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.
The prior 3 weeks I was in a remote area with essentially no contact with anyone. I came back to SF, stayed at home for one night, and left.
Also, if I feel endangered, I have every right to decide where to go. You might see it as selfish, I see why. At least I am paying my useless and expensive health insurance in the US (out of my own pocket, because you know what? I'm unemployed right now) to support the system, even if I am not taking advantage of it.
Sometimes things are a bit more complicated than "SARS-CoV-2 thanks you for your efforts...".
If you can't see the why we're incredulous at the idea of intercontinental travel at the height of a pandemic where an often asymptomatic and incredibly infectious disease is running rampant ... then I honestly do not know what to tell you.
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.
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.
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.
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.
> 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.
Long pre-trial detention in some rather uncomfortable situation and social isolation might help you obtain more "confessions" than in a different system.
Probably because you could end up losing your visa and get sued by the Olympic Committee if you say 'Shinzo Abe is suppressing covid-19 research because of the Olympics.' Maybe even jail time.
The "big internet presence" is among readers of Hacker News. He's nowhere near the prominence of plenty of people in Japan making public, pessimistic predictions about the pandemic without acting like they're going to get persecuted for it.
He may be afraid of non-official censure. He may be afraid of his employer getting publically crapped on for the bad behaviour of it's employee. (In this case, the bad behaviour is causing waves.)
If you have direct knowledge of how Japanese official process works in practice, could you relate it along with this observation? Because a thing not in much doubt on HN is that Patrick does have some significant experience with it.
Sure happy to share. I guess most people would be surprised, but Japan has very straightforward and easy immigration if you meet the right conditions, of which Patrick is a shoe-in. He probably already has permanent residency, but if not, he could either be on a work visa or a spousal visa. None of those are going to get rejected because he did some amateur pandemic modeling.
Assuming someone at immigration would take the time to look into his background (not just his paperwork), find out that he wrote a Covid-19 white paper with higher projections than the government at the time and then blacklist him for it is such a mischaracterization of Japanese process, I don't know where to start. It's not like there's a source I can reference, but I also have a lot of knowledge of Japanese immigration through knowing plenty of foreigners on different visas in Japan and have never heard of anyone getting rejected if they meet the conditions.
I can share one interesting anecdotal counter-example to show how easygoing Japanese immigration is. Someone I knew was on a fraudulent work visa "working" for a friend. He was actually creating a startup. By the time immigration found out, he had the necessary scale to sponsor his own work visa, so he wrote an apology letter and then switched to his own work visa even though the foundation of the company was built on a fraudulent visa.
I cofounded a company with Patrick several years ago and have known him for a long time, and in that entire time he has lived full time in Japan. I don't know the particulars of his immigration situation, but if I had to hazard a guess, yes, he's a PR.
I don't know anything in particular about his concerns about his own status. I have, on the other hand, known many LPRs in the US who were extraordinarily careful about their engagement in public matters out of concern about their status.
If your argument is that protection for PRs in Japan is stronger than that of US LPRs, I'm going to go ahead and call that an extraordinary claim. At some point, though, probably rapidly approaching, litigating this point becomes ghoulish. I haven't heard Patrick say he's specifically concerned about his own status, but he's clearly concerned about some of the people he worked with.
known many LPRs in the US who were extraordinarily careful about their engagement in public matters out of concern about their status.
That has to be a function of knowing a particular variety of (however reasonably) paranoid LPR's, though, no? I can't imagine it being a core concern for the vast majority of LPRs.
I assume most LPRs aren't really in a position to have to think about being engaged with public policy, and the LPRs I tend to know work in a field that intersects a bit more with policy.
Maybe I'm misreading something but do you mean their status as a person engaged in public policy? There's obviously a lot one can sensibly worry about while an LPR but I have a hard time seeing how even the most ill-advised engagement in public policy (short of things like fomenting insurrection) would lead to loss of the actual LRP status. Like, what would even the mechanism be?
I think your anecdote only shows how much discretion the immigration department has in enforcing the law. That same discretion could easily go the other way if someone were to embarrass Japanese authorities.
> That's not how Japanese immigration or prosecution work
Please enlighten us. How does public defamation work in Japan then? I don't know much but I did just google it right now[0] and to my layman eyes it looks bad:
> “(1) A person who defames another by alleging facts in public shall, regardless of whether such facts are true or false, be punished by imprisonment with or without work for not more than three (3) years or a fine of not more than 500,000 yen.”
Did? I think he just lost all of it with this arrogant stunt. Especially since he himself said,
Either:
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.
2) We need a data point to counter "Nobody could possibly have seen this coming."
He didn't predict anything "nobody could possibly have seen coming" and he was also mostly wrong, so...
You're all over the thread with comments like these. If you were responding to Patrick directly on HN, you'd be quickly and rightly flagged for writing this way. That Patrick wrote this in a blog post and not in HN comments has insulated you from that effect, but it shouldn't, and I would guess won't for long.
Patrick isn't infallible and may be wrong in a multitude of ways in this post (I haven't lived my whole adult life in Japan and wouldn't know). You should take your best shot at his arguments. But you need to do it civilly.
I'm all over the thread with comments like these since the whole charade is ridiculous and is only getting undue attention here since Patrick is popular on Hacker News and very few commenters have familiarity with Japan, either as a whole or especially regarding the pandemic response.
I've never met Patrick personally but also had a lot of respect for him from past writings; that's probably why I was so disappointed with what he did here. If I weren't knowledgeable about Japan, maybe I'd also just assume he's right because he feels like someone I know, but I do know better and that's why I'm commenting.
My shots aren't at his arguments about pandemic modeling, but everything he's done surrounding that. As plenty of other comments here mention; everything is heavily self-promotional and smug. And I agree under normal circumstances the above comment would be flag-worthy, but he specifically staked his reputation on this with extreme language, so I mirrored that. So I apologize for the poor tone; but I think it's appropriate in the context of referencing that Tweet.
A friend showed me the tweet last month and asked if it was about the pandemic in Japan. I said it can't possibly be that since everyone here sees it coming and knows the government is just dragging their feet. And I don't mean "everyone" in a smugly exclusive sense; all of the top comments on every article on the Japanese news sites were saying the same thing.
So maybe there's novel work in the white paper; that's great, but my "best shots" are that it's ridiculous to claim that no one else saw this coming, this paper influenced Japan to shift their strategy, and being public is going to get him persecuted in Japan (those last two even seem contradictory). These would all be obvious to anyone living here, and make it seem like Patrick is using this information asymmetry and his existing reputation to blow this into something it's not in the eyes of a foreign community.
Sorry I don't know how to quote so maybe my comment was confusing between what I wrote and what Patrick wrote. Here's his Tweet claiming that and explicitly staking his reputation on this:
To mention one more thing, I think what really frustrates me about this and incited me to comment a lot here is that to make his effort seem like a big deal, Patrick is presenting everyone else in Japan as fools and building up this white savior narrative.
His post implies that the Japanese experts and officials are both so inept that they couldn't keep up with his overnight-expert pandemic modeling and so malicious that they would persecute him for doing a better job. That's completely untrue, but with his reputation on Hacker News, it looks like a lot of people here are taking those characterizations at face value. As someone who knows Japan and respects the community here, that's a very upsetting development.
Unfortunately this thread blew up in the middle of the night in Japan. I happen to be awake, but it's so late I might be the only person in Japan in this thread before it dies.
You have to want this "white savior" thing to see that as a narrative. Corrupt and/or inept government responses to pandemics is something people of all colors seem to share right now. I'm not interested in debating it, but if your argument is that Patrick is playing "white savior", yes, you should make that more explicitly, rather than expressing it subtly through being a jerk.
> To mention one more thing, I think what really frustrates me about this and incited me to comment a lot here is that to make his effort seem like a big deal, Patrick is presenting everyone else in Japan as fools and building up this white savior narrative.
Whatever about any legitimate criticisms you may have this is just being one or both of being an asshole or a racist. If Patrick had spent his entire adult life in Sweden and he was writing about how the Swedish government had messed up you wouldn’t be calling him anything equivalent.
> This is a very different essay than my typical work. It may be judged to very different standards in very different quarters than usual. Please excuse my need to write more reservedly and participate less in subsequent commentary than I usually would. Some truths have social consequences, acknowledged or not.
I thought the same, like he's walking on eggshells? Maybe it's his assocation with Stripe or due to someone else in the working group? The memo doesn't read as particularly controversial nor did it recommend much concrete action.
I left Japan in early March, by personal anecdote masks seemed pretty ubiquitious (and all public facing employees were wearing them), hotels were screening guest temperatures, warning signs everywhere, etc.. Time will tell, but I still think I'd have been better of staying there than returning to the US.
> The memo doesn't read as particularly controversial nor did it recommend much concrete action.
Well it was pointing out that the current plan was B.S. and had already failed, and that the testing plan in place resisted falsification by preventing testing of unconnected / asymptomatic people. no biggie.
The point of the memo was to gather and surface disparate information already public separately un-worrisome but that together might be able to be paid enough attention to for a (positive) governmental reaction.
It was to force agencies to connect dots that the authors believe were not being connected. (Maybe it just wasn’t anybody’s job to connect them)
> I still don't really fully understand the rationale behind the cloak and dagger "hash of report" business.
I didn’t read every word of it but got the sense there were political and/or Japanese cultural sensitivities why he didn’t initially feel comfortable with a full public, attributed release.
I think you're being a bit too accommodating. McKenzie does have a flair for the dramatic; he did the same thing with Tether where there really was no reason he couldn't just say what he thought when he thought it.
At the same time, yeah, it seems very plausible that a white guy in Japan announcing the Japanese pandemic response is run by fools would face blowback for it.
>At the same time, yeah, it seems very plausible that a white guy in Japan announcing the Japanese pandemic response is run by fools would face blowback for it.
Haha, yeah pretty much that. And any blowback may also have been directed at his employer, Stripe. So there was certainly cause for caution.
That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
Having that realization back in January is evidence of foresight, but late March not so much. But maybe the situation was different in Japan and merits it, dunno.
> That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
Having that realization back in January is evidence of foresight, but late March not so much.
If this had been obvious to the Japanese authorities in late March they would have declared a nationwide state of emergency in late March, not late April. They would have issued stay at home orders for almost everyone 25 days ago, not five days ago. Being right when the government is wrong, it being wrong will cost lives and trying to get them to save those lives is not trivial.
The doubling time of this virus is well under ten days. If lockdown had begun on the date this memo was published there would be under a quarter as many cases as there are now.
That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
He made it amply clear to me that it wasn't much of a leap of insight, and the point of his original essay was to create proof that he knew that at the time.
The fact that taking the action that he did resulted in a group of people who put together a compelling enough argument with good enough connections to get the New York Times to write about it DOES seem like it is worthwhile.
As it turned out, having the New York Times asking whether the emperor had clothes caused lots of people in Japan to ask the right question which in turn caused the government to switch courses. The fact that this happened again underscores the point that, on publicly available data at that time, it didn't take an amazing leap of insight to understand that the Japanese story didn't add up.
The point being that this was foreseeable at the time. Which was indicated the first time when he said that he assumed that the authorities in charge with access to more data than he had already had come to same conclusions that he did.
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.
> 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.
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.
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%?
This is just my 2 cents but according to 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.
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.
I doubt there's much overlap in people who have so little human contact that no one knows they're dead and people who catch viruses that are still present in only a tiny fraction of the population.
Oh, and a third condition that these people be such recluses that they don't even call a doctor when deathly ill.
Japan is a country where at the best of times, a lot of people die at home and are not discovered for some time. If you remove social contacts thanks to lockdown, this is going to become more common.
Yes, that happens sometimes, but no, there are not thousands of unnoticed dead people in their apartments in Japan.
Occam’s razor in this case is that the pandemic in Japan isn’t as bad as the author projected. It’s not a conspiracy or coverup and there aren’t dead bodies hiding everywhere, the author was just wrong.
If you read https://www.who.int/bulletin/online_first/20-254565.pdf you will find credible reasoning for 90% of COVID-19 cases not being tracked in official numbers, with a wide uncertainty. That correction would make it 200,000 cases in Japan by the end of the month. If you update that argument with the lower IFRs suggested in https://www.cebm.net/covid-19/global-covid-19-case-fatality-... then you get to a projection of 500,000 cases in Japan. (The admittedly problematic Stanford study came up with a suggestion of similar underreporting factors in both Santa Clara and Los Angeles.)
Alternately we could arrive at a similar conclusion if you assume that Japan is doing less testing than average. And there is considerable evidence that this is true.
We therefore do not have reason from the officially reported figures that he is wrong.
Now let'd deal with the dead bodies argument.
Deaths trail infections with roughly a 3 week lag. (A week to get sick, 2 weeks to die.) Let's go back to the simple model of 90% of infections are not reported and the true fatality rate is 1%. On March 31 there were 1700 official cases. On that model there were 17,000 infected of which 170 should die. Guess what? Today there are officially 263 dead bodies.
We. Don't. Even. Have. A. Shortage. Of. Known. Bodies.
The stated conclusions only look absurd to anyone who HASN'T tried to understand the dynamics of exponential growth, and the problems with the official data. He might or might not have been correct. But directionally he was clearly a lot more right than the official government position at the time.
We often conflate asymptomatic and presymptomatic people: my understanding is that asymptomatic people aren't very infectious, but presymptomatic people are. I can't find a solid citation for this, though.
The mechanistic basis for that is simply viral load: asymptomatic people have some virus, but not enough to ever make them really ill, whereas presymptomatic people have loads of virus, but it hasn't made them really ill yet.
There is a world of difference between "asymptomatic people are infectious" and "asymptomatic people are AS infectious".
I saw early estimates based on detailed modeling from Chinese data that asymptomatic people were about half as infectious as symptomatic ones. I have not seen any such estimates for some time though, nor ones based on more recent data samples.
Given the widespread distrust of the Chinese reporting on what happened in January, and the fact that estimates of how infectious this is have approximately doubled from early estimates, I don't trust that early reporting. I would also love to see an estimate of how much more or less people are infectious when they are asymptomatic.
Given that I don't doubt that they can be infectious, research showing that they can be is not answering the question that I have.
You are correct that official coronavirus deaths are low. But official influenza deaths (blue diamonds) were almost double their baseline value (green line) and above a threshold value (purple line, but I don't know enough Japanese to know what threshold) back in week 8 of this year (late Feb, early March, depending on how you count it.)
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.
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.
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
It's not important to determine the amount of asymptomatic cases, but it's important to detect asymtomatic individuals so that their contacts can be traced and tested as well.
This was not done, and "strategy A" failed because of that.
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.
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.
This article frankly sounds like the rambling of a crazy person with all of the attempts of secrecy and defensiveness.
> A distant secondary consideration, but a real one, was that choosing to publish could bring down heavy sanctions, through predictable pathways.
Why is the author afraid of "sanctions" in a first world democracy with strong freedom of speech protections? A much more interesting and useful article would be an examination of the authors exact fears and why he feels afraid of publishing publically in Japan.
> Some have advanced a theory which starts from the observed timeline and assumes the behavior of very many people was motivated by a sporting event.
Normal people simply directly state their arguments about what is obviously the Olympics. Why is the author playing a game by pretending to be circumspect?
> I will broadly refrain from comment regarding that organization, for predictable reasons.
"Many Western human rights organizations alleged that the high conviction rate is due to rampant use of conviction solely based on confession. Confessions are often obtained after long periods of questioning by police as those arrested may be held for up to 23 days. This can at times take weeks, during which the suspect is in detention and can be prevented from contacting a lawyer or family."
> Why is the author afraid of "sanctions" in a first world democracy with strong freedom of speech protections? A much more interesting and useful article would be an examination of the authors exact fears and why he feels afraid of publishing publically in Japan.
I completely agree. Where is all this weird expectation of political persecution in Japan coming from? Both from Patrick and a lot of comments in this thread.
Patio11 seems like a good dude, and I have a couple of his consulting articles bookmarked that I reference regularly.
But "Silicon Valley" are the worst offenders when it comes to believing that smart people can be experts in everything with a bit of research. Covid19 has brought this to the forefront of public view (see Keith Rabois, Elon Musk)
I lived and worked there for many years, and at one point came up against this. It absolutely does exist, especially if you're leaning into journalism territory.
I also (briefly) worked with Patrick in a past life and have no reason to believe he's overselling it... though the writing style could be trimmed quite a bit.
I strongly suspect your mental model of “a first world democracy with strong freedom of speech protections” is based on your experience living in a Western country, quite possibly as a citizen of that country. I wouldn’t presume to understand how that differs from the experience of living in Japan as an American. Patrick should have earned enough good faith in this community for us to trust his ability to navigate this kind of situation appropriately.
Or he just likes to act like he's important. No one in positions of power cares what he has to say about pandemic modeling and they certainly aren't going to persecute him for it.
If there is uncontrolled spread in Japan, and the NYT article prompted the Japanese government to acknowledge it and begin locking the country down, and the Working Group motivated the NYT article in any significant way, he doesn't have to "act" like he's important.
Does the post claim that the NYT article was based on his work? The timing doesn't make sense unless he was working with the journalist before she published and I didn't see that claim.
I would also say he's over-exaggerating the impact of the NYT article, but I don't have any more proof than he does. I've been following Japanese news and didn't really see any splash based on something in the western press. There were plenty of pessimistic predictions and calls for stricter measures inside Japan long before that article or the white paper.
Saying that the white paper led to the NYT article which led to Japan's lockdown is incredibly western/English-centric and ignorant of the actual forces at play inside the country in their native language, press, public opinion, and organizations.
No, it doesn't say that the NYT article was based on the work of the Working Group. It would have significantly clarified the post to say whether the NYT article writer did or did not use the memo to help inform the article.
It does say that someone "suggested that I leverage a news organization." And that "This implied a publication deadline of Thursday." Thursday happens to be the day that the NYT published their article, but it was also the day that Dr. Cowen put a blurb on Marginal Revolution.
Isn't it odd that the most critical piece of information in the article is left out? I wonder why someone worried about the fallout of an article wouldn't specify the most important piece of information that the article might contain?
> Saying that the white paper led to the NYT article which led to Japan's lockdown is incredibly western/English-centric and ignorant of the actual forces at play inside the country in their native language, press, public opinion, and organizations.
You're totally right here. Good thing that Patrick did not write or imply this. I'm very glad that its just HN commenters that think this.
This is not an interesting or persuasive argument. It's premised on the idea that I should just assume that the Japanese government had this situation well in hand, because it is well-staffed with experts. My own country is also well-staffed with experts, and we've shut our economy down for lack of test kits while rationing PPE at hospitals; we botched our response in a variety of ways. Japan's outlier status has been a subject of commentary for weeks, and only now --- weeks after Patrick's precommitment --- is Japan acknowledging the gap between that reported status and reality.
I am certainly ignorant of the actual forces at play inside Japan. Patrick is not; he has lived there his entire adult life, starting with years as a salaryman. He is at pains to try to explain the dynamics of what's happening in Japan in the post we're commenting on.
He works for Stripe in Japan and is presumably worried about disrupting professional relationships in Japan. I generally assume he knows more about Japan than we do, having lived there for many years.
I used to work in the Japanese journalism scene, on the tech side. My cofounder at the time was a veteran journalist.
He (and a litany of his peers) would agree that Japan is not how you would describe it, and I'm inclined to agree with them after building a product in that space.
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.
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.
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.
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.
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.
> 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.
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.
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.
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.
> 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?
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.
> 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."
This thread is full of people who, never having been immigrants in societies hostile to immigration, dismiss the tone of the article as ridiculous.
Those people are simply wrong. Speaking up in places where you are not lucky to have that societal right has consequences. Some of those are legal, but some are not.
Criticizing the author for the politeness and secrecy of all things is a statement of immense privilege.
Criticizing falsifiability, on the other hand... One usually expects more precise estimations for a hashed prediction.
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.
> 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.
- 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.
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[ 4.9 ms ] story [ 175 ms ] threadThe 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.
Does anyone have up-to-date data on "excess deaths" in Japan for the past few months?
Yes. That fits data out thus far.
https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
> Although the majority of reported COVID-19 cases in China were mild (81%)
Combine the 19% severe cases number out of China with Japan's aging population (which COVID-19 hits substantially harder), and 1/4 is entirely reasonable.
> The largest cohort of >44,000 persons with COVID-19 from China showed that illness severity can range from mild to critical38:
> * Mild to moderate (mild symptoms up to mild pneumonia): 81%
> * Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14%
> * Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%
Isn't the point that, while the particulars were proved false, the overall thrust of the article that Japan was stalling action which MAY lead to those numbers was true?
Did I miss the point of this entirely?
The hubris of this guy is quite off-putting.
You’re not a certified expert. Shut up and listen to your betters.
If there were actually the reserves of competence you and others like you believe in; if the authorities actually deserved our trust almost everywhere would have done as well as Taiwan or at least Korea. In the world we actually live in the CDC stopped the Seattle Flu Study from testing for COVID-19 and banned private labs from testing for more than two weeks after fucking up its own tests.
In the world we actually live in the prestige media spent most of February making fun of people who thought this was a real problem that would spread outside China, and later Italy. They didn’t act like they were taking it seriously. They followed the lead of the WHO, which should have been setting the alarm and instead was telling people that the real enemy was prejudice.
Many countries with well credentialed experts failed. You wouldn’t accuse them of hubris. But they failed.
[1] https://www.bbc.com/news/world-asia-52313807
> One poll shows 75% of people think the prime minister took too long to declare a state of emergency in Tokyo. After a recent spike in cases in the capital Tokyo, experts warned that the city’s emergency medical facilities could collapse under the pressure. Officials in Tokyo have also urged people to work from home. Prime Minister Shinzo Abe, centre, declared the state of emergency at a special meeting of medical experts After the initial state of emergency came into force on 8 April, a number of other regional governors called for the measures to be extended to their areas, saying that cases were growing and their medical facilities were overwhelmed. Japan’s two emergency medical associations also issued a joint statement warning that they were “already sensing the collapse of the emergency medical system”.
If not, then shouldn’t you shut up and listen to those people, who are certified as your betters when it comes to their subject matter? Even the ones who you called out as being wrong in your initial post?
I think maybe you should kick up the leg rest on your La-Z-Boy and relax into your armchair rather than attacking other posters. Unless you’re a certified expert and not just an armchair expert.
The certified experts at the WHO, CDC and FDA failed. Why the hell should they be trusted?
The original comment was about the tone of patio11's post and the assertion that an anonymous white paper significantly altered policy decisions of one of the world's most technologically, scientifically, and academically advanced countries. The response the original commenter got from barry-cotter was to "shut up and listen to your betters" because the commenter wasn't a "certified expert" followed by a rant that could have come straight from an episode of Coast to Coast AM. Even his attempts below to walk back his position or re-frame his post as being somehow tongue-in-cheek fail basic logic checks and sound like the ravings of a lunatic bent on exposing some great conspiracy by the learned elite that control the medical-industrial-media complex.
It's just worthless noise. He says we shouldn't trust the experts because they got it wrong, but we should trust patio11 because he didn't get it wrong (or did he? who knows, it's in the future!), but we should trust the "certified experts," but we shouldn't trust the goddamn "prestige media" because all they cared about in February was making fun of people who thought this was a real problem, but wait a minute isn't that media also now taking aim at people who think we should relax social distancing? So is the media going after people who think it's a real problem or are they going after people who don't think it's a real problem?
See what I'm saying? It's just anger and frustration being vented through a keyboard. It's noise and serves no discernible purpose.
We can quibble about patio11's true contribution (we can, but I won't) but, again, that is orthogonal to the point which is that a lot of self-righteous folks have used the coronavirus outbreak as a great way to lash out and/or push their ideology in not so civil manners and through fear-mongering ("THOUSANDS of EXCESS DEATHS in Tokyo!!!"), and we should discourage this behavior as a community.
I apologize for a lack of clarity in my writing but not for being very, very pissed off. I assumed it was obvious that I was paraphrasing kspacewalk in the bit about one’s betters, given that it directly followed a quote about the hubris of thinking that a mere peon’s opinion is worth anything or that what they do might matter.
If the people and institutions in which we have placed our trust fail us we have every right to be angry. The populace’s of Taiwan, Korea and Singapore should be showering their ministers, civil servants and CDC equivalents with rose petals. Everywhere else screwed up to varying extents and thousands to hundreds of thousands of people will die because they failed at their job.
It was very obvious to me that it was tongue-in-cheek.
I’m not trying to flex on you, but it didn’t take me nearly that long to read it. And it really does not demonstrate good faith on your part to come here and tear down patio11 without even doing the basic due diligence of actually reading the damn thing you’re commenting on first.
The very general thrust - that Japan surely had community spread - I agree was true and not widely acknowledged at the time. But I don't think that exempts the more specific projections from analysis.
At the same time, the expected outcome of social distancing is for the outcome to be not as bad... so people will always be able to make this complaint. What exactly do you expect from people who are advocating social distancing?
Which hasn't been that bad until now, but it's going to be an increasingly large problem as most countries pass the peak and try to reopen. A lot of people have been convinced that reopening can never happen, that if people are allowed to go to school or restaurants that'll be what tips the health care system over.
A virus that spreads from close proximity with infected people, and you're arguing that shoving people back in close proximity is not going to contribute to spreading it? Why? On what basis will this not happen, despite this being exactly what happened?
Spain took about 1 month to go from "hm this coronavirus thing is spreading" to "if you're over 75 we're not going to bother with ventilators because we can't spare the capacity".
Things have to reopen eventually, but if you haven't actually increased your test and tracing capacity, then the effect is going to be exactly what happened in 1918 https://www.popsci.com/story/health/coronavirus-1918-flu-pan... (wherein an experiment with a control was accidentally run at a substantial cost in lives between two US cities).
I certainly wouldn't dispute that closing schools and banning public gatherings were good moves.
See the bottom graph. Deaths/week vs when closures were implemented. Another more wordy source: https://www.businessinsider.com.au/history-of-how-st-louis-v...
> Around the same time, the city of St. Louis was closing schools, libraries, courthouses, churches, playgrounds as well as limiting the number of people on streetcars and staggering work shifts to minimise contact.
St Louis did relatively well - but they released quarantine measures early and got an unnecessary double peak (see the first source, which shows exactly pretty clearly exactly when they did it, and then quickly reimplemented it).
The lessons of history here really could not be clearer.
That's silly.
They didn't know it was a virus. They certainly knew it was communicable. Contact tracing is entirely possible; we were doing that in the 1800s. https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outb...
Modern contact tracing could in principle have been done, but it's my understanding that it wasn't. The kind of tracing in the Broad Street outbreak is very different - cholera mostly doesn't spread from person to person, so John Snow had to figure out only where each of the victims spent their time and not an exponential sized web of people they went out drinking with.
the last couple months of experience tells us (imperfect) physical distancing has done the heavy lifting in flattening the curve, and yet the media orthodoxy is still that stepping one unsheathed toe outside your door is just asking for death. this morning an npr reporter openly mocked a governor for even suggesting a loosening of the lockdown. it's brainless.
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"?
https://www.facebook.com/groups/524159784940511/permalink/52...
> 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."
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.
With a mean time to symptoms of 14 days, depending on what Japan is doing, 10 days is an age (though it's worth noting that severe respiratory symptoms set in in week 3).
Mean is more like 5 or 6 days.
The average is 5-6 days to show any symptoms. That is the figure that you are remembering.
If it is going to turn severe, the average to develop severe shortness of breath from first symptoms is another 7-10 days. Which means that the range from exposure to severe shortness of breath is 12-16 days...or an average of 14 days.
Which is exactly what the person that you were responding to said. So your memory was correct in so far as it went, but you were remembering the wrong fact about COVID-19.
Though 14 days is probably a mean time to getting tested.
> In a world where I was wrong, people who trust me professionally would likely think less of me. That was an acceptable risk.
Yeah, what a hero taking an extremely slight risk to his reputation in the middle of a pandemic.
Sorry, I normally generally like things patio11 writes on here (he's the bingo card guy, right?) but this whole thing reads like a lengthy ego-stroke.
The author has a visa to stay in Japan, a country with strict rules on the disruption of public order. Spreading unfounded speculation on a pandemic might rule afoul of such rules.
Posting it and acting on it build a "track record" that is harder to dismiss.
The author was explicit: "sending up a flare", hoping "someone would read between the lines".
Yes, but all of those 6 days are still higher than 7 & 8 days ago. In fact, all the days you picked are also higher than they were through March 15st-April 4th too - and several days between April 4th onwards as well.
Today's new cases in Japan are many multiples higher than most days in March - but I do hope they continue their recent trend of decline.
> So... not only wrong on the numbers themselves, but also on the scale, trajectory and impact on society.
Maybe, but they did use the term "true count" which appears to mean: asymptomatic and those who have it but haven't/won't get tested.
As the US has learned, once you start to ramp up testing the case count ramps up too.
Looking at Japan's testing, they are testing more per day now than in March[0] but their total number of people tested is still not very high at almost 117k[1] - given they have ~125m population.
[0] https://ourworldindata.org/grapher/full-list-covid-19-tests-...
[1] https://ourworldindata.org/grapher/full-list-total-tests-for...
https://twitter.com/patio11/status/1252836409406152709?s=21
> NHK confirms that coronavirus-appropriate hospital beds are 80%+ filled in Tokyo, Osaka, Ishikawa, Hyogo, Shiga, and Okinawa.
> Experts threshold of concern for imminent impact on medical care is 30%, again per NHK.
> The 28 prefectures which are above that threshold will not fit in this tweet.
> NHK reports that several prefectures which were unable to sustain the prior strategy of hospitalizing all diagnosed cases have begun moving less severely affected patients to hotels/etc or asking them to self-sequester at home, temporarily freeing up bed space.
>!NHK reports that while reprioritization of hospitalization strategy and urgent measures to add more beds may buy some time, the situation risks a collapse in the provision of medical care, and that experts explain we cannot be optimistic.
Writing in a circuitous manner may have been necessary due to the author's immigration status but it's also a very convenient smokescreen that makes his group's results look more dramatic.
For example, the timeline for March 24th, the day before this epic whitepaper was released: "a sporting event is postponed." This "sporting event" was the Tokyo OLYMPICS! But showing that Japan was already starting to take COVID-19 a lot more seriously than some of their public pronouncements may lead you to believe before the whitepaper release date might undercut the article's implication that his whitepaper changed the public narrative and thus the author would be less deserving of asspats and clout.
I've heard people say that this pandemic highlights the (unfortunate) severe lag time of real-life discourse to Twitter's discourse (what is "known" on Twitter versus public narrative).[^1] From that angle this report could be a good thing to try to short-circuit that gap. My opinion is the attempt failed (more accurately their conclusion was already stale), and this writeup brings it right back around to the worst parts of Twitter's discourse - personal brand marketing and clout-chasing.
[^1]: While that's undoubtedly true, Twitter also generates a massive amount of garbage takes which are conveniently forgotten through severe selection bias (looking back with hindsight to see who was right is easy). Online takes also have zero cost compared to reality; you can throw infinite virtual darts at a dartboard but in reality you can steer your meat machine down only one path. Thus there will always be a lag between the two.
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.
SARS-CoV-2 thanks you for your efforts to help it find new populations to replicate in.
Also, if I feel endangered, I have every right to decide where to go. You might see it as selfish, I see why. At least I am paying my useless and expensive health insurance in the US (out of my own pocket, because you know what? I'm unemployed right now) to support the system, even if I am not taking advantage of it.
Sometimes things are a bit more complicated than "SARS-CoV-2 thanks you for your efforts...".
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.
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.
Also, tons of people have been saying that for months, both native and foreign.
There is a difference between someone with a big internet presence and someone without one saying something.
Assuming someone at immigration would take the time to look into his background (not just his paperwork), find out that he wrote a Covid-19 white paper with higher projections than the government at the time and then blacklist him for it is such a mischaracterization of Japanese process, I don't know where to start. It's not like there's a source I can reference, but I also have a lot of knowledge of Japanese immigration through knowing plenty of foreigners on different visas in Japan and have never heard of anyone getting rejected if they meet the conditions.
I can share one interesting anecdotal counter-example to show how easygoing Japanese immigration is. Someone I knew was on a fraudulent work visa "working" for a friend. He was actually creating a startup. By the time immigration found out, he had the necessary scale to sponsor his own work visa, so he wrote an apology letter and then switched to his own work visa even though the foundation of the company was built on a fraudulent visa.
I don't know anything in particular about his concerns about his own status. I have, on the other hand, known many LPRs in the US who were extraordinarily careful about their engagement in public matters out of concern about their status.
If your argument is that protection for PRs in Japan is stronger than that of US LPRs, I'm going to go ahead and call that an extraordinary claim. At some point, though, probably rapidly approaching, litigating this point becomes ghoulish. I haven't heard Patrick say he's specifically concerned about his own status, but he's clearly concerned about some of the people he worked with.
That has to be a function of knowing a particular variety of (however reasonably) paranoid LPR's, though, no? I can't imagine it being a core concern for the vast majority of LPRs.
Please enlighten us. How does public defamation work in Japan then? I don't know much but I did just google it right now[0] and to my layman eyes it looks bad:
> “(1) A person who defames another by alleging facts in public shall, regardless of whether such facts are true or false, be punished by imprisonment with or without work for not more than three (3) years or a fine of not more than 500,000 yen.”
[0]: https://kellywarnerlaw.com/japan-defamation-laws/
Did? I think he just lost all of it with this arrogant stunt. Especially since he himself said,
Either:
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.
2) We need a data point to counter "Nobody could possibly have seen this coming."
He didn't predict anything "nobody could possibly have seen coming" and he was also mostly wrong, so...
Patrick isn't infallible and may be wrong in a multitude of ways in this post (I haven't lived my whole adult life in Japan and wouldn't know). You should take your best shot at his arguments. But you need to do it civilly.
I've never met Patrick personally but also had a lot of respect for him from past writings; that's probably why I was so disappointed with what he did here. If I weren't knowledgeable about Japan, maybe I'd also just assume he's right because he feels like someone I know, but I do know better and that's why I'm commenting.
My shots aren't at his arguments about pandemic modeling, but everything he's done surrounding that. As plenty of other comments here mention; everything is heavily self-promotional and smug. And I agree under normal circumstances the above comment would be flag-worthy, but he specifically staked his reputation on this with extreme language, so I mirrored that. So I apologize for the poor tone; but I think it's appropriate in the context of referencing that Tweet.
A friend showed me the tweet last month and asked if it was about the pandemic in Japan. I said it can't possibly be that since everyone here sees it coming and knows the government is just dragging their feet. And I don't mean "everyone" in a smugly exclusive sense; all of the top comments on every article on the Japanese news sites were saying the same thing.
So maybe there's novel work in the white paper; that's great, but my "best shots" are that it's ridiculous to claim that no one else saw this coming, this paper influenced Japan to shift their strategy, and being public is going to get him persecuted in Japan (those last two even seem contradictory). These would all be obvious to anyone living here, and make it seem like Patrick is using this information asymmetry and his existing reputation to blow this into something it's not in the eyes of a foreign community.
https://twitter.com/patio11/status/1241553311024603140?s=20
His post implies that the Japanese experts and officials are both so inept that they couldn't keep up with his overnight-expert pandemic modeling and so malicious that they would persecute him for doing a better job. That's completely untrue, but with his reputation on Hacker News, it looks like a lot of people here are taking those characterizations at face value. As someone who knows Japan and respects the community here, that's a very upsetting development.
Unfortunately this thread blew up in the middle of the night in Japan. I happen to be awake, but it's so late I might be the only person in Japan in this thread before it dies.
Whatever about any legitimate criticisms you may have this is just being one or both of being an asshole or a racist. If Patrick had spent his entire adult life in Sweden and he was writing about how the Swedish government had messed up you wouldn’t be calling him anything equivalent.
He really did no such thing.
And I think your comments would be better if they presumed good faith on the part of patio11.
I left Japan in early March, by personal anecdote masks seemed pretty ubiquitious (and all public facing employees were wearing them), hotels were screening guest temperatures, warning signs everywhere, etc.. Time will tell, but I still think I'd have been better of staying there than returning to the US.
Well it was pointing out that the current plan was B.S. and had already failed, and that the testing plan in place resisted falsification by preventing testing of unconnected / asymptomatic people. no biggie.
The point of the memo was to gather and surface disparate information already public separately un-worrisome but that together might be able to be paid enough attention to for a (positive) governmental reaction.
It was to force agencies to connect dots that the authors believe were not being connected. (Maybe it just wasn’t anybody’s job to connect them)
If you read between the lines to what he is really saying, I would think you would revise your opinion substantially.
I didn’t read every word of it but got the sense there were political and/or Japanese cultural sensitivities why he didn’t initially feel comfortable with a full public, attributed release.
At the same time, yeah, it seems very plausible that a white guy in Japan announcing the Japanese pandemic response is run by fools would face blowback for it.
Haha, yeah pretty much that. And any blowback may also have been directed at his employer, Stripe. So there was certainly cause for caution.
That said, I don't think recognizing in late March that this virus spreads faster and is harder to control than previous similar ones was much of a leap of insight, and the article does seem a little too self-congratulatory over that.
Having that realization back in January is evidence of foresight, but late March not so much. But maybe the situation was different in Japan and merits it, dunno.
If this had been obvious to the Japanese authorities in late March they would have declared a nationwide state of emergency in late March, not late April. They would have issued stay at home orders for almost everyone 25 days ago, not five days ago. Being right when the government is wrong, it being wrong will cost lives and trying to get them to save those lives is not trivial.
The doubling time of this virus is well under ten days. If lockdown had begun on the date this memo was published there would be under a quarter as many cases as there are now.
He made it amply clear to me that it wasn't much of a leap of insight, and the point of his original essay was to create proof that he knew that at the time.
The fact that taking the action that he did resulted in a group of people who put together a compelling enough argument with good enough connections to get the New York Times to write about it DOES seem like it is worthwhile.
As it turned out, having the New York Times asking whether the emperor had clothes caused lots of people in Japan to ask the right question which in turn caused the government to switch courses. The fact that this happened again underscores the point that, on publicly available data at that time, it didn't take an amazing leap of insight to understand that the Japanese story didn't add up.
>The fact that this happened again
What do you mean by "again" in this sentence? What was the first time?
The point being that this was foreseeable at the time. Which was indicated the first time when he said that he assumed that the authorities in charge with access to more data than he had already had come to same conclusions that he did.
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.
The hash concept depends on social norms, and it's a fairly strongly enforced in his corner of the internet.
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.
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.
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%?
Having just ridden the Yamanote today though, it's unreal how empty it is.
Oh, and a third condition that these people be such recluses that they don't even call a doctor when deathly ill.
See https://en.wikipedia.org/wiki/Kodokushi for more.
Occam’s razor in this case is that the pandemic in Japan isn’t as bad as the author projected. It’s not a conspiracy or coverup and there aren’t dead bodies hiding everywhere, the author was just wrong.
From https://www.worldometers.info/coronavirus/country/japan/ Japan admits to about 10,000 cases now, with a doubling time of about 11 days so they will admit to 20,000 cases by the end of the month.
If you read https://www.who.int/bulletin/online_first/20-254565.pdf you will find credible reasoning for 90% of COVID-19 cases not being tracked in official numbers, with a wide uncertainty. That correction would make it 200,000 cases in Japan by the end of the month. If you update that argument with the lower IFRs suggested in https://www.cebm.net/covid-19/global-covid-19-case-fatality-... then you get to a projection of 500,000 cases in Japan. (The admittedly problematic Stanford study came up with a suggestion of similar underreporting factors in both Santa Clara and Los Angeles.)
Alternately we could arrive at a similar conclusion if you assume that Japan is doing less testing than average. And there is considerable evidence that this is true.
We therefore do not have reason from the officially reported figures that he is wrong.
Now let'd deal with the dead bodies argument.
Deaths trail infections with roughly a 3 week lag. (A week to get sick, 2 weeks to die.) Let's go back to the simple model of 90% of infections are not reported and the true fatality rate is 1%. On March 31 there were 1700 official cases. On that model there were 17,000 infected of which 170 should die. Guess what? Today there are officially 263 dead bodies.
We. Don't. Even. Have. A. Shortage. Of. Known. Bodies.
The stated conclusions only look absurd to anyone who HASN'T tried to understand the dynamics of exponential growth, and the problems with the official data. He might or might not have been correct. But directionally he was clearly a lot more right than the official government position at the time.
The mechanistic basis for that is simply viral load: asymptomatic people have some virus, but not enough to ever make them really ill, whereas presymptomatic people have loads of virus, but it hasn't made them really ill yet.
TL;DR contact tracing shows numerous cases of asymptomatic people that have introduced the disease to people near them.
I saw early estimates based on detailed modeling from Chinese data that asymptomatic people were about half as infectious as symptomatic ones. I have not seen any such estimates for some time though, nor ones based on more recent data samples.
Given the widespread distrust of the Chinese reporting on what happened in January, and the fact that estimates of how infectious this is have approximately doubled from early estimates, I don't trust that early reporting. I would also love to see an estimate of how much more or less people are infectious when they are asymptomatic.
Given that I don't doubt that they can be infectious, research showing that they can be is not answering the question that I have.
https://www.niid.go.jp/niid/ja/flu-m/2112-idsc/jinsoku/1852-...
I wonder if there are other, non-coronavirus causes of death that are significantly above their normal values?
Patrick, I admire your professionalism and restraint in service of your goals.
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.
This was not done, and "strategy A" failed because of that.
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.
> A distant secondary consideration, but a real one, was that choosing to publish could bring down heavy sanctions, through predictable pathways.
Why is the author afraid of "sanctions" in a first world democracy with strong freedom of speech protections? A much more interesting and useful article would be an examination of the authors exact fears and why he feels afraid of publishing publically in Japan.
> Some have advanced a theory which starts from the observed timeline and assumes the behavior of very many people was motivated by a sporting event.
Normal people simply directly state their arguments about what is obviously the Olympics. Why is the author playing a game by pretending to be circumspect?
> I will broadly refrain from comment regarding that organization, for predictable reasons.
Oh please.
https://en.wikipedia.org/wiki/Criminal_justice_system_of_Jap...
"Many Western human rights organizations alleged that the high conviction rate is due to rampant use of conviction solely based on confession. Confessions are often obtained after long periods of questioning by police as those arrested may be held for up to 23 days. This can at times take weeks, during which the suspect is in detention and can be prevented from contacting a lawyer or family."
https://www.tofugu.com/japan/sued-in-japan/ alleges truth isn't an affirmative defense in a libel/defamation suit like it would be in the US.
I'm pretty suspicious of any system with a 99% conviction rate.
I completely agree. Where is all this weird expectation of political persecution in Japan coming from? Both from Patrick and a lot of comments in this thread.
But "Silicon Valley" are the worst offenders when it comes to believing that smart people can be experts in everything with a bit of research. Covid19 has brought this to the forefront of public view (see Keith Rabois, Elon Musk)
I also (briefly) worked with Patrick in a past life and have no reason to believe he's overselling it... though the writing style could be trimmed quite a bit.
https://www.cnbc.com/amp/2020/01/27/carlos-ghosn-warns-forei...
I would also say he's over-exaggerating the impact of the NYT article, but I don't have any more proof than he does. I've been following Japanese news and didn't really see any splash based on something in the western press. There were plenty of pessimistic predictions and calls for stricter measures inside Japan long before that article or the white paper.
Saying that the white paper led to the NYT article which led to Japan's lockdown is incredibly western/English-centric and ignorant of the actual forces at play inside the country in their native language, press, public opinion, and organizations.
It does say that someone "suggested that I leverage a news organization." And that "This implied a publication deadline of Thursday." Thursday happens to be the day that the NYT published their article, but it was also the day that Dr. Cowen put a blurb on Marginal Revolution.
Isn't it odd that the most critical piece of information in the article is left out? I wonder why someone worried about the fallout of an article wouldn't specify the most important piece of information that the article might contain?
> Saying that the white paper led to the NYT article which led to Japan's lockdown is incredibly western/English-centric and ignorant of the actual forces at play inside the country in their native language, press, public opinion, and organizations.
You're totally right here. Good thing that Patrick did not write or imply this. I'm very glad that its just HN commenters that think this.
I am certainly ignorant of the actual forces at play inside Japan. Patrick is not; he has lived there his entire adult life, starting with years as a salaryman. He is at pains to try to explain the dynamics of what's happening in Japan in the post we're commenting on.
He (and a litany of his peers) would agree that Japan is not how you would describe it, and I'm inclined to agree with them after building a product in that space.
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.
Edit: It also appears to not be happening in Sweden. I think a lot of the modeling of this is flawed.
I cannot find where it's discussed in more detail below. Can someone point me to it?
> 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.
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.
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.
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.
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.
https://twitter.com/davidnwelton/status/1241556680833298434
So...was it just a coincidence that the results seem vindicated? Or is the above statement just too much modesty? Or both?
This alone is a pretty interesting point. Can apply to many other systems that are much less significant than literally "life or death."
Those people are simply wrong. Speaking up in places where you are not lucky to have that societal right has consequences. Some of those are legal, but some are not.
Criticizing the author for the politeness and secrecy of all things is a statement of immense privilege. Criticizing falsifiability, on the other hand... One usually expects more precise estimations for a hashed prediction.
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.
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.
- 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.