An update on a pre-registered result about the coronavirus

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

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

Maybe that's too harsh.

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.

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.

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

> 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.

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.

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.

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

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%?

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

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'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.

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.

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

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.

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.