Exploratory Analysis on Sweden's Coronavirus Strategy: How Successful Has the Swedish Approach Been So Far?

Many on the Left, particularly Senator Bernie Sanders, laud countries such as Sweden because the "Nordic model." Forget for a moment that Sweden abandoned actual socialism in the 1990s because it had failed, that Sweden economic freedom comparable to the United States, or that Sweden has some features that are undesirable to the self-identified "democratic socialists," whether that be school choice, abolishment of the wealth tax, or the fact that Sweden deregulated significant portions of its economy in the late 1990s and early 2000s. In spite of these counterfactuals, it had been common for the Left to idolize Sweden.....at least until the pandemic began.

Once we were in full lockdown mode, Sweden received considerable derision. Why? Because Sweden did not implement a lockdown. On top of that, there was no face mask mandate. Granted, they closed down secondary and tertiary schools and gatherings exceeding fifty people, but a lot of businesses and institutions remained open while multiple countries implemented lockdowns and stay-at-home orders. Sweden largely relied on voluntary social distancing. I can understand why lockdown proponents would throw shade at Sweden. Imagine if a country proved that the goals of the lockdown could have been achieved without a lockdown. It would mean that so many of us went through lockdowns for nothing. Those who get angry at Sweden for their approach to handling COVID-19 do so because they have skin in the game. They want to know that their sacrifice was worthwhile. But enough of psycho-analyzing (at least for now). Let's answer an important question here: how successful has the Swedish model been so far?

One way to answer this question is to look at the death rates. If keeping things open like Sweden were as bad as lockdown proponents purported, Sweden would be an unfortunate outlier. However, that is not the case. Looking at John Hopkins' Coronavirus Resource Center, Sweden has a death rate of 57.05 per 100,000 people. This is certainly a higher rate than multiple countries, including its Nordic neighbors: Denmark (10.73), Finland (6.05), and Norway (4.97). On the other hand, Sweden has fared better than four European nations that locked down: Belgium (87.48), the United Kingdom (62.44), Spain (61.72), and Italy (58.64). France was not so far behind, with 45.56. Another noteworthy example is when you compare the state of New York to Sweden. Andrew Cuomo touted his work on defeating COVID-19 at the Democratic National Convention last week, although the death rate for New York is almost three times that of Sweden, at 169 per 100,000 people (Kaiser Family Foundation).

Let's take a look the raw number of COVID deaths. One Swedish model, which was inspired by the Imperial College model that got the United Kingdom to go into lockdown mode, predicted back in April that if they did not "change their evil ways" by implementing stringent social distancing measures, there would be 96,000 deaths (Gardner et al., 2020). Where are we with that?  If you look at statistics at Folkhälsomyndigheten (FOHM), which is Sweden's health ministry, the deaths are slightly over 5,800. When looking at the FOHM death data by age, you have some interesting findings:

1. Nearly 4,000 of the deaths of those who are 80 and older. About half of Sweden's COVID deaths in Sweden during its peak were in nursing homes. If I were to have any criticism about the execution of Sweden's strategy, it was the inadequate protocol at long-term care facilities at the onset of the pandemic (Stern and Klein, 2020). 
• Although elderly deaths were high in Sweden, it still was nothing in comparison when New York governor Andrew Cuomo mandated that COVID patients stay in nursing homes, thereby significantly contributing to New York's COVID deaths.
2. As we see below, COVID deaths in Sweden peaked in April, but in recent weeks, COVID deaths have come to a grinding halt (Worldometer). 
3. One study from Sweden shows that those in nursing homes in Stockholm had an average about 5 to 9 months of life remaining (Stern and Klein, 2020). While we should not minimize anyone's death, looking at it from the angle of years of life lost (YLL) due to premature mortality also should play a role in assessing Sweden's success. For example, someone who dies from COVID at age 30 would have more years of life lost to COVID than someone who is in their twilight years. About 500 of Sweden's COVID deaths come from those who are 50 and younger. This is significant because setting the initial nursing home policy aside, you see there are not that many deaths for most age demographics. 

The other scary COVID model that came from Sweden had to do with hospital capacity. This model predicted that intensive care unit [ICU] would reach 10,000 beds, well above the pre-pandemic capacity of 526 beds (Sjödin et al., 2020). Sweden was quickly able to ramp up its capacity to 1,100 ICU beds, but if we took the model seriously, Sweden would be screwed in either case. Guess what happened? Did Sweden exceed hospital capacity? Svenska Intensivvårdregistret (SIR), which is Sweden's intensive care registry, has data on COVID ICU bed usage. There was a two-day peak of 558 ICU beds in April, but it has declined considerably ever since (see SIR data below). Not only did the model exaggerate by almost twenty-fold, but Sweden still had plenty of ICU capacity left. In other words, Sweden was able to accomplish one of the lockdown's main goals without locking down, i.e., making sure that hospitals did not exceed capacity.

I would like to say a word about herd immunity. When the pandemic began, experts postulated that herd immunity would be around 60 to 70 percent. In May, an antibody study showed that Sweden only reached about 7 percent (see here), which is a far cry from 60 percent. By late July we started to see a decline in cases, hospitalization, and deaths. If it is not the antibodies, what could it be? It could be possible that T-cell immunity is contributing to herd immunity, as is implied by studies from Karolinska University in Sweden (Sekine et al., 2020) and University Hospital Tübingen in Germany (Nelde et al., 2020). Even better is that herd immunity might not be so high. One study from Science magazine calculates a possible herd immunity rate of 35 percent (Britton et al., 2020), whereas a preprint study from Oxford suggests that it could be as low as 10 to 20 percent (Aguas et al., 2020). While this evidence is preliminary, it does suggest that Sweden could be closer to herd immunity than we might realize. If Sweden did inadvertently reach herd immunity sooner than expected, it could mean that Sweden has experienced the bulk of its COVID deaths as a result. And if that is true and other countries end up going through a second wave, it means that it is too early for lockdown proponents to use death rates as a metric.

While this a pandemic, there is more to consider than the health aspect. There has also been the question of whether keeping the economy open would help Sweden. If you would have asked me at the beginning, I would have expected the Swedish economy to get pummeled along with the rest of the world. After all, Sweden is more dependent on imports, not to mention greater dependence on international demand for Swedish goods. Not even the Riksbank, which is the Swedish central bank, was that optimistic. They were predicting an annualized contraction of 6.9 percent. Yet the GDP for the first half of 2020 surprised me. Although economists were predicting a 0.6 percent contraction for Sweden in Q1, it actually grew at 0.1 percent (or an annualized rate of 0.4 percent).

Sweden did experience a contraction in Q2, but it was not nearly as bad as their European neighbors (BBC). Sweden had a quarterly decline of 8.6 percent, which was still less than half of the United Kingdom (19.1 percent) and Spain (18.5 percent). As a reminder, the United Kingdom and Spain locked down, yet they both had higher death rates and a higher economic contraction than Sweden. The European Union average was a contraction of 11.9 percent, which is also worse than that Sweden. Capital Economics found that Sweden is going to have the least shallow recession in Europe, even in comparison to its Nordic neighbors.

Since the Swedish economy did not experience economic contraction in Q1, they technically are not in a recession yet. That could change in Q3, but as of now, economic growth is faring better than other developed countries.

Unemployment figures are less encouraging. Sweden has an unemployment rate of 8.9 percent (Statistika centralbyrån [SCB]), whereas the Euro Zone average is 7.8 percent (Eurostat). While it is still higher than the Euro Zone average, it is still lower than the U.S. unemployment rate of 10.2 percent.

Postscript: Yes, the Swedish government made some clear mistakes at the beginning, most notably with long-term care facilities. But even after that rough start, Sweden seems to have gotten the virus under control. The decline in deaths, hospitalizations, and cases since its April peak has been encouraging. The GDP figures are also higher than forecasted, which is also good news. Sweden's economy seems to be faring better than its European peers.

While there is some reason for initial optimism, it is still too soon to definitely determine if Sweden's light-touch method was the correct one. Whether Sweden gets hit with a second wave will help determine if its more lax, voluntary approach was the right one. If Sweden does not get a second wave, I would most likely give Sweden a rating of B/B+ for its overall response. For Sweden's sake, I hope that it does not get a second wave.

Should States Be Encouraging Voting By Mail During the Pandemic?

Democratic presidential nominee Joe Biden announced that his running mate for this election is to be Senator Kamala Harris (D-CA). With the presidential elections less than 100 days away, the American people are gearing up for Election Day. A question still remains: what is the best way to hold an election during a pandemic? One of the possibilities is to encourage voting-by-mail efforts, which many states are examining as an option. According to Pew Research, 65 percent of Americans support "no-excuse" absentee voting. Nevertheless, there is a partisan divide: Democrats are nearly twice as likely to support voting-by-mail. What I would like to do here is get past the partisan clamoring and examine whether we should push for more voting by mail or not.

1. How many states allow for mail balloting? Those who are against the proposal act as if voting by mail were unprecedented or untested. That's simply not the case. We have allowed for absentee voting for civilians since the late 1800s. There are five states in which voting by mail is the default: Colorado, Hawaii, Oregon, Utah, and Washington. Another 29 states allow for "no-excuse" voting by mail. According to the Election Assistance Commission (EAC), 31 million Americans (or 25.8 percent of ballots) were casted by mail in 2018.

2. Would allowing for more voting by mail give one party an advantage over the other? Given the partisan divide, I have to ask this question. On the one hand, greater access to voting could increase turnout for young adults, minorities, low-income individuals, all of whom are more likely to vote Democrat. On the other hand, this could provide greater access to voting for senior citizens, who skew Republican. It really could go either way. What do historical data have to say? Four political scientists from Stanford University answered this question. They looked at voting data from 1998 to 2016. Their conclusion is that although there is a mild increase in turnout, it does not favor either party when it comes to election outcome (Thompson et al., 2020). The statisticians over at FiveThirtyEight also explain how the net effects are negligible.

3. Is voting in-person during a pandemic unsafe to the point where everyone should vote by mail? This is the main impetus for those to be in favor for voting by mail. Waiting in long lines, being in tiny voting booths, and using pens shared by hundreds of voters could spread COVID-19. This is certainly plausible.

On the other hand, I remember how liberal media outlets were freaking out in April because the Republican assemblymen were pushing for the in-person voting, and the U.S. Supreme Court ruled that Wisconsin should hold their primaries without delay. A piece in the Atlantic said that voting in public during a pandemic is not compatible with safety. There was sure to be an uptick in COVID-19 cases in Wisconsin as a result, right? Not really. Researchers at Stanford University and the World Health Organization found no detectable surge as a result (Leung et al., 2020). The CDC came to a similar conclusion in July (Paradis et al., 2020).

Granted, Wisconsin is one case study. At the same time, if it were impossible to keep safe with in-person voting, the outcome from the Wisconsin primaries would have been different. As long as we keep the same protocols that we do while going grocery shopping or to a retail store (e.g., face masks, social distancing), the odds of an outbreak of COVID-19 would be low. Plus, if Liberia can conduct elections during the Ebola pandemic, I think the United States could handle this pandemic.

4. Does voting by mail increase the likelihood of fraud? This is a concern commonly held by those on the Right who oppose voting by mail. Theoretically, by-mail voting makes it easier for someone to falsely vote on behalf of someone else or tamper with ballots. The MIT Election Data and Science Lab points out that while it is more likely for fraud to occur for by-mail voting than in-person voting, voter fraud is still an overall rare occurence. How rare? Based on an investigative reporting project funded by the Carnegie Foundation, there were 491 reported cases of absentee ballot fraud between 2000 and 2012. As Snopes illustrates, the methods for tracking in-mail ballots (e.g., Electronic Registration Information Center [ERIC]) have gotten more sophisticated since then.

As the Brennan Center brings up in its analysis on by-mail voting fraud, one is more likely to get struck by lighting than commit mail voting fraud. In short, while it is more likely, the risk of widespread fraud is minimal, even if we reverted the entire system to in-mail voting.

5. How much less likely ballots by mail less likely to be counted? Let's forget for a moment that there are those on the Left accusing Trump of hampering USPS operations in hopes of undermining the election. As I brought up in May, the United States Postal Service (USPS) was having issues before the pandemic began.  Can the USPS honestly handle such an uptick in delivery both in ballots from election officials and back to them? Also, how many ballots will get lost in the mail?

Postal delivery could have a great impact on whether mail-in ballots are counted. For one, there is the issue of undeliverable ballots, i.e., the ballots that were returned the registered voter did not live at the address on file. Of those that were transmitted to voters (as opposed to returned to election officials), 1.4 percent were counted as undeliverable in 2016 (EAC).

Second, the 2020 primaries could give us a glimpse into what that could look like. According to the Associated Press, 1.5 percent of mail-in ballots for California's 2020 primaries received were ultimately rejected, the most common reason being that the ballot was not mailed and delivered on time. Another reason for ballot rejection could be in filling out the ballot. For thousands of Americans, this will be the first time voting by mail. As MIT political scientist Charles Stewart points out, first-time mail-in voters are more likely to have ballots rejected.

How bad is the rejection rate for returned ballots? According to the Election Assistance Committee (EAC), the national rejection rate for 2016 was 0.77 percent (Overview Table 2) and 0.9 percent for 2012 (Table 32). NPR highlights how multiple states, including Virginia, Arkansas, Minnesota and Oklahoma, had rates above 1.0 percent during their 2020 primary elections. And if you want a scary outlier, New York City is rejecting one out of five of its in-mail ballots. But we don't have to use an outlier to make a salient point: If in-mail ballots are done on a large scale, a 1-2 percent rejection rate could make the difference between a win and a loss for a candidate.

Conclusion
My take on the whole debate is this. Both sides of the debate are stoking fear to gain support for their side, whether that is the fear of the pandemic, of voter fraud, or of the erosion of democracy. My main concern is that of delivering the ballots. Absentee ballot rejections rates are high enough during normal election years. Combine that with the disheveled nature of the USPS along with perturbing rejection rates that were high in the 2020 primaries, I am skeptical of the ballot delivery system to be adequate.

Does this mean I want to force everyone to go to the voting booth in-person? No. Does this mean I want mandated by-mail voting? Again, no. Some people will feel more comfortable going to the voting booth because it helps better guarantee that their vote gets counted (plus, it takes pressure off the USPS). Others will feel more comfortable with an absentee ballot because they do not want to risk contracting COVID-19. Each individual should be allowed to assess their own personal risk and make the choice that best fits that situation. State government and election officials should do their utmost to make sure voters have the ability to exercise whichever method of voting works best for them.

Has the CARES Act Helped Out Small Businesses?: A Preliminary Look at the Paycheck Protection Program (PPP)

With the coronavirus-induced lockdowns, there have been millions who cannot go to work. Even with the reopening, businesses still struggle and the high level of unemployment is hitting millions especially hard. That is why Congress allocated $669 billion as part of the Paycheck Protection Program (PPP) as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The PPP was designed to provide up to eight weeks of federal-backed, forgivable loans to small businesses to cover employee payroll, utilities, and rent in order to make sure that small businesses do not permanently close during these lockdowns. The PPP was intended to prevent rupturing employer-employee connections and the matching of workers to firms, as well as limit the suffering of unemployment and loss of health insurance. The Small Business Administration (SBA), which is responsible for administering the PPP, went through the initial funding in a matter of days. Congress had to approve a second round of $310 billion in April. It is now August, and Congress is looking to pass another coronavirus stimulus package. While we wait to see whether there will be further funding for the PPP, I had been asking myself whether the program has been successful enough to merit another round of funding.

Since the main goal of the PPP is to keep payroll afloat during this tough time, one of the main metrics is whether the PPP had an effect on the employment figures. Economists over at Harvard concluded that "the PPP had little material impact on employment at small businesses (Chetty et al., 2020)," and that PPP-eligible businesses laid off employees just as quickly as those who were not eligible. Economists at the University of Chicago similarly found a negligible impact on employment (Granja et al., 2020). Those at the Federal Reserve and the Massachusetts Institute of Technology [MIT], on the other hand, found a modest increase of 3.25 percent, or 2.3 million jobs (Autor et al., 2020). There is a possibility that the PPP resulted in milder declines in unemployment and faster rehiring (Bartik et al., 2020).

Another important metric is how businesses fared. Firms with greater exposure to PPP had more cash on hand, they were more able to pay off loans. This means that the PPP likely helped with financial stability of businesses (Granja et al., p. 29). Another paper from the National Bureau of Economic Research [NBER] found that businesses were 14 to 30 percent more likely to survive (Bartik et al., 2020).

Going off that, let us see how smaller businesses or more vulnerable businesses fared. Smaller businesses are going to be more disproportionately affected by the economic downturn in part because they have less capital to weather such disastrous events as lockdowns and decreased demand. Looking at preliminary data, it does not look like smaller businesses have benefitted as much. Why? Because smaller businesses were less aware of the program, less likely to apply, faced longer application times, and were less likely to get approved (Neilson et al., 2020). In terms of geography, funds did not particularly reach the geographical areas that were hardest hit by the economic downturn (Granja et al., 2020). An industry-based look is not exactly flattering, either. The Peterson Institute points out in its analysis on the PPP that although food services, the arts, and recreation incurred huge job losses, other industries received larger shares of the loan money [see below].

Conclusion

So how has the PPP fared so far? We see mixed evidence on the effects of employment, ranging from negligible to slightly positive. It seems that the major benefit of the PPP is that it helped businesses stay afloat for longer. At the same time, there are concerns that the loans were not well targeted, either in terms of geography, industry, or businesses that needed the loans the most. On the whole, was the PPP a good idea? A panel of economic experts at the University of Chicago generally think that it was. The centrist Brookings Institution conversely thinks that it was not because past SBA loans have led to favoritism, delays, and high costs. To that effect, there is evidence that the average cost per job was about $224K through May 2020 (Autor et al., 2020, p. 24), which is a lot for a couple of months of work. It makes one wonder if it could have been more efficiently spent.

Some have proposed alternatives to the PPP. Economist Gregory Mankiw suggests sending a lump-sum, short-term loan to individual ex post. The American Enterprise Institute proposes a tax credit. The Brookings Institution has suggested hazard pay. Instead of the PPP, the Mercatus Center thinks that the government should better ensure access to credit instead. Right now, it looks like there are more downsides to the PPP than upsides. I don't know whether the PPP will ultimately be a force of net good, but I hope to revisit this topic in the future with updated information.  

1-23-2022 Addendum: An economist from MIT along with nine co-authors measured the impact of PPP. (Autor et al., 2022). They found that the PPP preserved two to three million job-years of employment over 14 months. That means to preserve the equivalent of 2-3 million jobs, it cost $170K to $257K. Only 23 to 34 percent of that money spent on PPP went directly to the workers who would have otherwise lost their jobs. Finally, three-quarters of the PPP funds went to households in the top 20 percent of earners. Talking about an ineffective way to spend $800 billion!

7-8-2022 Addendum: The Federal Reserve Bank of St. Louis released its study on the PPP (Emmons and Dahl, 2022). Not only were 75 percent of recipients were unintended recipients, but most of the recipients were in high-income households. Also, the cost of the PPP was anywhere from $169K to $258K, which means that it cost the taxpayers about $4 for every dollar received in wages and benefits.  

Not Eating Meat and Drinking Wine on the Nine Days in Judaism: The Value of Diminishing Happiness

I am sure you read that title and are wondering what the world is going on in my head. "Diminish happiness?! Why would you want to do that?!" Although multiple countries place value on the concept of happiness, it is especially pronounced in the United States. In the United States, the idea of "pursuit of happiness" is in the cultural DNA and the Declaration of Independence. The United States has been referred to as the "land of opportunity." The "American Dream" entails opportunity, success, material wealth, freedom, and happiness as ideals. Since positive psychology was founded in 1998, we have become even more obsessed societally speaking with a happy, carefree life focused on positivity and well-being (see here, here, and here). Placing such value on happiness plays a major role in why contemporary Jews have difficulty connecting to this time of year on the Jewish calendar.

We are currently in what is referred to as the Nine Days period, which takes place during the first nine days of the Jewish month of Av (אב). These Nine Days represent the communal and personal suffering that commemorates the calamities that have befallen the Jewish people. The list of tragedies include the destruction of the First and Second Temples in Jerusalem, the expulsion of the Jewish people on the ninth of Av in the Gregorian year of 1492, and the outbreak of World War One. These Nine Days are treated inauspiciously and are traditionally treated as a time of danger, even in the year 2020. One of the aspects I found of intrigue this year is a passage in the Talmud (Ta'anit 26b):

משנכנס אב ממעטין בשמחה.

From the beginning of Av [to the Ninth of Av], one decreases acts of rejoicing.

Although this Talmudic passage does not prescribe what that entails, it has become tradition that we abstain from consuming wine and meat (Shulchan Aruch 551:9) since they represent joy (Talmud, Pesachim 109a). Other prohibitions have also been included, such as listening to music, shaving [for men], bathing for pleasure, laundry, or buying and wearing new clothing. What took me most aback about this is that that one decreases rejoicing. What is implied is that one actively becomes less joyful. Why would anyone do that? We should do what we can to be as happy as possible. Trying to lower one's happiness is counterintuitive to such concepts as self-care and wellness. 

Part of the answer can be found in a practice found on another Jewish holiday: Sukkot. On this harvest festival, a common custom is to read the Book of Ecclesiastes during the Shabbat of Sukkot. For anyone who has read Ecclesiastes, it is hardly an uplifting text. Yet we read it on a holiday referred to as "a time of our joy" (זמן שמחתינו). According to such rabbinic commentators as Avudraham and R. Azaryah Figo, we are meant to diminish our joy so it does not turn into frivolity. This is to help us better focus on serving G-d. 

If curtailing joy during a joyous occasion can have utility, I wonder if diminishing happiness during the saddest time on the Jewish calendar has value. While negativity bias hardwires us to think more pessimistically, the pursuit of happiness dates back to antiquity, whether that is Aristotle, Epicurus, or Confucius. Especially in a culture that highly values the pursuit of happiness and positive psychology, becoming less joyful is countercultural, to say the least. That might be true, but I think there is merit in doing so.  

If we lived happily all the time, we would have nothing with which to compare happiness. It would get old really quick. Paradoxically, we need difficult moments in life so we can better appreciate the happier moments. 

Here is another salient point. We live in a society with such material wealth. We value comfort so much that we do everything possible to avoid pain and discomfort. That might sound nice in theory, but it ignores the fact that the world has been, is, and always will be full of problems. The first of the Four Noble Truths in Buddhism is that life is dukkha. This word is commonly translated as "suffering," but I prefer the translation of "unease." Even with the seemingly good times, there is still a layer of anxiety and uncertainty underneath, and that is because of attachment to impermanence. As Mark Manson brings up in his book "The Subtle Art of Not Giving a F*ck," "You may salivate at the thought of a problem-free life full of everlasting happiness and eternal compassions, but back here on earth, the problems never cease...they merely get exchanged and/or upgraded." 

The Book of Ecclesiastes reminds us there is a season for everything, including a time to weep and a time to mourn (Ecclesiastes 3:4). The Jews who lost the First and Second Temples lost their homeland, a sense of unity, and their spiritual epicenter. It is okay to not be okay because that is part of the human experience. So many of us are experiencing that feeling of loss and uncertainty right now during this pandemic. The reason why I think this has hit so many people so hard is because it has shattered the illusions of certainty and comfort. The pandemic has imposed upon us that life is more fleeting and ephemeral than we could imagine. We are mourning what we consider the "old normal." 

We are allowed to mourn our losses, but we are not meant to get stuck in the past. More importantly, we are not meant to despair and give into hopelessness. When we read the book of Lamentations (איכה), there is a litany of calamity, ranging from raping and pillaging, starvation, and the seeming abandonment of G-d. Yet despair is not how the biblical text ends. Towards the end, there is a plea to "bring us back to G-d, and we shall return, and renew our days as of old (Lamentations 5:21)." Plus, if we go back to the Talmudic text cited at the beginning, it says that we are to diminish our joy. We are never meant to eliminate it. No matter how bad things got for the Jewish people (and believe me, there has been plenty!), giving up on hope has never been a Jewish value. 

Tragedy hits. That much is inescapable. As I brought up shortly before Passover, bitterness is a part of life. We choose whether to add some sweetness in our lives or not. We also see that concept in the climax of the Nine Days mourning, Tisha B'Av. Even as soon as the afternoon service (Mincha) of Tisha B'Av, we begin to pick ourselves up and start to remove the mourning practices that we take on during Tisha B'Av. Maimonides taught that Tisha B'Av represents that through destruction and loss comes new beginnings. Passover teaches us a similar lesson because the seder starts with brokenness and ends with praise and redemption. Another quote from Mark Manson: "Happiness requires struggle. It grows from problems. Joy doesn't just sprout out of the ground like daisies and rainbows. Real, serious, lifelong fulfillment and meaning have to be earned through the choosing and managing of our struggles." 

Ultimately, I think the certain practices of abstention during the Nine Days teaches us that we cannot run away from problems. Not every year is a pandemic year, but life is not all sunshine and rainbows either. Tangentially, the Stoics realized this by practicing negative visualization. In Stoicism, one meditates on dreadful scenarios. This hardly seems like a way to be happier because it focuses on the negative. However, it allows us to prepare for the worst, as well as acknowledge the nature of life. Rather than be about pessimism, it is about being prepared and being grateful for what one has. Since the ritualistic abstentions during the Nine Days act a metaphor to readily accept pain, uncertainty, and loss as a part of life, I would argue that they engender similar outcomes as the Stoic practice of negative visualization. 

Not accepting these facts of life could be making us more unhappy because it sets us up for unrealistic expectations and chasing an impossibility. Think of that irony: focusing on being happy all the time can lead to greater unhappiness, whereas cutting back on happiness from time to time and properly focusing on the negative can lead to greater happiness. By accepting the inevitability of unpleasantries in life, we create resilience, take the steps towards a new beginning, and bring greater meaning and happiness to our lives because we came to terms with the suffering and loss that we are bound to experience.

The Smithsonian's Take on "White Culture" Begs the Question: When Does "Wokeness" Start to Resemble Racism?

My initial plan was to write on this week's ten-year anniversary of Dodd-Frank, which is the complex bill created in response to the Great Recession that enacted multiple regulations of the finance industry. But then I remembered that I wrote on Dodd-Frank a couple years ago, so if you are interested in my scrutinizing of Dodd-Frank, here you go! Today, I am going to write on a different topic.

Last week, the Smithsonian National Museum of African-American History and Culture (SNMAAHC) included an infographic on its online portal about racism in the United States. The infographic was especially controversial because it outlined what "whiteness" and "white culture" are. As you see below, it includes such features as individualism, work ethic, politeness, and "objective, linear thinking." 

SNMAAHC subsequently apologized for the infographic, but if you look at SNMAAHC's website on whiteness, it is unlikely that they reject the basic underlying premise of the infographic they later retracted. Let's get into some of the reasons what is wrong with this infographic. 

1. Overgeneralizing white people is factually inaccurate. Thinking that a heterogeneous group of people spread over hundreds of miles and that encompasses multiple ethnic and religious groups acts or thinks the same way is ridiculous. Your typical Swede is culturally, ethnically, and linguistically different than an Italian or a Greek. Spanish and French culture are different than British culture. Anyone who has had any exposure to anthropology or sociology would realize this basic truth. Even with some similarities across European-based nations and cultures, it still does not negate the fact that "white culture" is not a thing because there are multiple ethnicities that are predominantly Caucasian. 

2. Overgeneralizing white people is racist. If we are to take this infographic at face value, the people at the Smithsonian believe that being white means being competitive, eating bland food, emphasizing aggressiveness and extroversion (while somehow managing to be polite), obsessing about being timely, thinking that wealth is the key to social status or happiness, delaying gratification, and valuing self-reliance. The infographic from the Smithsonian paints some very broad strokes without a) allowing for any nuance, b) recognizing that not all white people are the same, or c) acknowledging that skin color does not define the entirety of a person. I have met plenty of white people who do not have drive to succeed, would rather rely on others for their well-being, or are habitually late. If anyone were to use this line of arguing against a minority group (e.g., "Those [fill in the blank with minority group] act like this or are incapable of doing that", "They are all the same"), it would be immediately construed as racist, and rightfully so. The question is whether it would be racist if the comment is targeted towards white people. Let us take a look at what Merriam-Webster has for a definition.

This past June, Merriam-Webster updated the definition of racism. Fact-checking site Snopes points out that Webster's did not change it so much as they contemporized the definition to make it relevant for modern times. The dictionary definition does recognize institutional and systemic racism (Definition #2), but it also acknowledges individual racism (Definitions #1 and #3). Per what is in Merriam-Webster, it is possible to be prejudiced against white people, least of all because there is not an exemption for a racial majority. Here are some real-life examples of pejorative terms used towards white people:

• Literally meaning "albino," the Indonesian word bule is a derogatory word for white person.
• The Chinese also have a phrase: guilao (鬼佬). This terms means "white ghost." It is used as a pejorative term for white people. In Singapore and Taiwan, they use the term ang mo (紅毛).
• There are some derogatory terms for white people used in the United States, including "cracker" and "honky", "whitey," and "peckerwood." 
• In Afrikaans, japie is a mildly offensive term for "white person" or "farm boy." 
• The Spanish language, particularly in Mexican Spanish, also has a term for white foreigners that assumes the white foreigner is monolinguistic and does not appreciate Latino culture: gringo or gringa.
• Farang (ฝรั่ง) is the Thai word for white people. Based off this word, the Thai phrase farang khi nok (ฝรั่งขี้นก) means "white trash."

This list is not meant to minimize or ignore ethnic or racial slurs used against minorities. Since minorities on average go through more hardship in life, what a typical minority undergoes in terms of discrimination and prejudice is of greater magnitude than what someone of the majority race or religion goes through. At the same time, it does not exclude the fact that people can also be prejudiced against white people. The ability to be prejudiced is not confined to one racial group or a certain political persuasion. Having biases and prejudices is part of the human condition.    

3. The values in question are not specific to white people. Individualism has been increasing globally (Santos et al., 2017). Working hard is not unique to the United States: the Protestant work ethic exists in much of Europe, not to mention that China and Japan are also known for high work ethic. Christianity is a religion practiced by millions of non-white people throughout the world, including Africans, Latinos, and Asian people. Nuclear families exist in many non-Western cultures, including the Middle East, Africa, Latin America, and East Asia. I can go on, but the point remains the same: so many of these values extend beyond the United States or Caucasians. 

4. Implications of taking issue with these values. If you look at the language used by the SNMAAHC on their website about whiteness, it does not take much to infer that they take issue with the "white-dominant culture." They point out how whiteness includes individuality, the nuclear family, "objective, rational linear thinking," the scientific method, jurisprudence based on British common law (which includes "innocent until proven guilty," a cornerstone of the U.S. legal system), and politeness. Does this mean that racial minorities that show up on time, use logic, or take personal responsibility for their lives are "acting white?" Were Frederick Douglass and Harriet Tubman internalizing whiteness when they emphasized freedom and "rugged individualism" in their lives? Was George Washington Carver acting "less black" when he used the scientific method to make his discoveries? Does the infographic imply that the people at the Smithsonian do not expect minorities to be on time or to work hard? I am sure that Muhammad Ali and Jesse Owens worked tirelessly when they made their way towards competing in the Olympics. Isn't it possible, indeed probable, that hard work, timeliness, logical thinking, and wanting to be the best one can be are values that are not simply for "the white folk," but indeed values that all people can and should strive for, regardless of race or ethnicity? 

Conclusion

It might be alluring to think of the Smithsonian debacle as an isolated incident, but viewing the predominance of "white culture" through this lens has become more prominent in U.S. society, particularly of those who consider themselves "woke." Although it is most commonly associated with the Far Left, the idea of being "woke" started off to simply mean "awareness of racial and political justice." It is one thing to want to fight inequities in society or to make the world a better place than you found it. After all, it can help bring us closer to that ideal of "life, liberty, and pursuit of happiness" for all citizens of the United States. 

Comedian Ryan Long covers this in a sketch (see below), but I do have to wonder at what point does acting "woke" mimic or parallel the views or behaviors of racists. Do you reach that point when you call advocating for a color-blind world a microagression because it collides with your worldview? Is it when you think racial identity is one of the most important, if not the most important, things there is? Is it when you look at others primarily or solely through the lens of race? How about when you make sweeping generalizations about an individual because they belong to a certain racial or ethnic group? Or is it when you see someone appreciating other ethnicities or partaking in other cultural activities and end up calling it cultural appropriation, thereby de facto calling for a form of cultural segregation (see here, here, here, here)? 

Regardless of the color of one's skin, we should all be willing to have conversations about race, even if it makes us feel uncomfortable. We should be able to talk about policies that help minimize racial inequality. Earlier this year, I have discussed on my blog eliminating police unions and qualified immunity, both of which would mitigate racial disparities in policing. We need to address issues affecting African-American citizens because the American Dream should be accessible to every citizen. At the same time, treating all white people as if they were the same or to view whiteness as a secular version of "Original Sin" is no way to bring people closer together or build broad coalitions. As Abraham Lincoln once said, "A house divided against itself cannot stand." 

The Argument for School Closures This Fall Simply Does Not Add Up

We have undergone the worst pandemic since the 1918 Spanish Flu. With it has come the worst economic downturn since the Great Depression. The United States has also experienced the worst social unrest since 1968. While we adapt to a "new norm," there has been considerable debate on the policy responses to COVID-19. In an unprecedented move, we severely limited movement by closing down large swathes of the economy with lockdowns. I have made it no secret that I have thought that the lockdowns were a terrible idea (see here, here, and here). There have been other non-pharmaceutical interventions [NPI] outside of lockdowns that have been used to flatten the curve. Aside from social distancing, face masks are an example of such an NPI. I have made an argument for a temporary, limited face mask mandate (see here and here). 

With the new academic year quickly approaching, another COVID-related NPI has gained attention: school closures. This past spring, there were a number of schools that closed down in attempts to limit the spread of COVID-19. Other schools allowed for children to play freely with one another, whereas other school remained open with considerable social distancing provisions. Much like with the lockdowns, the school closures have become one large social experiment. This brings us to the main question for this fall: Should schools be closed for the upcoming academic year? If not, which precautionary measures make most sense to implement while keeping schools open this year? 

Assessing Benefits of School Closures: Are schools hotspots for COVID-19?

The main purpose of keeping schools closed is to stop the spread of COVID-19. There is some intuition that children would be vectors of COVID-19. They are less likely to keep social distancing, basic levels of hygiene, or wearing their face masks all the time. Plus, children are in contact with parents, classmates, parents, and other school staff. The amount of people combined with apparent lack of adherence to NPI protocols would make children likely culprits of spreading COVID-19. Let's ask some key questions.

What is the COVID-19 fatality rate for children? 

"Think of the children." This sort of political rhetoric has been used to advance multiple policies, ranging from subsidizing school lunches and banning video games to the even-stupider idea of banning adoptions from same-sex parents. So let's focus on the children for a moment. Available public health data show that children account for 22 percent of the population, but two percent of the COVID deaths in the United States. Looking at international data, the countries of Spain, China, and Italy (collected by Oxford University) show that the case fatality rate for those under 20 is near-zero. 

Are children super-transmitters of COVID-19? 

The publication Pediatrics concluded that there have not been that many child-to-adult transmissions of COVID-19 (Lee and Raszka, 2020). Other studies show that children are one-third to one-half less likely to transmit COVID-19 (Bi et al., 2020; Li et al., 2020; Mizumoto et al., 2020; Zhang et al., 2020).

How will this affect teachers and other school staff?

At the same time, schools do not solely consist of children. There are teachers and other school staff that work in schools, many of whom whose age alone puts them in a high-risk category. While there is not a lot of data on teachers and school staff, there is one French study with 46 teachers showing there has not been a single case of transmission (Fontanet et al., 2020). Also, the average age of teachers in the U.S. is 42.4 years (National Center of Education Statistics), 81 percent of whom are under 55 years old. We should take precautions for teachers (especially older and/or more immunocompromised teachers), but teachers are, on average, below the age of being considered high-risk for COVID-19. 

Have school re-openings resulted in spikes of COVID-19 cases?

One good way to ask about the overall risk is to see if school openings or re-openings meant major spikes in COVID-19. Israeli schools experienced a second round of school closures. There was an outbreak at a school in New Zealand. At the same time, such outbreaks are exceptions, not the norm. Preliminary data from 22 nations in the European Union indicate that much of the European Union did not experience a spike in COVID-19 cases. Let's take a look at some of the EU countries. After opening up their schools, the Dutch government found that there were no children infected and very few school employees. Folkhälsomyndigheten, which is the Swedish Health Ministry, compared its school policy with that of Finland. Sweden kept its schools open, whereas Finland closed them. The Minister concluded there was no discernible difference in terms of COVID transmission (Carlson, 2020). Although Denmark gave Sweden some grief, Denmark ended up reopening their schools. And guess what? It didn't worsen the COVID outbreak in Denmark (Reuters). Ditto with Ireland (Heavey et al., 2020), Austria, Finland, and Taiwan (Esposito and Principi, 2020), as well as certain reported regions in France (Danis et al., 2020) and Australia. 

Will keeping schools open result in an increase of COVID-related deaths?

There is a bit of conflicting information on the answer to that question. A systematic review in The Lancet estimated that school closures would lower deaths by 2 to 4 percent, which is still something, but less effective compared to other NPIs (Viner et al., 2020). There are some studies that suggest the opposite. A study from The Lancet states that "school closures could lead to a greater number of deaths than they prevent" (Bayham and Fenichel, 2020). Another study from Health Affairs made a similar suggestion that not only are school closures ineffective, but they could cause greater death (Courtemanche et al., 2020). 

Costs of School Closures

Given what we have seen in schools thus far (see previous sub-section), I am inclined to think that it will not have a significant effect on the overall COVID death count. Even Kevin Drum at Mother Jones, a Left-of-center magazine, said that the current evidence on school closures have "a) little effect, and b) are probably nowhere near worth the tremendous impact they have on both parents and kids." Speaking of which, what is the impact that school closures have? 

• Remote learning means lower student achievement. Measuring RIT scores, the Brookings Institution found a loss in learning projection (Soland et al., 2020). It is estimated that the school closures last spring translated  into only having 70 percent of the learning gains one would normally have. It is even worse for mathematics, with less than 50 percent. Another study goes as far as suggesting that the school closure in spring results in losing at least nine months of educational growth if the school closures continue (Christakis, 2020).
• Economic loss and future earnings. The Brookings Institution has conducted some work on the matter. Their preliminary estimate puts the loss of earnings of $1,337 per year per student (Psacharopoulos et al., 2020). An older study from the Brookings Institution estimated that a 12-week school closure would mean a loss of over $120 billion lost in GDP [in 2008 dollars] (Lempel et al., 2009). 
• The achievement gap and its effects on race and income. Survey data from Pew Research found that children in low-income households were less likely to be able to complete homework at home. According to a survey from The Education Trust, 76% of African-American parents and 82% of Hispanic parents are concerned they do not have the adequate resources to keep their children on track. This has direct impact on being able to achieve in school in the long-run. Consulting firm McKinsey released a report on the achievement gap in the COVID-19 pandemic (Dorn et al., 2020). In addition to the $110 billion in annual earnings lost that McKinsey estimates, there is also a greater achievement gap as a result. While white students are to expect a 1.6 percent reduction in future earnings, black students and Hispanic students are expected to have a 3.3 percent and 3.0 percent reduction, respectively. 
• GDP and costs of parent absenteeism. Children staying home means that parents are more likely to use time off to take care of their children. NYU epidemiology professor Jeffrey Epstein calculated that a month-long nationwide closure would mean $50 billion in lost productivity due to absenteeism.  
• Mental health concerns. Students in China were found to have increased anxiety and depression (Xi et al., 2020). A study from The Lancet concluded that students with preexisting mental health conditions had those conditions exacerbated (Lee, 2020). Survey data from Gallup finds three in ten parents saying that their child's mental health is suffering. This says nothing of what the parents are trying to juggle between work and having children at home. 
• Child abuse and neglect. As the Heritage Foundation points out, 3.5 million children came into contact with Child Protective Services in 2018. This is alarming considering that parents are the perpetrators in 92 percent of child maltreatment cases, according to an Administration of Children and Families study. The Brookings Institution details in its report how COVID-induced school closures contribute to the high likelihood of there being a considerable increase in child abuse and neglect. 

Postscript

We do not have the luxury of living in a world without risks. Whatever we choose entails at least some risk, which is why we need to weigh the potential benefits of school closures against their costs. However, when we do so using the available evidence, the choice becomes clearer and clearer. A chief scientist at the WHO, Soumya Swaminathin, said in May that children are "less capable" of spreading the virus and are at "very low risk" of the illness. The accumulating data are showing that children are not a main driver of COVID transmission (Ludvigsson, 2020). The Royal College of Pediatrics and Child Health made an emphatic statement by saying how this risk is unprecedented and how it could scar the life chances of a generation of young people. As a study from The Lancet concluded, the evidence base for school closures is weak, whereas the costs are high (Viner et al., 2020). To quote the American Academy of Pediatrics, "all policy considerations for the coming year should start with a goal of having students physically present in school." While particularly hard-hit districts will have to reassess in light of exigent circumstances, the default should be to open schools for the upcoming academic year.

The American Academy of Pediatrics provides detailed guidelines on how to do so, but hand-washing, screening, physical distancing, environmental cleaning, proper ventilation, cancelling pep rallies and other large gatherings, staggered scheduling, and offering the possibility of high-risk employees either remote teaching or the semester off would go a long way in minimizing COVID-19 spread because truth be told, we cannot afford another semester without in-person learning. 

9-13-2020 Addendum: In case you needed more costs to the school closures. One paper from the OECD found that the school closures will reduce a student's lifetime income by 3 percent (Hanushek and Woessmann, 2020). Another paper from the National Bureau of Economic Research shows how school closures stunt skills attainment (Fuchs-Schündeln et al., 2020).

Why I'm Not That Worried About Latest Increase in U.S. COVID Cases (At Least Not Yet)

As we have lifted the lockdowns, we move closer and closer to whatever the "new normal" may be. Those have been clamoring for extended lockdowns worry that the lockdowns have been lifted prematurely. The New York Times dismally lamented about a gloomy picture. The Los Angeles Times analogizes the spread of COVID-19 to a forest fire. One of the main metrics that lockdown proponents have used to try to justify either returning to lockdowns or prolonging reopening provisions is that of increased confirmed cases. As we see below (figures extracted from Johns Hopkins website on July 5), the number of confirmed cases has reached 52,391. The percent of positive cases has also increased to 7.6% from its 4.4% trough. Dr. Anthony Fauci called last week "a very disturbing week" in terms of this increase. While it might make some intuitive sense to use number of confirmed cases as basis for whether the pandemic is getting worse in the United States (especially relative to other countries), I have some reasons to doubt that assertion.

• Confirmed cases are not indicative of total amount of infected individuals. One of the best features in favor of confirmed cases as a metric is that it is one of the earlier indicators within the infection timeline. Hospitalizations lag infections, and deaths lag hospitalizations. As nice as it might seem, it does not tell us as much as we would like. As a matter of fact, well-renown statistician Nate Silver wrote a piece in April about how coronavirus tests are actually meaningless. Especially at the beginning of the pandemic, the testing was prioritized for those showing symptoms. While the testing is still skewed in that direction, increased testing capabilities has allowed for more mildly symptomatic or asymptomatic individuals to get tested. Since the testing is not randomized, it suffers from a selection bias that makes COVID-19 look deadlier than it is. Over time, we see that the crude fatality rate (CFR) end up higher than the infection fatality rate (IFR), the latter of which being the apparent death rate. 
• On June 25, the CDC said that for every confirmed case, there are about ten people who had antibodies. At that moment, there were about 2.3 million confirmed cases, which means there were at least an estimated 23 million actual cases. 
• In case you did not have enough evidence that there are a lot more infected than we think, the Pennsylvania State University released an eye-opening paper late last month. This Penn State study examined influenza-like illnesses (ILI) surveillance data. After looking through the ILI data, they concluded that the initial infection rate was much higher. Rather than the initially estimated 100,000 new cases in the last three weeks of March, they estimated that there were actually 8.7 million cases, which implies an initial infection rate over 80 times higher than initially estimated. They also found that the number of cases also double twice as quickly as initially estimated (Silverman et al., 2020). 
• As Reason Magazine points out, even if we want to use CFR as a metric (although it is a poor one), the CFR has fallen from more than 6 percent on May 16 to less than 5 percent as of June 28 (see Worldometers data here).
• Demographic shift in who is getting infected. At the beginning of the pandemic, what we observed in the United States that it was those 60 and older disproportionately contracting COVID-19. Using Florida as an example, the median age dropped from 65 in March to 35 in June. On the whole, 43 percent of COVID-19 deaths in the U.S. took place in long-term care facilities. As the Heritage Foundation reminds us, the age demographics matter a lot when it comes to a serious illness. Younger adults are not immune from contracting a serious case of COVID-19, but the probability of a severe case or death for this demographic is much less likely. What has happened in recent weeks is that younger adults are accounting for a greater share of those infected. With more young adults contracting COVID-19, it is likely that the incident of severe cases and deaths vis-à-vis the IFR will be lower. While there is concern for younger adults infecting the elderly (which means we can have stricter protocols for long-term care facilities instead of another round of lockdowns), this shift is accompanied by other positive trends. 
• Decline in new hospitalizations. According to The Covid Tracking Project, which provides nationwide and state-level COVID data, there has been an increase in overall hospitalizations. At the same time, we have to be mindful of the number of new hospitalizations. Even when accounting for a two-week lag between infection and symptom onset, the CDC still shows an overall decline in new hospitalizations since mid-April. Looking at the CDC's interpretation of hospitalization forecasting, most of the models show a nationwide plateau of new hospitalizations in the upcoming weeks, although certain states (e.g., Arizona, California) are expected to see an increase. 

• Decrease in COVID-19 Deaths. It is more difficult to draw conclusions from the death data since it can take several weeks between infection and death. At the same time, what CDC data show us is that there has been a decline in all age demographics from the April 18 peak. 

• Our ability to treat COVID-19 has improved. Aside from adequate hospital capacity in most jurisdictions, we preliminarily have two treatments that show at least some promise: remdesivir and dexamethasone. We also have greater knowledge on how to treat COVID-19 in terms of treatment protocol (e.g., how to better use ventilators and their limits, prone positioning). I expect preparedness, palliative care, and treatment to only improve as time passes.

Postscript: Am I here to predict the future? No. I am aware the situation could change in either direction at any given moment. Am I here to say that the COVID-19 situation is under control in all 50 states? Again, no. It should go without saying that the situations are going to be different in each state. The impact of COVID-19 has been uneven geographically speaking. Early on, it was New York that got hammered. Now it is Texas, amongst other states, where hospitalizations are increasing. At the same time, Texas is not over capacity and is nowhere near where New York was at its peak (see press releases from Texas Hospital Association or Memorial Hermann, the largest hospital system in southeast Texas). Florida, California and Arizona are in similar situations, and they should improve protocols to make sure the situation does not get out of hand. 

What I do know is this. Although confirmed cases and hospitalization are increasing in certain states, there is enough reason to conclude that we are not at a stage where panic needs to be the response. There are way many more people infected than the confirmed case count suggests, thereby implying COVID-19 is not as deadly. The current caseload is younger than it was at the onset of the pandemic. We still have not seen the uptick in deaths or new hospitalizations over the past couple of months that lockdown proponents have feared. The fear-mongering never seems to end when it comes to COVID-19, but we should not let it get the better of us. We should use the data we have available to make evidence-based choices. While the number of confirmed cases are increasing, we do not see a negative shift in the indicators that would signal severity or lethality. Given the damage that the lockdowns have already caused, the last thing we should do is allow the media to scare us into another round of lockdowns.