slv77

Sometimes people want to be firefighters to protect the people they serve but others love how being in a crisis makes them feel alive. The later are why arson investigators first look at firefighters when doing an arson investigation. Some of them need the fires and will start them just to fight them.

There are a lot of these types that gravitate to crisis management roles like DevOps.

There is a lot of help and experience in setting up intentional communities. A good place to start is https://www.ic.org/.

If it were an arbitrary biological instinct then it wouldn’t be contextual based on cultural clues.

It is difficult to create scenarios that trade-off one life for millions without implying responsibility of the person being asked to make the decision. People are grappling less with moral trade-offs in these decisions than they are with the dual axis questions or morality and responsibility. Create a scenario that trades off one life for a million but doesn’t imply the person choosing is in a position of responsibility and it becomes morally unambiguous.

For example a researcher choosing to sacrifice a healthy individual to donate their immune cells to save a million terminal cancer patients is considered morally reprehensible because people can’t to see how the researcher could be considered responsible for the a healthy individuals life. If the individual goes from being healthy to being in a coma and researcher becomes family member the question then becomes morally ambiguous.

The scenarios aren’t the same.

The switch scenario implies that the individual has responsibility for the entire system. The switch and the train have a strong cultural component that implies responsibility for the system as a whole (employee). Even if you state it explicitly people simply don’t believe that a train switch is going to be left unattended and put into the hands of a completely independent third party. If you state that the train switch operator dies while you are visiting the station leaving the switch in your hands there is an implication that you are stepping into the switch operators role.

Society expects that someone with responsibility for the entire system would make trade-off decisions that would be immoral in the second scenario. For example, a politician would be expected to make policy of when it is acceptable to harvest organs from a donor while a doctor making a decision unilaterally would be morally repugnant.

The questions are more interesting in getting insights into cultural expectations of responsibility than deep biological biases about morality. It turns out that we have very finely tuned expectations on what rises to the level of “responsible” that moves a decision from one category to another. A health minister making a decision about which medical treatments are medically necessary are seen as less morally ambiguous than an insurance executive even if the process to make the decision and the outcomes are exactly the same.

Yes, civilization would have largely survived a partial and temporary collapse of the US healthcare system that was a potential outcome from covid.

There were multiple countries where the medical system came close to collapse. India in 2021 is a case study of a medical system pushed beyond its limits (https://www.nytimes.com/2021/06/28/world/asia/india-coronavi...) and civilization largely continued.

But there is a lot of latitude between normal and survived.

Let’s assume that US policymakers considered taking no-action and let the ICUs collapse. Could policymakers in that scenario reasonably expect that teachers would continue to teach? Would the school system function if 20% of school teachers decided to not risk death and opted out?

That answer was easy to get and the answer was that schools would be shutting down.

How many essential workers would opt-out? How many need to drop-out to care for children? How many because they are sick? For how long? How does that impact fuel and food distribution?

Can we expect crowds would gather at hospitals? How many in that case become violent? How do we control crowds? Do we call in the national guard?

I’m not sure I can see any scenario that a policymaker could consider where reducing spread wasn’t the only viable option.

In this case the queue was wait time for an ICU bed and the simulation allowed them to better model how events (infection, admission, resolution) would impact ICU wait times. This allowed policymakers to better understand the tipping point where ICU wait times went non-linear.

N-95 masks work to keep you from catching the virus and cloth or paper masks (somewhat) prevented you from spreading the virus. Ideally everyone would have worn N-95 masks but the US had four problems:

1) The US didn’t have enough N-95 masks. In Asia where masks in public were more common people used masks from their home supply. I think some segments of the population were resentful that the US didn’t have access to the best masks and Asia did. 2) We had only a general idea of who was high risk. 3) We had only a general idea of the long term impacts of the virus. There was some initial concern that the virus could be like the Zitka virus where mortality rates dramatically increase with the second exposure. If that were the case the second waves could have killed off half the population with wide transmission. 4) Households aren’t homogeneous and it is near impossible to prevent transmission from a possibly asymptomatic child to a high risk adult when they share the same home.

Unfortunately given the lack of consistent messaging about masks in the US one segment of the populations believed that the masks were to protect themselves and the other segment believed it was to protect others. Those that were low risk and believed it was to protect themselves resented the masks and those that saw the masks as a way to protect others resented those that resented the masks. I think those polarized views still persist today.

Deaths peaked in 2021 but hospitalizations peaked in 2022. Hospitals were at higher capacity in 2022 but treatment protocols had improved reducing mortality rates. Deaths caught the headlines so people missed the surge.

https://ourworldindata.org/covid-hospitalizations

Discrete event simulations is used to get better utilization of a constrained resource. The fact that hospitals were using it just reinforces that ICU capacity was considered a serious constraint by policymakers. Discrete event simulation will give policy makers more confidence in capacity models but doesn’t improve patient outcomes or reduce treatment time.

Hospital protocols also improved over time to reduce the need for respirators and the disease moderated but there was no magic protocol that really reduced disease progression or duration. Out of my social circle there were anti-vaxers that contracted covid late in the pandemic and spent weeks in the hospital (four total, two deaths) even with late stage protocols.

CONCLUSIONS Treatment with ivermectin did not result in a lower incidence of medical admission to a hospital due to progression of Covid-19 or of prolonged emergency department observation among outpatients with an early diagnosis of Covid-19. (Funded by FastGrants and the Rainwater Charitable Foundation; TOGETHER ClinicalTrials.gov number, NCT04727424. opens in new tab.)

https://www.nejm.org/doi/full/10.1056/nejmoa2115869

The hospital ship was never intended to take covid patients. The idea was the ship would take non-covid cases leaving ICU capacity in hospitals. It turns out that military hospital ships aren’t great for the general population given bulkheads and the general layout of ships.

My impression was that a segment of the population felt that the lockdowns and other constraints imposed by policymaker were primarily fear based. This may have been due a perceived difference between religious versus secular acceptance of death (a continuation versus end). My point isn’t that policymakers can’t make nuanced decisions about the value of a human life (since it is done on a regular basis) but instead that from a policymakers perspective it was irrelevant. The bigger concern was the collapse of the health care system which is a non-negotiable.

The assumption that friends and family will calmly watch a family member’s untended death from covid when ICUs are over capacity and that essential workers will continue to show up for work knowing there is no hope for care if they fall ill is unrealistic in my opinion.

ICU capacity consists of the room, the equipment and the staffing. Once oxygen saturation starts to drop the treatment options are oxygen and eventually intubation and a medically induced coma. There is no realistic scenario where untrained or semi-trained individuals are going to be able to provide that support and even if the staffing shortages could be worked around there wasn’t adequate equipment.

The at home treatment option was to watch the patient drown in their own fluids. There are few people in that scenario that would have the emotional capacity to calmly give support to a close family member or friend when there was no ICU capacity. Their more realistic scenario would be people loading the patient into the car and driving to the nearest hospital. Some percentage of that population will likely turn violent.

ICU capacity was a bottleneck that never got resolved. In the US there was never a nationwide effort to mobilize ICU resources to target hot spots other than an initial aborted attempt to gather respirators for the surge in NYC and send a military floating hospital.

Regional programs were put into place to shift patients during a local surge and to mobilize hallways and other non-traditional capacity. In California once capacity dropped below 10% health orders went into effect.

At the beginning of 2023 and well after widespread vaccination the California statewide capacity was at 24% availability with 7% of beds being taken by Covid patients.

https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Reg...

The cost-benefit calculations in terms of excess deaths are irrelevant. It was clear even during the initial outbreak that policymakers primary constraints were the due to uncertainty about the virus and limits on availability of protective gear and ICU beds. Without protective gear there was no way to reduce transmission without isolation and once ICU beds are at capacity mortality rates double and people are dying in the streets and the medical system collapses.

There is no scenarios where the collapse of the medical system is a viable outcome for policymakers that is also compatible with a functioning economy. A collapse of the medical system means non-covid fatalities also increase. Heart attacks, car accidents and childbirth all become mortality contributors. The most likely outcome of a medical system collapse would be martial law, mass graves, economic collapse and potential collapse of essential systems like food distribution.

The idea that policymakers were primarily constrained by the thought of grandpa dying a few years early and weighing it against the grandkids social isolation needs to die.

It’s called manufactured spending and the idea is to be able to buy something and liquidate at the same price with no risk. The intent is to rack up points on credit cards for free travel or to manipulate credit scores.

The adjustable grip hitch is great but the Blake’s hitch is almost magic and my favorite knot right now.

https://www.animatedknots.com/blakes-hitch-knot

A company is insolvent when liabilities exceed assets. Companies can remain insolvent indefinitely unless they miss a payment at which point a creditor can force them into bankruptcy where a court oversees liquidation.

Evergrande is insolvent and is now bankrupt. There is no reasonable scenario here where the company continues to operate as a growing concern.

Shareholders have no priority and the only hope for shareholders to recover anything would be through government intervention (e.g. American International Group). The value in Evergrande was entirely in its financial engineering capabilities and not in its construction expertise. The loss of confidence means that the financial side of the business has zero value now and nobody would be give them new money today even if excess liabilities magically disappeared and the construction side is severely impaired as there is little demand for new apartments.

Short sellers can use bankruptcy as a way of closing out their positions and also in the process provide some market and liquidity. Short sellers borrowed stock and sold it based on the belief that the stock was going to drop in price and need to buy the stock to return it.

Institutional investors will attempt to liquidate but are largely locked in as significant sales will take the price to zero. It is the irrational retail investors who see the stock trading above zero and believe that “smart money” is accumulating shares.

US regulators also require banks to move non-performing loans and assets off the balance sheet. Allowing banks to hold them makes the balance sheet murky and hard to determine if the bank is solvent. In the 2008 financial crisis banks sold houses off in blocks of 1,000 at a time to hedge funds.

A long time ago I dated someone whose Dad worked with nuclear weapons before the nuclear test ban was in place and at the height of the Cold War. At the time there was a saying that it would take less than a dozen nuclear weapons to destroy life on earth if detonated in the right location. Her Dad had told her that the number was more than a dozen but less than a hundred and was pleased to be one of the few that knew the exact number.

As for people dumb enough to make the weapons in large numbers (https://www.businessinsider.com/putin-doomsday-status-6-nucl...)

I’ve had a similar experience with someone who is close and was a hoarder. Hoarding can cause distress for loved ones both from the impact of simply having too much stuff but also the impacts of living with someone who has a mental illness. In my case the person passed away a few years ago and so it is less directly pressing.

I finally understood that hoarding is a breakdown in the error monitoring circuits of the brain. Error monitoring is the feeling that you would get if you almost throw your passport or wedding ring in the trash. Hoarders have been found to be more creative in being able to see alternate uses for everyday objects and also to see more emotional connection to objects than people without the illness.

For me it was important to realize that hoarders motivations aren’t different than mine, just stronger and in other scenarios the difference would likely have been helpful.

In an age of abundance the amount of packaging produced is enough to manifest clinically significant hoarding cases which wouldn’t have been recognized in the past. Think of people whose houses are piled up with old newspapers, magazines and empty cereal boxes. In most cases however clinically significant hoarding cases also require a concurrent issue with acquisition of material goods. Often this tends to fall more towards the traditional OCD behaviors where a premonition or feeling of dread can only be mitigated through a purchase.

Addressing hoarding in these cases requires both addressing the OCD behaviors and the problems with the error monitoring circuit. OCD is difficult to treat and there are no treatments that I’m aware of for misfires in the error monitoring circuits of the brain. That assumes there are no other concurrent issues such as financial pressures, physical disability or depression.

Society collectively displays some hoarding like behaviors with collective misfires in our error monitoring behaviors. We tend to attach more significance to objects we spend a lot of time with which creates an interesting scenario for companies like Apple. While companies like Kellogg’s can produce thousands of pounds of packaging which gets tossed without a thought we require (demand) to Apple that they carefully recycle our tiny but hopelessly outdated device lest they pile up in our houses due to our faulty error monitoring circuits.

Salted nuclear weapons would be a third scenario which could effectively sterilize the planet.

This assumes that both parties are rational agents acting with full knowledge, no coercion and no externalities. The rational agent in economics is similar to the spherical cow in physics. Great for modeling but pretty useless to a cowboy.

Comparative advantage is a thing but in some cases those comparative advantages are an ability to turn a blind eye to the environment or the ability to repress your population. Also, if there were no strategic implications there would be no nations that perused mercantilist policies and no need for WTO dispute resolution over things like dumping and subsidies.

The article summary seems to be that an emotionally resilient person in a supportive community may not need therapy in response to an adverse emotional event. Studies and meta-analysis show that therapy is effective but it is possible that the effects are overstated. The author doesn’t suggest alternatives to therapy.

Personally, it is possible that there are supportive communities where coping skills are widely taught at an early age and that those skills are better for complex trauma than those developed by therapists (e.g. EMDR) but I am pretty confident those types of communities are far from the norm.

Humming increasing nitric oxide production is well documented. Here is one journal article but there are others:

https://erj.ersjournals.com/content/22/2/323

Nitric Oxide dilates the nasal passages and is also a vasodilator as well. A simple n=1 test is to do nasal humming and test blood pressure before and after. I can typically get a (temporary) 10 point drop.

Nitric Oxide is also anti-bacterial and humming may help clear sinus infections.

Return on capital and deprecation tend to exceed energy input costs for most plants so it makes sense to run them 24x7x365 rather than over-size them and run them when energy costs are lower.