Sunday, August 2, 2020

Hi It's Stupid: Preoperational

Illustration by Andrew Couts via Daily Dot.

Hi, it's Stupid to say Donald Trump really believes Covid testing causes Covid disease. I was having an argument over this with a really smart friend, who took the view that with all the terrible things you can fairly accuse him of, it's a bad thing, both ethically and tactically, to accuse him of things he's not guilty of. With which I totally agree, as a general principle.

On the other hand, it developed during the conversation that he really didn't understand very clearly why it's wrong to say, "We have more Cases because we do more Testing," and as I say he's a really smart person, and it struck me that there are probably a whole lot of smart people who know Trump shouldn't say this but don't quite know what we should say instead, including the reporters and opinionists in the new media who have certainly done such a poor job of communicating it that they might as well not understand it. So I thought I'd walk everybody through the argument, ending up with an explanation as to why it's really not that unfair to accuse Trump of believing that testing makes people sick.

"If we tested less, there would be less cases."

Let's stipulate that he means fewer positive test results, and not fewer people infected with Covid-19 altogether (of whom who knows how many are going undiagnosed). 

Is that true? Clearly not. You can't know whether there would be or not, because you don't know who you're subtracting from the pool, some of whom are infected and some of whom are not. However, as a rule of thumb, you can assume people with symptoms or contact with people who are infected are the most likely to get tested, and by the same token people without symptoms or contacts are the least likely, so the shrinkage in the pool is most likely to be in the latter group. That is, you'll be more determined to get a test, or somebody else will be more determined to make you, if you have symptoms or if somebody you're close to is sick, and if it's difficult to get a test, because they're scarce, or because they're inconvenient, you'll still make an effort to do it, whereas those who don't have symptoms or sick contacts won't.

In this way, if the pool is reduced by natural means, the number of positive results could easily stay approximately the same; those who decide not to get a test will tend to be those who would have tested negative anyway. (This is complicated by the fact that there are infected people with no symptoms—40% of the total infections according to recent estimates—and some of them aren't aware of any contacts and don't know they should get tested, but that doesn't really affect the principle.)

"Cases are going up in the US because we are testing far more than any other country."

By the same token, if European or Asian countries increased the pools of people they tested, they would not necessarily get a bigger number of positives, because the people being added would be those who are more likely to test negative. As a matter of fact, in the places where testing and contact tracing is working best, such as Germany or Vietnam, virtually all the infections are caught, so that administering more tests couldn't catch any more, no matter how many additional millions you tested. They don't exist.

This is possible because the spread of the disease has effectively been controlled, and the number of new infections is small. The number of tests a community needs is a function of the number of infections they have—which you can make an accurate guess of in Vietnam or German. In the US or Brazil, where the disease is literally out of control, it's harder to guess, but it's clear that lots more tests are needed.

There is a way of estimating whether you're doing the right amount of Covid testing in a given community, in terms of the percentage of Covid tests that come out positive, as given for nations in this interactive map

The loose rule from WHO is that it's adequate if it's getting a positive rate of from 3% to 12%, but the countries where the disease really under control seem to be the ones where it's under 1%, like Uruguay, Germany, Malaysia, and Uganda. Those like the US where it's between 5% and 10%—Zimbabwe, Paraguay, Kazakhstan, Philippines, and Iran—are clearly in an order or two of magnitude more difficult situations.

But the relevant numbers for the US are really those for the state levels, where there's a huge range from 1% (New York) or lower (Vermont)  through higher levels like California (6.5%), Kentucky (7.2%), and Texas (12.4%) to scary inadequate levels for Alabama (20.1%), Arizona (18.6%), Florida, (19.1%), Idaho (18.8%), Kansas (18.6%), and Mississippi (22.2%). If you increased testing in New York, you'd clearly find a negligible number of new positives—we are in principle catching them all—while if you increased it in Alabama or Florida you'd find relatively a lot. 

But in Alabama and Florida you'd also find a lot more negatives, as has happened in California and Texas as testing has improved in those states, and the rate would go down. Which is where Trump is so pathetic: if he could only bring himself to understand the point, more testing would make him look better.

"We have more cases because we do more testing."

No. We have more cases in the US because
  1. the cases exist; and
  2. we do enough testing to find the number we find (which might or might not increase if we did more).
If the cases didn't exist, the amount of testing wouldn't make a difference. If you did more testing in UK (where the positive percentage is now down to 0.4%), the number of new cases would be insignificant. You can only find them if they're there. And this is where Donald seems to me not just pathetic, but cognitively impaired. And I don't mean suffering from senile dementia (on which I remain neutral) but from a failure to undergo the development most children are finished with by the age of seven or so. It's the insistence that the number of tests is the only factor:
"Think of this, if we didn’t do testing, instead of testing over 40 million people, if we did half the testing we would have half the cases,” Trump said at a press conference at the White House. “If we did another, you cut that in half, we would have, yet again, half of that. But the headlines are always testing." (CNBC)

In insisting that the number of cases is purely a function of the number of tests, Trump is acting exactly like the pre-operational child in Piaget's theory of cognitive development who insists that the volume of water in a glass is purely a function of the height of the glass. 

It's silly to say the kid believes the researcher magically transformed the amount of water by pouring it from one glass into the other, and it would be equally silly to say Trump believes the tests magically cause the disease, but it's tantamount to the same thing. Just as we've seen with his insistence that the proportion of red to blue on the 2016 electoral map proves he won the election in a way that's belied by the actual numbers. He's locked into a vision of the world in which conservation and object permanence don't obtain, a world so unstable that the magic might just as well be real.

And with that failure to mature into the concrete operational stage and beyond to abstract thinking, a more sinister development from toddler egocentrism:
Concrete Operational Stage
We estimate about 5% of adults in a modern society would be found to reason primarily at this stage. At this stage, the individual integrates the perspective of another with their own perspective, and so they can make a deal in which both people benefit. A hallmark of the concrete operational period is to know who cares and who does not. Many of the people in jail (drug dealers, pimps, prostitutes) perform at the concrete operational stage of attachment. Prostitutes functioning at this stage engage in quid pro quo (money for sex). These individuals know the deal, but they do not understand the social norms that forbid such deals even though they can state such norms. That is, their social behavior is based on deals with individuals, but they do not think more generally of what others, even in their own social group, might think. Another example of a concrete person is an individual who has sex with an underage girl. The girl might agree to the sexual encounter, but they do not understand that they are breaking the social norm against sex with underage people. This type of conception of attachment relationships can also be seen in at least some narcissists and psychopaths.  (Michael Lamport Commons and Patrice Marie Miller 2007, How Early Negative Caregiving Experiences Relate to Stage of Attachment)

Cross-posted at No More Mister Nice Blog.

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