Covid 3/18: An Expected Quantity of Blood Clots

by ZviDon't Worry About the Vase14 min read18th Mar 202125 comments

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Covid-19
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This week’s Covid news was that most of Europe suspended administration of the AstraZeneca vaccine over reports of blood clots. This was ludicrously stupid several times over. There was always going to be something that happened to correlate with vaccination days to some extent, somewhere, over some time period. The number of blood clots experienced after vaccination wasn’t even higher than the base rate you would otherwise expect. And even if all the observed clots were extra, all were caused by the vaccine, all were fatal, and that represented the overall base rate, and we ignore all population-level benefits and economic issues, the vaccine would still be worth using purely for personal health and safety by multiple orders of magnitude.

The WHO and EMA said there was no evidence there was an issue.

None of that mattered, as one by one countries suspended injections as part of a blame avoidance strategy. As a result vaccinations are hold, thousands (or more) will die as a direct result, with many European countries seeing things getting worse rather than better and facing possible new restrictions, and with a permanent new weapon in the arsenal of vaccine skeptics that we’ll have to hear about for decades, long after this is proven to be a non-concern. 

Meanwhile, in the United States, deaths are happily way down, but case numbers have stopped dropping due to the rise of the new strains, and will likely start ticking upwards once again for a while. Whether or not this will count as a last surge/wave is unclear, it looks like the strains aren’t as additionally infectious as we feared and vaccinations are going well, so it might not be so bad.

Also, we (myself and the anonymous donor) awarded the Covid Microgrants, for details see the section on that below.

Let’s run the numbers.

The Numbers

Predictions

Prediction (WaPo numbers): Positivity rate will be 4.2% (unchanged) and deaths will fall by 12%. 

Results from WaPo Covid page, which I picked last week as the data source:

Positivity rate was indeed close to unchanged, but I see a contradiction with the Wikipedia data. The Washington Post source says there were 26% fewer tests and an essentially unchanged positive rate. Wikipedia reports essentially a flat number of positive tests. Those two things can’t both be true at the same time, so someone has this wrong. John Hopkins has 4.7% positive rate right now, but their data a week ago was jumping around due to an anomaly so it’s hard to get a good week over week number out of them here.

I think this comes down to the data anomaly a week ago, which different places are handling differently? Which previously was easy to handle since I had a good chart, now I have a bunch of graphs and have to dig for actual raw numbers when I want them. Oh how I miss the Covid Tracking Project. 

My guess and hope is that such disagreements between sources will usually be much smaller than this, and my best guess on what happened is that the real positivity rate didn’t change much. I’m going to treat tha 26% decline in reported tests at WaPo as not real, and assume that’s where the mistake is.

On deaths, we did much better than I expected. A 12% decline is good, a 28% decline is fantastic. 

Prediction (WaPo numbers): Positivity rate of 4.3% (up 0.2%), deaths decline by 8%. 

I don’t think we can sustain this huge decline in deaths because the decline in cases mostly stopped about a month ago, but given how slow deaths were to decline there’s clearly a bunch of extended and variable delays in death reporting, even more so than previously appreciated, so some additional decline seems likely. Also, whenever there’s a huge jump there’s a decent chance some of it is shifting things in time, and there will be a bit of reversion.

Positivity rate likely starts creeping back upwards in the short term. 

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Jan 28-Feb 3552430788071341020083
Feb 4-Feb 10493726877165342918218
Feb 11-Feb 17383722215239270013997
Feb 18-Feb 24365224334782242713294
Feb 25-Mar 3383416695610195813071
Mar 4-Mar 1025951775371415399623
Mar 11-Mar 1714921010321714027121

This is excellent news as deaths continue to decline steadily. We’re finally seeing the full impact of the decline in cases, especially in the Midwest and West. This was essentially the best case scenario, as substantially bigger declines would have mostly caused me to suspect data issues.

The bad news is that these declines are probably going to stall out soon, since cases aren’t declining at these rates anymore.

Positive Tests

DateWESTMIDWESTSOUTHNORTHEAST
Feb 4-Feb 10144,90299,451255,256149,063
Feb 11-Feb 1797,89473,713185,765125,773
Feb 18-Feb 2480,62564,857150,493110,339
Feb 25-Mar 366,15158,295151,253115,426
Mar 4-Mar 1062,93557,262114,830109,916
Mar 11-Mar 1749,69659,881109,141115,893

All hail the control system, which has successfully once again reasserted itself. We will face increasing pressure from further reopenings and increased dominance of the new strains, and will get steady additional help from vaccinations and warmer weather. Soon we will see which side of that is stronger. In the long run, of course, the vaccinations will win out unless new strains manage to escape them and we don’t respond in time, but in the short run things are more likely to get somewhat worse first before they get better.

Vaccinations

Things are going well on the vaccination front in America. Regional differences exist but steady progress is being made everywhere, and additional supply steadily comes online. We may be a little bit ahead of ourselves with the weekly number due to the giant spike earlier in the week, but much of that was given back the next day, and the steady improvement in volume seems quite real. 

The news in Europe is not as good, because not only were they already far behind, now they’re suspending AstraZeneca shots for no reason, which is the big news item this week. 

(I’m going to stop showing the Europe graphs each week as I don’t think they’ve been worthwhile recently, but if you want to find that info yourself you can always get it at OurWorldInData.)

Europe Panics Over Actual Nothing, Halts AstraZeneca Vaccinations

The AstraZeneca vaccine does not cause blood clots.

At all. No, seriously. It simply doesn’t cause blood clots. Wenodis. We are aware of this. 

The whole incident is so mind-bogglingly insane and stupid that I don’t even know where to begin. 

From what I can tell, the sequence of events was something like this.

  1. A lot of people got the AstraZeneca vaccine.
  2. Because we are paranoid about possible side effects, there’s extensive reporting of anything that happens to people right after getting the vaccine.
  3. Because of #1 and #2, we record a lot of stuff that happens by coincidence, because this isn’t Unsong.
  4. At some point, in some region, over some time period, something bad will happen more often than chance within that region and period, because that’s how probability works.
  5. In this case #4 is certain types of blood clots in some places at some times.
  6. Many did not notice or care that the overall rate of blood clots for those getting vaccinated is actually below the population base rate, and similar to the rate for those getting the Pfizer vaccine.
  7. Many did not notice or care that even if all the blood clots were due to the vaccine, and then in addition even if all the blood clots were fatal, neither of which is possibly true, the vaccine would still be worth taking by multiple orders of magnitude.
  8. Even the WHO and EMA said there was no evidence and nothing to worry about.
  9. Everyone in Europe lost their minds and collectively massively sabotaged the vaccine effort, and likely all vaccine efforts everywhere permanently, by halting vaccinations ‘as a precaution.’
  10. People will die.
  11. People will also get more blood clots, because Covid-19 does cause them.
  12. People everywhere will have new stupid arguments that will make people not get vaccinated, likely for all vaccines, permanently, which is already happening.

All of this due, effectively, to pure p-hacking, without even bothering to pretend otherwise.

In addition to being below the base rate, the incidents with AstraZeneca weren’t substantially different from the incidents with Pfizer, because again they are random.

Or as my friend put it when in an unfairly charitable mood:

Or, in the modern vernacular:

Or, in the words of one of the few remaining possibly sane European health authority figures:

Again, let’s be crazy generous and say all 39 cases both were entirely caused by the vaccine (which they weren’t, since again below base rate) and also killed all the patients (which they didn’t, death rate from blood clots is 10-30% per Google). That’s 39 deaths in 9.7 million doses, for a fatality rate of one in 300,000. For example, if that happened to the entire United States it would kill about a thousand people, so purely in terms of deaths it would be about the price of delaying vaccinations by one day.

Also, by the way, there’s this:

So it’s not remotely fair to use the background population rate when you’re explicitly targeting your elderly population for vaccinations. This is so much more insane than it looks at first glance.

It’s purely and simply this (link to Reuters):

Another simple Fermi calculation:

And again, how many people could this possibly kill, even if several things went impossibly badly, in exchange for saving those 1,785 lives? 

Six. 

Not six thousand. Not six hundred. Six.

What do you idiots slash mustache-twirling villains have to say for yourselves, and do you have a preference as to which of those two ways would you prefer to be primarily identified?  

Link to the Q&A here (in German). Translated, here’s the meat of it:

So of all the potential things that can go wrong you managed to find one subsection of one thing that happened more often than chance, and let’s be super generous and again assume that all seven were lethal and also that all seven were caused by vaccination and that’s the typical rate going forward, and (does math) yeah you’re still off by more than two orders of magnitude and you know it, but you have a legal obligation to these people that forces your hand, because ‘there could be legal consequences’? And there’s no way to, say, pass a new law to fix that, even if you should have fixed it long ago? So that’s it, nothing you could do, huh? 

Also there was this:

Read that last line again and think about what it implies in the context of this question.

The amount of damage this is already doing to vaccination effort is staggering. I got this comment on my last post:

On her first day back after our trip, my wife saw five patients. Two of them expressed serious concern about getting vaccinated in the United States, where they don’t even give the AstraZeneca vaccine, due to these concerns, and she had to spend a bunch of time explaining the several-layered absurdity of that concern. A twitter poll I did already found multiple people saying they know of a shot that was missed. This is only going to get worse.

On my todo list is to do a standalone pure ‘why vaccinations are safe and effective and everyone should get one as soon as possible if they’re able to do so’ post, if no one else has one that does the job well enough. Is there a good one already in existence? Several people have asked, and there’s nothing I’m fully happy pointing people towards. The concern is not ‘you should take one now even if you’re worried others need it more’ but rather ‘if and when there’s enough shots for everyone you really really need to take one,’ which is the error that matters far more overall. 

Better To Have Vaccinated And Stopped Than Never To Have Vaccinated At All

Europe halted AstraZeneca vaccinations. And that’s terrible.

Then again, at least they started doing AstraZeneca vaccinations, without which halting them would have been impossible. America didn’t even start them, and have been holding hostage tens of millions of doses? Isn’t at least starting a pretty good relative result? Isn’t it a mistake to bring down the shame hardest on the person who at least interacted with the problem and did some good, even if they nonsensically stopped, rather than the one who did no good whatsoever?

In this case, I don’t think that applies, because halting distribution is causing large active harm over and above the lack of doses being administered, and because halting it now after approving it is far more indefensible than failing to approve in the first place. Failing to approve also isn’t defensible, but if you’re committed to defending power and ‘ethics’ and counterproductive principles above all else then at least it makes some sense. It can be argued it’s at least consistent and it doesn’t quite fully mean You Fail Statistics Forever. Halting now is some combination of malice and pure madness. It is choosing to cover one’s ass against blame for the perception of irresponsibility at the cost of thousands of lives. Perhaps the blame dynamics involve this, which would be an impressive shooting of one’s nose to spite one’s face…

…or it’s (also) something worse. 

There isn’t a better option. 

That doesn’t let the United States off the hook. But I am very happy that we are not right now halting one of the vaccines for no reason, because that would do that much more damage. And I do think the suspensions are a much worse sign of dysfunction than America’s failure to begin in the first place. To get this result, the rot must go far deeper. 

The most harmful act of all around AstraZeneca, of course, is the United States deciding to hold onto tens of millions of doses indefinitely, left to sit in warehouses unused, while it refuses to approve it and also refuses to send it out, although it is now considering sending some to Mexico and Canada, both of whom have asked for doses. Then again, that’s exactly as harmful as never making those doses in the first place, so it’s hard to know what’s effectively being punished if we accept that politics and power won’t let us export the doses. Economists talk about ‘tax incidence’ and who effectively ends up with the bill for a tax (e.g. the ‘employer half’ and ‘worker half’ of social security are not economically distinct and making one side pay all of it would change very little) and this makes me think about blame incidence, especially now that I (may? have begun to?) understand how central blame is in decision making.   

The English Strain

From the Washington Post, in a standard issue ‘look at the irresponsible ones’ article :

How does that stack up against what the naive model said? If we have 2.7% in January, and assume it means something similar to what ‘March’ means here, we can compare that to a predicted 2.88% for the week of January 18. Then we compare the 36% endpoint to our naive prediction of about 72%, and notice that things are substantially behind schedule since then. That’s great news. Curve fitting gives a rise in R0 from the new strain of only 35%. If that’s accurate, then the model predicts that the new strain prolongs our pain, but there is never a last surge. 

What that model isn’t doing is drawing any distinctions between regions. It presumes that spread is evenly distributed around the country, which is obviously false. That could plausibly mean that we’re underestimating the danger substantially and will see surges in the harder hit places.

Prediction for the control system is hard to evaluate, and will be key to how this plays out. Clearly levels of precaution are declining, but putting a figure on how much they are declining is very difficult. Could be a small impact, could be a large one. 

The alternate explanation is that my five-day cycle is too short, which would be bad news, but would still mean we have more time than we expected and it’s probably not so bad.

Six Feet Good, Three Feet Acceptable In Pinch

The CDC suggests child prison social distancing requirements could soon change, and be reduced from six feet to three feet. You see, there was one recent study that said with full and proper masking that three feet distancing was “safe.” 

This is what happens when various political requirements and elite demands are dominant over decision making, with the scientific justifications being designed to fit whatever the elites need, combined with the obsession with telling people strict/absolute simple rules rather than anyone involved treating the world as a physical object. 

What happened here seems simple. The CDC said 6 feet distancing because they’ve been saying 6 feet distancing for a year, and if you suddenly said 3 feet in a school then everyone would quite rightfully ask what the hell the whole 6 feet thing had been about this whole time, whereas the 6 feet rule is the one thing that everyone has mostly agreed to agree upon even if in practice it often gets ignored.

So the CDC basically came out with guidance that said for child prisons to do their best to follow existing CDC rules for adults, even for children as young as 2, and then do their best to reopen. 

(You should know this already: The actual physical effect, of course, is gradual rather than a step function, likely similar to an inverse square law, so 3 feet I am guessing is about four times riskier than 6 feet, if everyone is exactly 3 or 6 feet apart respectively, and the goal of a 6 foot restriction is to get people to at least be a few feet apart and not crowd into spaces too aggressively. 

There’s also what they see as a necessary distinction between ‘safe’ actions, which allow the retention of a state of grace, and ‘unsafe’ actions, which are blameworthy, and to label everything as either one or the other, with the ability of guidelines to change which is which when the guidelines change, because they don’t think people can handle anything else.) 

Then a lot of child prisons, and especially teachers and teachers’ unions, interpreted the guidelines as actual requirements rather than goals or suggestions, and it was clear a lot of child prisons would remain largely or entirely closed, with prisoners forced to go remote. 

People in power didn’t like that, they wanted the child prisons open, and things will soon be in a place where if the 6 foot rule became 3 feet in general in many places it wouldn’t be that big a disaster, so now the rules are changing, with the one Massachusetts study being used as a fig leaf, despite no one being fooled that we suddenly had learned something from it, let alone that it was strong evidence. 

As always when thinking about child prisons, it’s hard for me to get behind putting our children in child prisons, but given that the alternative is virtual child prisons that are very clearly even worse, and the economic aspects of all this, I’m fine with treating the desire to reopen the child prisons as legitimate. Given that need, and the real physical risks involved, the previous guidelines were wrong and the potential new guidelines are better. 

So this change would be good, even if the process that got us here wasn’t great, and even if issuing the first set of guidelines will continue to cause a bunch of issues. With children (who are effectively largely immune) and vaccinated teachers (almost entirely immune) and masks everywhere, of course you can loosen the distancing requirement.

The even more interesting question here is, if these guidelines do get issued, how do people react more broadly? Do they think ‘oh the six foot thing was all a lie?’ Do all elites memory hole that we ever said six feet and start saying three feet, and how much whiplash does that cause? If the one central rule goes out the window does everyone start treating all of it as one big joke? It would be quite an interesting experiment that should increase popcorn sales.

Alternatively, perhaps that’s a lot of the pseudo-intent here? Use the schools as a backdoor way to loosen distancing requirements without having to out loud admit they were arbitrary, by counting on The People to notice the contradiction, once we get to a place where we want some continued caution but not to go nuts, as we are likely to be in August? 

We Must Protect This House

The House of Representatives has a problem. They would like to return to normal operations, but 25% of their members are being idiots and refusing to get vaccinated (or getting vaccinated but then neglecting to inform others of this, presumably for political reasons). With so many unvaccinated members, the Office of the Attending Physician is unwilling to relax social distancing guidelines.

The problem isn’t lack of supply. That would be even more insane, and congress has its own supply. As much as crippling the speed at which the house can do business appeals to me, our representatives should have and do have full vaccine access at this point.

At least there’s this, which is some small comfort:

But they still have to put up with things like this:

If I were in charge of the house, I’d tell everyone to get vaccinated because starting in a few weeks I was going to expel anyone who wasn’t, or at least bar the doors and not let them in until they fix it, whether or not there’s a way to let them do remote voting anyway, unless they somehow have a physician’s note saying why they can’t get it. There are plenty of workplaces doing the same. Dare the other side to defend not getting vaccinated and make a big deal out of it. 

What I’m curious about is to what extent the refusals are about ‘worried that their crazy base will see it as a betrayal to get the vaccine,’ to what extent it is actual failure to understand that the vaccines are safe and effective and worthwhile, to what extent it is their hatred of the other members of the House and a desire to make their lives as difficult as possible, and to what extent it is a strategic move to delay the work of the legislature. 

I like to think the last one is primary, a lot of them secretly did get vaccinated but are refusing to say so in order to prolong the delays as long as possible, and that these Representatives are mostly like the one who had a cloth mask on that said “I’m just wearing this so I don’t get fined” while having an N95 on underneath. The alternatives involve sufficient disconnection from reality that they are even more concerning. 

One response to this is that a 75% uptake rate is better than what the public is reporting, and that’s without the ones who got vaccinated, so the number is not so bad especially given some of the 25% presumably did get vaccinated, and we don’t need an explanation.  

Covid Microgrants Have Been Awarded

I was very happy with the results here. We got many good responses, and I am proud to announce that we are giving out $39,000 in grants to ten applicants. 

Or at least, we are trying to give out $39,000. It’s proven surprisingly difficult, because several people who thought they had a working PayPal account were often surprised to learn that a four-figure international transfer required much additional paperwork. Hopefully all of that sorts itself out, and as of this edit on Thursday evening nine out of ten recipients have been successfully paid. 

The recipients are:

Someone who wishes to remain anonymous, who is working on the vaccine availability website vaxxmax.com, which interfaces with RiteAid.

Someone else who wishes to remain anonymous, who is working on the vaccine availability website vacfind.org

Someone else who also wishes to remain anonymous, who is working on https://forecasting-covid.com/, which will recreate covid19-projections.com using a new data source, likely Johns Hopkins.

Konstantin Likhter, who is working on the vaccine availability website covidwa.com for residents of the state of Washington. 

Po-Shen Loh, who is working on a better app-based method to do multi-stage contact tracing.

Lisa Hakkert, who is working on pandemic modeling and how the pandemic interacts with internet access.

Jakob Jonnerby, who is working on school reopening plans.

Garrett Schilkey, who is working on 3D modeling of UVC lighting and its preventative effects.

Dylan Alban, who gets special mention for stopping before accepting the money to note that his team had pivoted to working primarily on a different project, the vaccine availability website https://vaccinespotter.com, and making sure we still wanted to support him. 

Abraham Hinteregger, who is working on advocacy for First Doses First.

There’s a clear theme here. These are all IT or modeling projects, and the bulk of it are websites that help track availability of vaccine appointments. This was informative on several levels, not least of which it was a pointed reminder of who reads these posts. More than that, it drove home that this is the strongest current source of small low-hanging fruit an individual can easily pick. Offering information on where appointments are available is not illegal or even regulated, and that’s a sharp contrast to other many areas. 

The vaccine rollout is a hodgepodge of different stuff, so helping ensure that people can find appointments reasonably, and that vaccine does not sit idle, is a big game that can be accomplished for relatively little investment.

I’m sad we didn’t get to do this earlier, when there was more room to have a bigger impact, but better late than never.

Our plan is to follow up later to see how things went, and report back. There’s some chance this or something similar will be open again some time, but we do not have any concrete plans at this time for doing so. 

In Other News

From MR: A theory that when you listen to doctors and other health professionals and let them make decisions, you get decisions with a strong bias towards inaction and paralysis under uncertainty.

Not Covid-19 directly but central to how this column makes decisions: Politics is way too meta.

Badly needed, but actually, given we just now did it and only this much, it seems it’s incredibly hard…

In case there were still doubts what Cuomo is:

It’s not every day you get to look this clearly into a glass house and watch the residents throw stones, I mean wow just wow:

Novavax vaccine 96% effective in preventing mild and severe illness, still not approved. 

Yo-Yo Ma uses post-vaccination observation period as a concert for newly inoculated.

Not centrally covid, but seems like a worthwhile data point that private equity purchases of nursing homes found to have very large harmful effects

Would you go for it, or just let it slip?

Remember, you miss 100% of the shots you don’t book an appointment for. See everyone next week.

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25 comments, sorted by Highlighting new comments since Today at 6:45 AM
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As always, interesting overview and very useful cost-benefit Fermis etc. As usual, I'm confused by some generalizing statements.

The WHO and EMA said there was no evidence there was an issue.

 The EMA says:

EMA’s safety committee, PRAC, concluded its preliminary review of a signal of blood clots in people vaccinated with COVID-19 Vaccine AstraZeneca ...

  • the vaccine is not associated with an increase in the overall risk of blood clots (thromboembolic events) in those who receive it;
  • ...
  • however, the vaccine may be associated with very rare cases of blood clots associated with thrombocytopenia, i.e. low levels of blood platelets (elements in the blood that help it to clot) with or without bleeding, including rare cases of clots in the vessels draining blood from the brain (CVST).

These are rare cases – around 20 million people in the UK and EEA had received the vaccine as of March 16 and EMA had reviewed only 7 cases of blood clots in multiple blood vessels (disseminated intravascular coagulation, DIC) and 18 cases of CVST. A causal link with the vaccine is not proven, but is possible and deserves further analysis.

... Overall the number of thromboembolic events reported after vaccination, both in studies before licensing and in reports after rollout of vaccination campaigns (469 reports, 191 of them from the EEA), was lower than that expected in the general population. This allows the PRAC to confirm that there is no increase in overall risk of blood clots. However, in younger patients there remain some concerns, related in particular to these rare cases.

The Committee’s experts looked in extreme detail at records of DIC and CVST reported from Member States, 9 of which resulted in death. Most of these occurred in people under 55 and the majority were women. Because these events are rare, and COVID-19 itself often causes blood clotting disorders in patients, it is difficult to estimate a background rate for these events in people who have not had the vaccine. However, based on pre-COVID figures it was calculated that less than 1 reported case of DIC might have been expected by 16 March among people under 50 within 14 days of receiving the vaccine, whereas 5 cases had been reported. Similarly, on average 1.35 cases of CVST might have been expected among this age group whereas by the same cut-off date there had been 12. A similar imbalance was not visible in the older population given the vaccine.

The Committee was of the opinion that the vaccine’s proven efficacy in preventing hospitalisation and death from COVID-19 outweighs the extremely small likelihood of developing DIC or CVST. However, in the light of its findings, patients should be aware of the remote possibility of such syndromes, and if symptoms suggestive of clotting problems occur patients should seek immediate medical attention ...

The PRAC will undertake additional review of these risks, including looking at the risks with other types of COVID-19 vaccines (although no signal has been identified from monitoring so far). ...

Sorry for the lengthy quote, but I think it's worthwhile to read this, and I think it does not fit your description. I think that's not saying there was no evidence of an issue, it's saying there maybe was an issue among younger people and PRAC should look into that issue, but cost-benefit analysis says vaccination is still much better.

Given the different age groups affected and analyzed, I would like to understand what your "So it’s not remotely fair to use the background population rate when you’re explicitly targeting your elderly population for vaccinations." sentence means. Which background population rate was used by the authorities? (By the way, the media in Germany noted that the difference between UK and EU may be due to the fact that the age groups receiving AZ in these places are different. That is, AZ in Germany was seemingly given to young nurses, many of which are women, because it was restricted to people under 65.)

For your "sequence of events", as always I'd be happy to know whether "there’s extensive reporting of anything that happens to people right after getting the vaccine" is actually true. Intuition tells me that there's also extensive reporting of symptoms of COVID-19 in times of a COVID-19 pandemic, but in fact there's a relevant amount of unknown cases additional to official numbers. If headaches are the symptom of the relevant blood clots, should we really expect overreporting? My intuition would be that people underreported this symptom, in particular because everyone has heard that you should expect to feel sick etc after being vaccinated. On the other hand, after this discussion and media coverage, I expect people to report headaches more often, and this would also happen without any government-imposed interruption of the vaccination campaign - maybe even more so.

Being a European, I guess I must have lost my mind, so I don't really understand what "All of this due, effectively, to pure p-hacking, without even bothering to pretend otherwise." is supposed to mean. "p-hacking" would be intentional behavior, in particular combined with the "pretend" part. So you imply that there was an intention by analysts in some agency to stop the vaccination? And "without even bothering to pretend otherwise", that is, they also said so? (But then again, seeing the Samo Burja tweet and the text around it, I guess it's not even necessary to present a plausible mechanism how such things work. "Malice", "madness", etc. I can imagine the government meeting: "How do we cover up our failure?" "Let's stop vaccination by pointing out blood clots! We understand statistics perfectly, so we know that the experts in the Paul Ehrlich Institute are wrong, but due to our malice and madness, we follow their recommendation.")

"but you have a legal obligation to these people that forces your hand, because ‘there could be legal consequences’? And there’s no way to, say, pass a new law to fix that, even if you should have fixed it long ago? So that’s it, nothing you could do, huh? "

If I am not mistaken about the Bundestag procedures, the interruption of vaccination did not take long compared to the time it takes to change a law

The EMA report saying that there may be an association with very rare blood clots (which would still imply far more blood clots prevented than caused because Covid causes blood clots + math) came out after I hit the publish button. I agree that they then changed their tune from the pure explicit 'no evidence' line to a new line of Very Serious Person language designed to make it easier for everyone to resume. 

When I say p-hacking, I mean that the search function was identical to what happens when people p-hack, with identical results - they're looking at all conditions and subconditions, in all regions and subregions, with any possible lag ranges, in order to find something that happened above rate. And for the same reason - people are highly motivated to find a positive result somewhere. I don't think anyone in a meeting said the word "p-hack", but no one has denied that the search took place in this fashion, either, nor did they make any attempt to account for it, or notice any issues after they identified what they suspected was the issue. And there's still no mechanism.

I didn't intend to explicitly say that the authorities are failing to use an adjusted background rate, but my prior is that they're not doing so, because no one has mentioned doing the adjustment and in general no one silently does such adjustments when they make things seem more safe, because again everyone is on the 'make the vaccines look unsafe' team.

The EMA report saying that there may be an association with very rare blood clots (which would still imply far more blood clots prevented than caused because Covid causes blood clots + math) came out after I hit the publish button. 

It was around five or at a maximum ten minutes. They had one press conference in which the first person that spoke for longer laid out both. 

And there's still no mechanism.

Assuming that you refer to a biological mechanism, there are people who claim to have found just that.

The EMA report saying that there may be an association with very rare blood clots ... came out after I hit the publish button. I agree that they then changed their tune from the pure explicit 'no evidence' line ...

I may be naive and sound like a broken record but I still think it would be helpful if claims about what some said or did were backed up by a link or something.

When I say p-hacking, I mean that the search function was identical to what happens when people p-hack, with identical results - they're looking at all conditions and subconditions, in all regions and subregions, with any possible lag ranges, in order to find something that happened above rate. And for the same reason - people are highly motivated to find a positive result somewhere.

So when you say p-hacking, you don't really mean people p-hack? Or maybe I don't understand the aim of your word choice - is this just rhetorics, and not meant to be accurate? It seems related to the questions whether MLK was a criminal, and tax is theft?

I don't think anyone in a meeting said the word "p-hack", but no one has denied that the search took place in this fashion, either, nor did they make any attempt to account for it, or notice any issues after they identified what they suspected was the issue. And there's still no mechanism.

So no one has denied that - was there any public accusation to deny it? Any discussion where it would have to be denied? Or was there at least a serious indication that "the search took place in this fashion"?

I didn't intend to explicitly say that the authorities are failing to use an adjusted background rate, but my prior is that they're not doing so, because no one has mentioned doing the adjustment and in general no one silently does such adjustments when they make things seem more safe, 

"the authorities" seems like a word that doesn't explain anything. The health minister possibly does not "use an adjusted background rate", he relies on judgement by a specialized agency. Assuming that this agency does not use an adjusted background rate seems quite a stretch; of course it's possible, but where is the evidence for that in your summary? Where is the evidence for the claim that "no one silently does such adjustments when they make things seem more safe"?

because again everyone is on the 'make the vaccines look unsafe' team.

I have no idea why "everyone" should be on that side, and again, I don't see any evidence for that. Asked by Watson, 220 German politicians today publicly stated their trust in AZ. Your implicit model of politics (or of whatever, I still don't know who "everyone" is) seems to be wrong.

(Commenting from Germany.)

Some comments:
* Re: blood-clotting, I think you've bolded the wrong section. "it is difficult to estimate a background rate for these events in people who have not had the vaccine. However, based on pre-COVID figures" is the part to bold, which makes the rest of the sentence rather pointless. You cannot use pre-COVID figures to estimate expected blood-clotting when we're during a pandemic which involves an illness that specifically causes blood-clotting.
* Institutions use extensive amounts of caveats and other forms of blame-avoiding language as a matter of course, but this language doesn't contain much information. That is, irrespective of how high the actual risk is, I wouldn't expect the language to change much. For instance, the phrase "patients should be aware of the remote possibility" is a waste of time for me to read, and for them to write, unless it affects the agency's actual public health guidelines.
* The focus on this one particular symptom is arbitrary. It seems implausible that a drug that actually made people sick would do so only via rare blood clots and only in young people, whereas it's commonplace in bad statistics to find arbitrary problems in arbitrary subgroups. Hence the accusation of p-hacking. This xkcd comic is a decent illustration of how such a thing can happen.

Now contrast that with the real harms caused by delaying vaccinations, as Zvi points out in his essay. Orders of magnitude more people will die due to delayed vaccinations, not to mention the second-order effect of harming vaccine acceptance worldwide for the foreseeable future.

Insofar as one accepts the notion that a) the risk of side-effects is not nearly high enough to warrant this response, and b) the harm to the vaccination effort and to vaccine acceptancy is orders of magnitude higher, then the actual political response in Europe looks like gross negligence, malfeasance, or outright malice - not of the form "let's intentionally hinder vaccination and get people killed" (which I agree would be implausible comic-book villainy), but rather of the form "as a politician, I only care about avoiding blame; I don't care if my (in)actions kill thousands, as long as I'm not blamed for this", which has to me become an increasingly plausible lense through which to see politics. Here is one Zvi post on the politics of blame-avoidance and inaction.

For me personally, the part during Covid that soured me a ton on EU competence was this: The politicians were so worried of being blamed for wasting tax-payer money on expensive vaccines, that they negotiated lower prices in exchange for receiving vaccines months later. This calculation was so crazy and wrong-headed that you kind of need something like Zvi's blame-avoidance model to make sense of it.

The even more interesting question here is, if these guidelines do get issued, how do people react more broadly? Do they think ‘oh the six foot thing was all a lie?’ Do all elites memory hole that we ever said six feet and start saying three feet, and how much whiplash does that cause? If the one central rule goes out the window does everyone start treating all of it as one big joke?

Covid 3/18: An Expected Quantity of Blood Clots by Zvi

This is neither a new nor a novel phenomenon. The safe distance is three feet. The safe distance has always been three feet.

[T]he speaker had switched from one line to the other actually in midsentence, not only without a pause, but without even breaking the syntax….

Oceania was at war with Eastasia: Oceania had always been at war with Eastasia. A large part of the political literature of five years was now completely obsolete…. Although no directive was ever issued, it was known that the chiefs of the Department intended that within one week no reference to the war with Eurasia, or the alliance with Eastasia, should remain in existence anywhere.

Nineteen Eighty-Four by George Orwell

Sadly, I think that briefly stopping the AstraZeneca vaccine (In Italy it got restarted about today, I think) was a rational decision, made necessary by absolute rampant stupidity. 

I've heard of several people I know getting unreasonably scared about blood clots, and several people had commented over the vaccine being "unsafe" before that. If they didn't suspended it after those nonsense reports then we'd have faced months of general idiocy about it, with every single case of thrombosis in people having received the AstraZeneca vaccine becoming a news story. As a result, a lot of people would have resisted vaccination or tried to receive the "safer" vaccine. If things spiralled out of control, I fear that would have killed a lot more than a week worth of AstraZeneca suspension.

Just saying that there was no blood clots problem while continuing vaccinations would have left the no-vax crowd free to spread doubts.

Stopping the vaccinations for a week, instead, is a commitment to "safety" so insane that it almost comes across as villainous, "we don't care if 2000 people or more dies, if there is even a 1/300000 chances our vaccine might hurt you we will stop it and check it out". It leaves no doubt about where the government's priorities lie, safety above all, to the point of sheer evilness, and it also got people get really angry about it, so I guess that the talk about the government pushing unsafe vaccines onto you should have taken a serious hit.

 

So yeah, it's the decision of killing (in my country) about 2000 people to safeguard against a panic that might or might not have spread, to the goal of getting even more people to vaccinate. It gets me mad that it was necessary, and it was necessary for very stupid reasons, but it was not a stupid decision by itself. 

I'm not sure how much of this reasoning was actually responsible for the decision and how much was a consideration on popularity/liability, but I'm sure that if they didn't stopped it things could have turned out  worse.

This is a good point, and suggests that the bigger issue was whatever caused anyone to publish anything saying there seemed to be an association between the vaccines and blood clots in the first place.

I asked around my teacher acquaintances about the virtual classes. Turns out, no one is sending truant officers if kids do not attend their virtual sessions. All they have to do to get credit for a day is login in the morning. How is this worse than going back to prison?

Guessing that that varies by location—I've heard of online classrooms where you're not allowed to have your video off nearly all day.

But even if it's all as you describe, one answer for how virtual classes might still be worse is that for kids whose home situations are abusive or neglectful, it makes a meaningful positive difference to get to be around teachers and other kids outside their home.

Do they think ‘oh the six foot thing was all a lie?’

I think everyone understood that six foot was not a magic line but a rule of thumb, and it can be relaxed now that things are better.

I didn't get the point about Walid Gellad's tweet. Is he someone I should recognize?

I do not think everyone understands this, and I think if they did (in general understand such things) the world would look very different. Certainly those messaging do not think people understand it.

Walid Gellad is a relatively prominent Very Serious Person epidemiologist, but not one of the most known/influential, so makes sense you don't know, but he's one of the chorus of people doing the thing in quesiton.

I'm not sure about that. Seems like everyone gets that posted speed limits are not magic numbers such that exceeding them to any extent leads to carnage and high repair costs or that adhering to them ensure one avoids such results. The 6 foot rule is not really any different of a concept.

My experience has been that people generally give reasonable space, often erring towards more space than less where that choice is clearly possible.

Given that most people seem to get the arbitrary number is posted to give everyone some common standard to coordinate around without it being some type of exact numerical value of specific import.

As for those doing the messaging are also likely doing so based on filtered and skewed information -- just a variation on the central planner problem of non-omniscience.

I think EU countries might be calculating something like this: A) go on with AZ --> people keep talking about killer vaccines and how you should never trust the government and that no sane person should vaccinate and "blood clots today, what tomorrow?" B) halt AZ, then say "we checked carefully, everything's fine, we care, we don't want to kill anyone with our vaccine" and start again --> people will trust the vaccines just-a-little-more

And in the long term the general trust in the vaccines is much more important than few weeks delay.

I think you assume that scenario A is also better for the vaccine trust - maybe, I don't know, but I wouldn't be surprised if the European governments were seeing this the other way.

Also, obviously the best solution is "hey people, let's just stop talking about the goddamned blood clots", but The Virtue of Silence (https://www.lesswrong.com/posts/2brqzQWfmNx5Agdrx/the-virtue-of-silence) is not popular enough : )

Some people I know basically said they would not want to be vaccinated with AZ before the Paul Ehrlich Institute recommended a pause. I have no reason to assume that these people are particularly unrepresentative of the population. It is possible that the break, consideration, restart, communication (including cost-benefit considerations) works better.

The WHO and EMA said there was no evidence there was an issue.

None of that mattered, as one by one countries suspended injections as part of a blame avoidance strategy.

Fortunately, it does matter and France, German and Italy and now resuming vaccination. In Germany the government promised to follow the EMA recommendation before it came out. The ruling coaltion is Germany was split about whether stopping the vaccination was a good idea and by transfering the responsibility to the EMA, the politicians managed to agree with each other without having to take much responsibility for making hard decisions. 

🇨🇦 Tiny Canada update: we've now vaccinated 10 doses per 100 people, and since we're officially doing first doses first in most cases, that's nearly 10% of the population vaccinated. The territories, that have almost nobody in them, are like half-vaccinated already.

Interestingly, while we're way behind the USA on administering vaccine doses (they're at 37 doses per 100 people), we've already soared way past the "more people vaccinated than ever tested positive" figure because we had fewer people test positive in the first place. From a timeline perspective though, that unfortunately means we're even further from herd immunity than being so behind on vaccines would imply.

Nevermind, this update became not-tiny and I made it its own post:

🇨🇦 Canada Covid Update: thinking out loud

I think its unfair to say "everyone in Europe lost their minds" when the EU health agency was very loudly saying things were fine. It would be more accurate to say a couple of specific countries medical regulators and some politicians went crazy. 

Obviously that's still bad, but when looking at systemic failures like this it is important to identify the actual source of the problem. Which seem to be due to idiosyncratic political issues in teh countries involved. Blaming the wrong people undermines the ones who have been doing a good job

Hmm. I came here to nitpick your generalization about whole Europe stopping vaccinations when I only heard of three countries having done that, then googled a bit and discovered that you're basically right. Not whole Europe, but it's much worse than I thought despite the fact that I live here.

Then again, I heard the concerns about AZ from at least two sources already and my parents would delay vaccination if I didn't talk to them, so there's that. Thank you.

Anyway, thank you for these posts and all the time and energy you're putting into them. I really appreciate that I can read just one weekly post to keep up with this.

Now my only nitpick is that you're using clearly inferior meme when this one exists: https://mobile.twitter.com/kennethn/status/1364993536702115840

France's government was nicely explicit in their handling of the AstraZeneca stupid crisis. They basically said "We don't want to stop distributing it but Germany has stopped so we have to stop too". 

Also government officials and ministers have made public, non-ironinc comment like "Macron is now as good as epidemiologists". 

Isn't that even more stupid than the legal argument?

Regarding the suspension of the AstraZeneca vaccine: a crucial point I haven't seen mentioned is that the suspension is temporary: the AstraZeneca vaccinations were only suspended for four days. This is mentioned in the german FAQ that you linked (though presumably it was updated since you posted). In particular, EMA (the European Medicines Agency) recommended that vaccination be resumed on March 18, and the German Bund decided on the same day to resume vaccination on March 19th.

Also, not all EU countries halted vaccinations; my home country Austria for example continued using AstraZeneca. 

Germany has already reversed the AZ stop. Hopefully all other countries will do likewise soon.

The CDC suggests child prison social distancing requirements could soon change, and be reduced from six feet to three feet. You see, there was one recent study that said with full and proper masking that three feet distancing was “safe.”

Of course, with full masking the distance doesn't matter.