Covid 11/4: The After Times

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Covid-19Politics
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The hope is that the pandemic will be fully and truly over because case counts will be sufficiently low, and vaccination rates sufficiently high, that we can all agree to move on and resume our lives.

The fear is that this will never happen. Either cases will climb back up and be sufficiently high to justify a continued emergency state, or they won’t but people will react in a nonsensical and disproportionate way to a tiny risk, forever damaging or even destroying much of our way of life. 

At this point, that potential reaction is the true risk factor. Children as young as five can be vaccinated, and anyone who wants one can effectively get a booster shot. There’s no risk left in the room that is different from many other background risks we all take every day. 

Meanwhile, case counts stopped declining this week outside of the South, so the strategy of ‘wait until cases are much lower’ is looking like a less promising strategy than it did before.

For you, in your life, outside of official meddling, the pandemic is over for you, if and when you decide it is over. 

If you want them to, your After Times can start today.

As far as my personal life is concerned, the After Times started last week. Pandemic over. I’ll still have to flash my vaccination card and toggle my mask on and off as required, but that’s all for show. It’s over. If my building keeps requiring masks and keeps refusing to let delivery people go upstairs, that’s annoying, but so is it when one’s day sadly requires pants.

This past week I dove a bunch into the logistical situation at the Port of Long Beach, and the Tweetstorm that helped change the container stacking rule in the city. That first post was my most widely read post ever by a wide margin. I wrote a follow-up, and notice that the logistics issues seem urgent in a way that Covid issues increasingly do not seem urgent. Perhaps I can continue to work on transitioning away from a Covid focus towards a focus on things that now matter more, on a variety of fronts. The more of these posts I can keep short, the better. 

Executive Summary

  1. Child vaccinations for ages 5-11 good to go.
  2. Case counts may no longer be declining.
  3. Vaccine mandate compliance very high when mandates are actually enforced.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 400k cases (-9%) and 8,600 deaths (-10%).

Results: 442,620 cases (-1%) and 8,439 deaths (-11%).

Prediction for next week: 442k cases (no change) and 7500 deaths (-11%).

The death numbers are predictable. The case number is a major inflection point and will tell us a lot, given that cases stopped declining this week. It’s a very different story to see an increase versus no change versus a resumed decline, and all three are possible. For now I’m predicting no change, but it’s more likely that it meaningfully changes than that it stays essentially the same.

Deaths

Deaths continue to follow cases with several weeks of delay.

There was little uncertainty here, which may change in a few weeks if case counts have stopped declining, but it’s rare now that the death numbers tell us much that we didn’t already know.

Cases

Oh no.

Numbers in the South continue to decline, but the increases in the Midwest and Northeast are exactly what we’d expect to see if we’re headed for a winter wave. Positive test percentages tell the same story, so this is probably not a data artifact. I don’t want to draw too many conclusions from one week of data, and child vaccinations are about to start which could help a lot, but the chances of things fading away into the background that easily seem a lot lower than they did last week.

Vaccinations 

Vaccine Effectiveness

Vaccines are safe and effective, and boosters make them far more effective. You know what might be less effective than the vaccine? Homeopathic treatment, also known as nothing. So here we are, Green Bay Packers.

What’s great about this story is Rodgers petitioning to have his homeopathic treatments ‘count as vaccination‘ and also the NFL pretending it didn’t know what the situation was while Rodgers was going around ignoring the rules for unvaccinated players. Whoops. 

Vaccine Mandates

San Francisco wastes zero time, moves to impose vaccine requirements on five year old children after an eight week period to ensure that children have enough time to get vaccinated. How very generous of them. 

That which is not forbidden is mandatory. That which is not mandatory is forbidden. If you’re voting to make something not forbidden in such a context, you really do need to consider that this is definitely going to happen. 

As I’ve repeatedly noted, there’s a big difference between not getting vaccinated under normal circumstances, and not getting vaccinated even though it will get you fired. That’s a big difference.

It makes sense that the vast majority of the unvaccinated, when push comes to shove and their job is on the line, choose vaccination.

And that’s exactly what happens.

From 66% to 98% means that 94% of all unvaccinated employees agreed to get vaccinated. 

New York had a similar experience.

What’s funny about the NYPD situation is that the same people who would have cheered and laughed at the cops for quitting, are also cheering and laughing at the cops for not quitting. 

Air Canada suspends 800 more than employees without pay for not being fully vaccinated. That’s about 3% of their workforce, so right in line with other numbers.

Here’s an ethics professor who got fired for not getting vaccinated, willing to take a strong stand and pay the price. Yes, such people exist, but they’re rare. It’s unfortunate that the second half of her statement repeats a lot of what I believe to be misinformation, rather than sticking to her principled position that the danger level of Covid-19 simply doesn’t rise to the level that justifies violating bodily autonomy. 

This is in contrast to places where the alternative is weekly testing, especially when that weekly testing doesn’t actually happen. Those tactics are less effective. 

The Federal mandate isn’t going into effect until January 4, if it happens at all. Companies might find ways to not enforce it, but I expect similarly high compliance rates at any companies that do enforce it, and among federal employees, if and when it does go into effect. Republicans are trying to kill the mandate.

Does this mean that work requirements are effectively mostly involuntary? 

It could mean that, but it could also mean that switching jobs is annoying and expensive (and that for those where it wasn’t and they cared a lot about not being vaccinated, they simply already left), and it turns out that defiance of the vaccine mandate is shallow. In the face of actual costs, most fold like cheap tents. I’d expect the same if there was an (actually enforced) reasonably sized fine involved.

It also makes sense that many of the few who don’t do that are taking a stand for actual reasons, like allergic reactions.

There’s supposed to be medical exceptions available, but inevitably some people aren’t being given exemptions they need, because if you are sure to give out all the exemptions people need then lots of other people will get fake exemptions, so it’s very hard to not have this ruined for everyone. 

There’s also this approach. It’s not a great look, but the logic behind it makes sense. You don’t get a death benefit in case of a suicide either, and also I’m not sure why those who want it shouldn’t be buying their own life insurance, which charges different prices depending on a wide variety of risk factors.

These days, workers who refuse to get vaccinated against covid-19 may face financial repercussions, from higher health insurance premiums to loss of their jobs. Now, the financial fallout might follow workers beyond the grave. If they die of covid and weren’t vaccinated, their families may not get death benefits they would otherwise have received.

New York’s Metropolitan Transportation Authority no longer pays a $500,000 death benefit to the families of subway, bus and commuter rail workers who die of covid if the workers were unvaccinated at the time of death.

“It strikes me as needlessly cruel,” said Mark DeBofsky, a lawyer at DeBofsky Sherman Casciari Reynolds in Chicago who represents workers in benefit disputes.

Other employers have similar concerns about providing death or other benefits to employees who refuse to be vaccinated.

NPIs Including Mask and Testing Mandates 

This week’s investigation into our lack of reasonably priced or widely available rapid tests finds the same thing as every other investigation: The FDA dragged their feet sufficiently to drive most providers out of the market, so the few that are approved charge a lot.

Think of the Children

The referenced article makes the obvious point that vaccinated five-year-old children have almost exactly as much reason to wear masks in 2021 as they did in 2019. The fully vaccinated colleges are in deeply similar situations. For whatever reasons, the lives of young people are expendable and their experiences are not important, but their safety even at probabilities very hard to distinguish from zero has been declared paramount.

Young children being vaccinated opens the latest front in the war. Make no mistake, there is a war. 

In Other News

Britain approves molnupiravir, Merck’s treatment pill for Covid-19 (WaPo). 

I’m shocked, shocked to find politics going on in this establishment. 

The things policy isn’t being driven by here seem right. The thing it is does not seem complete, as those in Public Health and who are Very Serious People or offer Elite Consensus clearly can compete with and sometimes overrule public opinion, often not for the better. But yeah, science? How many divisions does it have?

It’s easy to confuse cause and effect. Often the people approve of whatever restrictions such folks get put into place, and blindly follow ‘official guidelines,’ rather than the other way around. Politicians in many places think they’re following polls, and maybe they even are, but that doesn’t mean that regular people are meaningfully driving events. It does offer hope and a (difficult to implement) model of action, if one could convince the public directly. 

In honor of polls driving policy, here are some recent poll numbers from Wisconsin, to give some context of where the public is on these matters. 

Mask requirements for schools split parents down the middle, and are strongly supported by those without children. That’s before child vaccinations, which presumably will move the needle on that at least a little. The same people who support mask requirements are very concerned about children falling behind or having mental health problems (and also, in an unrelated note, inflation). 

New Fluvoxamine results are in, and they look good. This now seems clearly like it should be part of the standard of care in appropriate cases.

I fully endorse that this is too good to check, so not checking.

Occasionally, in this world, there is justice.

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34 comments, sorted by Highlighting new comments since Today at 7:31 AM
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Please allow me to be very angry.

You can toggle your mask on and off as required. Meanwhile my 5 year old is required to wear a mask for 8 hours a day. Every working day. 

Anybody can get a vaccine if they want to. Meanwhile, a lot of people have to chose between getting a vaccine they do not want or losing their jobs. Mandates for kids are coming, scratch that - happening already.

Just because government mandates coincided with your personal choices does not mean that life returned to normal. We're very far from normal.

Respectfully,

Alex N

[Hope this isn't rude: On the chance that you haven't already seriously considered homeschooling/unschooling: Now may be the time to reevaluate to what extent the system controlling what happens to your child at school---the system as revealed in this non-normal time, but as operating even in the normal times---is aligned with your and your child's interests, and to evaluate what other possible options there might be (perhaps giving your child a hearing and a voice in the process).]

I'm so sorry about your kid having to wear a mask 8hrs/day :(

I agree with most of what you wrote, but...

Anybody can get a vaccine if they want to.

...some people can't, for health reasons (I do not remember what exactly). Also, kids under 5.

BTW, I do not have a strong opinion in either direction, just nitpicking.

I know at least one person whose doctor agreed they might want to avoid getting vaccinated for health reasons, but refused to put it in writing, even knowing they were going to lose their job if they didn't either get vaccinated or get an exemption from a mandate.

Mask mandates for students are ridiculous. Vaccine mandates are significantly more complicated, but honestly, people that are putting others' lives in danger based on misinformation should not be allowed to keep their jobs so they can continue to do so.

Do you think that people's driving license should be revoked after the first time they are caught speeding? Should DUI infractions mean that you automatically get fired from your job? Should convicted violent criminals never be allowed to hold another job? We need to maintain a sense of scale between the crime and the punishment, getting your livelihood taken away for the "crime" of not getting vaccinated is way way too excessive for the current death rate of covid. If you think the current death rate warrants such harsh punishments, what's the death rate where you think the threat of joblessness can be removed?

This is a bad analogy.  A DUI or speeding could be a one-time thing. Not getting vaccinated is a continuous decision. All you have to do to reverse it is make the right choice once (or twice if you get Moderna or Pfizer).

Also, drunk driving and speeding are not contagious.  A drunk driver can hurt or kill anybody they crash into, but that doesn't make those people go on to become drunk drivers as well.

I'm not sure that contagiousness is a good reason to believe that an (in)action is particularly harmful, outside of the multiplier contagiousness creates by generating a larger total harm. It seems clear that we'd all agree that murder is much worse than visiting a restaurant with a common cold, despite the fact that the latter is a contagious harm.

Although there is a good point that the analogy breaks down because a DUI doesn't cause harm during your job (assuming you don't drive in your work), whereas being unvaccinated does cause expected harm to colleagues and customers.

I’ve known plenty of people that had security clearances revoked for getting a DUI, which meant that they not only lost their jobs, but in their line of work they had to change careers.

Agreed. A more on point analogy would be that you're not allowed to drive a car that hasn't passed a safety inspection, since it poses an active threat to other motorists.

I'd be interested to see a good estimate and analysis of this multiplier. In places and times when r>1 the multiplier would be quite large indeed, whereas if r<1 then the mutiplier would be more modest. Some sort of time analysis is needed as to how long r stays greater than 1. (r here is the average number of new people infected by a person with covid.)

The punishment actually scales quite naturally to the crime, because you're most likely to get caught if you contract Covid, or - worse - cause an outbreak. In the event of an outbreak, contact tracers are allowed to verify who's vaccinated, inspect security cameras, etc. So the ability to practically enforce the mandate is commensurate with the degree of harm caused.

Canada (where I live) has QR codes that are scanned to verify your vaccination, you can't avoid a mandate by just lying and risking to get caught if you cause an outbreak. But in fact, I don't think you should get fired even if you do cause an outbreak, the death-rate of covid in a world with current vaccination levels is just not enough to warrant such a drastic punishment. Things would be different if no one was voluntarily taking the vaccine, and things would be different if covid had a 10x or 100x higher death rate.

OK, I'll revise. Should you be fired if you lie about your vaccination status and cause a deadly outbreak?

Question about vaccination: I have seen various sources claiming that to end the pandemic we should have vaccinated over a certain percentage of the population (say, on the scale of a country). 

However we have not and now the virus has mutated repeatedly. From this point of view, it sounds as if we will never be over it unless everyone gets bored or something. There is no end in sight as far as I can see. In my country, 61.7% are fully vaccinated, yet the number of daily cases & deaths is indistinguishable from the last fall. Worse, even.

What are your thoughts? I know this is not a rigorous comment (no sources), for this I apologize.

In Slovakia, comparing the beginning of Novembers 2020 and 2021, the daily number of cases is higher than the last year (700 vs 400), but the daily number of deaths is the same (4). Also, the behavior has changed; year ago people were worried, this year they are almost careless.

Comparison between winter 2020 and the beginning of Novermber 2021 shows even greater difference, more cases today than whenever during the last winter (700 vs 600) and yet much fewer deaths today than the maximum of the last winter (4 vs 18). But this is possibly not a fair comparison, because there is some seasonality of the virus, and also the number of deaths may be lagging behind the number of cases.

Considering all this, the vaccines at least divide the danger by 2, but potentially by 5 or more.

Why do you mention mutation? Are you worried that mutation will evade vaccines? This hasn't happened yet: the important new strains all appeared before there was much vaccination. They spread because they were generally more infectious, not because they infected people immune to the old variant. In particular, the trial of the beta-specific vaccine found that it took twice as many antibodies of of someone vaccinated with the original to defeat beta as antibodies of someone vaccinated with the beta vaccine. Twice isn't a lot. The standard for flu vaccines for replacing vaccines with those targeting a new strain is a factor of eight.

I keep checking nextstrain.org and Delta comfortably remains the king of the monsters. With evolutionary convergence, there is a limit as to how “bad” a virus can get from a transmissibility perspective. I can’t guarantee that we’re there, but it sure looks like we might be.

Yep. That's my thinking too. I'd love to know if there's a way of measuring how far off Delta is from the four endemic coronaviruses. Are there common characteristics of "domesticated" coronaviruses that we could be looking for? Like neoteny in domesticated cats and dogs?

Cases are equal because lots of people are vaccinated, but delta is more contagious. The real impact in terms of deaths / hospitalizations will be less. Also, eventually everyone will be immune: either vaccinated or recovered.

So don't despair. It will be over after this winter.

I think we can generalize Zvi's "over for you" concept to "It's over when it's over for a group of n people that you belong to", where you decide which n is relevant for you (your extended family? your circle of friends? your block? your apartment building? your village?)

Any advice on convincing fully vaccinated family members that we need to stop worrying so much about COVID now? The response I keep getting even after showing them the numbers is that "but COVID keeps changing, there could always be a new variant spreading through the population that is significantly more severe/deadly/evading the vaccines." I'm not an epidemiologist, but that seems like a worry that (with full vaccination) is pretty much on par with "we could have a new pandemic, so we should all mask and constantly take precautions"—especially considering that from my understanding, influenza is much more likely to mutate and responds significantly less well to vaccination? At this point, for fully vaccinated, relatively young, healthy people in 75%+ vaxxed communities, are there meaningful risks from COVID more dangerous than base risks from influenza?

I know I just said this above, but will give some more context. A few months ago I asked a similar question. https://www.lesswrong.com/posts/mXBBHAEXj2JyPC6Dt/is-there-a-theoretical-upper-limit-on-the-r0-of-covid

I think the answer is: there is a limit to how transmissible Covid can get. I don’t know that there’s a way to prove that it can’t get worse than Delta, but when I look at nextstrain.org and consider that Covid has now has been hosted by billions of people, and has had several orders of magnitude more opportunities to replicate and evolve, and as of yet it hasn’t come up with anything much better than Delta.

Re convincing family to stop worrying - sounds tricky. I know this sounds corny, but try using "I" statements.

As for "meaningful differences" between covid and flu - the last remaining meaningful difference is the lack of an antiviral. In a couple months we'll have a choice of two. Feel free to message me if you want to rehearse your convos with your family

[+][comment deleted]1mo 1

I expect similarly high compliance rates at any companies that do enforce it, and among federal employees, if and when it does go into effect

The deadline for federal employees is Monday, right? Isn't that cutting it really close? How will you know if it "goes into effect"?

Currently the CDC allows unvaccinated foreign travelers to skip quarantine here but requires quarantine for domestic travel for children under 5 who cannot be vaccinated here. I can understand there may be some arguments around required testing for international travel or the likely circumstances leading to international vs. domestic travel. I may have also missed something. All that said, this feels like a test case for many themes you write about (1) arbitrary rules that don't reflect a physical world model (2) punishing children excessively (3) punishing the type of people who would follow the rules and quarantine (or who worry about children  "outing" them to daycare), etc. In "the war" maybe this could be a test case to see if public attention could drive change? I am biased because my family and most of my friends are currently having to choose between visiting family and having daycare when returning. Perhaps a less motivated reasoning me would wish for consistency in stringency -- though I agree with your 'after times' approach.

Hard to understand how the CDC can say "Based on the potential difficulty that self-quarantine may pose to children under 18 years of age especially when accompanied by a vaccinated parent or guardian who is not required to self-quarantine, CDC has determined that self-quarantine should not be required" but then expect kids to self-quarantine in other circumstances. 

Perhaps I can continue to work on transitioning away from a Covid focus towards a focus on things that now matter more, on a variety of fronts.

Thus was born the most simulacrum-1 journalist the world had ever seen. I'd love this.

The pandemic will "end for me" when (not if) one of the following things happens (whichever happens first):

  1. I get a noticeable breakthrough infection (and recover), despite being boosted. This would tell me that I'm capable of surviving the disease, and would probably give me the coveted "hybrid immunity"

  2. An antiviral becomes widely available. At that point there would be very little meaningful difference between Covid and flu. Preventable + treatable + easily testable = normal

Can you elaborate on why these are your criteria?

How do you know you didn't already have breakthrough infection and recovered?

About two thirds of the vaccinated will not develop any symptoms in such event.

Good point. Revising - if I contract and recover from a noticeable breakthrough infection. Such an infection would accomplish two things:

  • It would tell me that I'm able to survive the disease, taking away the existential dread

  • It would probably give me hybrid immunity - apparently that's the best kind

Also, ideally I'd like the antiviral to be widely available before I get a noticeable breakthrough. That way, the infection could just amount to a booster.