China cares a lot about preventing Covid.

I haven’t written an additional China post because my sources have not turned up much additional information, and the situation does not seem to have dramatically changed, so I’m waiting until situation warrants an update. One development was mass testing going on in Beijing, raising worries about lockdown there which could be important politically, but so far the lockdowns haven’t happened.

America does not care much about preventing or treating Covid.

We don’t care about buying or distributing Paxlovid. We don’t care about updating our vaccines. We don’t care about much of anything else either. Nor does the public much care about any of this either. Given the physical situation and what state capacity allows us in terms of alternatives, I am not even sure I would prefer things be a different way. Yes, it means among other things that we literally have a cure for Covid and are barely using it, but it does mean we don’t suffer from lots of extra prevention costs.

The good news is that most of us can safely ignore the whole thing and get on with our lives. Given the alternatives, ‘government does literal nothing’ is not obviously bad news. If they’d done literal nothing from the start we could well be in a much better spot. Alas, this literal nothing does involve things like preventing children from being vaccinated.

The Current Thing not only is no longer Covid, it seems that the invasion of Ukraine has also been replaced due to the leaking of a Supreme Court draft opinion on abortion. Unlike Ukraine, that does not seem like a situation in which my analysis would be news you could use, and I hope to avoid writing much of anything about it.

Executive Summary

  1. New subvariants of Omicron that spread faster are taking over.
  2. They are not deadlier.
  3. Our government is acting as if it does not care about Covid at all.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 400,000 cases (+22%) and 2,720 deaths (+10%?)

Results: 358,439 cases (+9%) and 2,234 deaths (-10%)

Prediction for next week: 420,000 cases (+15%) and 2,275 deaths (+2%).

North Carolina reported 1,172 deaths yesterday, which is obviously a backfill. 1,146 of these were due to updated reporting, and I’ve removed them. With those gone, the number of deaths continues to decline even after the Easter weekend, and this drop is definitely genuine. I’m guessing the numbers that are getting reported are now reasonably decoupled from ‘from Covid’ deaths actually caused by Covid. I’d think they’d go up a little either way, but I wouldn’t have expected a drop this week.

On cases this was overall a good number but the increase in New York in particular is disappointing because it shows that we don’t have a clear peak waiting for us in the future. I’m going to predict a somewhat faster rise this week because I doubt the Midwest drop will get sustained.

Deaths

The deaths number going up this much shows that my prediction the previous week was indeed far too high, despite this coming in substantially higher than my median guess, confirming that last week was a cross between slower real growth than expected and the Easter holiday. This week had a huge jump in the South region.

Cases

BA.1,2,3,4,5

BA.1 gave way to BA.2. Now BA.2 is giving way to BA.2.1.12.

And so it goes, sub-variant gives way to sub-variant. There is no sign that BA.2.1.12 differs substantially in terms of case outcomes from BA.2 or BA.1.

Next up are BA.4 and BA.5 (Flashback to the movie Terminal Velocity: ‘What happened to three?’).

Here is a thread on a new study of cross-immunity between variants (data source).

The news isn’t great. There is reason to think that BA.4/5 might be better able to re-infect people, especially those who were not vaccinated, and thus could cause an additional wave. However they still respond well

Scott Gottlieb reaches similar conclusions.

Bloom Lab takes the same results, and tackles the exact mutations in BA.4/5.

This has all largely been the pattern. New variants make it easier to get infected despite vaccination or previous infection, but protection against severe disease and death remains mostly robust. As a result, additional waves are possible, but they do not case as much proportionate severe disease or death, and the wise move is largely to ignore the wave and go about one’s life. The bigger danger would be if we were unable to do that, but I am not much worried about that at the moment. That could be a big problem if physical circumstances got bad enough, but for now it is saving us.

Bloom’s call for updating the vaccines seems important, but the FDA disagrees. As the prevention section notes, they are dragging their feet and delaying updating into late fall for a variant we knew about last year. Utter disaster.

Physical World Modeling

Bill Gates, always helpful, is here to warn us that the worst of the pandemic may still be ahead.

“We’re still at risk of this pandemic generating a variant that would be even more transmissive and even more fatal,” the billionaire Microsoft co-founder and public health advocate told the Financial Times on Sunday. “It’s not likely, I don’t want to be a voice of doom and gloom, but it’s way above a 5% risk that this pandemic, we haven’t even seen the worst of it.”

This is a pretty weird hybrid of probability (great!) and not probability (less great?), what is ‘way above 5%’? My instinctive interpretation of this is something like ‘I would bet on this at 10% and my real odds are somewhat higher than that’ or something, so real odds in Gates’ mind of maybe 15%-20%, but I’d accept numbers as low as straight 10%. Chances are he doesn’t have a conscious probability estimate here, it’s more that he feels it’s definitely above 5%.

Gates is not reported as having presented evidence for this claim. Does it seem right? Purely in terms of deaths, I can’t disagree simply because 5% is not a lot and it seems fair to put this at more like 10%, and I wouldn’t have a strong disagreement if someone claimed 15%. I do think it is unlikely. We have widespread vaccinations, widespread previous infections and therapeutics that will become increasingly available over time. Covid-19 would not only have to get more deadly, it would have to get a lot more deadly and infectious. Still, there’s reason to think they could correlate, and this thing mutates quite a lot, so it could happen.

The intervention proposed by Gates is… aid to the WHO?

The WHO had “less than 10 full-time people” working on outbreak preparedness, said Gates, adding that “even those people are distracted with many other activities”.

“We’re down to the bare minimum, and if the UK cuts more, then others will do as well,” said Gates. “That would be tragic because . . . all that money saves lives for less than $1,000 per life saved.”

I am very much in favor of pandemic preparedness, of working on identifying and mitigating or preventing future outbreaks. We should spend vastly more on that.

I don’t think giving money to the WHO (or generally ‘foreign aid’) is The Way. Why do they have less than 10 full time people on outbreak preparedness now? What makes you think they’ll make good use of the money if given to them? When a pandemic did arrive, was the WHO helpful or did they actively get in the way of the most important prevention and mitigation measures while worrying about political implications? The questions answer themselves.

Prevention and Prevention Prevention Prevention

FDA Delenda Est as the invisible graveyard continues to fill. Not only are we not allocating any funding for the pandemic, we are not even willing to approve updated vaccines in a timely manner, such that updated boosters continue to be delayed. Omicron emerged last year and it looks like we might get substantial supplies of an updated booster by late Fall.

So much for expedited reviews and approvals. I guess they’re too busy focusing on banning Methanol cigarettes. The choice has been made, and that choice is death. Not all that many deaths at this stage, mind, but death nonetheless. Given this is how seriously FDA is taking even adult vaccinations, how is one to be harsh on individuals who decline to boost or even to vaccinate?

Patrick McKenzie continues to think like someone trying to do the most good for the most people for the least price, and be frustrated to learn our government officials are… not doing that.

I mean, yes, obviously if you triple the price of the first vaccine shots in exchange for producing them a few months faster that is obviously an insanely good trade. Yet it is obvious to most reading this, and definitely to Patrick, many of the reasons why this has zero chance of happening without a sea change at the top.

It’s worth noting that not only can the current pandemic budget not buy an aircraft carrier, there is literally zero money in it. Who exactly is affording the aircraft carriers?

Sam Altman also expresses surprise at our failure to get this done. It was, at the time, reasonably surprising. I wonder if this is making him update on his timelines for fusion power or AGI.

Two Paxlovid tales. The first short and sweet, the second long and less so, but quoted in full to ensure the proper sense of how things are going.

The chance of a given person, faced with that set of obstacles, managing to overcome them in time to make Paxlovid worthwhile is very low. Almost everyone would not know what to do and/or give up, likely at the first signs of social awkwardness but definitely after several failures. Again, no wonder we are not getting these doses distributed, and many of them that are given out are probably losing much of their effectiveness by being too late.

San Francisco reinstitutes its transportation mask mandate. If anything I’m happy that they ever paused it in the first place, an unexpected mark of sanity. I am entirely unsurprised they are bringing it back.

Think of the Children

Even now that Moderna filed, the FDA is still going to stall for an additional six weeks before approving both vaccines for young children. At which point the school year, with its associated mask mandates, will be over for summer.

There was much talk in the comments last week about how this was not an ‘emergency’ situation, and how it would be a ‘wag the dog’ situation if mask mandates dictated vaccine policy. I notice on reflection my real position is (of course) that it is always an emergency in the sense that someone being sick or in danger of being sick is an emergency, saving a life is a mitzvah even on the day of rest, and the FDA should approve anything that would ever get an emergency use authorization, whether or not there is an emergency.

I’d also take the position that yes, being forced to wear a face mask for months on end constitutes an impairment of life that rises to the level of an emergency, regardless of whether the mandate is justified or not, and thus justifies an emergency response. One can respond with ‘the mask mandate is dumb, kids are at minimal risk of Covid so we should fix the mandate not issue them vaccines’ and yes that would be good too. I would still want the vaccines available, because some parents are crazy and no matter what they will continue to cripple their kids lived experiences until they get the vaccine – and in some cases even after they get it, but at least somewhat less often and severely.

There’s also the question of, if you do all this crazy stuff to ‘avoid confusion’ what are you telling a reasonable parent about these vaccines that you’re in no hurry to approve?

Also, study finds remote learning greatly reduced pass rates, with largest effects in areas with more black students. This makes sense, as such students are less likely to have home settings conducive to learning, and also will be less able to tolerate the mind-numbing nature of the festivities involved.

Ministry of Truth

As a concept, free speech is very popular, and the tiny fraction who are opposed to it on the (not true for very long) assumption that they would get to choose who could say what things are endangering pretty much everything by not understanding either its popularity or why it is foundational to our way of life in the name of speech controls.

The relevant clown makeup has now been fully applied, and we are fully out of the ‘no we don’t want to restrict free speech’ into the phase of ‘yes of course we must end free speech.’ Usually with the justification of ‘otherwise those freedom-hating people will win.’

The government decided that days after the purchase of Twitter under the explicit goal of securing the right to free speech would be the right time to announce a new government division dedicated to the suppression of politically disfavored information.

The traditional view of such a timing decision is as a stupid mistake.

I don’t agree. The timing of this decision seems intentional. I believe on at least some instinctive level ‘they’ wanted us to know what they were doing and that they were violating sacred norms, likely for reasons fundamentally related to why Trump or Putin take similar actions. It is a show of strength and a belief that people will choose to align with transgressors because they are transgressing.

Besides, when the wrong person gets potential hold of the means of communication and says they don’t intend to do your bidding, and Obama himself calls upon you to put more limits on free speech, what are you going to do, wait around?

So, standard greeting that’s still permitted, may I present to you the actual not-from-a-dystopian-novel Ministry of Truth, run by someone who previously led successful efforts to suppress true but politically inconvenient information.

When asked about this connection, our press secretary made it clear she knew which novel we were basing the script on.

Oh, and also this person, Nina Jankowicz, seems to have left Substack because it was ‘platforming’ people via letting those who wished to do to type words and then have those words appear on the screens of those who chose to view them. The horror.

Officially the name for this new entity is Disinformation Governance Board, but I am not early to the game of calling this board by its right name. I’m showing restraint here, which is good because here are some examples of rhetoric I strongly suspect falls under Not Helping:

Or to sum up the naming situation:

That does not mean the whole episode will be consequential. Yes, there is now a Disinformation Governance Board operating out of the Department of Homeland Security. But the fact that Biden could simply make this happen whenever he felt like it, and the unclear nature of what power such a board would have to do anything, puts a limit on how much one should panic about what happens when the next president ‘gets their hands on’ this board, or what the board might do before then.

Indeed, rather than the symbolism here being botched, I think the symbolism was the point. As it usually is these days, it’s all such folks think exists. The whole idea is that now There Is a Board, which means you’ve Taken Bold Action. So good chance that the creation of the board is itself the main thing that will ever happen with it, and nothing will have changed. Then again, sometimes this kind of thing is a prelude to a steady ratcheting up of restrictions and the beginning of the end of what is left of our rights. Can’t rule that out either.

Also, Twitter staff react to news of Twitter being sold, without commentary. More of this type of reporting would be good.

And a poll of people who say by 62%-13% that Elon Musk will make Twitter better. I definitely agree that this is by far the most likely outcome.

In Other News

An explainer on Evusheld, it’s kind of crazy that it works.

The White House Correspondents Dinner seems to have infected a bunch of people with Covid. The usual suspects are going with the full rub-ins, as one would expect.

Was the dinner obviously going to spread Covid? Yes, absolutely. Do those who went to the dinner regret it? From what I’ve heard the answer is no. This is something that sounds stupid to regular people, but is super important to those who attend it. By all accounts people were in tears to be able to attend. This ritual is a huge deal.

Gated Stat+ article about the origins of Paxlovid.

How much of the government pandemic-related unemployment benefits were outright stolen?

A lot of the money government spends ending up being stolen is par for the course. It doesn’t automatically mean that the program wasn’t worth doing – the best uses of money are worth many times the amount spent, and it’s often not practical to spend the money without getting a lot of it stolen, like the classic ‘half the money I spend on advertising is wasted but I don’t know which half.’

In the case of the unemployment relief, we definitely needed to do something so it’s hard to say how far we were from the efficient frontier. But this still seems quite bad, as the money isn’t merely gone it is going into the hands of some very bad actors who will thus grow far stronger, and it is a very large amount of money. I do not know anything non-obvious to be done about this (as in, other than ‘make sure that our systems are robust going forward’ and I have every confidence we are doing almost nothing to ensure that this happens). On the margin this should be a major consideration to keep such programs smaller, given our inability to defend them.

Not Covid

Shout it from the rooftops (paper). People dislike their political opponents for views that most of them don’t actually hold. Also, they overestimate how much the other side dislikes them, increasing dislike. And telling them makes this less bad. Neat.

Also, I try to stay away from the current thing but this was too perfect not to share.

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Anecdote:

I took Paxlovid within minutes of my first positive test (my wife was highly symptomatic the day prior, so I fibbed a positive test to get the prescription early). It seemed to work wonderfully - I had virtually no fever and only minor congestion symptoms while everyone else in my family (including my wife who took Paxlovid about 24 hours after her symptoms started) suffered from high fevers, congestion, and in once case a loss of smell. Everyone was mostly recovered in a week while I was unscathed. However, almost exactly a week later, all the symptoms came full-force: fever, horrible congestion, and a loss of smell; even the test itself was a strong positive line which had not been the case before. Paxlovid seemed in my case not to 'cure' Covid but instead to merely delay the symptoms by a week. I've heard that "rebound" Covid cases can happen with Paxlovid and so maybe it was just bad luck for me, but it has definitely been frustrating.

Yeah, Paxlovid might not be as good of a cure as was initially thought due to the issue of relapse. How much of a problem this really is seems unclear.

After a quick search I came across https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/ as a way to find locations of Test-to-Treat locations. Seems solid.

banning Methanol cigarettes

You mean menthol? (The WordPress version of the post seems to have it right.)

I’m going to predict a somewhat faster rise this week because I doubt the Midwest drop will get sustained.

The deaths number going up this much shows that my prediction the previous week was indeed far too high, despite this coming in substantially higher than my median guess, confirming that last week was a cross between slower real growth than expected and the Easter holiday. This week had a huge jump in the South region.

These pieces of text don't seem to line up with their associated charts and graphs? I notice I am confused.