This weekly post is for things that are not Omicron. For the Omicron news, see my Omicron updates (#1, #2, #3), the last of which came out the same day as this post. There’s an extensive speed premium, so I’ve gone to a more-than-weekly schedule on that, although I hope to return to weekly-only soon and only do 0-2 more non-Thursday Omicron posts. We’ll see how that goes.

The news other than Omicron was relatively quiet and expected, except for the part where we are at best barely approving Molnupiravir (post on that here). Too quiet, as case counts and deaths dropped an extreme amount due to the holiday, far more than I expected. That makes predicting next week’s numbers especially hard, but I expect a lot of cases and deaths to be officially tallied next week.

Executive Summary

  1. Omicron is coming, see update posts (#1, #2, #3).
  2. Paxlovid remains illegal, Molnupiravir is touch and go.
  3. Cases continue dropped a lot and so did deaths, presumably due to Thanksgiving.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 620k cases (+3%) and 7,240 deaths (-5%).

Results: 528k cases (-11%) and 6,329 deaths (-16%).

Prediction for next week: 630k cases (+20%) and 8,000 deaths (+26%)

I did attempt to adjust for the holiday, I swear I did, but this was a gigantic swing in reporting, much much bigger than last year’s. We know it is reporting because it shows up in both cases and deaths, and there’s no possible way deaths fell substantially last week. That means that there’s a shortfall of at least a thousand ‘missing’ deaths that haven’t been reported yet, and at least 100k cases.

There’s always some chance a miracle happened given how large the change was, but that’s not what I expect.

How much of that gets missed permanently, versus how much gets put into next week, is unclear, so this is one of the hardest weeks to predict.

Deaths

Cases

Vaccinations 

It doesn’t look like all the noise about Omicron is motivating people to get boosted or vaccinated, and it’s now been a while since kids were eligible. Numbers declined a lot.

It’s not the WHO this time, it’s the WTO, and I’m not generally a fan of waving patent rights, if you want the patent rights then there’s a price at which they are for sale and you can always go ahead and Cut Lex Luther a Check, but wow should the you not let a new variant stop you? I’ll let Zeynep take this one.

I do think you want to buy or otherwise urgently arrange for patent/IP waivers for the antivirals, that’s probably the most important thing right now, but seriously, there’s no big fundamental skills/secrets issue like there is with mRNA, this isn’t hard, at most all you have to do is cut the check.

Permanent Midnight

There’s saying the quiet part out loud. And then there’s not realizing it was even supposed to be the quiet part in the first place.

There it is:

“We’re never going to go back to normal. Personally, I don’t think I will ever get on a plane without wearing a mask,” said Patti Solis Doyle, a Democratic strategist who worked closely with Biden during Barack Obama’s 2008 presidential campaign.

Meanwhile, the continued delusion that somehow credit is deserved for the existence of human life, or something.

“The administration has gotten us to a place where we can do things, where we can see our family and our friends and go shopping and go to a movie and do the things that bring back normalcy into our lives,” Solis Doyle said. “I don’t think he gets enough credit for that.”

It’s up to you whether to do those things. The only role ‘the administration’ has in that question is whether they’re going to use men with guns to stop you.

As noted above, he’s tying that decision to vaccination rates rather than tying it to any actual cost-benefit calculation, which should tell you what the actual calculation was.

Vaccine Effectiveness

Giant New York study (direct link) concludes vaccines remain effective against severe disease, but finds decline (although not continuous decline) in effectiveness against infection. Seems broadly consistent with many other findings. Likely won’t be that relevant soon thanks to Omicorn, and in the meantime behaviors likely shouldn’t change much, so I’m not going to invest in a deeper dive at this time.

There’s also the NBA’s findings.

It’s a smaller sample size, but it’s still reasonably big and the methodology here seems quite good. Intentional experiments are illegal so ‘natural’ ones like this (or what we found in New York) will have to do. Where else are we going to test and monitor a group of people this reliably?

Not having the raw data limits the upside, as does framing the questions entirely in terms of the booster eligibility thresholds. There’s no way six months and two months are exactly optimal according to the NBA data, all the NBA is telling us is that if one chooses that cutoff one finds an effect, rather than that time length being optimal if you look at the curves involved.

The key fact is that there were 34 cases of vaccinated players diagnosed with breakthrough infections, and all 34 had much lower antibody levels than the rest of the population. There are about 450 players in the NBA. It’s unclear how many remain unvaccinated, but let’s say ~50. This seems to imply something like, if we took those 400 vaccinated players and split them into two equal groups of 200, the lower-antibody group has 34 cases and the higher antibody group would have zero cases, and since we said ‘much lower’ we could likely do a 2:1 or higher ratio and get the same answer.

The chance of that being a coincidence is epsilon, and suggests that testing one’s antibody levels has high value of information. If they remain high, regardless of when you were boosted, you can treat yourself as outright immune for all practical purposes. If they’re low, you can choose whether to get a booster. I do realize this is not a practical solution for ‘the public,’ it’s too complicated on several levels, but it’s not too complicated for you if you are reading this and worried about maintaining protection and also worried about the cost of continuous booster shots.

Vaccine Mandates

The common ‘look what you made me do’ energy:

When we make rules that are meant to punish non-compliance, or that set up a lot of arbitrary barriers, what we often end up doing instead is punishing scrupulousness and honesty.

We also then turn around and blame the nonsensical punishment on the person who didn’t do what we wanted, rather than on the person deciding to administer the nonsensical punishment. The reason the unvaccinated person is ‘selfish’ is because if they are exposed to Covid-19, and then someone else is exposed to them, that this other person lost their doctor’s appointment. There’s no mention of them perhaps getting sick or actually spreading the disease. That’s quite the tip-off.

Yes, being vaccinated absolutely provides a public good, and ideally people should factor that into their calculations. But if you think that public good is mostly ‘reducing the number of arbitrary inconveniences imposed on others’ rather than mostly being ‘reducing number of people who get sick and number of people who die’ then which one of those is the real pandemic at this point?

Paxlovid Remains Illegal

Claims that everything possible is being done continue to fly in the face of the simple fact that Paxlovid remains illegal.

This isn’t some technicality. Paxlovid is by far the best weapon we have. Nor is it merely a nominal delay. Treatments barely get mentioned at all in people’s plans or speeches, including Biden’s on Tuesday. We are seeing no logistical efforts to prepare to distribute Paxlovid in a timely manner to those who need it once it is approved, nor are we seeing a serious effort to maximize production capacity around the world.

I presume that such treatments are a threat to the narrative that people bring Covid-19 upon them by being irresponsible (read: sinful) and thus must make various Sacrifices to the Gods in the hopes of making this stop. Treatments aren’t a sacrifice, and aren’t a morality play. In addition, any mention of them, or any encouragement, would lead people to be less eager to get vaccinated or take other preventative measures, and we can’t have that.

So, silence and delay.

Dan Elton does the math on how many people the FDA is going to kill, concludes it is only ~7k, due to expectation that most cases couldn’t be caught in time, and his decision to ignore the effect of approval delays on manufacturing and deployment. I don’t think that’s the right way to do the calculation and I think we can catch more cases than this.

There’s also our reluctance to approve Molnupiravir, which I discuss at the link.

NPIs Including Mask and Testing Mandates 

This must be some strange use of the word ‘rule’ that I wasn’t previously aware of:

I do not think it is helpful to make statements like this, that there is no authority to implement or enforce, and that sound exactly like making someone wear a dunce camp because they refused to do their homework.

It is also not all that helpful to make at-home tests ‘insurance reimbursable’ as opposed to ‘free’ and conflating the two or thinking the former solves your problems shows a fundamental misunderstanding about how humans work. Seriously, this is the opposite of hard.

This MR post about ‘the mask debate’ seems to suggest that second-order effects are so confusing and hard to measure, and the motivations involved so conflicted, that we shouldn’t much care about how much the masks actually prevent a given possible infection? I agree that control systems and the long-term nature of the game make it tough to know how much masks matter in the end, even if we did know exactly how much they did stop a given possible infection, but it still seems very important to know (or get our best estimate of) the extent of this effect. Because experimentation is illegal, and there’s no other good way to get data, we will never know, and we will continue to give up massive amounts of value as a result.

I do think it’s important to notice when there are large forces that do not want us to know things, in that sense this post is instructive.

The charitable interpretation is that the study in question is already doing population effects in the medium-term, so it already makes all of this super murky in all these ways, but the response to this needs to be to try and turn that into a best guess about direct transmission via additional gears, rather than protesting that gears are confusing and some people won’t like them, or something?

There was then a direct response from Jason Abaluck that was posted to MR, in particular to the claim that ‘with more data transparency [the study] does not seem to be holding up very well.’ I find the response convincing in the sense that it points out that the study is holding up fine by its own design and intent, it’s more that some interpretations of the study did not initially well-correspond to the actual contents of the study, and that studying such things is hard which makes it difficult to know how to properly interpret the data.

I do find myself confused about the intuition that a linear model is meaningful here? We’re dealing with a medium-term result, so why should additional mask wearing, however effective at preventing a specific infection at a particular time and place, translate into a linear reduction in the equilibrium number of cases? This would be a strange kind of control system, and the linearity assumption is less natural than it might look. The results largely fitting into that linear interpretation is therefore weird as well.

In other mask news, the perspective here seems clarifying, in two distinct ways – both for the people being described, and the people who do this kind of describing.

Hemry does not, it seems, think there was ever a lockdown or could ever be one in the future, or that restrictions on freedom can be thought of as a sacred value, or that one would worry about them because of what they symbolize or what they normalize and thus enable in the future rather than their direct impact. There’s also the implication that masks and other ongoing restrictions have no downsides worth mentioning, or which are trumped by other values that are sacred, which I keep running into. It also clarifies the default position of similar people that they are simply right, and those who disagree are simply wrong and are full of misinformation.

Hemry’s insight here is that they have a different ethical framework, and that’s more central to the disagreement than disagreements over physical properties of Covid-19. This is then framed as an ethical framework that ‘doesn’t respond to ‘better’ information’ and that is ‘withdrawn from the social compact as we generally understand’ because the ‘we’ in question who are entitled to determine the social compact excludes those with this other framework who understand the compact differently, and the two have different ideas about what information is important here.

I have not personally heard anyone refer to mask requirements and other clearly not-a-lockdown restrictions with the word ‘lockdown’ but I totally believe that this happens, and that the mindset behind that conflation is reasonably common.

For clarity: My working definition of ‘lockdown’ (to the extent it is a simple Yes/No across domains) is that it is a lockdown when people are told to close a large percentage of their places of business, and an ‘X lockdown’ is when some aspect of life X is closed down (so you might for example ‘lockdown the beaches’). A ‘full lockdown’ is when you need a justification for leaving your house.

Then again, while it’s not technically lockdown if you’re required to wear a mask in your own house whenever anyone visits, I am somewhat sympathetic to the alternative viewpoint in cases like this:

The Santa Cruz County, California, health officer has announced that masks will be required indoors indefinitely as part of its efforts to reduce the spread of COVID-19. Private homes are exempt from the order if only members of the household are present. But if there are people who live elsewhere inside the home, everyone must wear a mask. The order does not exempt those who are fully vaccinated.

Princeton continues to ban social gatherings of more than 20 people. A student asks them to perhaps reconsider, suggests slightly less over-the-top security measures that could perhaps be used instead to make the necessary Sacrifices to the Gods.

In Other News

This attitude seems healthy and totally how science works rather than super creepy and authoritarian and cult-of-personality:

Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said on Sunday that Republican lawmakers who criticize him are “criticizing science, because I represent science.”

Not Covid

For those that missed it, this is perfect: The trouble with NFTs. They stole Quark’s apes!

And if you missed it, don’t ask Santa unless you’re prepared to pay a premium price, I wish all news was this clear yet this only raises further questions edition:

What I don’t know is whether this is a comparison to 2020 or to 2019, and I choose to ponder it without checking. If it’s 2020, it’s rather amazing the supply is down. If it’s 2019, it’s rather amazing the supply is up.

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I do realize this is not a practical solution for ‘the public,’ it’s too complicated on several levels, but it’s not too complicated for you if you are reading this and worried about maintaining protection and also worried about the cost of continuous booster shots.

Is there a feasible way for me to measure my antibody level?

I don't know where you live, but in Europe you can get your antibody level measured for around 50€.

If it’s 2020, it’s rather amazing the supply is down. If it’s 2019, it’s rather amazing the supply is up.

Is the second “supply” supposed to be demand?

If variants are spawned as a function of total cases, shouldn't we worry that the billions of infections this winter will spawn a dozen new variants that all sweep the globe at the same time and possibly kill everyone?

Not necessarily. In many ways variants seem to evolve much more deterministically than one might think, and there's good reason to hope that we might ultimately exhaust the repertoire of viable combinations of mutations.

That doesn't sound like less then 20 percent probability! Just in case, we could close all borders just ahead of the billions-of-infections peak for a month to check whether the omnicronomicon opens; then at least each country might only get swept by its own variant.

Omicorn

Omicron


Great post as always. Thanks for linking the things that have been split off.

Re. the NBA study, say I go get my antibody levels tested (which is easy here in Australia), do we know what counts as a high result?

"Omicorn" was a really funny mispelling

I presume that such treatments are a threat to the narrative that people bring Covid-19 upon them by being irresponsible (read: sinful) and thus must make various Sacrifices to the Gods in the hopes of making this stop. Treatments aren’t a sacrifice, and aren’t a morality play. In addition, any mention of them, or any encouragement, would lead people to be less eager to get vaccinated or take other preventative measures, and we can’t have that.

I honestly have no idea what you think people are actually thinking here, except that it seems utterly ridiculous

Maybe Zvi thinks people think:

>In addition, any mention of them, or any encouragement, would lead people to be less eager to get vaccinated or take other preventative measures, and we can’t have that.

This is very similar to the Faucian notion of saying whatever, true or untrue, leads the public to take the actions he wants them to take, as was the case with masks, and we could find out is the case with something else in the future; we can't know when we're being lied to in order for the greater good to be served.

But personally, I think you can explain such an outlook entirely by association with earlier treatments. Treatments have generally been well-received by one of the major American political tribes, while vaccines have been not well received. It's natural for the opposing tribe to invert this, and it seems like they have, to the point where vaccines are the only acceptable solution and treatments are evil. 

This situation reminds me of the very beginning of the pandemic, when de Blasio was tweeting "New York is still open, go out" and Twitter was screaming for a lockdown. The silence about Paxlovid is rather deafening in comparison.