This post is a day late although not all that short, as I warned it might be. This is because I have spent the last week visiting the best place on Earth, my true home, which is New York City. I will return again soon, and soon after that I will once again be able to live there. A great moment. I hope to write about the trip, but I need to get this post out quickly, so that won’t make it in this week.
This week had three (other) big discrete things happen. The CDC issued unexpectedly sane guidelines for vaccinated people, and thanks to the day of delay, we also have Biden announcing a date that everyone will be eligible for the vaccine. Finally, on March 7 the Covid Tracking Project stopped collecting data, requiring another phase transition in much of the data and leaving me without a source for detailed positive test rate data that I’m happy about.
We also had a bunch of opening up around the country, despite what is obviously about to happen.
Let’s run the numbers.
Last week: 4.2% positive test rate and an average of 1,827 deaths after subtracting the California bump, using Covid Tracking Project’s final week of data.
Last week’s prediction: No prediction due to some combination of ‘somehow I forgot to do this’ and the expected lack of data collection making it difficult to fairly evaluate the prediction. We’ll start again fresh now.
(My (highly unreliable guess you should not trust to match what I would have said) would likely have been to see small declines, to something like 3.9% positive rate and 1,650 deaths, which absolutely does not count for anything as a prediction but does give a sense of vaguely where expectations were a week ago.)
This is the testing trends chart from Johns Hopkins, a plausible new data source.
I hate when I want charts and all I get are graphs, and also note that phase jump up and down, and also when you highlight a day it doesn’t tell you what date that is so unless you can work backwards from the final day (and this doesn’t make it that easy to know what the final day is, if it might or might not have updated yet) everything is super fuzzy.
The phase jump here appears in their data in some states and not in others. It’s clearly not ‘real.’ For now, I’m going to presume that the new 4.0% rate at the end is now calibrated however the old numbers were calibrated at the Covid Tracking Project, and ignore the numbers in-between.
Result: Thus, I will conclude that likely the positive test rate did indeed fall slightly, from 4.1% to 4.0%. Deaths fell from 1,867 to 1,374 (!).
Another possibility is the Washington Post, if you’re able to reliably check it on the right day before it updates:
Those are the headline numbers we need in easy to see form, so it makes sense to predict on those in relative terms. Note the 19.5% decline in the number of tests, which indicates that cases falling by 11.3% should be concerning.
Prediction (WaPo numbers): Positivity rate will be 4.2% (unchanged) and deaths will fall by 12%.
Deaths should continue to fall since they lag substantially. Cases could go either way, depending on the impact of the new strains and how people react to reopenings.
The search for a better data source continues. Wikipedia is still good for raw positive test numbers and for deaths.
Alas, the Covid Machine Learning project from Youyang Gu is also wrapping up due to the Covid Tracking Project no longer gathering data. I hope someone gets us a new version with a new data source, but Gu has already gone above and beyond.
|Jan 21-Jan 27||6281||3217||8151||4222||21871|
|Jan 28-Feb 3||5524||3078||8071||3410||20083|
|Feb 4-Feb 10||4937||2687||7165||3429||18218|
|Feb 11-Feb 17||3837||2221||5239||2700||13997|
|Feb 18-Feb 24||3652||2433||4782||2427||13294|
|Feb 25-Mar 3||3834||1669||5610||1958||13071|
|Mar 4-Mar 10||2595||1775||3714||1539||9623|
This is clearly wonderful news and deaths are rapidly on the decline. I worry there’s data artifacts here because the death counts on March 7 and March 8 are so low (e.g. 562 on March 8, and before the 7th the last day under 1000 deaths was November 29). For a while it’s been an increasingly large mystery why deaths haven’t fallen faster, and now they’re falling an amount that reasonably tracks declines in cases. Whew.
|Jan 28-Feb 3||191,804||122,259||352,018||174,569|
|Feb 4-Feb 10||144,902||99,451||255,256||149,063|
|Feb 11-Feb 17||97,894||73,713||185,765||125,773|
|Feb 18-Feb 24||80,625||64,857||150,493||110,339|
|Feb 25-Mar 3||66,151||58,295||151,253||115,426|
|Mar 4-Mar 10||62,935||57,262||114,830||109,916|
This is disappointing news, as is the positive test rate. The decline in the South is impressive, but the other regions are stalling out, and the decline in the South both likely reflects a (slightly) artificially high number last week, and conditions that have since loosened considerably in major areas including Texas. Our march straight down to zero will have to wait.
The next few weeks on this chart will be the moment of truth. If cases don’t pick up by the end of March, they’re likely not going to pick up at all from the current wave of variants, and vaccinations will have enough time to dominate. If cases do pick up, it’s going to be very difficult to pivot quickly.
(Data here is as of March 12 rather than March 11, so it’s 8 days after last time.)
Not only is it clear we can sustain and further increase this pace of vaccinations, we are building up an increasing surplus of vaccine doses, and getting appointments is becoming steadily easier in most places.
We had (and continue to have) a ton of unforced errors along the way that caused (and continue to cause) massive delays, but we are on a clear path to vaccinations on demand for every adult within a few months, and yesterday Biden made that official (WaPo). Every state has been directed to make the vaccines available to everyone over the age of 18 no later than May 1, and Alaska has already gone first and opened up vaccinations to all adults.
Biden delivered the announcement and the rest of his speech well, highlighting that while not everyone will be able to get vaccinated on May 1 or that soon after May 1, at least everyone can get in line on May 1, and emphasizing the need for basic safety measures for now. Needless to say, there was no discussion of cost/benefit, or why we did something very different from this earlier.
Meanwhile, Biden continues to double down on underpromising to maximize the chances of being able to claim overdelivery on all fronts. Meeting one’s 100-day vaccination goal in 60 days without anything unexpected happening that much impacted the pace is more of a sign that you set a very low bar than it is a sign that you went above and beyond.
It is also important to note that we have a strange two-tiered prioritization system. If you are actually high priority, mostly via being elderly, you can get a vaccine appointment (in at least many places) at pharmacies without competing against people who checked a box saying they once smoked a few cigarettes. If you are technically eligible, you can use one of the less convenient, harder to book vaccination sites, or go overnight for Johnson & Johnson.
Compared to most plausible alternatives, this is all actually pretty great. We’re not allocating by price in dollars, but we’re allocating by price at least a little. Rather than be obsessed with exactly what order people get shots in, we make it (relatively) easy to get a shot, and get it safely, if you’re at high risk, and charge a fee in annoyance to those not at as high a risk who want a relatively early shot. So those who are actually high-risk in a less legible way, or who highly value the shot, can mostly get one, and those who are mostly indifferent can wait while others pave the way. Best of all, the annoyance of going to a worse vaccination site is a built-in cost rather than a wasteful tax, so it’s even efficient. Bravo, I suppose.
That doesn’t mean the system doesn’t sometimes fail people when they need it most. It absolutely does:
I do think that particular case is mostly extraordinarily poor luck, but it still happens. Presumably in this particular case help is already on the way, but likely still worth DMing her if you have a lead.
Then again, remember it could always be worse, if we grade on a curve we’re killing it here in the good old USA:
European lockdown strategies continue to have stabilized things for now but not to have improved matters much, and there are signs things are slowly getting worse rather than better. The vaccine efforts are a huge fiasco across the European Union, and should be seen as a challenge to the heart of the entire European project.
The English Strain
Oh no. New strain versus old fatality numbers from this preprint:
The moment will soon be here, and case numbers are already substantially higher than they would be otherwise.
The moment of truth is fast approaching. Within a few weeks, new variants will be a majority of new Covid cases in the United States. Very soon after that, they will account for most cases.
It is clear that the number of people with the variants is continuing to rise, as the overall number of infected people is only falling slowly. It would be very surprising if the number of cases doesn’t rise before it starts dropping again – we are indeed almost certainly at least somewhat f***ed, and the resulting death rate will reflect the higher death rate from the English strain.
The question is how bad things will get. There are naively plausible mathematical models where we are rapidly vaccinating enough people to make up for the shift to the new strains. For example, there are these CDC projections which even underestimated the rate of vaccinations:
The problem with that model is that it fails to include a control system, and the control system is going to spend a while making things worse rather than better.
You can say things like this all you want, but all it will likely do is backfire because it will be seen as a completely unrealistic and unreasonable demand:
That’s pretty unreasonable! When those who always make demands in a direction make completely unreasonable demands – no loosening of restrictions of any kind for a very long time – the response is to go ‘yeah, that’s public health experts for you’ and that’s that.
That’s what happened.
Not to be outdone or even matched, here’s Texas:
Everywhere, we see states lifting restrictions in response to the progress we’ve made. All the vaccinated people that will start acting reasonably, especially now that the CDC has offered guidelines, will likely weaken the ability to enforce norms on the unvaccinated. We’ve already seen our rate of progress dramatically slowed before the impact of a number of rules being loosened, and it’s not clear that those loosenings can be easily reversed, or if they can be reversed before things get back to alarming measured (and thus delayed) levels first, and then are implemented with a delay.
If public health advocates had wanted a different result, they could have offered a reasonable policy backed by object-level logic. I’d suggest something like this: The new strains are taking over. We have to survive one last spike due to the new strains. If a month or more from now, cases are falling and are at or below current levels, you can start loosening restrictions then. That gives people hope and is clearly reasonable, while covering the issues we need to actually worry about. Yes, they might prefer waiting longer than that, but it aint gonna happen.
In Soviet America, Vaccines Still Work But Can You?
What can you safely do if you are vaccinated?
For a long time, Very Serious People have told us that the answer is exactly the same as what unvaccinated people can safely do, all but saying “If I were you I’d lock my doors and windows and never ever ever ever leave my house again.”
This was neither a realistic ask nor a way to get people excited about getting vaccinated. It’s the same problem as telling states they can never open, except even more obviously untenable. Weeks went by, and the CDC issued no guidance on what vaccinated people could do. Thus, this was the situation as late as March 5:
Then, finally, we got guidelines! Real ones that made a non-zero amount of sense! Nice.
That doesn’t mean we got there for the right reasons, and I definitely agree with this take.
And also, while we’re on PoliMath, this take as well, even more strongly:
Then again, if they did the other thing they would never be following the science, they’d be (Following Science™), which is what they do most of the time and what leads to telling everyone that they should build their lives around minimal symbolic improvements in protection against infectious diseases rather than living life. I’d much rather this follow the political realities if it can be combined, as it was here, with an attempt to get the priority order of interventions into a reasonable state. Also, if you are (Following Science™) and make impossible demands, even the politicians ignore you, as we’re seeing with the reopenings.
As a reminder, the key for us to remember is that the political considerations center around blame avoidance on a two week time horizon, so if we want to get sensible policy, what we need to do is create sufficient expectation of back propagation of consequences that blame can be inflicted for bad decisions (or lack of good decisions) within that two week window. Then we’ve got something.
Due to the intensity of the current blame avoidance and conform-to-authority pressures, people who would usually have treated CDC guidelines as an upper bound beyond which you get diagnosed with obsessive-compulsive disorder are now taking them literally, for example:
Yeah, that’s slightly unfair because homes have some self-limiting dynamics and offices can get very large with lots of people, but the ones who are thinking that only authorities can determine who does and does not have dark transmission magic are the problem here. Or rather, the dynamics training and forcing people into the posture that they must look to the relevant authorities for currently believed locations of dark transmission magic one would be blameworthy for not avoiding.
Also Robin Hanson points out that the authorities continue to treat people who have previously been infected as if they aren’t immune and this in no way counts, presumably because “no evidence.”
(Your periodic reminder that the WHO quietly changed its definition of herd immunity to exclude the previously infected.)
I don’t share his ‘they don’t much care about the infected’ conclusion, or rather I find it imprecise. They mostly don’t care about anyone, so why should the infected be an exception? Also, a lot of this is burning down the village because it isn’t legible. They’re likely thinking a lot of people think they have had it when they didn’t, and they don’t want to open up the can of worms that involves, and they want everyone to get vaccinated and to provide as many incentives towards that as possible, so better to pretend the whole thing doesn’t exist.
CDC Guidelines “Key Points”
Here is the CDC brief on the new guidelines.
So before we move on to the guideline details let’s look at these Key Points. And remember, this is their introductory explanation everyone is praising, for what everyone says are the pretty good, reasonable guidelines.
First one is good.
Then we learn that the vaccines may provide some protection against a variety of strains. However, reduced efficacy has been observed for the B.1.351 strain.
Saying that something may provide some protection is saying almost exactly nothing. It’s saying that we haven’t proven that it doesn’t provide any protection. It’s the kind of language one wants to use if one wants to avoid blame for claiming something worked, while also avoiding blame for not saying something worked, and also give the impression it likely doesn’t work.
So not only does this offer basically no confidence that the vaccines work against B.1.1.7, where we know they flat out fully work, it then says that one should be even more skeptical than the level of “may offer some protection” for this additional strain.
Next, we see that ‘a growing body of evidence suggests’ that fully vaccinated people are ‘less likely to have asymptomatic infection.’ But then it warns us the investigation is ongoing.
So we have something suggestive that they might be less likely, but who knows, these things are tricky, and no suggestion of things like ‘dramatically less’ or ‘prevents almost all’ or anything like that. Are we trying to prevent vaccinations here?
Next we are told that ‘modeling studies’ tell us that masks continue to be important, but that they generously will allow resumption of ‘some low-risk activities.’ I think this could be better summarized as ‘f*** you’ and also it seems modeling can be used to require precautions but a completely different standard of evidence applies to claims of prevention. It’s almost like it’s all about something else entirely.
Then they say ‘Taking steps towards relaxing certain measures for vaccinated persons may help improve Covid-19 vaccine acceptance and uptake.’ No s***, sherlock. Thank you for pointing this out, took you long enough. Also would help if you told people vaccines actually, what’s the word for it, worked.
The next line essentially says “ordinarily we’d tell you to lock your doors and windows and never ever ever leave your house again and actually that’s mostly what our guidelines say elsewhere if you look carefully, but we’ve driven half the population crazy so maybe we can reach a little bit of compromise this one time.” But it wants us to know that if there wasn’t a particular medical issue called ‘social isolation’ they wouldn’t let us meddling kids get away with being in the same room together.
As a side note: The CDC guidelines for gyms call for “consistent and correct mask use.” I have at various times used gyms, but it would never occur to me to use them during a pandemic until after I’d been vaccinated. The whole point of going is to improve your health, and there are plenty of other options. Also, the whole mask issue, which is going to interfere with exercising properly. It’s a small cost in many contexts, but not in this one. If vaccinated people still have to wear masks at the gym no matter the level of distancing, this seems a lot like a soft ban on gyms extended indefinitely. Perhaps we simply can’t hope to enforce a ‘vaccinated people can unmask’ norm in any public space properly, and we can mostly live with gyms being (more than usual levels of) terrible for another few months. The few true gym rats can get home equipment and/or are healthy enough that they can deal with the masks, I suppose.
Or (giant spoiler for John Wick 3 which you should definitely see), a shorter summary of our overall situation in video form.
All right, fine, yes, that’s not the part people are focused on and no one reads such words as if they mean things. I get it. Let’s see the actual guidelines for vaccinated people. The part that actually matters.
CDC Guidelines For Fully Vaccinated People
This is the part that matters so let’s see the details.
The first line is that if everyone involved is vaccinated fully, you can do whatever you want, at least for small size gatherings. Good. Excellent. Some common sense. Yes.
The second is the principle that, essentially, a vaccinated person is not a person with regard to gatherings so long as everyone exposed is low-risk.
Thus, you get one household with unvaccinated people, since that’s happening anyway, and if no one is high risk you can add any number of vaccinated people to the mix up to the limit of a ‘small gathering’.’ Good. Excellent. Some common sense. Yes.
That approval assumes a common sense evaluation of what ‘high risk’ and ‘low risk’ mean. It’s one thing to be cautious around the truly vulnerable, it’s another to look at the technical ‘list of high risk conditions.’ The orders of magnitude in no way match. If we treat ‘low-risk’ as basically ‘under the age of 65’ I think this is conservative but at least somewhat sane.
Note that this guideline is contradicted by the guideline that one must wear masks when in the presence of someone whose household includes a high risk member. That’s another degree of separation, and increases the effective annoyance level substantially if it trumps the permissive rule. It makes sense if one appreciates how the risk multiplications work, and you adjust the barrier for ‘high risk’ accordingly.
The third line is that vaccinated people need not quarantine. Again, yes. I could see asking them to act like unvaccinated persons during what would otherwise be a quarantine period, or otherwise use higher precaution levels, but for guideline purposes telling them to ignore it is likely even better. People with common sense will scale back on exposing others anyway if it looks like they took a big risk.
Then there’s the whole ‘you still have to follow every other rule same as everyone else’ clauses. Still getting tested makes sense, although presumably the bar for what counts as symptoms would go up. Following employer guidelines and CDC recommendations is something you gotta say.
Avoiding medium and large size gatherings seems overly broad, depending on what counts as medium versus small. If the concern is that medium gatherings of vaccinated people are actually risky, I think that’s mostly silly. If the concern is that people who aren’t vaccinated will come anyway, or this will normalize larger gatherings and we want to hold off on that, those reasons seem reasonable. Given how vague medium is, I’ll allow it.
Wearing masks when visiting with multiple other households is rather hilarious if you break down what is happening. It’s norm enforcement with a side of punishment. The CDC does not want multiple households of unvaccinated people meeting up, for obvious reasons, and wants to at least ensure mask compliance, so it’s not about to give anyone vaccinated permission to take off their masks in such a room. And I get that. Once anyone at a gathering takes their mask off, there’s a strong tendency for everyone else to take theirs off as well (or to tell them to put it back on). If everyone isn’t in it together, no one wants to be the schmuck going through the annoyance of wearing the mask.
Overall, these guidelines do seem reasonable, as a compromise between what makes physical sense and what preserve necessary norms of behavior, and as a compromise between encouraging vaccination versus letting risk get too out of hand. That doesn’t mean they need to be followed to the letter, but we could have done a lot worse, and this is far better than no guidelines at all, and far better than the previous FUD of ‘act the same as before.’
So yeah, all in all, I’ll take it.
Vaccines Only Work If You Use Them
AstraZeneca remains unapproved.
Novavax remains unapproved, and has new results (press release):
Johnson & Johnson did get approved but after several weeks of pointless delay and with still essentially no plan, after all the complaining about the previous administration’s lack of planning, so here’s what we got there:
Here’s a Bloomberg article (behind a paywall) describing what happened.
There’s nothing much left to say at this point, other than in a real sense #YouHadOneJob applies to all of this, and if you can’t do it, you’re a failure, period.
On another vaccine policy front, MR gives your periodic reminder that dose stretching (also known as vaccinating more people) reduces risk, and this includes mutation risk for obvious ‘shut up and multiply’ reasons.
I am in general strongly against lying. Even when dealing with people or institutions who lie to you, who are mostly against you, who are not to be trusted, I still believe it is usually best to not lie.
There are limits and exceptions. Some people and systems flat out refuse to accept not lying, and some of those aren’t things one can reasonably avoid, often gating vital resources behind lying, or otherwise imposing very large costs to not lying. They train people to lie and reward liars, and punish those unwilling to lie or who endure costs when forced to tell lies, and generate norms that lying is The Way Things Are Done, and is justified and to be expected.
If one wishes to cultivate virtues like honesty, justice and honor, what is one to do? Where do we draw the line?
There’s no clear answer, but I think this is clearly one of those cases:
I understand what the people designing the checklist were thinking. The first half of their thinking, that we need a checklist of questions to see if anyone has symptoms, makes perfect sense. Good thinking there. The problem is the other half where they implicitly assume that everybody knows that words do not have meaning and that everyone knows to lie about the questions when it would be pragmatic to lie.
There are several problems with this approach.
One is that once people realize ‘oh, clearly they don’t think their words to be taken literally’ then everyone makes their own determination of what things to mention and what things are none of anyone’s damn business, perhaps because they want to not be shown the door out of the building. Then there’s that to normalize that anywhere is to normalize it anywhere. We’re teaching that words are not supposed to have meaning, that we shouldn’t put necessary qualifiers on statements.
Then again, that could all be wrong. I am not at all convinced that the head cannon that it’s ‘new/unexplained’ symptoms is actually the intention at all. If you give people that kind of wiggle room, a lot of them will think ‘oh, sure, I can explain that’ and pretend everything’s fine when everything is very much not fine, and also there’s constant pressure on everyone to not be socially awkward, so you kind of need hard and fast rules to avoid disaster. Which people will then of course lie about, once they realize how this works.
Presumably the solution is to ask the question, then if someone says yes to check if it’s chronic or otherwise explained before escorting them automatically out of the building, or at least to say ‘non-chronic’ or ‘new’ or something. I would actually want to avoid ‘explained’ here and at most let a follow-up determine what counts as explained.
If You Aren’t At High Risk, Should You Get The Vaccine Yet?
The trickier moral dilemma is the vaccine.
If you are at actually high risk and are eligible for the shot, yes, 100%, you should absolutely get the vaccine as soon as possible.
The questions worth asking are, should you be willing to lie to get the vaccine? Should you get it while there are others who are high risk, even if you can get it without lying?
I’ll take the second question first. If you are legally eligible and can get the vaccine without lying, I say yes, 100%, you should absolutely get the vaccine as soon as possible.
This is rather overdetermined.
Authorities explicitly want you to do this, and I want you to do this as well, because the most important thing is getting shots into arms and not letting shots sit on shelves, and we’ve set up alternative methods to help the most vulnerable via pharmacies and also the best way to protect most of the remaining most vulnerable is to get as many people as possible vaccinated.
On the margin, if you don’t book an appointment, either the appointment and shot you decline will go unfilled, or it will probably go to someone else who is ‘high risk’ according to some list but unlikely to be actually high risk, or someone who is lying. In many jurisdictions all you have to do is say you are somehow eligible. That’s it. No one is verifying anyone’s claims.
If there’s someone in contact with you refusing to claim a shot they are eligible for on these grounds, and this is exposing you or those around you to covid risk, I think it is correct to be rather upset about this. It’s not a reasonable concern.
The real question and least convenient world is, suppose (because this is the case in at least many places) that the law is inefficient, unjust and unenforced and none of that is an accident. For example, suppose there’s a giant list of ‘high risk conditions’ that qualify people, including ever having smoked a few cigarettes, or having a ‘developmental disorder’ which explicitly includes your motherf***ing Tourettes (which can also get you medical weed). And it’s clear that they never actually ask for any kind of verification – in Washington DC they literally just ask ‘do you have one of these 20 things?’ and all you have to do is say yes. Press X to not die.
It is valuable and important to cultivate the virtue of not lying, but at some point this isn’t even lying anymore because you are dealing with the words of actors rather than scribes and the actual meaning of your words is the pure and truthful ‘I want to get vaccinated.’
How meaningfully different is all this from a box that says “I want this vaccine”? How meaningfully different is this box from the box that says ‘I have carefully reviewed the 40 page user agreement?’
Did you pack your own bags?
Then there’s the question of Prizer’s CEO, who it seems is not vaccinated, and this forced him to postpone a trip to Israel. Presumably the PR department decided that it would be a bad look to ‘skip the line.’ My suspicion is he’s actually vaccinated but is pretending he isn’t and he can’t tell the Israelis that.
Not only should he be vaccinated, he should have been the first person vaccinated. That’s basic Skin In The Game 101. The person in charge of making the vaccine takes the vaccine. Instead, we’re so concerned about perceptions of ‘line jumping’ that the person who literally led the vaccine development effort doesn’t feel entitled to publicly claim a dose for himself, let alone feel under his proper obligation to take a dose (that would also benefit him, but the point is that he proves that he believes this and we can know that.)
Similarly, a better vaccine approval system (for the first vaccine, anyway) might be that everyone at the FDA decides secretly when to get themselves and their families vaccinated, entirely up to them, and when enough of them decide to do it, the vaccine is approved. You can have any meetings you want, but they don’t count for anything. Ideally you’d hold some people out-of-sample so you could do this for other vaccine candidates later.
Who Wants the Vaccine?
The above section assumes that if you’re reading this, you’re aware that vaccines are the greatest thing and the only question is how to get one.
Alas, this is far from a universal perspective. Here’s current survey data, and some more:
The six point gap between Republicans and Trump voters makes the role of tribal identity here very clear.
I wonder several things. First, I wonder how much the ‘wait and see’ category is mostly ‘I don’t want to have to think ever and this is an excuse not to for now’ because most of those people aren’t yet eligible. They know they don’t want to think enough to look over a list of conditions and figure out how to get an appointment, so why think about something now when they can at worst have to think about it later, and hopefully by then the answer is obvious?
The group that says ‘get only if required’ feels like it has to be way bigger than that. Are the majority of people who aren’t in the first two categories really going to give up their job or place in school rather than get the shot? That’s a super strong preference to not take the vaccine. I am super excited for the vaccine but would I quit my job or drop out of school to avoid it under a normal person’s life circumstances? No, I would not. I’m guessing most of this is all talk.
There’s also the question of blame and social pressure, because it seems (standard warning about anecdotes) like there’s a lot of this:
Mostly people deciding about vaccines aren’t basing their decision on physical world models and a study of immunology and statistical findings. They’re responding to various forms of social pressure and information cascades and blame dynamics. For various reasons there’s a bunch of ‘vaccination bad’ social pressure in many places, so my model says that such folks will mostly reverse when the forces going the other way are sufficiently strong that the social pressure has to back off, and such folks aren’t realizing that the pressure from other sources will relieve the social pressure when the time comes. If you can’t (hold a job / go to school / travel / go to a restaurant / etc) without vaccination, they’re gonna fold and they know it, but for now their social rewards are for putting up a front that they’re not going to get vaccinated, so that carries over to the survey because there’s no incentive to be super-honest and self-aware.
I continue to be rather baffled by the whole ‘wait and see’ attitude, unless it’s another case of avoiding blame and social pressure, in this case by avoiding taking a position, and doesn’t cash out to anything at all. What are we waiting to see, at this point? We’ve given about 100 million doses in the United States and everything’s going great so literally what do these people worry they are going to see? Is it basically this?
Seems like it would have to be, except without as plausible a mechanism as that one.
So I guess that means it’s time to address the whole blood clot thing…
AstraZeneca and Blood Clots
Even by 2020-2021 pandemic standards this one seems beyond ridiculous.
Several places, including Denmark and Thailand, have suspended use of the AstraZeneca vaccine due to concerns about blood clots. There have been voices of panic, warning that if this turned out to be a real thing that it could destroy public confidence in all vaccines, perhaps for all time.
I did not have to look to know this was almost certainly Obvious Nonsense, because it looked nothing like what the response would be if it wasn’t Obvious Nonsense.
And also because blood clots on this scale are somewhat more plausible an issue than being struck by lightning more often, but not that much more plausible.
And also because math. If there was a blood clot issue big enough to make the AstraZeneca vaccine potentially not worth using, either it comes along only after a several month delay and then suddenly happens to tons of people, or we somehow missed it for several months under mass vaccination drives. Thus, until I got back home I didn’t bother checking for data.
Then, of course, I saw this from the BBC:
Here’s the BMJ confirming that investigations show zero signs of a statistical effect of any kind. Even if somehow there was some small effect, the chance of this being big enough to justify not using the vaccine is very, very close to actual zero.
I love this post by Nate Silver…
…because, while there are a lot of previously existing real consequences and they’re really terrible (and thus that part of it is really weird), the implicit assumption here is that none of this has anything to do with an actual problem with the vaccine and that no one even thinks anyone else actually doubts seriously this. There’s common knowledge that the concerns are stupid.
The amount of damage done to vaccine efforts due to the suspensions and beyond catastrophic messaging and failure to do any math at all, both by suspending them directly and by making everyone around the world have one more reason to worry, is rather large here.
I wonder how many people didn’t get laser eye surgery due to the throwaway Ned Flanders joke on The Simpsons. I’m guessing more than one might think. I know that I was for a time under some social pressure to get it, but I didn’t want to, and the throwaway joke gave me some ammo to push back. Then compare that to this.
We Have Established as Common Knowledge That Andrew Cuomo Is The Worst
Andrew Cuomo has been The Worst for a long, long time. I have it on very good authority that he got his start cruelly bullying his brother Chris in early childhood, kept going from there, and Mario Cuomo should be viewed in many of the same ways we might think of Marcus Aurelius – you can be a great leader while you’re alive, but all is lost if you botch the line of succession.
For those following the actual underlying scandal and cover-up, there’s this: Cuomo administration altered a Covid report, intentionally omitting the true magnitude of Covid’s impact on nursing homes. (HT/Source, administration response that their cover-up was sufficiently badly implemented that it was legitimate).
It’s worth noting also that the inappropriate workplace behavior is looking worse and worse, as there’s more and more accusers and the things he is accused of get worse and worse. By any reasonable standard yes he should definitely go down for the sexual harassment if it wasn’t for the fact that he very much needs far more to go down for the directly caused mass deaths and cover up of the mass deaths and it’s hard to truly go down for multiple things at once.
So basically this (and you gotta love the photo):
At first it was plausible to claim the sexual harassment accusations were some combination of false or not that serious. That no longer seems plausible.
What seems clear is that, if it wasn’t for the nursing home situation, Cuomo wouldn’t be facing any of these accusations, would likely never have faced them, and he would have continued to get away with lots of sexual harassment.
All the revelations are entirely unsurprising. What would have been surprising would have been if Cuomo wasn’t engaging in and getting away with lots of sexual harassment, because the prior on such behaviors by men with power is rather high, and Cuomo is a mean petty tyrant and bully and a liar – remember, he’s the worst – so to have his behavior in this other realm suddenly be appropriate and reasonable would have required an explanation. Then, once his grip on power had sufficiently slipped and things turned against him, things turned against him and others amplified and encouraged reports of his actions rather than discouraging and suppressing them, and others (including the victims) suddenly interpreted his actions as unwelcome and offensive rather than maximally permissible.
And now essentially every Democratic politician in New York is lining up to call for his resignation.
I do find the dynamics here interesting in a broader sense, but this is already dangerously deep into ‘there be dragons’ territory and I’m only going here because it’s Cuomo, so let’s move any further discussion to a different venue more appropriate to such issues.
And Yet, No, Technically We Are Incorrect, Eric Topol Is Actually The Worst
Beware scope insensitivity! For it seems likely Eric Topol did this:
No, seriously, it looks like he did that. Thread. See the MIT link for more details.
If this actually made a difference, the amount of blood on this man’s hands is staggering. Not history’s greatest villain, but we should not be confident he doesn’t make the list.
From The Drunkwriting Files of Polimath: A Short Dramatic Scene Within the CDC
Seems legit. Tacos are great.
In Other News
France is going to start vaccinating on weekends.
Report from WSJ that P.1, the new Brazillian variant, is really dangerous (WSJ link).
I haven’t seen talk elsewhere and haven’t had an opportunity to follow up on this. These numbers even if accurate are definitely something vaccination can overcome if we have enough time, which we likely do if this hasn’t arrived here yet. The highlighting of ‘cases include people in their 30s and 40s with no underlying conditions’ highlights that this is clueless journalism where wet ground causes rain, so I’ll hold off on updating much until more information is available.
Goodbye what-to-do-now thread from Covid Tracking Project, alas not that helpful. Links to data summary and a guide to federal resources.
New nature study on long Covid (paper). As he says, it’s not great, but the alternative data points seem even worse.
Alex Tabarrok reports that the condition of his students is increasingly dire.
California variant seems unlikely to be important.
CDC study on Covid and obesity.
FDA decides its agents not flying is more important than doing drug company inspections, then says they had no choice and that the backlog of drug approvals is ‘due to pandemic.’
Australian doctors are uncertain in what ways they can legally promote vaccinations due to anti-drug-advertising laws. MR chimes in and reminds us that England banned mask advertising.
A modest proposal on price gouging.
CDC still, today, discouraging use of N95 masks because of supply concerns. Delenda est.
Our vaccine messaging is so terrible that the mayor of Detroit turned down an allocation of J&J vaccine doses, so his city’s residents can ‘get the best.’ As far as I know, he remains the mayor.
Twitter thread of examples of ‘public health experts’ calling for kids to return to school.
If you’re finally going to vaccinate around the clock, why not give it an ‘80s theme?
Doing a randomized oncology trial means overcoming 50+ people with veto power over several steps. There is indeed likely someone you forgot to ask.
Teachers refusing to return to ‘unsafe’ in-person schooling warned by their union not to post social media pictures of themselves on spring break.
From LessWrong: A tool called MetaForecast that is Exactly What It Says On the Tin. I don’t find such things that useful right now but this seems much better than trying to find the data elsewhere.
Facebook is censoring doctors writing in the Wall Street Journal on grounds of ‘misleading information.’ As Gu points out in his thread, this sets a highly dangerous precedent and the procedure being used to decide what to censor makes no sense and is fully arbitrary. It would be entirely unsurprising if links to this column were to be censored by Facebook. Please do not rely on them as a source of news, or ideally for anything at all.
Next week I plan to return to the Thursday cycle of posting.
I have a family member in the "wait and see" group. Why? I think: their main source of truth about the world comes from friends and family; they are generally skeptical of the medical establishment and authorities; and they won't really believe the vaccine is OK until many people they know have had it and nothing bad has happened, and/or people they trust tell them it's fine.
I told them I'm getting it as soon as I can, and I'm happy to be their guinea pig. I think it may help -- once I'm actually able to get a vaccine, that is.
I'm in the "won't get vaccine until legally obligated" group. Since a lot of people seem to think this is baffling, let me explain my reasoning.
The main reason why people my age want to get the vaccine is to be able to resume their ordinary lives. This does not motivate me, because I already resumed my ordinary life nine months ago. I was completely WFH before the pandemic ever started, and my kids have been homeschooled for years, so I experienced no substantial disruption on those fronts. Like everyone else, I spent much of March and April completely confined to my house, but over the summer I gradually came to realise the following:
And then I multiplied those two numbers together and realised that it wasn't worth it to do any more than the easiest and most obvious things to reduce COVID risk. And so I've lived the period since then doing exactly the same kinds and number of activities that I would have before the pandemic, modulo some masks and temperature checks at grocery stores.
Under these conditions, what exactly is the benefit to me of getting vaccinated? I'd still have to mask in public, and my preferred restaurants still wouldn't open for indoor dining. Save my dose for the people who are actually at risk. I won't bother until there's something I want to do that actually requires it.
The benefit is that regardless of your personal risk tolerance you're part of a dynamic system where every individual's risk is a multiplicative factor towards the population risk. It's more irresponsible , not less, for you to avoid it given your chosen priorities.
If you are truly staying in your house, and not going indoors anywhere with people from outside of your household (ordering grocery delivery, working from home, etc.) then I can see avoiding the vaccine until later, as you wouldn't really be a risk to anyone else. But if you are still grocery shopping, or running any other errands inside or stores, then every time you do so you are putting everyone at some level risk.
On a related note, I find it strange that many of the groups hardest hit by COVID are also the groups least likely to get the vaccine. If anyone has any insight into why this is the case I would love to hear it.
A fairly cruxy upstream belief here for me is how often vaccines go to waste. My impression is that while there's a lot of screwed-up-ness with the vaccine rollout, vaccines that do get produced basically get snatched up immediately by someone. So it's not obvious that jaspax getting a vaccine actually reduces the amount of people contributing communal risk while grocery shopping.
(Some vaccines get thrown out and unused, but it seems like it's fairly hard to find those)
We're always putting others at some level of risk when we go out in public -- in fact in some cases we might say we're putting them at some risk if we don't for say people with medical and emergency skills that might just happen to be in the right place at the right time. So I think the question here is what is the marginal risk we're adding given the adjustments in behaviors nearly everyone has adopted while out in public.
It is also probably worth factoring in that for the grocery store it's also highly unlikely that we are now introducing (at least directly) any additional level of risk to those there than they are comfortable exposing themselves to.
I do agree that there is an element of risks are clearly better understood from a system and not individual level analysis. But at this point, and for the example, I'm wonder just how much error and bias we introduce with the simple individual level argument compared to the complex system level argument.
Externalities are a thing, and are the main reason why I'm taking any precautions at all. Nonetheless, the same factors which make my own risk small also make my ability to pass it on to others small. This risk is pretty far below the threshold at which I feel obligated to make extraordinary efforts to drive a small risk down to zero, especially as vaccination of the highest-risk populations continues. (I might pass it to someone at the grocery store, but the odds that I give it to someone who suffers serious consequences goes down as the most vulnerable people are vaccinated.)
As others have pointed out, there is definitely some risk, which I don't deny. The question is: how much? And how much is it worth it to avoid that risk? My answer is "very little" and "not worth the trouble."
The news report you link to on the CDC study of BMI and Covid is highly misleading. The CDC report (https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e4.htm) says
"the analyses in this report describe a J-shaped association between BMI and severe COVID-19, with the lowest risk at BMIs near the threshold between healthy weight and overweight in most instances".
The CNBC news report falsely states that "The agency found the risk for hospitalizations, ICU admissions and deaths was lowest among individuals with BMIs under 25". They go on to say, "It doesn’t take a lot of extra pounds to be considered overweight or obese. A 5-foot-10-inch man at 175 pounds and 5-foot-4-inch woman at 146 pounds would both be considered overweight with BMIs of just over 25", without mentioning that this BMI of 25 is actually optimal for avoiding hospitalization for all but the youngest (18-39) age group, according to the CDC study (see Figure 2).
I'll check it out in more detail when I have time. Very plausible you're right.
Got another report it's misleading, so edited to simply link to source for now. Don't have bandwidth/energy to investigate further at the moment.
why are so many things so bad :(
Besides the incentives (cf. the Scotty Factor), it's an important safety valve against the Planning Fallacy.
Could also be people who'd get it if required, but (believe they) definitely aren't going to be required. Then both answers can fit, and the second arguably more so.
Or you could not deny treatment to symptomatic people, whether they have COVID or not.
That seems like an intuitive version("native implementation"?) of a safety trial.
Fun Fact: Germany stopped AstraZeneca vaccinations as well.
At least in the Bay Area, a couple hours of looking into this / thinking about it suggests this is false. I'm interested in counterarguments, but I think the pro-social thing to do is to wait until more of the at-risk population has received their vaccine. https://forum.effectivealtruism.org/posts/J2a2t2QEZJLdb2MkR/when-to-get-a-vaccine-in-the-bay-area-as-a-young-healthy
[Edit was to fix block quote formatting]
Is anyone tracking “variants of indifference?”
By which I mean variants that do the expected thing where mutations increase transmissibility but decrease virulence?
The logic of natural selection would tell us those should be the much more common kinds of variants as they should increase the changes of newer generations of virus surviving to reproduce.
It’s strange to me that all of the variants discussed have both increased transmissibility and virulence. It seems anti-Darwinian.
If there are thousands of VOIs (variants of indifference), which you might predict for every VOC, could that not have an effect on the overall statistics? More people get less virulent VOIs and some immunity?
Although it is widely held by biologists that there is a tradeoff between infectiousness and virulence, people (eg, Paul Ewald) who actually study the evolution of virulence say the opposite, both in theory and data. In the case of sars2, it is overdetermined: death is due to immune overreaction, after the window of selection is over.
Does he have anything to say about the case of sars-Cov-2 specifically?
On one hand, yes it seems like there’s something like antagonistic pleiotropy here where most of the transmission is done before the “acute phase” (the time when your o2 sat drops and you go to the ER, there’s probably a better term for that I’m just not sure what it is).
But we’re also applying non-trivial selection pressure via lockdowns and other precautions, and if sars-Cov-2 would stop killing people and just give them a runny nose we would stop and it could reproduce more. I’m just not certain why that isn’t have more of an effect.
That's a group selection argument.
Not trying to be antagonistic, but how so? It applies individually to each virion that would have a mutation that decreases its virulence.
Here is a simple question I got from my vaccine hesitant coworker:
VAERS lists about 1400 deaths following vaccination by mRNA vaccines in 2021.
He checked the flu vaccines deaths listed in VAERS and couldn't find more than 50 for each of 2016, 2017, 2018 and 2019. The question is why is there 30 times more deaths reported in VAERS following covid mRNA vaccination? Does it mean regular flu vaccines are 30 times safer? The total number of shots is comparable in tens of millions.
1400 deaths from about 70 million shots after lag, so even if that was 100% the vaccine, that would be a death rate of 1 in 50k. Seems well worth taking. But also if life expectancy vis about 80 years, that's about 30k days, so if they report deaths that day, and vaccinate a lot of elderly, isn't 1400 deaths on 70mm shots below baseline?
If you die after a flu shot no one thinks the flu shot kills you. If you happen to die after getting an mRNA shot they report it.
I think I know why the deaths are below baseline as you said. A significant percentage of people who die spend many weeks on their deathbeds, and people on their deathbeds are too sick to be vaccinated.
Supposing hypothetically that those 1400 deaths were all caused by the vaccines -- wouldn't the math still be on the side of getting one? (Of course, most likely the relationship is not causal, as discussed by the CDC link below, as well as Zvi's reply, but hypothetically assuming it was.)
"Over 92 million doses of COVID-19 vaccines were administered in the United States from December 14, 2020, through March 8, 2021. During this time, VAERS received 1,637 reports of death (0.0018%) among people who received a COVID-19 vaccine."
Chance of death from COVID for young healthy people is probably somewhere between 0.05% and 0.1%. (CFR seems to be around 0.2%, but IFR is lower. I'm eyeballing from https://link.springer.com/article/10.1007/s10654-020-00698-1 .) For older people it can be as high as 10-20%. Even if you are in the youngest, healthiest group, making the most optimistic assumptions about the danger of COVID, and the most pessimistic assumptions about the danger of the vaccine, that it caused every single death reported after receiving it -- it seems to me that COVID would still be at least 20x more dangerous. And realistically the difference is much higher than that, and for older people it's going to be orders of magnitude higher.
Of course, if you think you can perfectly avoid exposure to COVID, then you could declare any amount of risk from the vaccine to be too much. But I think most people are both unable and unwilling to do that, and I suspect that most people who ARE able and willing to completely avoid exposure are also more likely to be getting the vaccine, not less.
One objection to that is that one must not just compare between vaccinating and getting Covid. One must also strive to pick the safest vaccine.
Rotashield, the first rotavirus vaccine only caused one bowel obstruction in 20,000 vaccinated children, yet it was pulled from the market after a year because there were already vaccines 5 times safer.
If there is a large safety gap between different available vaccines, least safe must be declined in favor of most safe.
Another objection is that long term effects of any covid vaccine are not yet well-studied and there could be plausible mechanisms by which some of the vaccines could cause long term damage for example due to cumulative effects.
Well, as to the vaccines available right now, I'm not aware of any evidence for one of them being more or less safe than another, so your choices seem limited to "vaccine" or "not". But even if they were different -- getting the safest one is only a usable strategy if it's available, i.e. there is not a vaccine shortage, which there currently is. If your choices are "get whatever vaccine is on offer" and "nothing", you should get whatever vaccine is on offer as long as the expected value of doing so is better than the risk of COVID exposure if you do nothing.
This is definitely the scariest hypothetical, IMO, but I'm not aware of any evidence for it, only a lack of long-term data. How you weigh "unknown unknowns that are hard to measure" against the risks of COVID seems like a very personal choice. (I'm not aware of any past vaccines having hidden long-term side effects that didn't appear at all in trials or early use.)
This is because little evidence is available. You are looking at vaccination as an urgent matter. But your average chances of getting infected are only one in 4 in a given year. That is an average exposure of about 250,000 microcovids per year. Since average chance also includes people who make very little precautions against infection, it is likely that your personal chances are better than average. There are some people here whose personal chances are an order of magnitude lower than average. If you calibrate it by 3-4 months it will take for vaccines to become abundant in US and coincidentally to add 3-4 months of safety data, you might conclude that rushing vaccination with whatever is available is not necessarily the safest strategy.
As for unknown unknowns, this where more data helps. mRNA vaccines with lipid nanoparticle delivery mode are not like any previous vaccines so one might want to discount any experience obtained with past vaccines.