NormanPerlmutter

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Let's Go Back To Normal

I think the points about non-obvious costs are very important to consider and nicely evaluated. Nonetheless, I think your conclusions are a bit too strong. It's possible that I'm being too conservative and not giving adequate weight to the obvious and non-obvious costs of continued restrictions.

I think that in light of the risks of long covid from mild infections (small sample size but I haven't seen a larger study contradicting it) and the ongoing risk of vaccine-resistant mutations, saying that young healthy people are protected from overall risk by a factor of 1000x through vaccination is overly optimistic. I'd say that a 100x reduction harm might be a reasonable estimate.  This thread by Ruby which you linked to as well has lots of good analysis of vaccine efficacy for healthy young people. If I am interpreting the note at the top correctly, due to the risks of vaccine resistance, he has adjusted his harm reduction estimate from vaccination downward to 10x-100x reduction, from his initial estimate of 100x-1000x reduction. He also mentions long covid in his caveats towards the bottom. It's not clear to me why you are still saying 1000x in spite of these factors, and I'd be very interested in understanding how and why your assessment differs from Ruby's in this regard.

It's also worth considering the possibility of a tipping point. If we hold off a few months longer on full reopening, we might get enough hesitant people and people under age 16 vaccinated to avoid the rise of a highly vaccine-resistant strain in the US.

Furthermore, there's a big difference between returning mostly to normal and fully to normal. It's possible that the most extreme potential superspreader events (examples: an indoor rock concert with thousands of people pressed shoulder to shoulder and yelling over the music; a large group indoor choir singing event; a crowded bar indoor bar in Manhattan; Burning Man) are much more risky with regard to covid spread than all the other stuff combined. And at the same time these sorts of crowded and touchy-feely mass gatherings are a very important part of the human experience, and disallowing them has significant costs.

I am now more than 2 weeks past my second Pfizer shot. Considering the factors above, I am not planning to return completely to my 2019 way of life right now, but I am moving substantially in that direction while monitoring covid prevalence, vaccination rates, and new variants for the next month or more.

My current lifestyle that I've experimented with for the last several days includes eating indoors at restaurants (but being mindful of how long I spend at indoor restaurants and how often I go); hugging and hanging out indoors unmasked in small groups with some consenting friends and family who are at least one of young/healthy, vaccinated, or have recovered from covid in the past. I'm probably interested in attending large events outdoors such as concerts so long as people are mostly masked and are not crammed shoulder-to-shoulder. And also small indoor parties with an adequate combination of social distancing, ventilation, and vaccine coverage. 

But so far I'm avoiding such activities as going to especially crowded restaurants/bars where I would be spending a lot of time within three feet of many unmasked people, riding on a crowded subway at rush hour, attending crowded indoor concerts, attending large indoor conventions, playing Spin the Bottle, or getting anywhere near other people who are sick and who I assign a substantial probability of having covid. I think those types of activities I will continue to wait on as I monitor the prevalence of covid and spread of variants.  

I think that for the next few months, we should maintain legal restrictions on very large gatherings such as the potential superspreader type events that I discuss near the top of this post, either forbidding these sorts of gatherings or requiring most or all attendees to be masked or vaccinated or test negative. Setting guidelines that we will return further to normal once enough people are vaccinated, or allowing vaccinated people different privileges from unvaccinated, may coerce people to get vaccinated, to the benefit society. This will give us a chance at actually hitting something resembling herd immunity through vaccination and preventing a new vaccine-resistant strain from spreading while the overall vaccination rate is lower. I agree that it's problematic to have unenforced regulations. I think the optimal solution to this, both with covid and other unrelated areas of law (though it's much easier said than done) is to reduce the number of regulations and more strenuously enforce the most critical regulations.

The Case for Extreme Vaccine Effectiveness

Very nicely researched and explained analysis. Contains several points that I had not thought about much before if at all, including the analysis of false negatives in this particular context.

I'd be interested to hear more thoughts on your mechanistic explanation from commenters with more expertise in immunology.

Also interested to hear how you and other commenters are planning to change your own Covid risk-taking behavior after being vaccinated. I am coming up on two weeks after my second Pfizer shot and debating that for myself.

It seems the caveat regarding selection effects, that vaccinated people might be prone to more health-seeking behavior and might risk compensate, could swamp many of the other careful arguments. Is there any way we could get a rough estimate on these selection effects?

The variants caveat is scary, but at least we can monitor variants over time and try to adjust our risk behavior accordingly.

The Case for Extreme Vaccine Effectiveness

Seems to be of great practical significance to me. If there's a decent chance that I could return completely to unlimited degrees of interpersonal close contact and have only a 1/20 - 1/100 chance of getting symptomatic Covid with unlimited amounts of exposure, even if I would get covid many times over while unvaccinated, I'd be quite tempted to do it. If returning to that level of exposure would mean that I'd almost inevitably get Covid eventually, I'd be much more likely to play it safe for at least a few months more and see where things go with infection rates and new variants.