All of tkpwaeub's Comments + Replies

Weirdly, with the collapse of any externally imposed controls (lockdowns, mask mandates, vaccination requirements) and just general fatigue in the population at large, it's become easier than ever to buy one's way out of getting covid than it's ever been. For instance, N95 masks are way cheaper - enough that I can switch them daily. With so few people getting the bivalent shot, I'm seriously considering going back for seconds.

1Nanda Ale25d
>For instance, N95 masks are way cheaper - enough that I can switch them daily.  The pandemic showed me how useful masks are to have around, generally. Cleaning that dusty room? Throw on my N95 and my allergies aren't triggered. Smoke from industry or wood stoves hanging in the air on a winter day, making my walk miserable? Oh right I have a mask in my glove compartment. Sometimes I just use one purely to keep my face warm on a brutally cold day, if I didn't bring something specifically designed for that.

Just dropping in to plant the idea of "parametric insurance indexed to wastewater surveillance."

Munich Re, Lloyd's, are you listening?

Re medical bills (or any bills, for that matter):

A major change from the TCJA in 2017 was allowing more businesses, including some health care providers and third party debt collectors, to use cash accounting rather than accrual accounting for the purpose of computing taxable income. The upshot is that treatment plus a printed and mailed bill no longer counts as revenue for a lot more businesses. That's precisely what allows for the "aspirational" bills you're describing. Repealing this provision would go a long way to taming this particular aspect, I believe.

The news about Evusheld is indeed disappointing. Why mAb's aren't updated in lockstep with vaccines is baffling: they could be harvesting mAb's at the same time that they're testing vaccines using the same mice

One thing I don't see talked about very much is that attempting to predict who's at risk of long covid, as a function of severity of the initial infection is very much playing to an inside straight: the illness has to be severe enough to cripple you but not kill you. It's related to the reason that long term disability insurance I'd tricky for even the best actuaries and underwriters.

I think it depends on the externality. Widespread destitution is itself a "public bad" when it impacts crime, public health, noise, etc

That's income tax. Sales tax is a different story. In fact since wealthier people benefit from bulk discounts, I'd go so far as to guess that the poor pay proportionally more per, say, toilet paper roll.

5romeostevensit4mo
True, though the negative externalities of consumption taxes are much lower.

I can't begin to tell you how much I appreciate this. The reality that novids like me need to accept is "learning to take yes for an answer." We've reached the point where we are no longer under any compelling legal or moral obligation to know if we have Covid at any given time. Meet the new normal, same as the old normal.

From the article, here's a description of the strategy:

As an example, consider a hypothetical community of 5 households labeled A through E, with 5 individuals in household A, 4 in household B, 3 in C, 2 in D, and 1 in E. This gives a total of 15 individuals, none of which are previously immune. Suppose that we only have the capacity to fully vaccinate 5 individuals. In line with the reasoning above, EHR gives the following vaccination strategy:

  1. The largest household by effective size is A, with 5 individuals. The first vaccine is therefore allocated to the
... (read more)

I found this:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263155



"Further investigating herd immunity thresholds for a range of values for R0  we find that for most parameter choices, EHR achieves herd immunity with fewer vaccinated individuals than the other presented strategies (and universally, dramatically earlier than age-based strategies). At the most extreme, assuming a 90% effective vaccine and R0 = 2, EHR achieves herd immunity at just 48% of the population vaccinated, compared to thresholds of 61% and 89% for random and ... (read more)

2tkpwaeub5mo
From the article, here's a description of the strategy: As an example, consider a hypothetical community of 5 households labeled A through E, with 5 individuals in household A, 4 in household B, 3 in C, 2 in D, and 1 in E. This gives a total of 15 individuals, none of which are previously immune. Suppose that we only have the capacity to fully vaccinate 5 individuals. In line with the reasoning above, EHR gives the following vaccination strategy: 1. The largest household by effective size is A, with 5 individuals. The first vaccine is therefore allocated to the eldest member of A. 2. A and B are now tied in terms of effective size, with 4 susceptible individuals each. We therefore vaccinate one person each from both A and B. 3. A, B, and C are now tied in terms of effective size, with 3 individuals each. With enough capacity left to vaccinate only two people, we therefore randomly choose two of the three households, and vaccinate one individual in each of the randomly chosen households.

I doubt it would cost very much. Epidemiologists have software they can use to model it. Moreover, an easy way to do controlled experiments would be dorm assignments on college campuses.

At any rate, my unabashedly Bayesian gut feeling is that it's obviously a good idea to do it. See above for my priors.

To the extent that this kind of thing is hard, I'd put it squarely in the "hard but worth it" bucket, along the lines of JFK's speech at Rice University. I'm calling for us to stop meekly accepting case surges as inevitable, and I don't think it's unreasonab... (read more)

I'm gonna throw this idea out there: might it be a good idea to stagger booster shots within a household? We never know for sure when the next surge will occur, but we do know that (1) immunity against infection wanes and (2) household transmission is a big factor during surges. Careful timing boosters within a household (or social bubble) might be a good way to take more control of what can be controlled.

Just spitballing, as they say.

2tkpwaeub5mo
I found this: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263155 [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263155] "Further investigating herd immunity thresholds for a range of values for R0  we find that for most parameter choices, EHR achieves herd immunity with fewer vaccinated individuals than the other presented strategies (and universally, dramatically earlier than age-based strategies). At the most extreme, assuming a 90% effective vaccine and R0 = 2, EHR achieves herd immunity at just 48% of the population vaccinated, compared to thresholds of 61% and 89% for random and eldest-first strategies. At 100% efficiency, the relative herd immunity thresholds are 44% and 55%, for the EHR and random strategies, respectively."
2Zian5mo
Would the costs of figuring that out and implementing it exceed the expected benefits? Assuming that everyone in the household is already boosted with the monovalent version, it seems unlike for the costs to be worthwhile.

In the specific case of Moderna vs Pfizer, maybe an equitable trade secret swap? Pfizer could simply agree to let Moderna produce its own version of Paxlovid.

In the long run, we really need to revisit the Bayh-Dole Act. It's not unreasonable for the government to retain some rights to intellectual property that's the result of federally funded research, whether it's from grants or because the government agrees ahead of time to purchase the finished product.

Yeah, you'd have to prove that the costs are somehow shifted. That's not at all clear. A dollar in accounts receivable is something of a legal fiction. It exists on a probability distribution according to how likely it is that the debt is going to be collected. Before credit cards, it was standard practice for businesses to "age" their AR over the course of months, ultimately writing off the most intractable debts. In many ways, that's all that's going on here. Credit cards are simply a way for businesses to sell their AR (at a modest discount). Interest rates partially offset this, but only to a point. If $200,000 isn't collectable neither is $2,000,000 - interest theater, if you will.

The fundamental problem with student loans is that education is an intangible asset. Unlike a loan to buy a home or a car, there's nothing that the lender can repossess if things go sideways. Financing education, both at the individual level and societal level, is always going to be a difficult problem, contentious and fraught. That being said, there's some low hanging fruit.

1. Streamline the collection of student debt by creating a system of payroll deductions - maybe even add it to W4's. It's all going to the U.S. Treasury anyway. 

2. Cap paymen... (read more)

Killing pets was a bit brutal, don't you think?

I think part of the problem is in the fog of a contentious election, we never had a rational, nuanced discussion of how mask mandates should be enforced. The CDC had some constructive suggestions early on, that struck a reasonable middle ground.

1Phil Scadden6mo
Mask-wearing falls foul of political values which are a major obstacle to rational thought. If just wearing a mask was ironclad protection, then there wouldn't be an issue. Those that wanted protection would wear them and those that preferred unmask could take the risk. The moment that there was a suggestion that an  unknowingly infectious person could reduce the risk of infecting others if they masked then a can of worms opened up. The implication is that everyone's safety is improved if everyone wears mask. Whoops! that would be collective action versus personal responsibility. Any suggestion of collective action sounds too much like communism for some. And for others, well if collective action is necessary for safety (eg like road rules), then obviously the state should enforce it. Battle lines are drawn and rational thought flies off. Not to mention it being quite difficult to exactly quantify the effectiveness of masks (especially on an infectious person) given variations in type and use practice (ie are they worn in way that is effective - not to mention things like mask fitting and facial hair).
  1. Is it at all possible that the bill could promote greater honesty towards investors? After all, if you're taxed on book income you're that much less likely to make it appear to investors that your company is more profitable than it really is. Not saying thus will necessarily happen, but certainly worth watching and keeping an open mind.

  2. I'm not sure how much different taxing book income is from reversing a key provision in the TCJA from 2017 - namely, the TCJA raised the income threshold where companies are required to use an accrual basis to report income.

I think the reality at this point is that while Covid is certainly endemic and will be a permanent fixture of our lives, it is also in every way that matters, deterministically avoidable.

  • N95 respirators are cheaper than they've ever been ($25 for 50 Kimberly Clarke pouch style masks - I can switch out my single use masks daily)

  • It's really not that hard to get boosted every 3-4 months if your D&D alignment is "neutral-good". The only person stopping you from getting an extra booster right now is...you.

  • Labcorp is now offering spike antibody tes

... (read more)

Just a reminder that this paper provides a cute way to estimate the "true" prevalence of Covid (or indeed any pathogen) in a community: geometric mean of case rate and positivity rate.

https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1009374#:~:text=We found that the state,cases and test positivity rates.

Thus for instance based on today's numbers for the NYC metro area on covidactnow.org

50.4 per 100K = .000504 13.7% positivity rate = 0.137

True prevalence = 0.831%

Thing is....our public health infrastructure is pretty well buggered at this point, and we don't have the resources to do adequate contact tracing. So is it spreading beyond sexual networks? Can't be sure, but it also seems like that's the only place we seem to be looking.

I'm probably a bit more concerned about monkeypox than you are, mainly because it has an alarmingly long incubation period (up to 14 days) and then a punishingly long infectious period (3-4 weeks). That's a lot of time to infect a lot of people in a lot of places. Plus it seems like it's pretty hardy on surfaces. In places like NYC, monkeypox + covid could easily overwhelm public health systems.

The public health messaging is awful, and you couldn't think of a better way to create distrust and homophobia.

As with Covid, the clunky system for prioritizing who... (read more)

5JesperO7mo
Given that AFAIK there's been virtually no cases (1%?) among people who hadn't had sexual relations it seems like it transmits really ineffectively via non-sexual means. Why would it suddenly start infecting lots people in other ways, like via surfaces?
2denkenberger7mo
So with doubling every 10.5 days, that would seem to mean a high R0 - what's your estimate? And really because some people are still being cautious about COVID, the true R0 (with normal behavior) would be even higher than what is measured now.

For #10, I'd replace it by a more agnostic "allow price gouging OR enforce nationwide rationing" - however you feel about free market vs government control, the idea that there's a conflict-free middle ground where we ban price gouging but don't go all in with rationing is pure fantasy.

"those few people can be well-compensated in money and also honor and status and would happily volunteer and so on, all the usual arguments. Worth noting."

I'm so glad you made this point. The resistance to challenge trials as being somehow unethical always struck me as odd - lots of people put their lives on the line for the public good, and we don't see that as an earth shattering moral dilemma.

What's needed is state level counterparts that can approve manufacturing facilities within their borders. The FDA can simply distribute funds and periodically "approve the approvers" and thereby ensure that states give one another full faith and credit.

Are we going to talk about the coincidence that Abbott is also the leading supplier of rapid Covid tests???

Appalling, since it's pretty easy to verify obesity on the spot. Most pharmacies sell calculators, scales, and tape measures. 

What's not within our power is making sure that well-fitting respirators (full or not) are available to everyone. In order to make this happen, at the very least, we need to make sure that public or private insurance covers qualified fit-testing services (and we need some sort of infrastructure for certifying who offers such services - this appears to be a thing in some other countries). 

And I'd also remove the word "covid" from the initial part of the sentence, and have it read "If people actually took risk seriously",  since big part of our fai... (read more)

Part of the Covid endgame we should probably be considering right now - and feel free to down vote me until I add links (if you hate me) or add links for me (if you love me) should probably be - underlying genetic resistance (or susceptibility). There are tantalizing clues that this might be relevant:

  • the UK challenge study - about half of the participants stubbornly refused to catch Covid

  • actual progress in identifying genes for susceptibility, lots of data

  • experience with other viruses, often with tradeoffs (e.g. HIV vs West Nile virus - weird, rig

... (read more)

A possible reason for being cautious about prescribing Paxlovid to just anyone (regardless of underlying risk factors and severity) from a public health standpoint is the issue of rebounds. The Paxlovid might hold the infection at bay for a while, and then people could start testing positive again a few days later, so quarantine protocols become a bit more complex.

https://www.bostonglobe.com/2022/04/21/metro/puzzling-phenomenon-patients-report-rebound-covid-19-symptoms-after-taking-antiviral-paxlovid/

This NYT article is a bit closer to deserving the "stop being poor" criticism:

https://www.nytimes.com/2022/03/30/well/live/ba2-omicron-covid.html

4MondSemmel10mo
... indeed, if by that you mean that it's paywalled and I can't even check it T_T.

In our current landscape we've got an insurance/banking regulator in every state, plus DC and Puerto Rico. Then there's the US DOL, that regulates self-funded employer plans (ERISA). Then there are local, state, and federal employee/retiree plans. Then Medicare and Medicaid, which fall under CMS. Finally there's the wild west of plans offered by religious employers, which aren't under the jurisdiction of any administrative agency (if you exhaust your internal appeals your only recourse is the courts). This state of affairs is largely due to the McCarran-F... (read more)

To me the most compelling reason to let people go ahead and get all the boosters they want, at this point (as long as they're reasonably safe) involves going back to the basic function of government: managing human conflict. For over half a year now, the principal axis of conflict has been between people who won't get vaccinated and people who will (and want more protection from those thar won't get their shots). At this point, the best way to settle this would be to move towards a boosting-free-for-all, with clear communication that (1) You should really ... (read more)

Every time I hear someone start preaching to be about single payer, I want to say "Good idea, but maybe we can start with single regulator?"

6JenniferRM10mo
It is a good one liner :-) I'm not sure how that unpacks into policies, or of those policies would cause more healthy life for less money. Is this a slogan for an extended idea that you can link to?

Which is why insurance companies should be encouraged to start underwriting the cost of quarantines. With a discount for people who get vaccinated.

Fascinating stuff about possible beneficial effect of MMR and TDAP boosters - they could help mitigate the risk of getting Covid:

https://www.sciencedaily.com/releases/2021/08/210831142423.htm

"The sense in which you have to ‘beat the market’ is the danger that everyone might be trying to get the booster at the same time when things are about to get bad, and fighting for limited appointment slots. That is potentially a concern, but given people’s reluctance to boost, I do not anticipate there being enough additional demand to cause much of an issue. Even if there is, you’ll have ample warning."

That, and it's not a zero sum game. If there's a mad rush to get boosted right before a wave, that's going to have the aggregate effect of making that wave into more of a ripple.

Right. There's definitely some sort of bias in the testing.

One area in which I've run out of patience is the "Home tests are keeping case counts down" trope. In order for that to be true, you need to make a lot of assumptions about what those home-testers would be doing if there weren't any home tests available. Would they be running out to get PCR tests? Somehow I doubt it.

Thanks for this thoughtful analysis. Concrete example: there have been house fires in which loss of smell from Covid was a contributing factor.

Also people who are "hard of smelling" often develop cardiac issues because they tend to over-salt their food. My aunt has struggled with this for several decades now after a chemical accident, and recently had a heart attack.

2JenniferRM10mo
Fascinating. There's a whole literature on sense/nutrition interactions [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051307/].

I'm assuming insurance companies will pay for it. The government will still be paying indirectly to the extent that insurance premiums are pre-tax.

I'm also predicting that Paxlovid will probably end up being used for way more viruses than just Covid. If that happens, it could obviate the need for testing.

I'd counter with the theory that there's been a marked shift in why people are testing. If you're mostly testing for the purpose of controlling the spread (e.g. contact tracing) then the CFR will be lower than if you're focused on treating people who are acutely ill (with the goal of getting antivirals ASAP)

I do broadly agree with you that there are perverse incentives for people to avoid going on record as having Covid, especially with what we're finding out about possible long term cardiovascular issues (if you ever want to buy life insurance, don't get a PCR test). That could have the effect you're describing.

5Trevor110mo

The photo of the anti-vax sign has only reinforced my belief that anything printed in comic sans is inherently dubious

Reducing all constitutional rights to a "freedom to transact" seems like a bold claim. It may have been realistic a few centuries when the only transactions had natural limitations because they required proximity. In the context of modern society and instantaneous transactions (both financial and non-financial) over large distances I'm not sure it's as clean cut. Not saying that the reasoning is wrong after the initial assumption is made, I just find the axiom a little hard to swallow.

Microcovids start to diverge from actual probabilities earlier than you might think. I've commented on their github page

2Orborde1y
Can you link to your comment?

I appreciate how you balance skepticism with empathy. It took guts. Thank you.

Yes, they do what they claim to do because the insurance companies and underwriters have been tracking this stuff for decades. Physical fitness for operating heavy machinery is essential for public safety.

Um, no. Rules requiring truckers to keep certain health issues in check (or not have them in the first place) are to prevent accidents involving trucks. Because accidents involving trucks can end very, very badly. Because trucks are enormous.

1Douglas_Knight1y
Well, let's just go in a circle. As I said in my first comment, before we create new rules, we should check whether existing rules do what we claim they do. 

It never used to be regarded as overbearing or paternalistic to have medical exams for truckers.

4Douglas_Knight1y
Yes, truckers are slaves. That is exactly what they are protesting. The question is whether they should be. If the purpose of the rule is to protect the truckers from gangrene, then it is paternalistic, no matter how people regard it. I am not necessarily against paternalistic rules, but I am strongly against rules that are mislabeled, and thus impossible to audit. If it is to protect other drivers from drowsy truckers, it could be a nonpaternalistic public health rule. But if the truckers have such uncontrolled diabetes that they have gangrene, it seems unlikely that the rule is having any such effect. Probably it is exists purely to harass truckers.

The most brutal way of understanding a pandemic in economic terms is to view humans as "widgets"

  • lockdowns can be thought of as recalling a defective product
  • the value of humans is marked down, leading to an economic crash
  • through a mixture of vaccination and infection, we create covid-proof humans. Some of the non-covid-proof humans die. In order to avoid the law of diminishing returns we need lots of different production methods. The hot mess of vaccination/restrictions being loosened to get more people infected is a feature, not a bug
  • eventually most humans will be either dead or covid-proof

And yet the history of protests specifically involving trucks frequently does lead to coups.

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