Covid Covid Covid Covid Covid 10/29: All We Ever Talk About

Trump wishes to register a complaint

He does so within a thread full of clips that have to be seen to be believed but which you are under zero obligation to see either way. 

Here is the central quote, which is real: “Covid, Covid, Covid, Covid, Covid, it’s all you ever talk about. A plane goes down, 500 people dead, they don’t talk about it. ‘Covid Covid Covid Covid.’ By the way, on November 4th, you won’t hear about it anymore … ‘please don’t go and vote, Covid!’” 

This is his closing message to the American people. So unfair, we’ve beaten the virus, we’re turning the corner, we only have so many cases because we run so many tests. He kept saying it in the debate, he said it in the 60 Minutes interview, he says it rally after rally. 

Whereas he now also claims that: “In California, you have a special mask. You cannot under any circumstances take it off. You have to eat through the mask. Right, right, Charlie? It’s a very complex mechanism. And they don’t realize those germs, they go through it like nothing.” 

I mean, Covid is all we ever talk about here. That’s kind of the idea.

He must think these closing messages will resonate. 

Most of all, Trump’s central point is he wants you to know that he is Not Biden, and most importantly, Not a Democrat. Because, you see, the Biden and the Democrats are terrible.

Meanwhile, Biden warns of a Dark Winter. 

Biden also has a closing message. His closing message’s central point is clear. He wants you to know that he is most certainly Not Trump, and also Not a Republican. Because, you see, Trump and the Republicans are terrible.

Partisanship, as ever, is a hell of a drug.

As we discussed last week, two things are simultaneously true. Trump’s statements are completely unconnected to reality, and most the Doom Patrol of Very Serious People are also mostly unconnected to reality. 

When it comes to Covid-19, both sides constantly make false claims about where things stand, with Trump’s claims being by far the farthest from reality. 

But on the question of whether the worst is behind us, the answer is probably yes. 

In March and April, the hospital system broke down. Supply lines were hanging by a thread and we were having trouble finding ways to put literal food on our literal table, especially meat. Thousands were dying each day. Supply chains and the whole economy and the market on the verge of collapse. It’s easy to forget how bad things were at first.

Yes, we might completely lose control of the situation once again. But thanks to improved treatments and mask use and all the time we’ve had to adjust and prepare, I don’t think there is room for things to be as bad as it was back then unless the medical system completely collapses. Barring a system collapse, we would get to herd immunity long before we got to 500k deaths.

Which is good, because White House Chief of Staff Mark Meadows said the quiet part out loud once again: ‘We’re not going to control the pandemic.’ This was a problem, because it undermines Trump’s message that the pandemic has already been controlled and will be gone any time now and he did a great job.

Vote. Consider everything you’ve seen, everything you’ve heard, and vote. In person or at a drop box. However long it takes. Pause here if you need to. 

Then let’s run the numbers.

The Numbers

Deaths

DateWESTMIDWESTSOUTHNORTHEAST
Aug 27-Sep 212457593631334
Sep 3-Sep 911417712717329
Sep 10-Sep 1611599543199373
Sep 17-Sep 2310168932695399
Sep 24-Sep 309349902619360
Oct 1-Oct 779711032308400
Oct 8-Oct 1478212172366436
Oct 15-Oct 2180415912370523
Oct 22-Oct 2889517012208612

The Midwest number is reassuring here, as it now looks like last week’s number was a bit of an aberration and got ahead of the curve. That doesn’t mean things are good, with clear increases in three of the four regions. We got to offset a lot of that because the South had a surprisingly good week for unclear reasons. While it makes sense that the South may improve in relative terms, as it is starting from a bad baseline and has warmer weather, it would be very surprising if things got actively better there any time soon.

Test Counts

DateUSA testsPositive %NY testsPositive %Cumulative Positives
Aug 20-Aug 264,785,5796.0%553,3690.7%1.76%
Aug 27-Sep 25,041,6345.5%611,7210.8%1.85%
Sep 3-Sep 94,849,1345.3%552,6240.9%1.93%
Sep 10-Sep 164,631,4085.8%559,4630.9%2.01%
Sep 17-Sep 235,739,8535.2%610,8020.9%2.10%
Sep 24-Sep 305,839,6275.1%618,3781.1%2.19%
Oct 1-Oct 76,021,8075.2%763,9351.3%2.29%
Oct 8-Oct 146,327,9725.8%850,2231.1%2.40%
Oct 15-Oct 216,443,3716.5%865,8901.2%2.52%
Oct 22-Oct 286,936,3007.5%890,1851.4%2.68%

We see substantially more tests than ever before, and also a full percentage point rise in the positive test rate. The problem is not only continuing, the problem is accelerating.

Positive Tests

DateWESTMIDWESTSOUTHNORTHEAST
Aug 7-Sep 2550007540112741421056
Sep 3-Sep 9472737243910640821926
Sep 10-Sep 16450507526411581223755
Sep 17-Sep 23540258538112773223342
Sep 24-Sep 30554969293210630027214
Oct 1-Oct 7567429724311017034042
Oct 8-Oct 146828412574411799538918
Oct 15-Oct 217557114985113323843325
Oct 22-Oct 289498318188115812357420

This is why we shouldn’t expect the South to remain stable or improve. Like the other regions, cases are on the rise, and if anything that trend is accelerating rather than slowing down. For now only the Midwest region is setting all-time highs, but that is unlikely to last. The West should get there within a few weeks, with the South not that far behind, although the increased testing will obviously be some of that story. Either way, leading indicators this week seem to be consistent with the troubling end of the range of plausible outcomes.

Positive Test Percentages

(Note: Hawaii seems to have stopped reporting negative tests as of two weeks ago, I’m ignoring it because the size of the effect is so small.)

PercentagesNortheastMidwestSouthWest
8/27 to 9/21.87%6.37%9.38%4.78%
9/3 to 9/91.97%6.02%8.48%4.13%
9/10 to 9/162.41%5.99%11.35%4.49%
9/17 to 9/232.20%5.96%7.13%4.11%
9/24 to 9/302.60%6.17%6.18%4.27%
10/1 to 10/72.61%6.05%6.74%4.23%
10/8 to 10/142.57%8.14%7.09%4.75%
10/15 to 10/222.95%8.70%7.85%5.36%
10/22 to 10/283.68%9.87%8.58%6.46%

Again we have an unmistakable situation, with positive test rates rising across the board, even on rising test counts. Things are rapidly getting worse and there is no sign we are turning the corner. Nor does there seem to be any appetite for the type of response that would cause the corner to turn. It’s distressing to see this happen so close to a potential vaccine, but what remains of our civilization made its choices. Now it has to face the consequences.

That doesn’t mean a full-blown crisis or medical system collapse is inevitable. What we see here is consistent with an R0 of about 1.1. That means that we’d only need to cut our exposure by 10% to stabilize the situation, plus each day we get more help from herd immunity. 

The question is whether colder weather and increasing fatigue, potentially combined with a loss of hope for containment, plus the messaging from Trump and supporters that the Covid-19 pandemic is effectively over, will make things worse faster than people’s control system reactions can bring things back in balance. The other question of course is whether there will indeed be any appetite to reapply meaningful restrictions, and enforce them enough that they are indeed meaningful. I don’t sense much eagerness to comply with official recommendations for Thanksgiving or Christmas gatherings, or on anything else that isn’t easy to enforce. 

My advice is to assume that things are going to get substantially worse before they get better. Catching Covid-19 now is a lot less scary than it was back in April, but we might do substantial backsliding for a while on that front, and the risk of infection is high and growing higher. Prepare to have a lonely winter.

The good news for now is that deaths are still mostly under control, only up roughly 10%. This is the third week of cases rapidly increasing. If historical patterns continue, the next two weeks will see rapid increases in rates of death, and we’ll be able to fully confirm what is happening. If deaths do not see a rapid increase in the next two weeks, that will be a very surprising and hopeful sign, but it will only buy us a small amount of time. 

I wonder to what extent people can ‘feel’ the danger levels rising. When they are told that things are rounding the corner and the virus is beaten, can they tell that this is not the case? Or is it mostly one set of talking heads saying one thing, while another set says another? At any given time, the number of infected is still relatively low, and they are clustered, so many won’t know anyone recently infected even if their social groups don’t wear masks or take many other precautions. For now, the hospitals are mostly holding together. A month or two from now at this pace, this will all be much harder to miss. 

Note that it’s unlikely there will be a substantially safer time to do things, regardless of where you are located, within the next month and probably several months. If there are things you need to do, you’re better off doing them sooner rather than later. Same with people you want to see. 

Europe

After asking around, the best data source that doesn’t require teeth pulling of any sort seems to be Our World in Data. One thing to be careful about is they only seem to get United States data with a few days of lag in some ways, so their test counts for us will take a while to become accurate.

So, how are things going out there?

Oh no.

Cases per million people:

Number of cases:

That’s over a 35% week over week increase, once again, for the European Union. The hockey stick is still shooting upwards. The United Kingdom is not as bad but still over a 10% increase. Both are running well ahead of the United States. 

Here are positive test percentages:

And here are deaths:

France is off the charts for infections with deaths likely to soon follow, and is announcing a lockdown. Or at least, sort of:

If you are keeping schools open in light of the graphs above, and think you are not giving up, I don’t even know how to respond.

Not that giving up is obviously the wrong thing to do! But that does not seem to be Macron’s plan.

I got a lot of interpretations of what’s happening from European readers last week, all of which seemed mostly consistent. The model presented was that Europeans were under the impression that they had beaten the virus. Life had mostly returned to normal, masks were largely no longer being used at all. As the virus came back, governments wanted to keep the peace and thus chose to do nothing about it, and because they were told they’d won, the populations are not now willing to be told they need to lock down once more. There was little herd immunity being gathered over those months, so most everywhere was still highly vulnerable.

Essentially, Europe chose to declare victory and leave home without eradication, and the problem returned, first slowly, now all at once, as it was bound to do without precautions.

What I didn’t get from my readers were good (English language) news sources that could give me a feel for goings on across the pond that go beyond raw data. Suggestions on that are still appreciated.  

Other Data Points

What other information did we get this week to help measure infection and death rates and how they are changing?

This is a good Twitter thread about France. Things have clearly been spiraling out of control there. He establishes that old people are not being protected, and expects to reach levels similar to the old peak 20 days out (at most 17 when you read this). He gives an estimate of R~1.2, which is lower than my instinctive guess which would be closer to R~1.35, but it’s possible. As usual, even when things look completely out of control, they aren’t that far from being turned around, if we cared enough. Some very good data analysis and visualizations later in the thread.

I don’t typically look too much at the numbers for hospitalizations, because who is hospitalized will be a function of availability of beds in which to be hospitalized and on various behavioral choices. I made that decision in April, when hospitals were at maximum in many places, making these problems severe. Also there were big data collection issues involved. 

Still, one can reasonably say that they are a very good sanity or error check, and their relationships in time and magnitude to other factors can be enlightening:

The currently hospitalized line ran well above the new cases line in the first wave, despite the hospitals being maxed out. A lot of that is because our testing was also inadequate, but also our care has improved. In the second wave, the two lines are at similar levels. Now in the third wave, it looks like we are seeing concurrent hospitalizations running well below daily positive tests. The question is, to what extent is this lag, to what extent is this better testng, and to what extent is this better treatment or adjusting who we send to the hospital whether it’s better or not? 

The linked article suggests about a 12-day lag between cases and hospitalizations. That seems long but plausible. If that’s the delay size, as the article notes, there has clearly been a divergence. Of course, they then warn that the virus is not less deadly, this is all due to other factors, because they are Very Serious People. Can’t win them all. 

A different approach is to track Google searches, such as for loss of taste, and get this:

It doesn’t look good.

Also not looking good are the wastewater results from Boston (that link updates periodically).

I am not optimistic about that little tick down at the end being the new trend. 

We also have reports that Utah hospitals are on the verge of rationing care, and temporary supplementary hospitals being deployed in El Paso. It’s getting bad out there.

Rule Abiding Citizen

My friend Luis reports that he has his bags packed because he is slightly outside the evacuation zone for the latest wildfire in Irvine, California. 

There has to be some evacuation zone with some set of boundaries. The government has no choice but to say, those in this area must evacuate, and others must not.

But what do you do if you are slightly outside those barriers, presuming you think the government is making remotely reasonable choices?

You evacuate, of course. If it would be right to require you to take a safety measure if you were in slightly more danger, then you would be well-advised to take that measure now before things potentially get chaotic or out of control. This is the same principle that because I got my family out of New York City exactly in time, we were way too late.

Yet this is here because it is a clear example of how the opposite remains common. Once an evacuation zone is declared, the rule is not interpreted as telling one about the physical world so as to make better choices. The rule is that locations and behaviors inside this box are ‘unsafe’ because they are not allowed, and thus anything outside the box must therefore be ‘safe.’ 

Needless to say, this is madness. 

If we do not think for ourselves, things will not go well.

It also points out a key danger when designing a rule. When telling people to stay six feet apart, you are preventing them from staying twelve feet apart. If you tell people gatherings are limited to ten people, many will think that means ten is fine. And so on. 

It’s not that different from what happens when there’s a limit to how much chocolate cake you can eat, and you really should only eat about 75% of that amount. There is probably not going to be leftover cake.

This cost of rules and restrictions seems highly underestimated. Rules and regulations crowd out a lot of private action. When we ask whether rules or private choices are most responsible for keeping us apart, don’t neglect the full extent to which rules crowd out that private action. Even without that, this new study finds private action is mostly responsible. 

All I Want For Christmas Is a Covid Vaccine

The Covid-19 vaccine hopefully will be ready soon. People will be lining up to get it and jockeying for priority so they can return to their old lives as soon as possible. There are tons of logistical and ethical issues to address to sort all that out. 

We certainly are not going to allocate a scarce valuable resource according to ability to pay. That’s crazy talk.

Even crazier would be to not inoculate those in the placebo arm of the vaccine trials until the trials were over. You see, once there is an emergency use authorization allowing vaccination, things flip on a dime. Yesterday it would have been “unethical” and illegal to vaccinate anyone except in the test group of a controlled trial, no matter what they want. Today, it is “unethical” to not vaccinate the placebo arm of that same trial that is vital to knowing if our vaccine works. Thus, if we don’t confirm our effectiveness in elderly people first, we will never know, because otherwise finding out would be deeply “unethical”. As opposed to it being unethical not to know whether we are giving an effective vaccine to hundreds of millions of elderly people worldwide. 

The people in studies that are gathering vital data must be given priority over a scarce resource, and vaccinated before others who need it, destroying our ability to gather data. As opposed to allocating the vaccine so as to run additional experiments and gather better data, or even just holding off on vaccinating those already providing invaluable data. Thank you once again, Copenhagen Interpretation of Ethics

But that’s also only half the issue. That’s the half of people who realize that, at least once the scientists and regulations are onboard, getting a vaccine against a deadly virus is good.  

What about the other half, who think that getting a vaccine against a deadly virus is bad? The people who don’t want it? There’s the anti-vax crowd. I’m sorry, they say, I thought this was America. There’s those who see the vaccine being approved while the other party is in charge, and don’t trust that. There’s those who think they can hold out and let other people try out the vaccine for them, and they’ll wait and see thank you very much, or even let those people eradicate the virus for them. There’s those who want to hold out until we know which vaccine is best, which of course we will never know because we won’t be allowed to run the necessary tests. There are those who are plain lazy. 

They need a message given to them in a language they understand. They need a trustworthy and beloved fellow, an all-around jolly guy who they are used to using to get them to believe in the existence and benevolence of invisible forces beyond our understanding that don’t make any sense on reflection, and which we lie to our children about. 

Who could be better for this job than our good friend Santa Claus?

Thus a planned $250 million government program to get mall Santas to advocate for vaccination (WSJ), which offered them an early place in line plus cash money to help convince the people to get the damn vaccine already once it was available.

People are treating this as another Trump mini-scandal and the latest horrible boondoggle. They are wrong. This is a great idea. The price tag is essentially zero dollars. Mall Santas are constantly in close contact with others, so giving them priority already makes sense. If people are going to take into their worldviews those who live at the North Pole and travel all around the world in one day delivering presents made by elves while keeping a list of which kids are naughty and nice? Yeah, it’s kind of weird. But let’s use that. What could be a better Christmas present? 

This is an example of actually thinking and proposing something that might work. Even if it might have little or no effect, it’s definitely worth a shot.

Of course, once people heard about it, it was quickly cancelled. Previous versions were insufficiently explicit about this.

Doom Patrol

Good news! In an edit to correct a previous version of this post, Dr. Fauci has NOT thrown in with the eternally sacrificing scaremongers, who hereafter will be referred to as the Doom Patrol, by telling us that the vaccines will not block infection. I apologize to him and to all for the error. Instead, it is the headline writers and summarizers who took his true statement – that the vaccines are being tested and measured for preventing illness rather than testing for whether the person is infectious – and transformed that into “Dr. Fauci says early Covid vaccines will prevent symptoms, not block infections.” 

That’s what the Doom Patrol does. It takes everything and uses it as a tool to show everything in the worst possible light.

The perversity of this resulting talking point is off the charts. It’s true that the vaccines might not block infection, but there is no scientific reason to assume that they wouldn’t. Nor is there any reason to draw the conclusion these headlines are effectively designed to cause people to draw, which is that someone with the vaccine is still potentially infectious and should not be treated as safe. 

Then there’s the social implications of this line of rhetoric, taken purely as a consequentialist attempt to change behaviors. They’re pushing the line that even after both of you have an effective vaccine you still need to socially distance. The implication is that our lives will never return to normal, or would only do so after eradication. 

This kind of willful misinterpretation is the norm. It works. It gets clicks, and it gets rewarded. I fell for it too, and I’m sorry about that, and thankful to those on Twitter who found and corrected my mistake. 

I don’t think this is something being said in order to influence behavior, or even to influence beliefs. That is not the mindset we are dealing with at this point. It’s not about truth. It’s not about consequentialism. We have left not only simulacra level 1 but also simulacra level 2 fully behind. It’s about systems that instinctively and continuously pull in the direction of more fear, more doom, more warnings, because that is what is rewarded and high status and respectable and serious and so on, whereas giving people hope of any kind is the opposite. That’s all this is.

Doom Patrol Warnings

Now Look What You Made Me Do is a favorite of the Doom Patrol. We are going to lock you down if you misbehave, so if you misbehave all you’re doing is locking yourself down. She’s right, of course, that things will keep getting worse until we change the trajectory and make them start getting better, but no the interventions to regain control are exactly the same either way. You either get R below 1, or you don’t. Except that the more it got out of control first, the more voluntary adjustments you’ll see, and the more people will be immune, so the more out of control it gets the easier it is to control later. 

Another favorite is the Nightmare Herd Immunity Multiplication. You get claims like this:

Which is one of the better ones, since even though I think we’re past 15% infected, 15% isn’t a crazy estimate, and he didn’t pretend it was only the 2.6% that have had a positive test. But he ignores the obvious point that the infection fatality rate is far, far lower. If we’re at 15% infected with 223,000 deaths including the period where CFR was 1% or more, and it’d down by at least a factor of three, then no, we can’t have another 500,000 deaths. There’s only 85% of the population left, by your own estimate, and to get to a ‘lower bound estimate of herd immunity’ there’s a lot less than that. We mathematically have to be more than halfway done in terms of deaths unless the medical system collapses. 

It seems every week I feel forced to reiterate that it’s been one more week without substantial numbers of reinfections, thus pushing our best guess for how long immunity lasts to two weeks longer than before due to the Lindy rule. That’s because every week we get warnings about how immunity is temporary.

AstraZenica is piling on, their CEO previously saying they expect immunity from their vaccine to last a year. Article did not provide any explanation why they think it only lasts a year, but my guess is that this is merely more Doom Patrolling. The vaccine is great if it has to be retaken every year, so long as it works, so no reason not to look like a responsible Very Serious Person and give your lower bound estimate as your overall estimate.

This of course comes from a story that their vaccine produces immune response in children and in both younger and older adults. That doesn’t mean it works, but it’s a very good sign. So we’d better find some downside to remind our readers of as well, lest they have some hope.

Similarly, a useful investigation into whether a new virus variation is more infectious than the old one is explicitly said to not be useful, because either way you should be afraid of the virus, and you should never take anything else away from scientific information. If the virus is confirmed to have become more infectious, that provides a huge hint in figuring out what is going on, and changes our calculus. The more infectious the virus is, the more we need to either do a better job containing it, or decide that it’s not worth containing. And the more we can get a realistic assessment of how effective our various countermeasures have been in containing spread. You need to know the baseline. Also, it notes that full cross-immunity holds, so you don’t have to care about which one you are exposed to or catch in that sense.

Covid-19 Ages Brains Ten Years, Says Doom Patrol

A paper came out last week where they administered an intelligence test to those who had recovered from Covid-19 in the United Kingdom, and found substantial negative effects on cognition even for those who had not experienced major symptoms. I didn’t get to the paper last week, so I’m looking at it now.

This paragraph jumped out at me:

Participants | Amongst 84,285 participants, 60 reported being put on a ventilator, a further 147 were hospitalised without a ventilator, 176 required medical assistance at home for respiratory difficulties, 3466 had respiratory difficulties and received no medical assistance and 9201 reported being ill without respiratory symptoms. Amongst these 361 reported having had a positive biological test, including the majority of hospitalised cases. 

That’s really weird, right? We have only 361 ‘positive biological tests’ out of about thirteen thousand participants reporting having Covid-19. So only three percent of them had a positive test at all? I suppose we should be grateful for what little testing we have here in America!

Here’s their core finding:

The scale of the observed deficits was not insubstantial; the 0.57 SD global composite score reduction for the hospitalised with ventilator sub-group was equivalent to the average 10-year decline in global performance between the ages of 20 to 70 within this dataset. It was larger than the mean deficit of 512 people who indicated they had previously suffered a stroke (-0.40SDs) and the 1016 who reported learning disabilities (-0.49SDs). For comparison, in a classic intelligence test, 0.57 SDs equates to an 8.5-point difference in IQ. At a finer grain, the deficits were broad, affecting multiple cognitive domains. 

Here’s the core results graph:

Here is that split up by task:

The effect size for those not hospitalized seems small, on the order of one or two IQ points. A substantial life disruption combined with various subtle selection effects seems like it should be enough to account for this. When one is coming off a serious health scare it can be tough to focus and think straight. 

Their take is this:

Previous studies in hospitalised patients with respiratory disease not only demonstrate cognitive deficits, but suggest these remain for some at a 5 year follow-up 19. Consequently, the observation of post-infection deficits in the subgroup who were put on a ventilator was not surprising. Conversely, the deficits in cases who were not put on a ventilator, particularly those who remained at home, was unexpected. Although these deficits were on average of small scale for those who remained at home, they were more substantial for people who had received positive confirmation of COVID-19 infection.

It seems that it takes a lot to get confirmation out of the UK medical system. This raises the question of how those who had few or no symptoms could know they have Covid-19 without a positive test, which suggests that they’re using terms in strange ways. 

The bottom line question is, should you be afraid for your own cognition? 

My reply would be essentially no. These effects are large for those coming off respirators, sure. But they’re much smaller than the IQ deficit I and likely most of you are suffering due to worrying about Covid-19, or the one from us worrying about politics, or any number of other similar things. I don’t think we have to worry about this as a physical risk. 

Thus I do not think that this finding should adjust our priors much on how much we should care about not catching Covid-19.

Of course, when the Doom Patrol gets hold of such findings, they get misrepresented. Even places like The New York Post end up telling their readers things like: COVID-19 causes ‘chronic’ cognitive deficits equivalent to brain aging 10 years without clarifying that this is only for the patients who were on ventilators. If you read that article, or you look at crazy headlines like this…

…you would come away with the impression that the problem is an order of magnitude worse than the paper claims.

Bursting Your Bubble

In the seventh inning of the sixth and final game of the World Series, which was played in a bubble in Texas, Justin Turner of the Dodgers was taken out of the game. Baseball later revealed that this was due to him having had a positive Covid-19 test, after having been told that his previous test was ‘inconclusive.’

When the Dodgers won the game and with it the World Series title, Justin Turner joined his teammates for an on-the-field celebration, including what definitely qualifies as a lot of close contact. 

That did not make any more sense than it did in your head. 

Baseball, it seems, runs its tests on players during games. This would seem to be rather useless, or at least epically bad timing. Isn’t the whole point to test you before the game so you can not play if you’re positive? One would think so. And somehow there was previously an ‘inconclusive’ test, and it took them until the eighth inning to clarify? Which given it was playoff baseball, means presumably a bare minimum of three hours.

That pales in comparison to the post-game celebration. What the hell is he doing on the field doing a traditional post-victory celebration? Isn’t that going to infect the whole team?

Well, yeah, good chance of that. Yet it was allowed to happen anyway.

You can call Turner selfish, or his team foolish, and like MLB throw Justin under the bus. You could also plan on lumping the Dodgers in with the Astros and debating whether it’s better to infect your whole team or to illegally steal signs. It’s certainly a valid perspective.

But you know what else is a valid perspective? He just won the damn World Series.

This is the moment Justin Turner and the Dodgers have been working for their entire lives. There is a good chance, as good as the Dodgers are, that it will never happen for him again. 

Is it so crazy to think that, given the risk level for healthy ballplayers in their 20s and 30s at this point in the pandemic, and an entire offseason to recover, that maybe let them all have this moment? 

I don’t think there’s a right or wrong answer. But that’s the point. Life is always about tradeoffs. Life under Covid-19 even more so. Certainly I would have tried to celebrate in less obviously risky ways on the margin than what happened, if at all possible. But no. I don’t think celebrating with the team was a horrible decision. Life matters. The highlight of your life, that so many dream about and few achieve? That really matters. 

It’s certainly plausibly a lot less crazy than when I stood in a line of people for an hour on Tuesday, in the middle of a pandemic, so that I could take the purely symbolic step of voting in New York. Which don’t get me wrong, I’m happy I did, but imagine dying to ever so slightly change numbers that are in no way in doubt and that no one will ever look at.

Transmission Risk Explained Pretty Darn Well

As these things go, this explainer about how various decisions influence Covid-19 infection risk is quite good. It comes off as way too confident, and even more than that too definitive about what outcomes will happen. This transforms an ‘on average’ result into a resounding inevitable victory for karmic justice. Even more than that, they seem to conflate some sort of ‘up to X infected’ with ‘definitely X infected,’ which is far more misleading than conflating with ‘an average of X infected.’ Perhaps people need to hear that. I think it is more likely that the Very Serious People only think people need to hear that, but I understand their perspective. 

The big thing this emphasizes, that almost everyone neglects, is the importance of airflow. If one must be indoors for an extended period, it is vital to avoid poor ventilation. Masks are great, keeping social distance in the moment is great, but you also need to open a window and ideally do much more than that. 

Every time I see explanations like this, once I set aside my urge to nitpick, the thing that always strikes me is that it’s kind of hard to catch Covid-19. Yes, if you talk to people in indoor spaces for long periods with people who are infected, it won’t be long before you catch it. But if you’re taking reasonable precautions, together those precautions drop your risk by orders of magnitude. Your chances are pretty damn good. 

In Other News

We now have a new case of reinfection, because someone deliberately reinfected themselves. I am willing to acknowledge that if you actively try to get infected a second time, it can work, so immunity is not total and permanent. We still await seeing substantial reinfections. On the flip side, CNN reports that a new study finds that immunity lasts for at least five months, and the title of the study was for some reason not ‘we paid a tiny amount of attention to the world.’

Antibody treatments work but are hard to make and therefore expensive. Several companies are working on them. Regeneron reports its cocktail is highly effective, but that it only has about 50,000 doses worth of treatment available at this time. The government agreed to pay them about $150 per dose, which seems like a bargain at ten times the price.

Flu shots correlate with less Covid-19 infection. I’d be very careful ascribing this to causation, but the effect size is rather large. 

AstraZeneca is allowed to resume its American vaccine trial that was halted due to a death in the placebo group, weeks after its other trials resumed. So naturally the move is to complain about a lack of transparency

Masks do seem to correlate quite well with reporting of symptoms. What a coincidence. Of course, common cause is still a plausible explanation if you want to explain this away. Or you could find something else with a R-squared of 0.73 and mock the results. Either way.

Twelve minute naval swab test coming to United Kingdom pharmacies. I’m cautiously hopeful, but we keep hearing about such things and then they mostly don’t materialize or don’t happen in large numbers. As I’ve said multiple times, this is a huge step forward and a potential Path to Victory on its own.

A prison might not be the safest place to catch Covid-19.

Should vaccination prioritize the most vulnerable, or those who could resume the most valuable economic activity? Here is one attempt at an answer that says it depends on the counterfactual that would have happened with no vaccine. I applaud this person for at least trying to think about this, even if what resulted was mostly nonsense. No one seems to have pointed out that his line of reasoning makes actual zero sense. The counterfactual is the other prioritization option. You have two worlds, you choose between them based on which is better. What the world would be if you didn’t choose either option doesn’t matter at all. 

Don’t Mention the War

This Tuesday is Election Day. 

Remember that there is a good chance we won’t know the winner on election night, or even if we essentially know, that we won’t be able to call the race let alone get a concession. 

It is probable but far from certain that Trump will lose and then refuse to admit defeat. He will almost certainly fight in the courts to the extent available. He may do more than that. There may be serious attempts to prevent votes from being counted, or to disregard them despite the count. Be mentally prepared.

There is even a small but real chance that there will be substantial disruptions or even violence in the wake of the election. 

It is far from the top of the list of concerns raised by such possibilities, but it is also true that all of this could make the Covid-19 situation much worse.

Be physically and mentally prepared to deal with all of that. It probably will all be fine, the same way that catching Covid-19 will probably not kill you. But either way, best to be prepared.

If we are all fortunate, by the time I sit down to write my November 5 column, we will be able to dismiss all these concerns and get back to worrying about Covid-19. The Covid-19 news is unlikely to be good next week, but if we are properly calibrated then in that sense good news is always a strong possibility. 

In the meantime, vote, and maybe also try to convince others, and prepare as need be, but also do whatever you need to do to not stress out about the election and get through the coming week. Stressing out and doomscrolling, or posting on social media to make others stress out, does not do anyone any good, no matter what outcome you prefer. You have full permission to eat delicious desserts, play games, get it on, aggressively use counterprogramming that lacks any redeeming social value, and do whatever else you find helps keep you safe and sane. Treat yourself. 

It’s been a long year. You’ve earned it.

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20 Responses to Covid Covid Covid Covid Covid 10/29: All We Ever Talk About

  1. Mike says:

    “The model presented was that Europeans were under the impression that they had beaten the virus. Life had mostly returned to normal, masks were largely no longer being used at all. As the virus came back, governments wanted to keep the peace and thus chose to do nothing about it, and because they were told they’d won, the populations are not now willing to be told they need to lock down once more. There was little herd immunity being gathered over those months, so most everywhere was still highly vulnerable”

    This rings very true in Canada too, especially the Western provinces — we escaped a bad first wave mostly through luck (by having advance warning, not being a travel hub, etc.) and some good choices by the government (locking down early, before cases rose too much). Now pandemic fatigue has set in, the anti-masker sentiment is rising, and cases are rising faster than ever because we opened up far too much and got too careless, while having nowhere close to any kind of herd immunity.

  2. Eric Fletcher says:

    Australia seems to be following the New Zealand process, but slower: Test, Trace, Quarantine, and eventually eradicate. Probably a good choice for any Island nation that can control it’s borders. Too bad the UK couldn’t do it.

    • Lambert says:

      We’re an island but we have the world’s 7th busiest airport. Also an order of magnitude more densely populated than NZ.

  3. Jordan says:

    You could probably use a CO2 monitor to get live estimates of the extent to which a room is well-ventilated. I have one and I’ve learned a ton about the extent to which different factors influence the buildup of CO2 (e.e., opening/closing doors/windows, two people sitting quietly in a room, two people sitting in a room talking to each other. It wouldn’t detect anything useful about, say, the effect of masks, but you take what you can get.

    • Kenny says:

      What’s a cheap study protocol that people could opt in to to test this? What would Gwern have us do?

      I couldn’t think of anything after a few minutes. You’d want to track people in a room with the monitor, maybe the room if you’re moving the monitor. Maybe the data alone would be useful in combination with some kind of contact tracing app? Or regular location data history?

      Maybe Robin Hanson could come up with a cheap protocol that could possibly produce some good info.

      But this is a good idea just in terms of ‘gears level’ understanding of ventilation.

  4. RM says:

    Could you walk me through your math on number of deaths required for herd immunity?

    I’ve been working with the assumption of an IFR of 0.5%, through most of this epidemic.

    220,000 deaths / .005 = 44 million cases = 14% of the population. Seems like a reasonable estimate.

    Naively extrapolating to 60% for herd immunity says we’re only 1/4 of the way through this, eventually we see about 900,000 deaths.

    Where do you think that naive calculation is wrong? Do you think we’re above 15% infected, already? Do you think the IFR is lower? Do you think herd immunity comes earlier than 60%?

    Are you imagining that we get herd immunity by mostly infecting younger people, so you’re using a lower IFR?

    • TheZvi says:

      I had 0.6%-1% in the initial stages, and think deaths were underreported then. However I think death rates have fallen dramatically. My guess for the rate going forward is 0.2%. Thus, I think we currently have roughly 15-20% infected similar to you, but that by the time official deaths double, if hospitals hold on, we would get to 60%+. And I think that is more than enough when combined with any reasonable adjustments.

      Given reactions I will likely go into detail on this soon.

      • RM says:

        Thanks, I’d definitely like to hear more about this.

        I understand that CFR has gone down, as the pandemic progressed. But I thought that was mostly because more cases are being diagnosed, the denominator is larger.

        I’d be interested to see the evidence that the IFR is actually going down. Also, I’m curious as to why.

        Very few drugs have shown effective, AFAIK. Dexamethasone reduces death rates 35% for the worst off patients, less for milder cases. Remdesivir maybe reduces hospitalized time, but mortality is unchanged. Lots of other drugs, like HCQ, didn’t prove to work at all.

        Otherwise, what else has changed in treatment? Proning? I don’t think we got a 60-80% reduction in IFR just from flipping patients over.

        If treatment isn’t getting better, the only thing left is a changing cohort of patients. So, the question would be how well we can focus infection towards younger people, if we go for herd immunity.

      • RM says:

        Hmm… a few sites are saying anticoagulants have cut the death rate as much as 50%. If that stacks on top of a 20-30% benefit for steroids, I guess that could get us closer to your IFR estimate.

  5. myst_05 says:

    Are there any updates on how prevalent “long COVID” is? Its now been 7 months since the first patients in NYC reported having “long COVID” symptoms, so presumably we should have a good estimate of how many people experience it all the way into November. My Google-fu fails to find a proper survey. There’s one by the CDC which asked people 1 month after diagnosis if they feel well, but that’s too short and biased towards the heaviest cases as initially tests were very scarce.

    • TheZvi says:

      I wish there was good data, like everything else, but from what I see there just isn’t. So it’s a known unknown. I do think the IQ loss is overblown but the long physical stress is real. I’d consider this risk about as important as risk of death for those under 50, but really I don’t know how to size it.

  6. remizidae says:

    The El Pais article is a piece of harmful garbage. Zvi points this out when he says that it “seem[s] to conflate some sort of ‘up to X infected’ with ‘definitely X infected,” but I don’t think he gives that adequate weight. Confusing “X people might be infected” with “X people WILL BE infected” is a huge, huge, mistake, and if the authors can’t make that distinction, they shouldn’t be trying to write about science at all.

    People who see this will come away with the belief that going to a bar/restaurant for a few hours with a COVID infected person means they almost certainly will get infected—and that’s just bullshit. People can’t make informed risk decisions if the media is going to lie to them like this. The fact that it’s probably incompetence rather than an intentional lie does not make it better.

    • TheZvi says:

      I was so happy to see an illustration of the basic stuff that I was willing to cut a lot of slack. Gotta take your victories where you can. But with time to reflect this was indeed pretty bad. I wish we could do better.

  7. Brett Bellmore says:

    “The question is, to what extent is this lag, to what extent is this better testing, and to what extent is this better treatment or adjusting who we send to the hospital whether it’s better or not? ”

    Perhaps the people who caught it easiest were also the people most likely to end up with a bad case? How much of the change here is due to nursing home residents not being available to die a second time?

    By the way, conspicuously missing from the cognitive deficits paper was any mention of the subjects’ O2 saturation at the time of the test. I’ve had walking pneumonia, and I can testify from personal experience that low oxygen levels, even in a range where you wouldn’t be hospitalized, shave points off your IQ. Want to bet that the deficits for people who didn’t get severe cases were actually due to still suffering marginal hypoxia?

    They’re calling it “silent” hypoxia, because the effects of Covid reduce your ability to bring in oxygen, without compromising your ability to expel CO2, so you never actually feel the low O2 level until it’s seriously low: At anything remotely close to normal O2 levels, breathing is regulated by CO2.

    I suspect it can take a fairly long time after a Covid infection to get your O2 saturation back up to pre-infection levels.

    Now, the people who actually got put on ventilators? I’d easily believe THEY have brain damage, it’s a well known side effect of even short term use of mechanical ventilators.

  8. pithom says:

    “Vote. Consider everything you’ve seen, everything you’ve heard, and vote.”

    Why? What evidence is there that either party’s governors implement better policies on coronavirus?

    • Brett Bellmore says:

      Relative death rates in different states?

      Granted, you can probably explain a lot of the difference between death rates in different states on the basis of population density and the location of large ports of entry. It’s not Cuomo’s fault NY includes NYC. Or Murphy’s fault that NJ is next to NYC.

      But the huge differences in nursing home deaths seems to have been clearly driven by state level policy, and that policy was correlated with the party of the governor. And there wasn’t any shortage of people telling those governors that demanding that nursing homes take in people who were likely contagious was crazy.

    • TheZvi says:

      I am intentionally not being explicit about that. If you look at it and can’t decide which choice would be better than the other, on this and other matters, then act accordingly.

      If you think both are equally awful, Jo Jorgenson is on the ballot in all 50 states, and would abolish the FDA.

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