Covid 11/12: The Winds of Winter

Spoiler Alert below the fold, can’t be helped.

We have perhaps the best possible news. Pfizer’s vaccine is over 90% effective, and they are going to ask for emergency use authorization in a few weeks. Woo-hoo!

We also have very bad news. It was clear the numbers were going to get worse, and they are substantially worse than I expected. Things are about to get quite bad out there. Also the attempts to overturn the results of the election aren’t great.

There’s a thought I can’t shake, though.

You ever think a writer is getting a bit lazy when it comes time to wrap things up? 

An inhuman threat that grows more deadly as it gets colder, that no ordinary sword can slay and that cares nothing for politics, grows exponentially in power by the day. 

There remain two who would rule the land. 

One, who is currently in the seat of power, claims they and their family are the best at business but their longtime revenue sources are bankrupt and they rely heavily on loans from banks to stay afloat, while their true accounting method is being vindictive as hell. Infighting has caused the most competent people in the administration to abandon it. Having seized control in the crucial moment amidst divided opposition and maintained it against claims of their illegitimacy and worse, they put up a surprisingly strong fight. When provided with evidence of the inhuman threat right in front of their face, menacing them directly, they briefly acknowledge it, but mostly ignore it and are happy to let others deal with it. It’s not their problem. They warn that their rival would destroy all if allowed to rule. They refuse to admit defeat and keep only the counsel of very close family, even after the verdict is clear. 

The other used to be high up the line of succession before power changed hands, and has returned with allies of varied ethnic origins. They have assembled a broad coalition, many with pasts they are ashamed about, and some of whom have proven difficult to control and prone to rioting. Many are there purely because they would welcome almost any change. They have suffered great tragedy in their life, losing two children and a spouse. They arrive to restore the old norms, for honor and dignity, and to free the people. They pledge to fight systemic injustice. They claim they will rule for all the people, especially those who need help the most. 

As the conflict between the two looks to be reaching its zenith, the inhuman threat threatens to overtake us all. 

The second claimant, with almost no help from the other, puts their campaign on hold and attempts to rise to the challenge, assisting allies in developing new weapons while their rival consolidates their base. But their efforts to defeat the inhuman threat seem to have no plausible path to success and to be in vain. The enemy’s ranks swell and all seems to be lost.

Then, as our darkest hour approaches, a hero answers the call! An outside force has been working the whole time to hone advanced techniques that many people do not believe exist or would prove ineffective. Just in time, they deliver the blow we need to defeat the inhuman enemy before all is lost. Shortly thereafter, the second claimant dispatches the first. 

We are saved, but winter is upon us and much has been lost. It will take much time to rebuild, on many levels. The urge to celebrate is understandable, but the coming months will be the deadliest. Even if most would prefer to pretend otherwise.

I need to stop this aimless musing. Time to focus. Let’s run the numbers, then deal with the vaccine news, then double back to the shorter term in light of both halves. 

The Numbers

I am sorry about all this, I really wish it wasn’t necessary to point out who won the election before going over the Covid numbers, but it is. If you want to know how we will handle the pandemic, it is important to know who will be leading the fight. 

By all means, skip this first section if you don’t need it.

Votes

You really, really should know this already, and I’m sure most of you do, but remarkably large numbers of people are in denial or lying about it, including the President. People are crazy, the world is mad. So I’m going to pause here up front and say it.

Congratulations to President-Elect Joe Biden, who defeated Donald Trump in a free and fair election, and will be the 46th President of the United States at noon on January 20, 2021. Votes are still being counted in several states, so the popular vote margin will continue to grow. Trump continues to file frivolous lawsuits and all-caps tweets alleging voter fraud and that the election was stolen, just as he promised to do before the election. In those lawsuits, no evidence of fraud has been provided. 

Trump is successfully undermining faith in our elections among many of his supporters. Most top Republicans are choosing their words carefully and refusing to acknowledge Biden as President-Elect. Some are choosing their words less carefully and indicating their support for ending our democracy and keeping power regardless of the vote. But Trump has no legal path. 

Trump has also fired most of the civilian pentagon leadership and replaced it with loyalists, while continuing to claim he won the election. Secretary of State Pompeo said there will be ‘a smooth transition to a second Trump administration’ and when given an opportunity later refused to say he was joking. 

Prediction markets are offering a 10% return even now for betting on Biden, including at BetFair where the resolution rule is ‘projected winner’ so according to their rules as written Biden has already won and they should have paid out last week. You can bet hundreds of thousands of dollars that way at any time at those odds. PredictIt’s markets are even crazier. 

We really do live in (at least and probably more than) two disjoint realities. 

Any number of things could happen (probably won’t, almost certainly won’t, but could) between now and January 20.

Also, the pandemic is completely out of control.

So for many reasons, it wouldn’t be a terrible idea to maintain and even top off the emergency supply stash just in case things turn truly ugly. Very low probability but highly dangerous tail risk events are worth guarding against. 

The anti-politics rules for the comment section still apply, now more than ever. Do not discuss politics in the comments section except as it directly relates to Covid-19. Definitely stay away from any discussions or debates about voter fraud or who is or isn’t committing a coup or autogolpe. This is not the place. Reign of terror rules apply here. 

If you know me and want to discuss politics to better understand what is happening, I’m not against that at all, but contact me privately. 

(Or if you want to talk about other stuff, that sounds good too, I don’t talk to friends often enough.)

Deaths

DateWESTMIDWESTSOUTHNORTHEAST
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
Oct 29-Nov 495619772309613
Nov 5-Nov 11108926882535870

We knew it was coming. You still hate to see it. The Midwest and Northeast numbers shot way up and there is no good news anywhere. New York’s number rose from 95 to 158 and is now clearly distinguishable from zero on the chart. There is no reason to not expect an even larger percentage rise in deaths in the next few weeks. We will doubtless hit 2,000 per day soon. I still would be very surprised to hit the scare tactic number of 400k deaths in 2020, as that would require averaging 3,340 per day from here, and I don’t think there is enough time for that to happen. 

Positive Tests

DateWESTMIDWESTSOUTHNORTHEAST
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
Oct 29-Nov 411268425291716709870166
Nov 5-Nov 11157378384862206380108581

The Midwest is completely out of control, with cases doubling in the last two weeks. Other areas are better, but not much better. Things in South Dakota are very, very bad and that was several days ago. The Midwest and West are already at record levels. The Northeast should be at record levels within a week or two, the South within one to three. Testing is increasing, but it is only a small part of the story and the testing we have is increasingly inadequate to the task at hand in most states.

Positive Test Percentages

PercentagesNortheastMidwestSouthWest
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%
10/29 to 11/44.28%12.79%8.86%7.04%
11/5 to 11/115.56%17.51%9.89%8.31%

Once again, disaster across the board but the Midwest is in especially deep trouble. Iowa and South Dakota are above 50% positive test results. I would have thought that essentially the maximum, and means we have no idea how many infections are being missed and can expect to undercount deaths as well because many will go undiagnosed. But North Dakota is now at 72% positive which was never seen even in the worst places in New York City. So it’s possible. 

Test Counts

DateUSA testsPositive %NY testsPositive %Cumulative Positives
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%
Oct 29-Nov 47,244,3478.6%973,7771.6%2.87%
Nov 5-Nov 118,185,15410.3%1,059,5592.4%3.13%

So much for New York being able to keep things under control. No place in America is safe. 

This will likely only get worse. Yesterday’s positive rate was 12.7%. Next week looks in expectation to be something like a 12.9% positive rate on 9 million tests and an average of 1,200 deaths per day. Which means half the time it will be worse than that. Yikes. 

Europe

Lockdowns in the United Kingdom, France and Belgium (see below section for Belgium, which I keep off the charts because of scale issues) seem to have at least stabilized matters, although at a terrible level, and deaths will continue to rise for several weeks. Belgium is now making clar progress. France might be, but I don’t believe the spike can be as sharp as the above graph, and it looks like reported tests for that last day are way down, so it’s too early to know what’s happening there. Germany’s half measures seem to be slowing down the rate at which things get worse but not doing enough to stop things getting worse.

Getting away from an unambiguous hockey stick is great news compared to the alternative, but at first glance it looks like a lot of countries are signing up for long periods in limbo again, with highly damaging lockdown restrictions that aren’t strong enough to quickly get the job done. The exception, perhaps, is the hardest hit place of all: Belgium.

Lockdown in Belgium

Belgium’s lockdown is rather strict. It turns out that when you care enough to do it properly, yes, lockdowns still work. And they work fast. 

They don’t work quite as fast as this indicates…

…because either they are doing less testing or the reporting of tests lags a bit, but it does seem that things are turning around. 

Whereas other European nations are doing relatively half-assed lockdowns while keeping schools open. That is not going as well. For graphs, see the Europe numbers section. 

The song remains the same. Either lockdown and try to win for real, or accept defeat for real. Half measures end up in limbo.

All I Want For Christmas Is a Covid Vaccine

It’s happening!

Not for me until next year. Not for most of you either. But it is happening.

The question now is: What does this mean in practical terms?

In the short term, for the next few months and the wave of infections currently upon us, it means nothing. This wave will almost certainly peak before the vaccine has time to have a non-trivial impact on the pandemic.

A few months from now, health care workers will hopefully get vaccinated. That expands the capacity of the hospital system and other health care a substantial amount, because workers can take less precautions and fewer of them will be out sick. That’s great, but on its own it won’t move the needle that much on the overall course of the pandemic.

Early next year, there will be enough people vaccinated that it has a substantial impact on the overall arc of the pandemic. Alas, it is likely that people’s control systems will kick in, and rather than take less risk in order to wait for a vaccine, the majority of people will instead take more risk because they’ll sense things are less dangerous. So if you are a responsible person waiting for your turn to get the vaccine, you’ll need to continue to be careful up until your turn. With vaccination on the horizon, the value of not being infected will be very high.

My guess is that some time between March and July, there will be enough vaccine doses that anyone who actively seeks out the vaccine will be able to get it. At that point, you’ll be able to return to your old life. Dr. Fauci said April for widespread availability after I’d written that guess, smack in the middle of the range, so it seems like the right estimate.

A few months after that, enough people will be vaccinated that life overall starts to feel normal again. I hope.

A lot of things could change that timeline. A key question will be whether we only have one vaccine available, or whether we will have multiple vaccines. The Pfizer vaccine is harder to scale than the others, because it requires extreme cold storage and two doses, and the effects of having multiple available vaccines would mostly be additive.

CEO of Pfizer will take the vaccine first in order to reassure people that it is safe. Skin in the game at its finest. Also a great excuse to get yourself first in line for the vaccine. That’s all right. He’s earned it.

Don’t Care How I Want It Now

When should we begin distribution of the vaccine? How should we choose who gets the vaccine? How much should we be ramping up production? What about other vaccine candidates?

First question is easy. We should begin vaccine distribution yesterday. The ‘good’ news is that not doing so is a small mistake due to limited dose capacity, and the ability for now to keep what doses do exist in cold storage until needed. So by waiting, we are moving some vaccinations from November into December, but not (as I understand it) delaying vaccination in general. That’s unfortunate because getting our health care workers vaccinated now would be a big help, but far less bad than many other mistakes that are being made.

Second question is not as easy. A lot more people want the vaccine as soon as possible than we will have doses available any time soon, so we must choose who gets the vaccine first. It’s clear that using prices is a non-starter because people wouldn’t stand for it, so I won’t bother making that case. 

Doing distribution via lottery allows us to conduct (semi) natural experiments to see how effective and how safe the vaccine is on larger sample sizes, at little extra cost. With prices unavailable, some form of lottery should clearly be part of the solution, whether it’s by birthday, or by area, or something else. I don’t expect us to do this.

I do hold out hope we can give priority to essential workers, especially health care workers. As noted above, vaccinating health care workers not only helps stop the spread, it expands our ability to provide treatment. It also seems highly equitable. These people are putting themselves on the front lines, they get the vaccine first. 

Other essential workers that need to interact with others to do their jobs can follow after that. 

The core argument there is that what matters is getting the pandemic under control and being able to provide essential services, so we should concentrate on the most exposed first. 

The other argument is that we should instead protect the most vulnerable first, and give the vaccine to the elderly or those with other conditions that put them at higher risk of death.

Both sides can point to models that say their way is better. Both sides can make a moral case that they are right. Both factors matter, so it’s a trade-off question.


The important thing is that we get the vaccine out, as quickly as possible, to as many people as possible.

Then there are those who disagree. They have other priorities.

Andrew Cuomo Is The Worst 

Can we finally all agree that Andrew Cuomo is a giant douchebag and always was? 

He has already extensively lectured everyone on how we can’t trust a vaccine that was developed under Trump’s watch. Now that one is coming, he’s stepped up his game.

He is now saying that it is “bad news” that the vaccine was developed while Trump was in office and he is going to “work with other governors to stop distribution of the vaccine.” Because, you see, they’re having “private providers” distribute the vaccine, which will “leave out” some communities. Seriously. Listen to the clip. 

So the vaccine is a cupcake that you have to throw away because you didn’t bring enough for the rest of the class and – seriously listen to the clip if you don’t believe me but this is what he is actually saying – some people don’t live close enough to a CVS, so no one should get vaccinated until Biden is in the White House.

Alternatively: If we don’t do something to stop it, someone somewhere might have two cows.

He is saying that everyone needs to have equal access to health care, and to achieve that he’s going to actively stop others from getting it. Because otherwise, when Biden takes office, he can’t “undo” what Trump has done, and those people will have permanently gotten the vaccine earlier than some other people.

Lest anyone accuse me of false equivalence on Covid-19, let me be clear. This isn’t equivalent to denying there is pandemic or engaging in literal piracy and banditry of medical equipment. 

This is worse. 

If you don’t believe one should ever hate anyone or anything, then I congratulate and salute you on your enlightened attitude. However, if you believe it is good and right to sometimes hate at all, and you hate this with less than the fire of a thousand suns, you aren’t hating it with the fire of enough suns. 

Pitchforks are available at Home Depot and many other fine stores.

We’ll Need More

How much should we ramp up production? We should do all the ramping up of all the production.

Look at what happened to the stock market on the day Pfizer announced its results, note that Pfizer was only a tiny fraction of total gains and went up far less than many other businesses, and then note that the stock market’s gains are a small fraction of the real human gains in economic terms. And the economic damage is only part of the toll on human lives even for those who stay healthy. 

If you do the math on how much it is worth to end this pandemic one day sooner, the answer comes back to a much higher order of magnitude than it would cost to speed up vaccine production and make that happen. 

We missed our chance to do this in the development stage, but we can still do it in the distribution stage. The more money we can throw at this problem to get more production faster, the better. I do not care what it costs. 

We will also need more different vaccines. Even with the right incentives, Pfizer will not be able to produce enough quickly enough on its own, so the other candidates (that turn out to be effective) need to help out as well. 

There are several nightmare scenarios that need to be avoided. If you are in any kind of position to ensure that these do not come to pass, please do everything you can to help!

The first nightmare is if vaccine trials are not allowed to continue once the first emergency use authorization is given. The argument will be that it is not “ethical” to continue to not vaccinate the control group. This is pure insanity, and it is even more pure insanity when there isn’t enough vaccine to go around and those in the control group could not otherwise have gotten it anyway.

I’m still naive enough to think we’re not that insane. At least not yet. But I’m still worried this might happen! Both for the Pfizer trial, and for other vaccine trials. We need to make sure that doesn’t happen. 

Even worse would be denying the EUA because of fears that the trials would end if the EUA was given. This is seriously something we have to worry about – that our “ethics” principles are so reversed that we need to deny everyone the vaccine in order to deny the vaccine to the few people we need to not (yet) vaccinate.

There’s the nightmare that Andrew Cuomo or others like him hold up distribution, as described above in his own section. Please do not let this happen.

The mistake I fear the most is that we might refuse to allow a second vaccine because it is ‘less effective’ than the first vaccine. That Pfizer’s comes in at let’s say 91% effective, and then AstraZenica’s is 87% effective, and because of that they refuse to approve it, even though Pfizer won’t have enough doses available for years. From what I can tell, this is a real worry and this could actually happen. Similar things happen all the time. 

Immunity to Covid-19 For Some, Miniature American Flags for Others

Thanks to a combination of the existing anti-vaccination movement, and the fears that were raised during the campaign by the likes of Andrew Cuomo and Kamala Harris, there will be a lot of people who are reluctant to take the vaccine, or at least to take it relatively early. It might even be a majority of Americans who are not interested. 

When I posted to Twitter about the vaccine, several responses were to inform me that the person responding was most definitely not interested in taking a Covid-19 vaccine, and found me rather crazy for wanting to take one.

In the long term, that’s a problem. We need to get enough people vaccinated that we can resume normal activities. If we only get half the people, especially the half we’d get in this scenario, that on its own won’t be enough. 

In the short term, this may sound like a problem, but actually this is great. We don’t have enough vaccine doses for everyone who wants it. If half the people volunteer to opt out of the process, then the rest of us can get vaccinated twice as fast, and can be less worried about not being high in the priority queue. 

Then, in the long term, there will be hundreds of millions of us around the world who have gotten a Covid-19 vaccine. Our experiences will prove it is safe, and most of the people doubting now can follow later. If they like, they can feel smart for having waited to be sure. Or, if they prefer, they can acknowledge their mistake. Either way seems fine. 

That still leaves the hardcore anti-vax people, but we were never winning them over in any case, and I don’t think there will be enough of them left to cause a major problem. 

What The Hell Is Happening To Us?

Venk Murphy, newly tapped as one of the heads of the new Covid-19 advisory board, points out this story that those who had Covid-19 are 20% likely to have gotten a new mental illness in the last 90 days, which is twice as high as the general population.

It’s easy to bury the lede here. Yes, 20% of people who survive Covid-19 getting a new mental illness is really bad. I was going to ask whether this result was expected. With the broad ways we today define mental illness, combined with the trauma of dealing with the virus, it would make sense that a lot of people would develop a problem at least in the short term under our technical definitions. 

I’d also note that this is among people who know they had Covid-19, not the entire group of people who did have Covid-19. That’s a big difference, and is likely pushing up the difference quite a bit. It’s also the better thing to track, though. It’s no surprise that it is not trauamtic to get asymptomatic Covid-19.

But that all misses the point. 20% of people who survive symptomatic Covid-19 having a new mental illness is bad. But 10% of the entire population developing a new mental illness every three months is much worse! 

That’s more than a third of the population each year. That’s… really terrible.

[EDIT: It turns out that I misunderstood, and this was instead a risk ratio of 1.65 for the population that got any form of care. It makes sense that this group would have more issues than the general population, but that population includes 65 million people.

Even if it wasn’t fully accurate, the claim resonated broadly, which is scary enough.]

Multiple friends of mine with no connection to each other responded that 10% matches their observations. That’s how bad it is to live under these conditions. How much of that is the pandemic versus the rest of American life today is an open question, but it’s clear something is deeply, deeply screwed up here.

For comparison to pre-Covid, I googled and found this, which claims 26% of Americans have a diagnosable (not necessarily diagnosed) mental disorder in a given year, and this source claims 46% will suffer from a mental illness at some point in their lives, which presumably are all pre-Covid stats. These numbers are much higher than for the rest of the world. 

I don’t know the usual duration of a mental illness, but if you combine 26% suffering in a given year with 46% suffering at least once at some point, you definitely get a radically different picture than looking at a 10% chance of a new problem every three months.

Someone I know reports that the majority of her daughter’s remote learning class is newly suffering from depression. When she described how the school was running things, and how their entire lives had become dominated by a combination of being tied to screens and then potential and real interruptions demanding proofs of work at any and all hours of the day in order to destroy the lives of both the kids and their parents, I didn’t have to wonder why. 

(Then I may have gotten the parents to form a union that fought back and forced the school to change its policies. But that’s another story.)

This is all only part of the non-economic cost of our countermeasures to contain the virus. What percent chance of death should a person risk to avoid developing a mental illness?

The question of ‘why were so many of us were already so mentally screwed up’ is an important one, but beyond the scope of this column. 

In Other News

In other Andrew Cuomo being the worst news, gyms, bars and restaurants with liquor licenses can stay open but have to close by 10pm. I do not wonder what will happen to capacity utilization when we cut the number of hours available. The bars might be a net benefit because people act stupid at night, maybe even the restaurants, but closing the gyms some of the time definitely makes us less safe. He’s also limiting indoor gatherings to 10 people. Which is at least somewhat helpful. Although, I wonder to what extent telling people the limit is ten causes ten person gatherings.

I remember a few days ago when there were musings like this: Will a small, long-shot U.S. company end up producing the best coronavirus vaccine? They still might. It’s great that we have so many backup plans.

Did you know that congress set aside money so airports could do Covid-19 tests, and then the FAA kept the submitted proposal in limbo where it still is today? Thus no screenings at airports. 

On a related note, what happened to the rapid tests? Exactly what you would think. Regulations and regulatory uncertainty. 

This thread claims that a 22-day delay from positive tests to deaths best matches state data. That is on the extreme high end of my range based on the approaches I’ve taken, which focus more on the national and New York levels, but is plausible. Longer delays are worse news given the current situation. My guess is that you see the biggest direct impact at more like 14 days, but with other deaths that take longer, so if you pick one number it will depend on how you define your error term. 

Deutche Bank proposes a 5% tax on those who work from home voluntarily, to ‘support those whose jobs are under threat.’ I know I was talking about maximizing harm in the name of showing concern, but even I am impressed by this one.

Marginal Revolution offers words of wisdom on how we are told to put our lives on hold but all vaccine development doesn’t have to figure out how to approve and distribute a vaccine while continuing to conduct clinical trials, and this is threatening to potentially take away months of our lives for actual zero reason.

Did you know that being indoors with others is ‘safe’ under a certain threshold of infections but ‘unsafe’ over that threshold? “Some experts” are here to remind us that this is how they model the world. In case it wasn’t obvious, these actions were never safe.

Anecdotes are what they are, but this was only the latest example of someone reporting falling mask use. I’m guessing this is a lot of why things are getting so bad. This isn’t complicated.

In case you are wondering how we handled Covid-19 in prisons, this answer from Texas is not reassuring, and reminds us how bad Covid-19 can get under worst-case conditions.

CDC finally admits, this week, that mask wearing benefits the wearer and not only those around them. Better (ridiculously over the top amounts of) late than never, I suppose.

North Denmark in lockdown over mutated virus in mink farms, and all the minks were going to be killed, because minks are highly vulnerable to Covid-19 and there was worry about potential mutations. I was all ready to give kudos to Denmark for treating this problem with most of the seriousness it deserved, and thinking that maybe, just maybe, there is a threshold where we get ourselves together. Then some Danish MPs started complaining about the threat to livelihoods and claiming that the cull order was illegal, and the government backed down. It seems you can lock down the people and destroy their livelihoods together, but threaten the mink farm lobby and there will be hell to pay. A sobering turn of events.

Also, somewhat off topic, but relevant to how decisions are being made these days: while Denmark is farming fifteen million minks in cages and cares more about doing that then guarding against the mutation of a global pandemic, they also banned butchering of kosher and halal meat in 2015. I would wonder why, except that I don’t wonder why.

Even more off topic but worth pointing out: The Netflix series The Queen’s Gambit is excellent and you should watch it. Tier one, must see.

The Winds of Winter

A vaccine is coming. If you want it but do not have priority, chances are you will get it some time around April. That’s five months from now.

Meanwhile, cases are soaring. Positive test rates are over 10% and rising at >15% per week. Deaths are rising over 15% per week. Hospital systems are starting to become overloaded in the hardest hit areas, with the worst yet to come. Things are even worse in Europe.

The value of staying safe is higher than it has been since April. For at least the next two months, that value will only rise.

The chances of becoming infected are at an all-time high. If you become ill during the next few months, there is serious danger that the hospital system you arrive at will be rationing care. Our care has improved greatly, but temporarily it will likely get worse. 

Whereas if you make it to April, you can get a vaccine, and be (not entirely, but mostly) safe permanently. The cost of staying safe is only about five months of precautions, rather than an open-ended nightmare.

There are many variables to consider, but a rough estimate would be that the effective risk level of a given activity is somewhere between double and ten times the rate it was a month ago. That’s why I’ve been saying for weeks that if you have a risk that you need to take, that is worth taking, take it sooner rather than later. 

Whatever level of precautions you decided were appropriate before, you should increase that level.

Because everything works in power laws, it isn’t obvious that this will have a major impact on the way you live your life over the next five months, if you were already working or going to school from home and generally playing on the ‘safe’ side of things. I often mock calling some things ‘safe’ and some things ‘unsafe’ as a binary, but most things are clearly on one side or the other of that binary. There aren’t that many things that are borderline choices! 

If you are forced to take risks, now is the time to do everything possible to minimize those risks. 

But as always, think ahead! You need to retain your safety and sanity for at least several months before things improve, and likely at least five before the vaccine is available. Do not put yourself on a path that you cannot sustain.

Do I still think the worst is probably behind us? I do, but I am more concerned that the medical system will collapse, in which case things could quickly become very bad. It also seems more plausible that people’s control systems have broken down – people may be so sick of it at all that they won’t adjust, at the very time safety is most valuable both personally and collectively. 

The next few months are going to be difficult, but assuming a peaceful transition of power (even after everything, I still can’t quite fully believe that I need to write those words, but I do) the supply chains will hold. Our health care workers and other essential employees will have the equipment they need. Many of the most vulnerable will have a chance to protect themselves. A vaccine is on its way. And it’s a grim thing to say, but already 3.13% of the United States has tested positive, with the likely true infection rate closer to 20% and rising quickly. 

It may not feel like it, but this wave is the climax. We are eight months in and more than halfway home, but we need to hold things together until the tide turns. 

It can be done. Let’s hope we have the will to do it.

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39 Responses to Covid 11/12: The Winds of Winter

  1. Dave Orr says:

    IDK how much feedback you get for these posts but I, for one, find them totally invaluable. Thanks for writing them!

  2. Anonymous-backtick says:

    Why do you make provocative claims and then forbid anyone to respond to them?

    • TheZvi says:

      Regardless of the nature of my non-Covid claims herein, I do not believe that it would enlighten or help anyone to discuss such matters in a comments section, and it’s my blog. You are free to disagree with them, or make counter-arguments elsewhere.

      • J says:

        Fwiw, I’ve often wanted to share these posts with my friends on red team who do care about staying safe, but the anti-Trump stuff makes me think they’d reject it. It sucks that he’s continuing to be an idiot. But I think they’d wonder why you called out his evil in undermining the election and fda’s evil in dealing with Pfizer, but not Pfizer’s evil in delaying their announcement until just after the election. It’s your blog and I’m grateful for all the things you write about, but it does make it harder for me to share it outside our bubble.

      • TheZvi says:

        I respect that concern, and I thank you for saying it explicitly. I of course realized that I would pay a price here with the red tribe, but didn’t feel like events left me any choice. I chose my words even more carefully than usual in the Votes section.

        For the same reasons I felt I needed to say what I said, I felt it was not the time to be discussing whether Pfizer intentionally delayed their announcement. We all wish we weren’t in this situation, but that’s life.

        Hopefully you will be able to share next week’s post with them – Trump seems to be doing actual nothing w/r/t Covid-19 and I don’t expect to need to note non-Covid things again, and I really hope I’m right.

      • Dan Pandori says:

        I want to mention that I’m very grateful you have explicit comment moderation policies like this, and that it seems to produce much more informed conversations that letting culture war discussions take over everything.

  3. Eric Fletcher says:

    I guess the only question left is: who has the best story?

  4. oskar31415 says:

    From Denmark.
    The change seems to be that they cant do a “quick law” which requires 3/4 of the parliment to support, it seems there is a 50% support so they can manage to make it law eventually.
    The center right party is the votes needed to do a quick law. (Personal speculation: they had a leader change, the old leader was booted due to considering over the middle cooperation (due to other right wing parties getting to racist) but this was apparently unpopular with the base, so now the new leader is trying to distance themselves by being “tough” on the government party)
    The biggest “lobby” (which in Denmark works more like a union (or a union of unions) of employers) Danish Industri supports a “quick law”.

    • TheZvi says:

      Good perspective, I didn’t know about this at all. So if you only have 51% support laws take a while to enact, and there’s no authorization to allow this to be done without a law? What would have happened if this were an emergency situation, as it looked like it might have been?

      • oskar31415 says:

        I believe the hope is that if you have an emergency then you would have 75% support, or to have a bias in favor of it not being an emergency if more than 25% disagree.
        The autorisation level is that they can cull all sick mink (and mink in “risk areas” around already infected mink), but there is questions about mink that aren’t already sick.
        51% get you the normal procedure with debates and readings. If 75% agree they can ignore some of those steps.

      • oskar31415 says:

        Worth noting that they did a “quick law” in the beginning of the pandemic, so it does happen sometimes

      • oskar31415 says:

        The normal process is that there are 3 readings usually taking ~30 days

      • oskar31415 says:

        Finally the prime minister hopes to get a deal tonight, which will include culling of all mink.

      • oskar31415 says:

        The law has now been agreed on.
        I would expect almost all mink to be dead by tuesday (as that is when the tempo bonus ends)

  5. joshuatfox says:

    > claims they and their family are the best at business but their longtime revenue sources are bankrupt
    I have wanted to call him “Littlehands” or “Littlefinger” since 2016 https://abcnews.go.com/Politics/history-donald-trump-small-hands-insult/story?id=37395515
    It’s perfect: The little fingers (that he is embarrassed by), the financial mismanagement and bankruptcy, the conspiratorial manipulation of government.

    The only reason I did not try to spread the term in 2016 was a desire to avoid troll wars.

  6. myst_05 says:

    Given your old “On R0” post, what is your updated estimate on the true herd immunity threshold? Are we likely to reach it in the US before the vaccine?

    • TheZvi says:

      I discussed this last week, my estimates are slightly higher than back then but still similar, while noting that herd immunity has multiple meanings. I certainly think the third wave we are now seeing will burn out with substantial help from herd immunity without a vaccine. I doubt we’ll get to herd-immunity-with-minimal-precautions levels but it wouldn’t be that surprising if we did. Exponential growth happens fast.

  7. KPM says:

    Zvi, thanks again for all your work. I got to see maybe a third of your presentation on November 1st before I lost my connection. Any chance I could have a copy of your slides from that talk?

  8. benquo says:

    >The second claimant, with almost no help from the other, puts their campaign on hold and attempts to rise to the challenge, assisting allies in developing new weapons while their rival consolidates their base.

    I missed this – what specific events are you referring to?

    >Just in time, they deliver the blow we need to defeat the inhuman enemy before all is lost.

    This also seems like it didn’t actually happen.

  9. benquo says:

    Why do you think the vaccine works and is safe?

    • TheZvi says:

      Safe: This is a phase 3 trial, so they’ve already done Phase 1 and 2. Also, if they deployed a Covid-19 vaccine that was actively unsafe (as in so unsafe you might not want it) then that would do huge damage to Pfizer’s reputation and to vaccines in general. I expect them to be overly cautious here. They paused trials for a single adverse event, etc.

      Effective: My prior for any given vaccine working before seeing data, provided safe and deemed worth a phase 3 by a Western company, starts out something like 50%, after updating somewhat higher on other countries doing vaccinations already, but the exact number doesn’t matter. If they claim this shows >90% efficacy with a 94 sample, then the chance that means at least 86-8 and if it means confident >90% via frequentism it means more like 93-3. The likelihood ratio there is not small for any reasonable amount of error short of outright fraud.

      I do not expect outright fraud here, there’s too many people with the incentive to stop the vaccine if they have any doubts about it. Pfizer isn’t trying to bridge to new funding, so a temporary illusion doesn’t help, and stock was only up 4%. In theory maybe someone bought options on other stocks and then they somehow faked it, but that seems very unlikely to me.

      Also, Pfizer CEO is taking the drug first, which tells me it’s at least safe – skin in the game.

      I’m also letting the defenses do cognitive work. If the press release caused the vaccine to be distributed, we would be right to worry for many reasons. But because it doesn’t, and it’s going to be many steps before we can get it, I’m confident that in almost all the worlds in which I actually get to take the vaccine, it’s safe and effective.

  10. Doug S. says:

    The charitable interpretation of what Cuomo said is that if Trump’s plan goes into effect, they’re going to fuck it up the same way they do everything else and people are going to get screwed out of vaccine access for predictable reasons – and Biden will be stuck unable to change things so they’ll *continue* to be screwed out of vaccine access even after he takes over in two months. On the other hand, if they do the plan right in the first place, nobody gets long-term screwed.

    I don’t know whether to extend this kind of charity to Cuomo, though. :/

  11. danohu says:

    I’d be interested to see Slovakia in the graphs next week. Their mass testing seems like a great move. It’s also a Big Gesture which should appeal to politicians’ egos, and thus be more feasible to implement elsewhere. “Test everyone in South Dakota” feels like something even Trump might like the sound of, and would do a lot of good.

    • TheZvi says:

      Good point, I’d forgotten about Slovakia. I’ll make a note to check.

      The problem with testing everyone in South Dakota is you can’t keep out people from North Dakota.

      • danohu says:

        That’s a problem everywhere. Slovakia is surrounded by countries with high case numbers. Its capital even has something of a Tijuana-San Diego relationship to Vienna.

        The inevitability of imported cases is why I was relaxed about not aiming for complete eradication in the summer. Unless you close borders there will always be imported cases, so it’s not worth the extra hardship to get the last domestic cases. [I’m admittedly much less sure about this than I was 3 months ago!]

  12. Anonymous says:

    Has the efficacy of high vitamin D doses been replicated independently in preventing severe Covid cases?

    • TheZvi says:

      I remain convinced by the data I’ve seen. I have not seen new data, so to extent that this wasn’t true a few weeks ago, I don’t have reason to believe it is true now. I also don’t know of any failed attempts or ongoing but not yet concluded attempts to replicate. We’re very bad at running experiments.

  13. Michael Crone says:

    I’m seeing much lower positivity rates for North Dakota and the upper Midwest on https://covidactnow.org/?s=1318327

    What am I missing?

    P. S. Really really glad that you have been doing these posts. Thank you.

    • TheZvi says:

      They must be doing a different calculation. I double checked and CovidTrackingProject has the higher numbers, and those discussing echoed that. I’ll try to figure out what is up with the new source of I can.

  14. Nicholas Weininger says:

    I continue to be surprised that the MIT audio-based COVID classifier, which appears to detect asymptomatic infections with high accuracy *just from recordings of forced coughs*, isn’t getting more attention:

    https://news.mit.edu/2020/covid-19-cough-cellphone-detection-1029

    Like, if this holds up, it could literally be the most impactful ML model ever, and way, way easier to distribute than a vaccine. I hope there is a team of productivity-maximizing size working to get this into a production app as soon as possible, and I’ve reached out to a bunch of folks including Subirana either offering or soliciting help, but haven’t gotten useful responses yet. I don’t know how one could more effectively shout it from the rooftops, as Tyler Cowen would say, but would appreciate any suggestions. Or is there some reason I’m missing why this is a less huge deal than I think?

    • TheZvi says:

      I covered that last week IIRC. My take on it was that if it works it will be illegal so no one will get to use it, so I didn’t look too carefully into how well it works. Unless we have an end around the regulatory barriers, in which case it would be great. That would be my angle?

      • Nicholas Weininger says:

        Ah, yes, you did cover it, thanks, and others I’ve talked to also think the regulatory approval problem is the long pole. Sigh.

  15. myst_05 says:

    Very interesting article in Washington Post on Moderna’s vaccine: https://www.washingtonpost.com/health/2020/11/16/covid-moderna-vaccine/ (non paywall mirror https://archive.vn/JcIOr)
    “Moderna has committed to completing its trial before applying for emergency-use authorization — which means waiting until there are 151 cases of covid-19 in the study. A previous projection showed that the trial might end early next year, but it is instead expected to reach its endpoint in seven to 10 days, Bancel said, because of surging coronavirus cases in the United States.”

    If I’m reading this right, aren’t they essentially admitting that without vaccine challenge trials, vaccine development could not have been completed without reaching a certain number of COVID cases/deaths? So effectively… America’s lax COVID attitudes helped end the pandemic faster rather than prolonging it as was previously claimed by proponents of stricter measures?

    • TheZvi says:

      They could have had a larger trial, and in the end the safety data was the listing factor, and they could have started faster. So no. But the core idea has merit. If you are insane about challenge trials, then you need to infect the population in general…

  16. Pingback: Covid 11/19: Don’t Do Stupid Things | Don't Worry About the Vase

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