Covid 2/25: Holding Pattern

Scott Alexander reviewed his Covid-19 predictions, and I did my analysis as well. 

It was a quiet week, with no big news on the Covid front. There was new vaccine data, same as the old vaccine data – once again, vaccines still work. Once again, there is no rush to approve them or even plan for their distribution once approved. Once again, case numbers and positive test percentages declined, but with the worry that the English Strain will soon reverse this, especially as the extent of the drop was disappointing. The death numbers ended up barely budging after creeping back up later in the week, presumably due to reporting time shifts, but that doesn’t make it good or non-worrisome news.

This will be a relatively short update, and if you want to, you can safely skip it.

If anyone knows a good replacement for the Covid Tracking Project please let me know. Next week will be the last week before they shut down new data collection, and I don’t like any of the options I know about to replace them.

Let’s run the numbers.

The Numbers

Predictions

Last week: 5.2% positive test rate on 10.4 million tests, and an average of 2,089 deaths.

Prediction: 4.6% positive test rate and an average of 1,800 deaths.

Result: 4.9% positive test rate and an average of 2,068 deaths.

Late prediction (Friday morning): 4.5% positive test rate and an average of 1,950 deaths (excluding the California bump on 2/25).

Both results are highly disappointing. The positive test rate slowing its drop was eventually going to happen due to the new strain and the control system, so while it’s disappointing it doesn’t feel like a mystery. Deaths not dropping requires an explanation. There’s no question that over the past month and a half we’ve seen steady declines in infections, and conditions are otherwise at least not getting worse. How could the death count be holding steady?

One hypothesis is that weather messed with the reporting, but Texas deaths went down and the patterns generally do not match. Virginia saw a giant jump in the death rate and I’ve adjusted them down by 475 deaths to account for that, which seem to be holiday-related catchup even though it seems super late for that. Nothing else stood out in the charts. As per my rules, since the Virginia adjustment improves my accuracy and there’s a non-zero amount of ambiguity, I’m not including it in the results section. If included, that would move us to 2,001 deaths per day, which still feels too high.

Added Friday 9am: I realized this morning I hadn’t made a prediction, so I’m making one now, after seeing Thursday’s results that include a high death count (3138, 800 of which are a backlog from California), and a lot of tests (1.8mm) with only a 4.1% positive rate. I expect some continued improvement for now, but there are signs that improvement is slowing dramatically.

Deaths

DateWESTMIDWESTSOUTHNORTHEAST
Dec 31-Jan 64553412750194162
Jan 7-Jan 136280396373834752
Jan 14-Jan 205249338672074370
Jan 21-Jan 276281321781514222
Jan 28-Feb 35524307880713410
Feb 4-Feb 104937268771653429
Feb 11-Feb 173837222152392700
Feb 18-Feb 243652243347822427

Using the Wikipedia numbers we do see continued declines in death rates, but still highly disappointing ones. The English Strain might be substantially more deadly, but it’s too early for that to account for this. It’s definitely odd and I not only see no explanations and lack a good one to offer, I don’t see anyone noticing that it is odd.

Positive Tests

DateWESTMIDWESTSOUTHNORTHEAST
Jan 14-Jan 20360,874185,412452,092250,439
Jan 21-Jan 27260,180158,737386,725219,817
Jan 28-Feb 3191,804122,259352,018174,569
Feb 4-Feb 10144,90299,451255,256149,063
Feb 11-Feb 1797,89473,713185,765125,773
Feb 18-Feb 2480,62564,857150,493110,339

Continued improvement, but slower than one would like especially given the continued drop in testing. We may not have much more time to see declines before counts start increasing again.

Test Counts

DateUSA testsPositive %NY testsPositive %Cumulative Positives
Jan 7-Jan 1313,911,52912.2%1,697,0346.6%6.97%
Jan 14-Jan 2014,005,7209.7%1,721,4405.9%7.39%
Jan 21-Jan 2712,801,2718.8%1,679,3995.3%7.73%
Jan 28-Feb 312,257,1237.7%1,557,5504.6%8.02%
Feb 4-Feb 1011,376,5416.4%1,473,4544.1%8.25%
Feb 11-Feb 1710,404,5045.2%1,552,5553.5%8.41%
Feb 18-Feb 249,640,1094.9%1,502,7413.2%8.55%

New York continues to test robustly, but many other places are not following suit. This continues to mean that the positive test rate is dropping slower than the true rate of new infections, but it’s also worrisome that we are getting out of the habit of testing people. This is nowhere near enough testing.

Vaccinations

This is very much not great.

It is hugely disheartening to see our weekly rate decline from 1.61 million per day last week to 1.3 million per day now, with no signs yet of a full recovery let alone getting back on our previously accelerating path. I do hope that will happen soon, and slow progress is still progress in the meantime, but it’s all scary.

How are we doing vaccinating nursing homes? About this well:

A line for only those not in nursing homes would make this contrast even more stark. We botched this job, but even with that botching it was hugely impactful.

Pfizer and Moderna claim to have solved their bottlenecks and pledge massive boost to US supply (WaPo). They are promising 140 million doses over the next 5 weeks, more than double the recent pace of vaccinations. 

If we do get to that pace, we will be back on track to be able to give vaccine shots to everyone who actively seeks them out by the end of April, even if we don’t get our act together on half doses or first doses first or get any help from Johnson & Johnson or our other known safe and effective vaccine options. 

On the first doses first front, yet another group of experts is out in favor of this obviously correct approach:

What I find most interesting is the explanation that this is motivated by the English strain:

The English Strain didn’t change the right answer. Instead, it puts additional pressure on the answer to be correct, giving a sufficiently short time-horizon problem slash scary downside scenario to allow ‘experts’ to come out in favor of the better answer over the worse answer. Whatever prevents the most infection, hospitalization and death is the right answer either way, and that’s far and away first doses first. 

What would a country actually using its vaccine doses look like? I’m guessing something like this:

At a minimum, it would look like this:

Europe

You can see Europe’s situation mostly holding steady here, and you can see America’s death rate having climbed back up in the last few days (even adjusting for Virginia). It’s definitely troublesome.

UK vs. EU vaccine efforts, looks like a tie, oh wait:

Covid Machine Learning Project

Yet another place to see the drop in vaccinations recently, especially in first doses. Other than that, the lines continue to move in the same directions previously expected. He now has us up to 28.1% ever infected as of February 11, and 13.8% having at least one vaccine dose as of today.

The English Strain

Some hard data from NYC (full report):

This seems like very good news given our priors. If we are only up to 6.2% now versus 2.7% for all of January, then the variant isn’t on pace to take over for another few months. That would be enough time to offset the increased infectiousness via additional vaccinations. 

Alas, data elsewhere in the country is not as promising. This is another data source, this one covering sequencing in the United States, showing us in the 15-20% range.

Kai’s latest update on Denmark, where new strain is now 57% of cases, and cases are rising despite the lockdown.

Some hard data from a variety of countries, this website seems great. Doesn’t paste well, so click on the link. In the USA it has the English strain up into the low double digits, which is closer to my overall prior and still importantly better than I’d feared.

A Youyang Gu thread looks at various possible scenarios, and noting that new variant takeover need not mean we get a gigantic wave.

The South African Strain

A well-deserved break from insanity is now official:

A thread goes over the key passages:

This looks like an eminently sensible system. One age group, one week to assess safety, effectiveness judged straightforwardly based on immunogenicity. 

Also good is that South African cases have fallen dramatically down, which should lower our worries about this strain on multiple levels.

Also, Moderna is testing an updated vaccine designed for the South African variant. It’s good news to confirm this but it was so inevitable it almost isn’t news.

Johnson & Johnson

The FDA has announced that the Johnson & Johnson vaccine meets the requirements for emergency authorization. You might think this would mean it is now authorized for emergency use. You would be wrong. You can’t rush meetings.

You might think that would mean we have a plan for what to do when it is so authorized. You’d be wrong again. Remember when Biden complained that Trump didn’t have a plan?

WTF, indeed. Taking three weeks to approve the vaccine is bad enough, but I can sort of understand it. Not using that time to make a distribution plan (this should not even be necessary, the plan should already have existed long ago) is a whole different level of sabotage. Rumors of the new administration’s ability to administrate seem greatly exaggerated. 

Vaccines Still Work

Latest confirmation that vaccines work, in this case one shot of AstraZeneca:

Meanwhile, America continues to sit on a massive unused supply of AstraZeneca doses. What is the right way to describe that FDA decision?

Chinese data reports their vaccine also works, with effectiveness levels similar to Johnson & Johnson. Note that I say their data reports, rather than that it is true. Watch who gets vaccinated. 

People continue to treat confirmation that vaccines work as news. It is not news. 

We know vaccines work. They are highly (but not fully) effective in preventing infection and the spread of disease. They are even more effective at preventing severe disease, hospitalization and death. 

That doesn’t mean that getting the exact numbers right isn’t valuable. Getting it right is valuable.

But those who imply, or outright say, that this is the ‘first information’ we have or that it is the ‘first evidence’ or anything like that, shame, shame, shame, shame on you.

Shame!

Shame!

No shame here, only facts (some shame further down thread but let’s ignore that):

If anything I find this a little disappointing, as I was very much enjoying the straight 100%s. Still, don’t get me wrong, I’ll take it.

Then there are those that are still going with the ‘no evidence’ line somehow. Note the date. 

Shame.

This leads us to your periodic reminder:

There are no CDC guidelines for what vaccinated people should do.

After what happened with the schools, I’m not optimistic about what those CDC guidelines are going to say. The good news is that people are not schools, and can more easily hit ignore.

The attitude goes like this:

What the hell, Dr. Fauci? You were supposed to be lying to get better outcomes…

Who cares if you’re vaccinated, same energy, f*** everything, we’re doing five blades. 

What happens when your messaging is all about how vaccination priority is the most important thing and also how vaccines can’t be relied upon in any way: Many NBA players reluctant to promote vaccine, largely out of concern that getting the vaccine too soon would look bad, but also because many of them don’t trust the vaccine.  

You also get reactions like this:

I am not claiming that ‘tell the truth’ is always the correct simulacra-level-2 play, but blatantly lying to the public to their faces, in order to scare them and warp their perceptions of physical reality to get them to do what you want, is a strategy that keeps getting tried by elites and media, and keeps blowing up in their faces. 

Good news, in the UK you’d at least be able to travel:

The continued FUD around whether previous infection protects people continues to be insane, as is forcing those already infected to compete for limited vaccine supply. The people I know (or secondhand know) who got Covid mostly then got the vaccine anyway, and worries about being punished for not having done so are a lot of the reason for that. Great strategy. 

When is it time to go back to normal? Youyang Gu offers one perspective, the graph seems optimistic but the curve seems mostly reasonable:

There will come a day when there is once again a pivot, from everyone must take precautions to everyone must do their part to restart the economy. It probably won’t be as bad as the UK’s payments for dining in and only dining in during a pandemic that paid more if you had a larger group. It should still be expected to be perverse, because the system selects for perversity. 

People like Dr. Fauci will instantly transform from ‘even fully vaccinated you can’t see a movie’ to ‘it’s important for our economy and mental health for us to get back to our regular lives.’ 

And then, if necessary, they’ll transform back, as many times as necessary. 

This week we saw one of the first signs. Cuomo is proposing a $5,000 reopening tax credit per employee for restaurants (max 10 per restaurant). 

So, let me get this straight. Restaurants are in danger of closing, so we’ll hold off on paying them for a year, then pay them money if and only if they reopen, exactly at the moment they’re not in as much danger of permanently closing. So if you managed to survive without payments, congratulations, you deserve a reward check? But only if you open now? It’s as if we wanted to transfer funds to restaurants, but held off until now because doing it earlier would have been helpful. If we do it now, it’s in the name of Economic Recovery, so giving preferred interests cash is now fine.

In Other News

Somewhat unfair, but still…

From The Onion, on Cuomo, but don’t tell me you think it didn’t happen.

Meanwhile, in Florida, this is how the news covers…

prioritizing the most vulnerable citizens (the elderly) for vaccination.

They also continue to use outdoor events as their go-to blame totems and cite them as superspreader events, despite this consistently proving not to be the case. Our continued closing of outdoor spaces and preventing outdoor activity is actively counterproductive on every level, so doubtless it will continue until this is fully over.

In other Fauci news:

Thread by Youyang Gu of the Machine Learning Project, on whether in-person instruction at universities impacted Covid-19 rates. He concludes that, while there was a short-term bump in cases when classes began, there was no clear long-term rise in cases. 

Marginal Revolution reminds us that “medical ethics” has no interest in benefiting humans or making the world a better place, is instead actively working to make the world a worse place and ensuring that humans suffer, and the field is proud of this. 

MR also highlights some related liquid fire from its comments section, specifically on first doses first.

Welcome to 2021:

Via same account, same energy:

Meanwhile in North Dakota, a ban on mask mandates. Gotta love the detail that the legislature uses a mask mandate themselves.

More data on who thinks we should wait until teachers are vaccinated, I continue to find it interesting that we rarely ask if they should fully reopen or not once all teachers who want the vaccine have received it, which is the question I’d be most curious about:

The Eyes Have It: Study suggests wearing glasses could reduce Covid risk by more than half. Proposed mechanism is that this avoids rubbing and touching the eyes, because everyone has to constantly use their purity instincts and blame touching things instead of the obvious explanation that glasses shield the eyes from airborne particles the same way masks shield your nose and mouth. Either way, this suggests eyes might be a more important infection vector than we’d realized, and provides even more emphasis for what you do mattering more than people realize. The other alternate explanation is that wearing glasses correlates with a bunch of other things, and those things reflect lower risk, which also seems highly plausible. I wouldn’t read too much into this but yes I would try to wear non-prescription glasses or sunglasses if I had that option. Lucky for me my eyes are terrible and this is well-covered.

Adding daily tests to border quarantines into zero-Covid areas like New Zealand seems like it more than passes every possible cost-benefit test, but even there, nope, not testing. They’re only now even testing those working the border on a daily basis. Meanwhile, Austria is now testing all schoolchildren twice a week

Looks like drinking is actually down over the past year, although not for those 50+?

The right thing: Still available! Congratulations, Connecticut.

Even if things start to get worse again before they resume getting better, I’m hopeful that we’re getting close in general, and that we’re close to getting everyone who wants one a vaccine. In the meantime, Xkcd is at long last on top of my cutting edge pandemic-beating strategy

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17 Responses to Covid 2/25: Holding Pattern

  1. Rahul Nandkishore says:

    It seems like the decline in vaccination administration last week was largely a product of weather delays to delivery. In particular while 15m doses were *scheduled* for delivery last week, the CDC counter of doses delivered only increased by 5m in the whole of last week, and the `gap’ between delivered and administered dropped to 10m, which is the lowest I’ve seen it in more than a month. Likely many localities actually started to run out of doses to administer. Meanwhile, per CDC, 13 m doses have been delivered in the past 2 days (presumably including most of last week’s backlog) so I am hopeful that the administration rate will start to climb again.

  2. etheric42 says:

    My mom works in a public school and they’ve moved to the hybrid model (some students in person, some students at home, some students at school but in a room with a TA videoconferencing into th the teacher). But they botched it and the students comingle on the bus, at the lunch room, and go between various teachers’ classes. The school administration is lax on mask strictness, staff has been offered the vaccine but almost nobody took it. The school refuses to issue any kind of alert if staff or student is diagnosed positive. There isn’t regular testing.

    My mom is vaccinated, but lives with someone who is just outside of the current vaccination age group and has a number of comorbidities. The school has just informed her that they are taking the chronic non-mask-wearers out of the TA’s room and are putting them in her room (because they keep getting distracted and the TA doesn’t want to have to deal with keeping them on task, even though that should be the TA’s primary job). Now my mom is not only frustrated with the school changing plans every few days, and burdening her more when her obligation is to everyone she teaches, but also is deathly afraid she’s going to bring COVID home.

    As messed up as the other parts of that story are (and that’s not even getting into the school cutting the number of days remote learners are allowed to attend in order to try and convince them to come back in person) I really want to try to reassure her that her vaccination should help prevent taking the virus home (in addition to the kids being less likely to be vectors). Does anyone here have any kind of data I can send her to help ease her mind?

    • TheZvi says:

      So first off, I’m really sorry that is happening, that’s all deeply messed up and they’re getting the worst of all worlds at the same time, and on top of that they’re essentially trying to give your mother in particular Covid-19. They probably won’t succeed in a meaningful way, but alas it can’t be ruled out.

      My best guess is that against infection of others, vaccination is something in the range of 90-95% effective in general, and 35% is the baseline for in-household spread, so that means that if there was previously a 100% chance that this setup would have gotten someone infected if your mom wasn’t vaccinated, there’s now… a 2% chance? Something like that. And it’s obviously still far from 100% that a non-vaccinated teacher in that spot gets infected, so this is a sub-1% situation. I don’t have new data to site towards that, that isn’t already in the posts, maybe use the Israeli data from last week.

      If she needs reassurance that the vaccine is protective at all, then at least that should be easy, but I definitely hope she isn’t teaching science!

      • etheric42 says:

        No, elementary school reading and math. The emotional charge to the situation is compounded by the fact that her father died at 62, my dad’s father died at 62, and my dad is about to turn 61.

        She definitely believes the vaccine protective for her, but how much it’s protective for others she has no background on and doesn’t know what to expect. The 35% baseline for in-household spread is a really valuable piece of data though, since I’m pretty sure she assumed it was near-guaranteed to someone you share a bed with. (And according to a meta-analysis from University of Florida, it looks like specifically spouses the transmission rate is only 37.8%, not as much of an increase over general household transmission as I expected.)

        Thanks for the reply!

  3. Will says:

    For vaccines:
    Bloomberg posted the following note:
    “Due to a significant change in CDC’s reporting methodology, we are no longer able to include data obtained directly from states in our analysis. The CDC’s update results in a sudden change in reported vaccinations in some states. Data reported by the CDC may not update as quickly as some states, which will cause a temporary dip in our overall U.S. daily rate.”
    The full details are here: https://www.bloomberg.com/news/live-blog/2021-01-21/methodology-and-analysis-for-the-covid-19-vaccine-tracker#60319089B2240006
    So I believe that accounts for some of the drop between 1.6 million and 1.3, but I couldn’t say how much.

    For deaths:
    My guess was that it was not just weather, but also President’s Day that made last week’s numbers lower than they should have been, and this week’s higher than they should have been. President’s Day is obviously not a big holiday, but government offices are presumably closed, and that could delay reporting. This is just a guess, I haven’t looked at this in detail, maybe it doesn’t fit with the data.

  4. The glasses study seems… not great. It’s purely correlational based on hospital observations, but their control group isn’t even a matched population, it’s a 2018 study across all of India (vs this specific hospital in Kanpur Dehat), and from the looks of it the cited study counts all forms of vision correction (e.g. contacts), so we would expect the rate of glasses-wearing in the hospital to be lower than the figure they cite by default, since they’re measuring a different and more specific thing. Better than nothing as a Bayesian update, but at the very least I’d want to see some bigger correlational studies against better-matched populations before putting much stock in this. (Still, seems harmless enough to wear glasses, unless you’re prone to fiddling with it a lot.)

    To comment on the actual hypothesis: An explanation I’ve heard for this is that glasses fog up while wearing poorly-fitted masks, so you adjust the fit until your breath doesn’t hit the glasses (and thus hopefully exits/enters through the filter). Anecdotally, this seems true enough.

  5. myst_05 says:

    “It’s definitely odd and I not only see no explanations and lack a good one to offer, I don’t see anyone noticing that it is odd.”

    Its also happening in Israel where you would normally expect a rapid reduction in deaths thanks to vaccinations, but they’re kind of hovering at the same level. My theory is that COVID has a very long tail of deaths due to sometimes taking weeks to damage someone’s body sufficiently to kill them. Either they’re stuck at the hospital on oxygen and then finally succumb weeks later or they were at home the whole time kind of barely making it through, until eventually their body gives in and they can no longer maintain breathing. I imagine we’ll keep seeing COVID deaths even if you magically vaccinated 100% of adults tomorrow, simply because many “Long COVID” patients will keep dying as the months go by.

    • TheZvi says:

      That explains why it wouldn’t go super down / go to zero, sure. But it doesn’t much explain why there isn’t a relative decline even if it’s a large effect, right?

  6. Aaron says:

    How much should we worry about the new variant (B.1.427, B.1.429 – 20C/L452R)? Could it cause 4.8x more ICU admissions and 11x more deaths in a representative sample, as well as be more contagious?

    https://www.sciencemag.org/news/2021/02/coronavirus-strain-first-identified-california-may-be-more-infectious-and-cause-more

    I recall a text arguing that we shouldn’t be very concerned with the new strains, as the general direction of mutation is towards less severe, cold-like infections, the vaccine tends to minimize the major risks no matter what the strain is, plus the media optimize for fearmongering clicks. At the same time, I see no reason why mutations can’t go towards a strain that’s twice as contagious, twice as deadly, and more resistant to the available vaccines. If this was the case, then given the vaccination pace, we would enter a truly dystopian period…

    Could you please share some 0-100% predictions related to this, Zvi?

    • TheZvi says:

      I do think going in either direction is possible. The numbers cited here are from tiny sample sizes and the effect sizes are bonkers, etc etc, if it’s really anything like 10x deaths that would be very, very surprising to me. 2x is possible. I do expect accelerating vaccinations soon, and I expect adapting vaccines to be relatively easy, and I expect vaccines to still help a lot. Obviously the nightmare is always *possible* but it’s single digits and even that is not permanent, just a few months.

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  8. Remove 'Rona says:

    Are there any situations in which you would avoid taking a vaccine (besides severe allergy to vaccine’s ingredients and a high risk of viral infection in the place of vaccination)?

    What’s your personal ranking of the currently available vaccines? I know they’re all much better than nothing and one dose is better than no dose, but I wonder which one you would pick if given a free choice.

    • TheZvi says:

      For Covid? I can’t think of a reason to not take one of the majors. Obviously there are other vaccines with worse cost/benefit profiles.

      I’d probably have Pfizer/Moderna > J&J > Novavax > AZ > Sputnik >> China, with China being unclear if it’s worth taking but you take the others when you get the chance. I don’t think Pfizer vs. Moderna differs enough to worry much.

  9. bbqturtle says:

    Hi Zvi!
    I love your writing and am a huge fan. In the last 3-4 posts, I’ve noticed a not-so-subtle call to action about vaccinated people going back to normal. For them to stop distancing, for us to encourage vaccination as much as possible.
    That almost sounds like a social movement. However, it’s missing the killer, call-to-action, all-the-evidence in one place blog post.
    I started to write the blog post myself, but I have neither the skill at writing or the audience for something of that nature to take off.
    Would you consider writing a manifesto of Pro-Covid-Vaccine-Returning-To-Normal? That way, I can “come out” in favor of vaccines stopping transmission, and ending the pandemic, to my social groups, and share the manifesto.

    Thank you!

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