Covid 4/9: Another Vaccine Passport Objection

I’ve been travelling to New York City once again, and it’s been a busy week, including putting in bids on multiple different apartments. Developments are ongoing, so I’ve been even busier than usual and it’s likely some stuff has slipped through the cracks. 

The overall situation seems unchanged. As people take more risks and the new strains dominate, we’ve settled into about a 10% week over week growth in positive rates, but due to vaccinations death rates continue to decline. That means that one’s risk as an unvaccinated person continues to rise, even as risk on a population level goes down. With everyone eligible now or at least soon, I’d urge once again for everyone who isn’t yet vaccinated to schedule an appointment as soon as possible.

Many places that have less robust vaccination efforts than America are seeing record high case numbers and hospitalization numbers, as the new strains overwhelm efforts that were previously calibrated to let things stabilize. Things are quite bad out there in many countries. Check your local situation, and act accordingly. 

Vaccination rates have stalled out in America, but at 3 million shots a day, which will still get us there pretty soon. Unless something unexpectedly makes our situation worse, we should reach the tipping point on vaccinations within a month or two, at most within three, after which we see a steady and accelerating improvement across the board. 

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: Positivity rate of 5.3% (up 0.4%) and deaths are unchanged.

Result (on Friday):

Deaths falling a lot indicates that last week’s failure to drop was a measurement error, and the numbers from Wikipedia were more accurate. On reflection, I should have realized this and made a better prediction. The positive test rate number matches my intuition. 

I notice I am confused by the continuing decline in test counts. It’s faster than the rate of new vaccinations, and the number of cases isn’t declining. I haven’t seen a good explanation. Seems like an important piece of the puzzle.

Prediction for next week: Positivity rate of 5.9% (up 0.4%) and deaths decline by 8%.

Deaths

Oklahoma reported 1,716 deaths due to finding previously uncounted ones. I’m calling that 100 deaths from this week based on their previous weeks, and assuming the rest were in the past.

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Feb 18-Feb 24365224334782242713294
Feb 25-Mar 3383416695610195813071
Mar 4-Mar 1025951775371415399623
Mar 11-Mar 1714921010321714027121
Mar 18-Mar 241823957289512946969
Mar 25-Mar 311445976256412626247
Apr 1-Apr 71098867178911604914

Cases may have stopped falling several weeks ago, but deaths continue to improve each week across the board, with improvement even in the Midwest. Vaccinations were not prioritized perfectly, but they were prioritized well, and they protect even better against death than infection. It makes sense that deaths continue to decline, and I again affirm that my prediction on this last week was bad.  

Cases

DateWESTMIDWESTSOUTHNORTHEAST
Feb 18-Feb 2480,62564,857150,493110,339
Feb 25-Mar 366,15158,295151,253115,426
Mar 4-Mar 1062,93557,262114,830109,916
Mar 11-Mar 1749,69659,881109,141115,893
Mar 18-Mar 2447,92172,81099,568127,421
Mar 25-Mar 3149,66993,690102,134145,933
Apr 1-Apr 752,891112,84898,390140,739

Vaccinations

Progress on the rate of vaccination seems to have stalled out for now, which is disappointing. Still, three million shots per day is pretty good, and one third of the population has had its first dose. 

Vaccine eligibility map is complete. At this point, most of the light blue states (not California, Washington or Illinois) have open eligibility, as do all the green ones, so within the week only six states will be left, and everyone’s agreed to finish it by May 1 at the latest. Since this was created, New Jersey moved up a few weeks, so it’s only Oregon and Hawaii waiting out the clock.

Vaccine Passport Hype

There was a lot of vibrant discussion of vaccine passports in the comments, both on the blog and on the crosspost at LessWrong. Topics ranged from the technical feasibility of various ways to conserve privacy while ensuring accuracy, to various strong opinions about how we should operate in general once vaccinations are freely available.

As many pointed out, the conflict between security and privacy is difficult in practice. Usually we fail at both, such as a driver’s license to buy alcohol, where it’s not that difficult to fake and also reveals who you are, although without any automatic record. Having a QR code unique to the individual means some “they” could track the QR code, if desired. Having a one-time QR code continuously generated wouldn’t work with people without phones and might generally be tricky. And of course, if they can’t tell who you are claiming to be, there’s nothing stopping you from using someone else’s QR code by borrowing their phone or what not. 

As usual, if we have a system that effectively requires you to either get vaccinated or have a willingness to use an app to fool the system (i.e. lie about your status) that is a subsidy to the dishonest. That can be difficult to avoid.

Overall, I think I’m fine with a system that’s relatively easy to fool at any given time for those making an effort, in order to preserve privacy. There’s still a record of who was and wasn’t vaccinated, so when it matters enough, records can still be kept and cross-checked. It also lets those running venues, from restaurants to stadiums, avoid blameworthiness and get on with the show. Everyone shows their passports, and life can resume. If a few people aren’t vaccinated, they might infect each other, but if they’re making an effort to get in via fraud then I feel fine with that being the consequence.

My guess is such fraud will be rare if it’s even a relatively trivial inconvenience. It’s easier to get the vaccine, even if the fraud isn’t that difficult. I already know of several concrete examples from this past week. For example, I got my first post-vaccination haircut, and the (young) barber said she was going to get vaccinated in order to be allowed to do stuff. I pointed out that it also would be nice not to get Covid-19, and despite the other barber pointing out he still didn’t have his sense of smell back after catching it, she didn’t seem to notice that the vaccine might have a health benefit to her. And yet, she (quite reasonably) was eager to get it the moment she’s eligible.

What I see playing out so far is exactly what one would hope, which is that the expectation of needing to be vaccinated is causing people to get vaccinated, without any need to actually impose meaningful restrictions. If that works, then we won’t have to.

Others disagree, including large states. Texas is banning the use of vaccination passports (WaPo). Florida has taken a similar position. I am curious to see if this results in situations where their venues are often not at full capacity for longer than in other places, despite starting out ahead of the curve, or if the culture that disdains the passports also allows life to return to normal without them and shrugs at the consequences. That shrug will hopefully be reasonable not that long from now.   

I missed at least one good objection. From the comments:

If people depend on a vaccine passport, then anyone who can take that passport away will be tempted to use or leverage that power. Would the government take the passport away from you if there’s a warrant out for your arrest? If you have unpaid parking tickets? If you attend a protest? 

Or, you could raise the more generalized version of this objection. Also from the comments:

Let’s generalize the argument, which is a strong one. The proposal the vaccine passport is really making is to gate freedom of movement with a government document on your phone. This is ‘papers, please’ everywhere, with GPS tracking and check-in logging plausibly attached. It isn’t simply a question of whether the government will abuse the records to track people. It’s a question of what will happen once it realizes that it can change the requirements to get papers, or what information is revealed by those papers. Historically this all ends quite poorly, and one should quote Benjamin Franklin

I should have taken this objection seriously enough to list it and respond to it, and that I didn’t do so worries me. It really should be a 101-style extrapolation, even if there are good reasons not to expect such outcomes here. At a minimum, it definitely does lower the bar for similar future systems that are more likely to be abused – accelerate such trends, as Craken puts it. 

What’s scary is when I try to put a probability on ‘this turns into a broader thing that outlives Covid and people have to show the computer has them in good standing to get on a train’ or something like that. I still think it’s a super low probability thing, maybe 2% (it’s a Fermi answer, but a considered one), but that’s 2% of a really, really bad outcome. It’s not obvious one should take those odds. The argument that convinced me is that in the 2% of worlds where this happens, I think mostly it was going to happen anyway within a reasonably short time frame, one way or another. 

So on reflection I think this a real downside, but that ‘give everyone the information that matters and let people do what they want with it’ is still the right attitude. Your vaccination status simply isn’t a private concern, it matters to those around you. The alternative to a passport is people either literally laminating their vaccine cards (hence CNN running with the headline ‘things to do before you laminate your vaccine card’) and using a super-easy-to-fool system, or banning people from asking about vaccine status, and those alternatives seem far worse. 

This also relates to this other instinct, which I also understand:

 If I felt this was centrally government coercion, I’d have a different view. Instead, I view this as providing for the flow of necessary information to let us all make informed decisions, which in turn enables behavior that would otherwise effectively be shut down entirely by coercion and/or by health risks, and the worry is that future action will transform the passports from vaccination information flow into a more general case of the government coercion thing.  

Risk to the Unvaccinated

I haven’t said this explicitly in a while, so it’s worth saying it again: If you are not vaccinated, the current level of risk out there is much higher than the graphs and charts naively imply. On top of that, the cost of getting Covid now is much higher than it was earlier, both because the new dominant strain is deadlier, and also because the main benefit of getting infected – that you can’t get infected again – no longer matters much since you’ll have vaccine access soon either way and things aren’t so bad out there that prevention is hopeless. You won’t even be able to skip the vaccine, due to people requiring it (plus it’s a good idea anyway, since the cost is trivial).

Not only have we vaccinated over a quarter of the population, and given one dose to over a third of the population, we’ve done so with an emphasis on those most at risk.

That means that if you’re in the remaining two thirds, not only is your risk a third higher than it looks (e.g. almost all the infections will happen to unvaccinated people) but also the risk of death is more than double what it appears, as those at risk have largely been vaccinated early.

Thus, if you have not yet been vaccinated, you need to treat things as much more dangerous, relative to the past, than the numbers indicate. Over time, this effect will get larger. 

This Atlantic article by Katherine Wu points out the phenomenon of people seeing vaccinated people going around doing things, and various gatherings happening, and the resulting temptation to take more risks and feel as if things are safer now. They’re a lot safer than they were in December, but in many places and in America overall they’re much less safe than they were any time before October. Don’t lose sight of that.

Interacting with vaccinated people still has very little risk involved, but using the vaccinated as an excuse to do things involving other unvaccinated people, that you wouldn’t have done in a situation like the one in October, is a trap to be careful about.

Did the FDA Get One Right? 

Two weeks ago, I noted that the FDA hadn’t even approved Emergent to make the J&J vaccinate, and that this was holding up production to the extent that it looked like all the doses actually being using ingredients from abroad instead:

Then the week afterwards, the world learned that Emergent had put ingredients for the AstraZeneca vaccine into a batch of Johnson & Johnson vaccine, running the entire batch of 15 million doses. That’s a true disaster, enough to set back the overall American vaccine effort by over a week. The mind boggles at how many lives we’ll lose and how much economic value was lost, including being later to start exporting overseas. 

I didn’t connect these two events at the time in my head, so I didn’t mention it, and deservedly got this comment challenging that:

It’s hard to argue against the claim that if someone refuses to give someone else approval to do something, and the next week they massively screw up doing it, and also it turns out they’ve had similar (if I presume less dramatic) issues in the past, that the refusal to approve has to look at least somewhat reasonable. One needs to notice this, and update, or if not updating then clarify why that shouldn’t be the case. 

At a minimum, this should have been explicitly noticed.

One incomplete but important question to ask is, in this particular case, what did the FDA’s intervention change? 

Then we can ask the more important question of expected value. What does this type of intervention change in expectation, in general, and at what cost?

Let’s start with the obvious. Did the FDA’s refusal to give approval to Emergent prevent a disaster? Would we have otherwise been looking at giving out 15 million contaminated doses, likely useless and potentially dangerous? 

If so, then this is strong evidence that the FDA being picky about who can get manufacturing approval has high value, whether or not it justifies the costs involved, and that would transfer a non-zero amount to other types of FDA approvals as well. The whole idea is to guard against disasters.

I have not seen any details on how the error was noticed, so we can’t be certain of the counterfactual, but my very very strong prior is that this error gets caught in all worlds. The composition of the batch was wrong. No sane major corporation is going to have a batch of 15 million doses and not test it to see if it is the thing it was meant to be before shipping it out, and having something in there that wasn’t supposed to be there should get found many times over by the tests they’d run in all worlds. Ordinary corporate reputation and liability are more than enough to motivate catching this error. 

My model says that’s not how the FDA is even trying to prevent this mistake when it withholds approval. The FDA’s strategy for withholding approval is to force Johnson & Johnson to use a better manufacturer using better procedures. The failure to get approval, based on the FDA noticing that Emergent does not know what it is doing, is a heavy incentive for J&J to find another partner here. What is interesting is that this didn’t happen. 

That’s the part that’s still baffling me. If Emergent had a bunch of violations already, and was going to have trouble getting approved slash hadn’t already been approved, why did J&J use them rather than someone else? My understanding is that J&J’s vaccine uses relatively well-established manufacturing procedures, so they had plenty of options especially given their lead time and deep pockets, and also there wasn’t much risk that key knowledge would leak out in this fashion. That also implies of course that they should have been using multiple factories to make a lot more vaccine doses faster, although there could be another limiting factor somewhere on the ingredient list.  

The benefit of the whole FDA system comes when corporations look ahead to the approval process, notice they won’t get approved unless they did things right, and then people do their jobs right in the first place, or it comes when the FDA notices something bad that wouldn’t have otherwise been noticed and stopped, and stops it. The second mechanism is important to the extent it happens. 

The question here is why that first mechanism, which is supposed to be how you stop this disaster, failed. And by implication, how often this mechanism silently prevents disasters in other situations, that would otherwise happen. It’s a thankless job to prevent disasters that, if you succeed, no one knows were ever an issue. That’s the dog that didn’t bark. I don’t think that it happens often, because I think there are lots of other robust checks that would work instead, but it’s reasonable to disagree with that.

The blame in this particular case looks like it falls on J&J (and of course on Emergent), to the extent that I’d want to downgrade my view of their prospects and stock on the basis of J&J likely being less good at what they do than we thought. J&J knew full well Emergent was a risky choice here, without the necessary experience, and used them anyway. If anything, it seems more like the FDA ended up effectively forcing J&J’s hand because regulation made it much harder to build a new plant or spin up a new partnership, which would have required a whole new set of approvals across the board. If they didn’t have those obligations, they would have had other options. 

By tying everyone’s hands and delaying things across the board, and generally constraining the range of possible actions and actors, my guess is the FDA made this disaster more likely. They definitely made it more of a problem, because without them we’d be way ahead of the current schedule for vaccine production across the board. Certainly ‘catching this’ does not justify the red tape they’ve thrown over vaccines and also everything else.

The FDA did, to its credit, provide strong evidence that its decision to withhold approvals was based on a legitimate real world consideration, and that in general, however slow and cumbersome what it does might be, it at least does provide some amount of quality checks and safety standards. That’s much better than not doing that. They’re a sane regulator, responding to their incentives, which put very little weight on production they prevent or innovation they stifle, the time and money and lives lost through inaction, and almost all focus on avoiding disasters due to action, or avoiding being blameworthy for any disasters due to action that aren’t prevented. Within that framework, one could plausibly argue they did their jobs quite well here. 

The goal is to change the incentives and the job.

One can also ask how exactly we got into this mess, since Emergent is so obviously a terrible choice on so many levels, and the answer is that they’re a government contractor hired explicitly to handle exactly this problem, except they chose a company with a long history of problems and which the FDA refused (with reasonable justifications) to certify:

It was a great idea to pay to have capacity always at the ready. The problem was that this was a contract awarded on the basis of politics and power, rather than by the market, and thus people whose focus was on winning contracts via political power games, and which not coincidentally didn’t have that much to do all day because no one else was that eager to hire them, beat out the places that would have been capable of actually doing the job. 

This makes J&J’s fate somewhat more understandable. They chose a terrible partner, but it wasn’t entirely their choice. Once again, the free market fails due to lack of a free market, requiring intervention from regulators.

In Other News

England offers free twice-a-week at-home tests to actual everyone. It’s about time. A day late to be sure, but all the pounds are there. 

Meanwhile, we’re a little behind that, but at least we’ve… legalized Abbott to do home testing? (Source)

Kai compares what happened now to the response to AIDS.

Starting to see frequent posts on Twitter about available vaccine appointments. For example, here was Sam Black, although that one’s in the past. Here’s another from LA, presumably also expired by now. The bottom line is, keep an eye out for such opportunities if you or anyone you know has had trouble finding an appointment, or would like an earlier one. 

Our government allocates life-saving medicine explicitly on the basis of the racial identity of your household. Then it restricts what people’s movement and what they can do if they haven’t yet had access to that medicine.

Chronicle of a parent who finally lost it when their child’s school closed for ten days due to two Covid cases… for a fifth time. New York City is finally changing that rule. It was even more absurd than it sounds:

From the perspective of actual people leading physical lives, this is indeed nuts. From a blameworthiness perspective, and a ‘state of grace/purity’ versus ‘state of sin/contamination’ perspective, though, and a very explicit ‘if I can say it’s keeping kids safe I don’t have to care whether it makes any sense or drives people crazy and disrupts their lives’ perspective (that was the first reply to the Tweet announcing the story), it makes perfect sense. 

Efforts to promote First Doses First continue, remain obviously correct, remain doomed to failure. I don’t see any way to turn this one around at this point. We are requiring full vaccination to engage in everyday life, so people aren’t going to accept going around half-vaccinated even if it’s 90% as good, so long as they’re told to treat it as 0% as good.

Gentle reminder that if you book your appointment for a given day, you’d better be ready to get the second dose exactly the right number of weeks later to the minute, or you’ll need to actively reschedule at a minimum:

Your periodic reminder department:

I think Eliezer is flat out correct here that it’s dirt cheap to build out what we might call ‘generic mRNA vaccine capacity’ and that even if the pandemic was over we should be doing enough of that to vaccinate everyone, except I’d say the USA should be planning to make enough for the whole world, not only Americans, because the payoffs here are so ridiculous. Instead, we aren’t even doing this for the current pandemic. The footnote on never even investigating far-UV light properly is also a good periodic reminder.

Our lockdown rules being applied differently depending on which groups and activities are favored by politics and power is the default, not an exception

We repeat, suicides were actually down last year, rather than up. Your model needs to account for this. 

We see extra deaths from heart disease, Alzheimer’s disease, diabetes and stroke, and in general about 140k extra deaths on net that aren’t listed as being directly from Covid-19. Some of those are likely Covid-19 deaths that got misidentified. Some others are likely due to people not getting any exercise or change of scenery. What we don’t see are suicides. 

CDC finally starts getting explicit on surfaces not being much of an issue. Still a lot of ‘it depends’ and ‘we don’t know anything about anything’ but the bolded part is bolded:

Tyler Cowen and Russ Roberts podcast revisiting the state of the pandemic. Self-recommending and as good as you’d expect if you like this kind of podcast conversation. Cafe Hayek responds, arguing that Covid response has been far more damaging to social cohesion than it would have been to let things play out. Tyler in turn responds that this wasn’t an option, because once things got worse the lockdowns would have happened regardless, from a worse place, and been more severe. I’m with Tyler here, the alternative to lockdowns that works is to do more earlier, the public choice of letting Covid mostly play out was never going to do anything but backfire. There are still some clear examples in the response post of utterly crazy policies in the name of prevention, of course, as I often point out.

Health care provision across state lines, to-go cocktails and other purely good deregulations that might stick around (WSJ via MR).

Post on the option to use IP suspensions to solve the vaccine shortage, and alternative ways to get production to go up. That seems like a disastrous road to go down, and if formal IP was the issue we could simply buy the companies out, which the post points out is the correct play here, plus the post also points out that mere suspensions wouldn’t actually work, because (among several other reasons) the IP that matters is not in the patents. So Moderna won’t enforce its patents but that doesn’t mean anyone knows how to make its vaccine, and those secrets are valuable to Moderna for future products so they won’t share. Of course, we could buy them out of that too if we were sane, it’s worth it, but there’s no willingness to do so. Also of course, the simple play is to offer to pay a lot more money to get vaccine doses, and let them work out the rest, but that’s crazy talk.

Zaynep thread about claims that places have reached herd immunity

Finally, this seems very right, and it’s important once you’re fully vaccinated to remember to live your life once again:

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53 Responses to Covid 4/9: Another Vaccine Passport Objection

  1. Humphrey_Appleby says:

    I think your 2% Fermi estimate is a bit on the low side. Regarding `In that 2% of worlds, something like this would have happened soon anyway’ (so we shouldn’t worry) – isn’t that like saying `getting into the Cuban missile crises will be no big deal, in a world where this leads to nuclear armageddon, something else would have led us there soon anyway, so lets go ahead and put missiles in Cuba’ (or equivalent)? If you keep putting yourselves in dangerous situations, sooner or later things will go wrong. Sooner if you are fatalist about it and keep doing it.

    In any case, why do we need to run this risk? As you have yourself said, vaccinated people don’t die of COVID. Once we are at the point that anyone who wants to be vaccinated can be vaccinated, then who exactly are we protecting? Note also that we will be in this world in a couple of months, and getting a nationwide vaccine passport system up and running will likely take at least that long. So this is a dangerous solution to a problem which will not longer exist, by the time the solution is ready to deploy.

    Sorry Zvi, I’ve read your blog for a year now and thought it one of the most insightful on the internet regarding COVID, but I think you’ve got this issue dead wrong.

    • Humphrey_Appleby says:

      (NB I’d say an improved `vaccine card’ (akin to a drivers license) would be acceptable, but anything along the lines of an electronic `passport’ is a huge no-no in my book. (I’ve been fully vaccinated for a month).

      • TheZvi says:

        Is your true objection then that it is electronic in nature, which is easy to modify or track? But you’d be fine with a card because it’s a fixed thing? Would you be OK with a card that had a QR code or bar code on it in case someone wanted to scan it?

        (Worth remembering that passports and ID cards/driver’s licenses do have bar codes, it’s just rare to scan them).

    • TheZvi says:

      I do think it’s valid to say ‘we care about preventing the Cuban Missile Crisis in the worlds where the cold war doesn’t inevitably end in nuclear war a lot more than in other cases.’ That seems very right! There are possible worlds (from a 1962 perspective) where the probability of nuclear war is close to 100%, thankfully we weren’t in one of those worlds, but changing our/their behavior in the CMC alone would be a dumb response. Instead we’d need to ask why the war was coming anyway, and address that. And sure, living a few more years first is still good, but also the rubble would bounce additional times if you wait, so who knows.

      Of course, yes, thinking the war is inevitable can be a self-fulfilling prophecy often, and this is true for many wars, and also your utility is mainly in the non-war worlds so you mostly want to optimize for those words and less for the war worlds except to maintain incentives since incentives in the war world can prevent the war.

      This is in some ways the opposite case – if it was widely understood how government programs like this often lead to overreaches later, there would be less of them rather than more of them, because it would create opposition. There’s a strand of ‘your privacy/rights are dead get over it’ in places, but this doesn’t seem like one of them.

      Certainly possible I got the Fermi wrong here, and it’s material – if I thought it was 20% instead of 2%, I’d think passports were a mistake, but I think there’s very strong forces pushing against such an evolution here. I’d also change my mind if I felt that the system wouldn’t be ready in time to matter, but e.g. NY’s system already exists and functions and is being used in practice.

      As to the core question, I thought I answered it, but I’ll be explicit: Because (1) this will lead to higher willingness to get vaccinated, as I’ve observed myself directly in real people, thus ensuring that this *does* only last a few months, and (2) because you’re not going to get your first-best solution of people just doing what they want and taking the consequences, if that’s the situation then a lot of stuff will remain limited or shut down for a long time, and (3) because the real alternative is using the literal vaccine cards instead or (4) barring people from asking about vaccine status, and those options don’t seem better.

      • Humphrey_Appleby says:

        Regarding (2) – why? Why can’t we treat people as adults here, with the free choice to either get the vaccine or risk infection? If the issue is legal liability then you can use the literal vaccine cards as passports (3) and not worry about the ease of faking.

        Also, can you provide any evidence of prior similar government programs that were disbanded once the emergency was past? Bin Laden has been dead for a decade and we still have to take our shoes of to get through airport security. According to google, 33 different states of emergency are currently active in the US. Our default assumption should be that if the `COVID vaccine passport’ system (with GPS tracking) is rolled out nationwide, then it will remain in place indefinitely, and will gradually be expanded in both scope and use.

      • TheZvi says:

        Yeah, basically the alternative is using vaccine cards that are literally pieces of paper someone scribbled words on, and making the condition ‘vaccinated or willing to scribble’

      • amac78 says:

        Re: Humphrey_Appleby’s concerns about Vaccine Passport Mission Creep, this prior seems relevant.
        License Restrictions for Failure to Pay Child Support: “All 50 states have statutory or administrative provisions authorizing the suspension or revocation of various licenses for failure to pay child support. The licenses affected generally are driver’s, occupational, professional (e.g., law), business and recreational (e.g., hunting and fishing).”

    • Humphrey_Appleby says:

      I’d be OK with a physical card with barcode, yes. I’d prefer a physical card without barcode.

      • Humphrey_Appleby says:

        Making the condition `vaccinated or willing to scribble’ is much less bad than introducing a program whereby the government can track all citizens at all times and deny them access to various services, which will almost certainly never be disbanded even long after the emergency is past, and which will almost certainly be continuously expanded in scope over time. e.g. it will start with you need to show your electronic passport for indoor dining, and finish with you need it to leave your house. I don’t understand what forces you think will push back against this inevitable mission creep.

  2. CWG says:

    New numbers out of Oregon: 168 Covid cases among the ~700,000 vaccinated, 19 hospitalized, 3 dead. That seems about what was to be expected, but I’m curious whether those numbers prompt Zvi or anyone else to update their view of vaccine efficacy.

    (source: https://www.oregonlive.com/coronavirus/2021/04/168-oregonians-got-covid-19-despite-full-vaccination-state-says.html)

    • TheZvi says:

      That seems like it narrows our range but is about expected? E.g. much better ratio of hospitalizations to deaths, but non-zero number of deaths.

  3. Brendan Long says:

    > I notice I am confused by the continuing decline in test counts. It’s faster than the rate of new vaccinations, and the number of cases isn’t declining.

    Isn’t this what we’d expect if the group of people who get tests are also the most interested in vaccines? In an extremely-simplified model where 10% of the population cares about COVID and 90% ignores it entirely, the first 10% of vaccinations would reduce the testing rate by 100%. Presumably in the real world the groups aren’t quite that extreme, and the effect is also less extreme.

    • John says:

      I think this is part of the story, as well as changes in government regulation. Personally I never had symptoms and got vaccinated in January, after which I started traveling more. Living in New York City, I had to get a ton of tests whenever I travelled because they were often required by the places I was going to — and to avoid the full post-travel quarantine in New York, I had to get tested once before returning and again on the fourth day back. My employer also required that we follow NY rules before returning to the office (which I prefer, even though most people are working from home). I probably had 10-15 tests while vaccinated to comply with the New York rules (or rules in the places I visited). Now there’s no quarantine requirement in New York for domestic travel, at so I’m no longer testing except for international travel, which is more limited.

      My guess is that the testing pool is made up of a small percentage of people who actually have symptoms (e.g., maybe 10% are getting tested because they are sick, and half of those will turn out to have COVID), and 90% don’t have symptoms and are doing it to travel, shorten post-travel quarantine, comply with employer/school requirements, or just to be extra careful. As the rules loosen up and the conscientious people get vaccinated and worry less, a lot of testing by people who don’t have symptoms isn’t happening anymore.

    • Jeff Russell says:

      Another possible driver, here: getting your vaccine requires not having tested positive for COVID for some amount of time before getting vaccinated (I don’t remember, maybe two weeks?). This might provide an incentive to avoid tests (not a very rational one, but still).

      Somewhat related: I work at a university that provides weekly tests to all students, faculty, and staff, but you are explicitly not supposed to get that test if you have any kind of cold symptoms. There’s another procedure with more friction to get a test if you’re afraid you have COVID. What that meant for me when I had what seemed like very mild cold symptoms a couple weeks ago was that I just stayed away from campus and skipped the test that week.

      Put these together, and you might have a situation that is some combination of “folks most motivated to test are more vaccinated, people might avoid testing due to inconveniences and feeling like ‘I already have lots of practice at infection-minimizing behavior’, and some people avoiding tests ‘just in case’ they might come up positive and deny access to what is currently rare, desirable, and a pain in the ass to schedule.”

      I’d appreciate a sanity check on any of these, as I can’t think of a good way to estimate the number of folks these factors might explain.

    • ADifferentAnonymous says:

      Another possible secondary effect: people getting vaccinated may also lead their unvaccinated contacts to test less. e.g. I used to get tested before visiting older relatives, but stopped when said relatives got vaccinated.

  4. TK says:

    This isn’t a direct comment on the post, but I’m curious whether people here are choosing to get their second mrna shot in the same arm or in the other arm. I vaguely remember seeing something about benefits to the second shot entering the lymph system rom a different point, but I can’t find it anymore.

  5. Harry says:

    While most states have been level or decreasing, Michigan cases have shot up in the past month and are already at peak December levels. And that’s with 30% vaccination and decreased testing, so the actual risk is far higher than December. It seems clear that Michigan has lost the variants vs. vaccines race, and I’m worried that we might see the same in other states soon.

  6. Getting pretty frustrated says:

    Oh no, Eliezer recommended UV light to kill viruses. The 2021 protocol for responding to that is shriekingly accusing him of wanting everyone to try injecting themselves with bleach.

  7. jonas says:

    Minor correction to the eligibility map: Oregon moved its universal 16+ eligibility date to April 19. This announcement was made on April 6.

    https://covidblog.oregon.gov/all-oregonians-over-16-eligible-to-receive-covid-19-vaccine-starting-april-19/

  8. “if you have not yet been vaccinated, you need to treat things as much more dangerous, relative to the past, than the numbers indicate. Over time, this effect will get larger.”

    This is a really insightful and great point that I hadn’t been thinking about. What, in your opinion, is the point in vaccination at which it is reasonable for a healthy person to do moderate-risk activities like spending time indoors and maskless with unvaccinated relatives, or grocery shopping with a mask in a large grocery store where about 90% of people are correctly wearing masks? Or high-risk activities, like dining indoors or traveling on an airplane?

    I ask because I am a young and healthy person 8 days out from my first shot of Moderna, and I am interested in doing some moderate-risk stuff in a week, but I don’t feel like I have a great handle on how much the increased risk of the new strains and decreased risk from being semi-vaccinated cancel out, from both a personal-risk and a society-risk perspective. The Very Serious People, of course, would have you believe that you can’t leave your house until 14 days after your second dose. But from looking at graphs with my untrained eye (and reading your blog!) it appears that you’re almost fully protected a week and a half after your first shot, so moderate-risk activities make sense at that point, but high-risk activities are still probably a bad idea. Is there something I’m missing here?

    • TheZvi says:

      Five days after shot 2 you’re close enough (based on my understanding) to finished you can start acting as if you’re done. Before that, yeah at 10-14 days after shot 1 you’ve got something like 80% vs. infection and 90%+ vs. death and you have to decide how much you adjust to that.

      My experience was that there wasn’t as much in the middle category as there might seem, when you’re around others you’re trying not to expose – yes you picked up almost an order of magnitude, but your decisions were kind of overdetermined in most cases. I ended up doing very little moderate-risk stuff in that window, in practice, cause the question is always whether it’s Worth It. And a lot of me was like ‘yeah I can do this but I’ll be able to relax and enjoy it much better if I just wait a bit longer’.

  9. kronopath says:

    I was kind of hoping you’d comment on the more recent developments around the AstraZeneca blood clot situation. It seems there are now some scientists that believe it was a real (though rare) side effect?

    Of course, I think banning/delaying the vaccine caused more harm that good overall, given the relative risks involved, and that doing this was more out of blame avoidance than public good. But it looks like it may be an actual thing?

  10. dreeves says:

    Tiny correction: I got notified by getvaccinated.oregon.gov a few days ago that starting April 19, everyone age 16+ will be eligible in Oregon.

  11. Dave Baker says:

    Yudkowsky’s point is certainly apt. In addition to building vaccine production capacity as he suggests, we should also be building capacity for production of N95 (and P100) respirators.  On my read of the evidence, these are many times more effective than cloth or surgical masks, if the latter are really effective at all. And they can be stockpiled for several years before reaching their expiration dates! Any future mask mandates should mandate masks that are known to work.

    • Tobias says:

      My read of the evidence is different. N95s are more effective when properly used. Using them properly is difficult and requires training and fit testing. Before the pandemic, the general consensus was that they should only be used for specialized tasks, and that proper use was difficult to maintain when wearing them all day every day. When used in the real world by untrained people, N95s aren’t significantly more effective then surgical masks. If you have any studies contradicting this view I’d be interested in reading them.

      • Dave Baker says:

        I don’t necessarily disagree with it, although I’m a bit skeptical of that research because its conclusion (like the pre-March-2020 “masks don’t work except if doctors wear them” party line) is convenient to the establishment in a suspicious way.

        But if it is correct, the fact remains that 3M respirators with P100 filters are easy to wear correctly, and that N95s could no doubt be redesigned to fit more easily (by adding a plastic lining shaped like the plastic facepiece of the 3M respirator). So if the research showing that N95s are hard to fit is correct, they should be redesigned so they’re easier to fit before the next pandemic.

      • TheZvi says:

        To me this is information that we need to train people in the use of such masks, rather than a reason not to produce them or not be able to produce them. At a minimum, we should have the capacity to do such training (e.g. be funding better ways to teach it and test fits, etc).

        I personally found that the KN95s I’ve used a lot are much more comfortable for long term use than surgical masks.

  12. Rory Rohde says:

    I understand there are so many things that are unknown, but is would be nice if there would be some guidance for those of us ‘Covid Survivors’. I had Covid last April (not life-threatening). I tested positive for Antibodies in May, in December, and again a week ago today (my ‘score’ was 250> whatever that means).
    I’m totally ignorant here. Should I get a vaccine or wait until my antibodies go down? Can my antibodies disappear overnight or am I safe for a while? Shouldn’t somebody be studying people like me to learn more about antibodies, etc.?
    My instinct is to wait to get vaccinated as long as possible.

    • TheZvi says:

      1. Get one vaccine shot as soon as you can, J&J if available easily since you only need one shot.
      2. Get the second vaccine shot anyway if you took Moderna/Pfizer because we have enough supply soon and it will put everyone’s mind at ease, but you don’t actually need it. Totally fine to postpone this until there are open appointments all the time.
      3. Until you get vaccinated, you should treat yourself more or less as you would if you’d had one shot but not two shots (e.g. you might get infected but severe effects are highly unlikely). This is a conservative action, which seems fine in context.

  13. Brian Lui says:

    “If you are not vaccinated, the current level of risk out there is much higher than the graphs and charts naively imply.”

    What’s your advice for under-16s?

    • TheZvi says:

      Live your life but use masks and don’t do ‘stupid stuff,’ and get vaccinated when it’s legal to do so. There are still some long tail risks that are hard to measure, so worth spending at least some effort to avoid it. Things are still much better than they were in December.

  14. cakridge2 says:

    I disagree with universal installation of UV lights to kill viruses. Just seems like that would result in UV-resistance being selected for. Better to do it in places with lots of risk (nursing homes, hospitals, etc.)

    • Humphrey_Appleby says:

      I’m not a biologist but I would doubt `UV resistance’ is a thing. I expect it is much easier for virii to evolve to develop resistance to biological or chemical lines of attack, than to physical lines of attack. (viz. UV light literally breaking up the virus). Corrections from virologists welcome.

    • If UV resistance were possible, it would require building a pretty thick wall of highly effective sunblocking chemicals. I’m not sure how plausible that is.

    • TheZvi says:

      That seems like a discussion we’d have in a sane civilization that could at least do it in nursing homes and hospitals, and which would depend upon physical questions. Other responses suggest it’s not a real worry but I haven’t thought about it (and worst case isn’t worse than doing nothing).

  15. Andrew Hunter says:

    Via some covid-skeptics, an interesting fact from a non-skeptic:

    This is fascinating. In my personal life I’ve noticed that the paranoiacs I know are still paranoid post-vaccine (which seems insane to me. It’s quite frustrating to deal with them.) But the flip side of it is just…dumb. It seems like this is pure mood affiliation? People who think Covid Is a Big Deal get vaxxed and don’t get rid of that tribal belief, and vice versa….

    How do we covince both cohorts to come towards each other? I’m really worried about the sort of person currently claiming “post vaccinated I’m still going to isolate at home for a year…” The people refusing to get vaxxed I’m of two minds about: play stupid games and win stupid prizes, but can they keep life bad enough that we’ll all suffer?

    WDYT?

    • TheZvi says:

      I noticed that but forgot to include it / ran out of time. I’m definitely in the ‘paranoid pre-vaccine, happy-go-lucky post-vaccine’ camp. Note that half of people who are vaccinated are not yet “fully” vaccinated, and are in the ‘if I can stay safe a few more weeks I’m safe forever’ window, that might be part of what happened here? But it and ‘not sure’ graph look very similar, which is evidence that they didn’t mess this up?

      This does suggest that the people not getting vaccinated will be doing real harm until the virus goes away, because they’re causing real worry in half the vaccinated, which in turn will harm their lives a lot. You can say ‘that’s everyone being stupid’ but a general policy of letting stupid people suffer for being dumb is just anti-human and also there’s a lot of secondary harms on others too.

      My guess is that the people who are worried post-vax are worried because they think that it’s the socially correct thing to do slash are following nonsense scripts for worry, and at some point their brains will pick some meaningless reason to stop worrying. Mostly. And that society will at some point flip the switch and start telling people to go out and party rather than stay home and not party, to make that happen, but it can’t both do that and give the vaccine pressure unless it’s making vaccines mandatory and we’re unwilling to do that.

  16. That means that if you’re in the remaining two thirds, not only is your risk a third higher than it looks (e.g. almost all the infections will happen to unvaccinated people) but also the risk of death is more than double what it appears, as those at risk have largely been vaccinated early.

    …I don’t understand this at all. I’m not vaccinated. I’m maybe a little less cardiovascularly fit than I was six months ago, and I’m being a little less cautious in some situations than I was previously, just out of weariness. But… what does it mean that my risk of infection is a third higher? Surely my risk is just about the same, given the same local case rate.

    And my risk of death should be about the same too. I can’t find data on this at the moment, but I believe the percent of cases that end in death is declining, for a variety of reasons.

    • For simplicity, assume the case rate is constant now and was also constant at the same level at some point early in the pandemic. Back then, nobody was vaccinated and only a few were immune, so you had something like “R”=1.05 transmission, with acquired immunity blocking 5%, for a net R of 1. 5% of the population had 0 risk, 95% had 1.05-level risk (ignoring heterogeneities, etc). Now, with something around half of the population immune (via vaccine and infection), R is still 1, but the risk profile is different. Half of the population can’t be infected, so the virus is actually trying to spread like an R=2 level of risk. There are far more “attempted infections” now than there were at the same case level early in the pandemic, due to riskier behavior and a more transmissible virus, but the spread is the same because half of them fail due to immunity. Since you’re not immune, you don’t get the “half of them fail” protection, so you’re just at double risk relative to before. (I think Zvi made a miscalculation, 1/3 immune =50% higher risk among the remaining for a given level, not 33%)

      • Hmm, I see what you mean about constant R and higher immunity indicating more “attempts”. That does assume homogeneous contact scenarios, though — what if some segment of the population is behaving with way more risk than they were before, rather than the whole population doing so?

        But I have noticed my own behavior changing, so I can’t put it all on that. :-/

  17. Pingback: Covid 4/9: Another Vaccine Passport Objection – Actuarial News

  18. sid says:

    I realize these posts are mostly US-centric, but I’d like to see some info on big non-US events as well.

    e.g.: Brazil is currently recording record deaths in 24h periods *every day*, and they’re going into their winter, which will only make things worse. It’s also speculated that these deaths are undercounted. There’s already one important Brazilian variant, named P1; with cases continuing to increase and their government not promoting any sort of general lockdown, I think it’s quite possible that we see more variants emerge from there, even potentially vaccine/previous-infection-antibody-avoiding variants.

  19. sandorzoo says:

    Note that the Bloomberg numbers divide the number of vaccinated people by the *total* US population, including kids, even though kids aren’t eligible to be vaccinated and are at very low risk generally. ~45% of the eligible US population (16+) have gotten at least one shot as of now (April 11th).

  20. fred says:

    “such as a driver’s license to buy alcohol, where it’s not that difficult to fake and also reveals who you are, although without any automatic record”

    Many of the places that scan your driver’s license retain that data in order to exclude undesirables (nightclubs), or for targeted advertising. Smaller venues and businesses often use a third-party company such as PatronScan to manage the surveillance, increasing the intrusiveness of the surveillance by creating centralized databases.

  21. The most pressing covid question says:

    Here’s a thought experiment. Would you take a bet structured as follows:

    1/10000 chance of death
    3/100 chance of hospitalization
    50/100 chance nothing happens
    in all other cases, you get a free 2 week stay-at-home vacation

    I realize not everyone’s work situation allows the payoff and some people aren’t in the 20-49 age bracket, but for those this payoff matrix applies to, would you not slam this button?

    • Humphrey_Appleby says:

      Absolutely not. I would view 2 weeks forced stay at home vacation to be significantly worse than my ordinary life. So you have put up four options, three of which are strictly worse than status quo, and the fourth neutral. Why would I possibly take that bet?

  22. Dave Baker says:

    More blood clots huh?
    https://apnews.com/article/us-pause-j-and-j-vaccine-blood-clot-reports-2dde2aacf486bab59844ef907a28cbce
    Literally one in a million (six people with clots out of 6.8 million doses administered).

    • Humphrey_Appleby says:

      Moreover…VAERS reports over 3k fatalities from 180 million mRNA doses. That’s a fatality rate an order of magnitude more than the `one in a million’ from J&J. (Of course, many of those 3k fatalities may be unrelated to the vaccine). But this really seems like statistical illiteracy on steroids, plus unwillingness to accept any risk whatsoever.

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