Covid 4/22: Crisis in India

The United States appears to have turned the corner. Despite our determination to sabotage vaccination efforts, they have taken only minor damage, and we are starting to see declines again in the number of cases. Unless a new strain more dangerous than the English one reverses things once again, we should soon start to see steady declines in cases.

Other places without our access to vaccines are not as lucky, and in particular India is in crisis. Things there are worse than they’ve ever been and rapidly getting worse, with the hospitals on the verge of collapse. This is likely to be the biggest human cost of the entire pandemic, plausibly by a very large margin given how many people live in India, and it is entirely the our responsibility for not accelerating vaccine production in time to help them. Even when we have vaccine we are unwilling to use, we refuse to use it to help where it is needed.

Actions have consequences. In particular, a lot of death.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: Positivity rate of 5.8% (up 0.2%) and deaths unchanged.

Result:

The number of tests continues to crater, and also the numbers continue to not make much sense as reported here, since if tests fall 26.5% and cases fall 11.9%, that should imply the positive test percentage is higher rather than lower. I still don’t get how that one keeps happening.

Johns Hopkins has the rate declining from 5.2% to 4.7%, so I suppose that decline is real, and the 26.5% number isn’t real and I should chalk this kind of thing up to systematic reporting delays.

Can you tell that I really, really miss the Covid Tracking Project?

The trick as always is whether this is a data error that self-corrects, or the start of a trend which in this case would be the beginning of the final phase barring a new strain worse than the English one. I’m going to cautiously say it’s more likely to be mostly real, but likely got a little ahead of itself because graphs should be smooth.

Deaths should continue to slowly decline as vaccinations work, but it’s a slow process.

Prediction: Positivity rate of 5.1% (down 0.2%) and deaths decline by 4%.

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Mar 4-Mar 1025951775371415399623
Mar 11-Mar 1714921010321714027121
Mar 18-Mar 241823957289512946969
Mar 25-Mar 311445976256412626247
Apr 1-Apr 71098867178911604914
Apr 8-Apr 1410701037162111454873
Apr 15-Apr 21883987174711684785

Things will bounce around due to random fluctuations and data timeshifting, but the default should continue to be a slow decline in deaths until cases have had several weeks of declines, at which point the drop should accelerate. 

Cases

DateWESTMIDWESTSOUTHNORTHEAST
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
Apr 8-Apr 1460,693124,161110,995137,213
Apr 15-Apr 2154,778107,700110,160119,542

Clearly the corner has been turned. We will see if it can be sustained. 

Vaccinations

You know what’s not good for vaccination rates? Suspending the use of vaccines. I hear that’s bad for vaccination rates.

That number was greatly boosted by a +15% acceleration in California. Most states had double digit declines. 

Without Johnson & Johnson, and with the increased vaccine hesitancy, things are going to be harder from here on in, and I have little hope that J&J vaccinations will be allowed to resume, nor do I expect us to agree to export the doses to a place that would actually use them any more than we’re letting go of our AZ doses. It’s at least kind of murder, and all kinds of foolish and destructive. 

There are those who say that the slowdown has multiple causes, and that we’re starting to run into the wall where there aren’t enough people who want vaccinations, making supply not the limiting factor in many places and making the second half of the job harder and presumably much slower as well. I do acknowledge this is a real dynamic, but also we intentionally hurt demand via the suspension of J&J, both in terms of increasing hesitancy, and in terms of taking away a one-shot-only vaccine that was logistically far easier to deal with, thus making harder to reach people that much harder to reach and making those who dread shots or ‘this new mRNA technology’ that much more hesitant. 

Thus, while I do think it’s unfair to attribute the entire deviation from the previous upward trend as being due to the suspension of J&J, I do think that’s most of it. At a minimum, I would be very surprised if we would have otherwise seen a decline in the rate of progress rather than a plateau. 

For next week, my expectation is that it will drop below 3 million doses per day, let’s say a median prediction of 2.9 doses per day, assuming that J&J remains suspended, as it appears that it will be. I do still expect all the second doses to happen on schedule, which should prevent the number from dropping too dramatically, as the number of scheduled second doses should still be rising. 

Note of course that this still represents a steady stream of additional vaccinations, and that our situation will continue to improve. Even if we decline to 2 million doses a day, and all of them are from 2-dose vaccines, that’s still 1 million extra immune people per day, or an extra 2% protected every week. With 40%+ of the population and 50%+ of the adult population already having at least one dose, that should lower the weekly spread of Covid by a compounding 5% or so a week. The results of that should still be good enough.

Others, however, are not so lucky. In particular, the situation in India looks very, very bad.

India

It doesn’t look good.

It looks very, very bad (Financial Times).

They’re still barely below the United States in confirmed cases per capita, but the graph looks like this:

With no signs of stopping, and no reason to doubt that this is a massive undercount.

Official deaths are lower than in the United States as well, but likely much, much higher than reported, and going vertical:

Here’s the comparison (from FT) to cremations of Covid victims, it’s really bad out there:

As always, share of positive tests is a key metric, and it has the same straight line. Yikes.

The hospital system is on (at least) the verge of collapse.What happened? And what is going to happen now?

As there usually is, there’s a variant involved, this time it’s B.1.617. 

The thing is that being vaccine evasive wouldn’t explain what’s happening, because India doesn’t have that many people who are vaccinated. Even if it had full escape from all immunity, that wouldn’t explain what’s happened here. India’s old positive test percentages were never that high, so it’s that much more unlikely there were massive previous waves we didn’t notice. To the extent that this strain is the cause, it’s pure additional infectiousness doing most of the work. That doesn’t preclude escape, but it means we don’t have much reason to expect escape either.

I haven’t been tracking India, but I don’t have any reason to think there was a large behavioral change since February that could take us from static to doubling every week. What could this be other than the variant? So I went looking for what we know.

Here’s a Forbes explainer, which also notes that the variant has arrived in California. It seems there are a lot of different mutations in B.1.617 that are contributing to it being a bigger problem, part of which is making immune response more difficult. Forbes also reports that Israel found eight cases, and that the Pfizer vaccine still works but has ‘reduced efficacy’ against it. 

This from the Indian Express covers the basics but doesn’t have insight into the questions we need answered. This from The Guardian is similar, with those quoted thinking this likely isn’t as dangerous a variant as the Brazillian or South African ones.

Zaynep comes through and hooks us up with the good news that the vaccines still look effective against B.1.617:

That thread also points out the obvious. Yes, we need to worry about and think about the possibility that the variant will cause trouble on our shores and for ourselves personally, but the main thing for the world is that there’s a huge disaster happening right now, in India, and no one seems to care to do much about it. Certainly our vaccine policy has given little or no thought to getting doses for the third world, despite it protecting us against variants and buying massive goodwill while being super cheap. To the extent that anyone ever says anything, it’s ‘let’s get rid of the IP incentives that created the vaccines’ rather than ‘let’s pay more money and make more vaccine doses.’ 

This from Science Media Center is the standard thing where ‘experts’ refuse to speculate until they have all their data lined up, and act like the variant both taking over and taking over while cases explode all of a sudden aren’t together much evidence, and there’s no reason yet to call this a ‘variant of concern.’ I’d say I’m concerned.

I know that jumping to conclusions can backfire. But if something is probably concerning, that’s concerning. One shouldn’t remain unconcerned until there’s proof, that’s not how this works, that’s not how any of this works. 

I’m putting it at about 85% that the surge in India’s primary cause is that the B.1.617 variant is far more infectious than their previous variant. I’d go higher, but the possibility that lots of cases have been missed for a long time, together with my lack of detail knowledge in India, makes me not want to make too strong an assumption yet. I could easily get higher quickly. 

What happens now, unfortunately, is presumably the collapse of India’s hospital system. I don’t see a likely way around that, since they’d have to stall things in their tracks right here without another doubling. The only way this doesn’t happen is if individuals react dramatically, and cut their exposures by almost half within the next few days, or perhaps it would even need to have already happened several days ago. Either way, seems unlikely, as I don’t think India or its people have that kind of slack.

This was always on the table as an outcome, from the very beginning. There’s a maximum amount of baseline infectiousness, beyond which adjustment to stop it is not practical, and the control system breaks down. It’s that much easier to hit the breaking point in a country that’s much poorer, and thus has much less effective hospital capacity. We’ll find out soon if India has reached that point. 

The flip side is that there have been places with much higher positive test rates for quite a while. Mexico spent a long time around 50%, and many places in the United States may have been in worse spots than India is now, and turned things around or at least stabilized them via behavioral adjustments. 

Vaccines Still Work

Some perspective, I didn’t do the math myself but seems reasonable even if the other person is unvaccianted, cars are rather unsafe:

Before you say we can’t pause cars, we paused seeing other humans for a year, so we can do a lot of things.

Some lack of perspective, if you’d prefer that instead. If you have a vaccine that is only 95% effective, and there are 71 people who catch the virus post-vaccination none of whom die, you could always do something like this, including having officials ‘urge caution’:

Pausing Vaccines For No Reason Still Doesn’t Work

Damage to public confidence was done quickly, and will be hard to reverse.

From April 15:

Also:

As noted last week, a brief pause was something that could be steelmanned. If you had a very different model of how the public reacts to news, and assumed the news would always get out, then you could argue for a brief pause.

You can’t argue for our current policy of keeping the blanket pause in place for weeks. We could mitigate most of the damage by restricting the ban to young women, putting a fig leaf over the whole thing and moving doses around between populations, but we aren’t even doing that.

Matt Yglesias points out how much whiplash is involved here, as every consideration is either mandatory and total, or forbidden to even speak its name:

Here’s Wired:

Again, what is this new data we’re looking for? What about the current data is insufficient to reach the necessary conclusions? 

This seems like a good intuition pump:

When you’ve lost Eric Topol on your abundance of caution (WaPo), and he’s calling it a ‘deadly mistake,’ you know you messed up. Unless, of course, you didn’t

This comment on last week’s post kind of says it all:

There’s also this, which is now increasingly causing direct damage by giving the impression that things were rushed:

It also has the standard splash damage that when a completely insane standard is applied in one area, it makes it impossible to think clearly about other areas, resulting in things like this:

That’s not to take any position on firearms, any more than one would call for a pause on slicing bread. You could argue for a pause in actual almost anything if all it has to do is unintentionally kill two people when done millions of times.

There’s this claim today that the AZ and J&J pauses did not increase vaccine hesitancy. I do not think this reflects what’s going on at all, as willingness to get vaccinated naturally increases over time as people can see others doing it and everything going well, but it’s at least saying that this hasn’t been that large of a disaster in terms of the threshold that counts. I’m still highly confident things are going substantially worse than in the counterfactual. 

The Next Strain: P.1

Eliezer Yudkowsky asks the obvious question. Only about a third of the population is covered, but there are also a lot of children:

Thread contains a bunch of real data (as usual, he has to follow up with a Tweet saying “please only respond with actual data) that led to James Babcock pointing out the CDC’s variant data, which he then put into this spreadsheet

The end of March was when B.1.1.7 was taking over, going from 11.4% of cases on 2/27 to 44.1% of cases on 3/27. Thus, in April, strains with a competitive advantage are growing, other cases continue to shrink, and the shift from one to the other has cancelled out our vaccinations. The good news is that B.1.1.7 can only hit 100%, whereas vaccinations can also hit 100%, and that’s a battle vaccines win. If that was the whole story, we’d be in great shape, and confident we can turn things around soon.

The bad news is that P.1 is growing as well, potentially faster than B.1.1.7 (there’s enough measurement error here that I wouldn’t be confident in that), and its advantages likely involve some amount of immune escape. If that’s true, even if (as it seems from this and what other data we have on the question) that’s mostly about evading immunity from infections rather than from vaccinations, it will be the dominant strain in several months, and we’ll have to up our game another level if we want to stay ahead. 

The good news is that, unless the immune escape is much stronger than we think it is, we can totally get there, even with our vaccination pace slowing down due to regulatory sabotage. Or at least, we can definitely get there in areas without a lot of vaccine hesitancy, which also is up due to that same sabotage.

There’s a graph for that.

It’s worth stopping to contrast these two world views. 

In the first corner, we have Dustin Moskovitz, who works on projects he hopes will make humanity thrive. He notes how amazing it is we’ll be able to immunize essentially the entire population of many areas. 

In the second corner, we have the reporter from The New York Times, who points out how Just Awful some places are, and then associates the whole thing with Donald Trump. Classy.

I wonder what magic is taking place along state borders in many places, especially Wyoming, but mostly the graph should not surprise us. I’m not sure how much of the detail I would have guessed on first principles, but certainly a lot of it. 

The number of people who live in areas where the refusal rate is going to be 30%+ looks very low. The worst this gets for places with a lot of people in them is roughly 20-25%, which means (if these calculations are correct) they can still get to 75-80% vaccinations. That should still be enough. We might still be left with some states where things stay bad for a while, but when there’s almost zero cases in the Northeast and still a lot of cases in the places people aren’t vaccinating, I have a feeling we’ll see some people change their minds. 

If you’re looking to help change those minds, here’s some good advice (WaPo article):

From that article, it turns out that even vaccine skeptics can do math better than the FDA, and but haven’t figured out that this is true and important:

It took less than a week for us to go from ‘pause is important to keep people confident in the vaccines’ to ‘every public health official, me included, thought this would be a big hit to vaccine confidence.’ I don’t even get whiplash anymore. (And yes, I know that if you steelman their position there’s a way to reconcile those two statements, where the alternative would have been worse.)

What I found most interesting was also surprising to those who ran the focus group, which is that talk of booster shots pisses off such people:

I fail to understand why people can’t live like that. A vaccine shot every year is that bad? In a world in which, by definition, Covid is still around? All right then.

On the other hand, there’s this other thing they found that they did not expect, and yeah they should totally have expected it and I’m not sure why they didn’t:

You thought people who didn’t want to get vaccinated wouldn’t want fake vaccination cards when the cards are required in order to do things? Really? 

Finally, it’s worth noting that this is a place where regular people, most people, still are willing to take the FDA’s word for things. The problem is that what they’re taking the FDA’s word for is that the vaccines might not be safe, but either way, public support for the announcement is strong.

That’s in contrast to the people I talk to and respect, who universally think of this decision the same way I think of this decision. 

In Other News

Bill Maher offers his weekly new rule to not mix politics with our health. Well said, and good luck with that. 

Washington state denies people vaccinations on the basis of the color of their skin

Researchers in Belgium register a trial of Moderna half-doses, which I expect will produce less side effects, almost identical protection and double the number of people protected; I’d put the chance of a success here around 90% if the study is well-designed. Thing is, it’s only 200 people, so all they can measure is immunogenicity, which the clinical trials already checked. So what’s likely going to happen is they note ‘immune response is almost identical’ and then everyone says ‘yes, but what if somehow it’s not as effective’ and continues actively wasting half the doses.

Pirate Wires preaches it: “Science” and safety porn

Nate Silver thread reminding us of the pattern where when we play up dangers, we scare the people who are already safe while alienating the ones who are taking real risks. 

Dr. Fauci thinks it’s paradoxical that people don’t want to get vaccinated when he doesn’t want to restrict any restrictions for those who are vaccinated

We now have a Philippines strain to worry about, there will be more until we solve this globally, yet there is no sense of urgency whatsoever

Child shows up at their facility daily so they can perform required labors remotely on their computer anyway in an overflow room. Yes, you can have the worst of all worlds at once.

Interesting analysis says that English Strain’s relative infectiousness likely declined greatly over time, and at a minimum we have no idea how much more infectious it actually is despite ‘experts’ pretending otherwise on the basis of, as he essentially puts it, two points and a line between them. One could reply that we know a lot because the strain did indeed take over everywhere more or less within the predicted time frame, but it’s good to look from additional angles. There’s definitely some weird data here. There’s also reason to think that restrictions could alter the relative infectiousness levels. The English strain is slower to spread and slower to go away, and it produces higher viral loads. Various restrictions could be more or less effective at stopping the different strains, and the timing could also give a misleading impression.

Demand falling below supply at University of Arizona. Seems to be steadily happening in more places. If still need to get vaccinated, there are lots of places to go if you look around.

If you’re 50+ in NYC, you can walk in and get a vaccine without an appointment, here’s a list of where to go

Soon you’ll also be able to go to Alaska, and get vaccinated at the airport. It’s part of a plan to reinvigorate the Alaskan tourist industry, via getting as many unvaccinated visitors as possible.

A paper reporting on (spoiler alert: complete lack of) lockdown effectiveness, and on benefits versus costs. 

United Kingdom has a day with only one Covid death. New goal is a day with only one death of any kind. Fund anti-aging research! 

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35 Responses to Covid 4/22: Crisis in India

  1. Nick says:

    What to make of this survey that claims vaccine hesitancy has been reduced in the wake of the J&J pause? Is it a matter of “vaccine hesitancy was already generally on the decline and would be declining faster if not for the pause” or should we disregard simply because it’s only one data point?

    https://debeaumont.org/news/2021/poll-vaccine-confidence-grows-despite-jj-pause/

    • TheZvi says:

      I had not seen that survey. Good find! Weird that none of my sources found it otherwise.

      It’s a deeply bizarre survey, because that topline number and the internals are claiming to co-exist, and… I can’t help but notice that HUH, WTF?

      39% say this is ‘one of many serious side effects’ we are going to hear about.
      28.6% say this is ‘an example of why they should not be taken unless you absolutely have to’ which is identical to the 29% who say they won’t be vaccinated, but seems like a much stronger statement.

      Half of voters say they are ‘concerned’ about these (essentially non-existent) blood clots, which seems like it would matter, no?

      My basic take is ‘vaccine hesitancy was steadily declining and mostly we’re picking that up here.’ and that this compares to a full month prior. We’ll see what happens going forward; I’d love to be wrong about this.

      • Nick says:

        Maybe all of the loss of confidence in J&J due to blood clots/other side effects is simply redirecting those people to Pfizer/Moderna and not affecting overall vaccine hesitancy, allowing it to continue declining? But we’re still left to wonder about the overall drop in vaccinations nationwide…

  2. Totally unsubstantiated hypothesis for India (or maybe everywhere). Assuming each of the following is true, wouldn’t we expect to see susceptibility increase over time?

    – There’s some cross-immunity if you have had one of the non-COVID coronaviruses.

    – Immunity to coronaviruses wanes over time.

    – COVID restrictions reduce spread of non-COVID coronaviruses.

    Would waning cross-immunity from these effects be enough to matter?

  3. Evan Þ. says:

    I think there’re several reasons for vaccine-hesitant people to be annoyed by talk of booster shots.

    I’ve heard some of my friends talking as if booster shots still being needed means the initial vaccine must not be really worthwhile. And it sort of makes sense. Most of them don’t take the flu vaccine either, so their points of comparison are childhood vaccines generally regarded as protecting for life and maybe “get a tetanus shot every seven years if you actually get a puncture wound.” And, for people like them – young and generally healthy – on a personal level it makes sense. They don’t really value a year’s worth of protection from COVID.

    Also, one of my friends who had COVID pointed out that another friend’s vaccine side effects were just about as bad as his COVID symptoms, and he was right. So, if people are judging “get a shot every year and feel crummy” versus “risk getting COVID every year and risk feeling crummy”… I can hardly blame them for picking the latter.

    And beyond that, I’m personally worried that politicians will use the excuse of booster shots to keep COVID restrictions around longer than they’re merited. If vaccines are a one-time thing, once everyone who wants one has gotten one, we should open up everything because the people who haven’t gotten one have accepted the risk. But if there’s a booster shot needed every year, we’ll need to go through this same dance of restrictions every year. For people who value liberty, this is a horrible thing. For politicians who might value central planning over liberty, it’s a present.

    • Evan Þ. says:

      (And lest you accuse my friends of being selfish and not caring about spreading it, half of them were repeating the old canard that the vaccine doesn’t stop you from spreading the disease. Given that, their behavior makes perfect sense.)

      • Humphrey_Appleby says:

        Probably the main reason is people assume `need for boosters’ will be used to keep restrictions in place indefinitely. Or at least the possibility of restrictions, which could be imposed at the drop of a hat, will be around indefinitely. Which is quite a big departure from the status quo ante

  4. thechaostician says:

    One explanation I’ve heard of India’s dramatic rise in cases is that the Hindu festival of Kumbh Mela is partially to blame: https://www.npr.org/sections/coronavirus-live-updates/2021/04/13/986686352/millions-flock-to-hindu-festival-amid-coronavirus-spike . I don’t know if a closer look at the data supports this, but a 3 million person superspreader event or a bunch of smaller events indoors afterwards could explain that sharp of an increase.

  5. Catweazle says:

    Partial explanation of what’s happening in India. Coronaviruses are seasonal. In Toronto the peak was in Winter. In Florida and much of the Southern US, there was a clear Summer peak. This appears to correlate with “outdoor weather” and “indoor weather”.

    In most Indian cities, November-March are marked by relatively mild temperatures, perfect for outdoor activities. By end of March, beginning of April, the heat builds up to insane levels, which make Florida look like Winnipeg. Indoors air conditioning is the only way to escape or even survive.

  6. remizidae says:

    >Before you say we can’t pause cars, we paused seeing other humans for a year, so we can do a lot of things.

    I know this is a joke, but…no. No we didn’t.

    I never know what to do with jokes about not leaving the house or not seeing friends for a year. Is it just hyperbole or did the person really, literally act this way?

    >I fail to understand why people can’t live like that. A vaccine shot every year is that bad? In a world in which, by definition, Covid is still around? All right then.

    People are desperate to see light at the end of the tunnel. They’re desperate for an end to COVID and a return to normal life. “Normal life plus COVID shot every year” seems close enough to normal life to me and you, but if you’re very concerned about vaccines or if you assume yearly vaccines will come with continued lockdowns, then booster shots might feel like “this will never end.” And that’s a terrible feeling. If you want people to keep working to defeat COVID, you have to give them hope.

    • kronopath says:

      It’s not an exaggeration for some people. I can count on the fingers of one hand the number of IRL social outings with people I don’t live with I’ve had in the past year. Society-wide, though, I don’t expect most people to have been as cautious as I have.

      • remizidae says:

        I avoided in-person social interactions for about 3.5 months, but after that? We’re social animals. And outside interactions are very low-risk. So I do think you’re an outlier (and I hope that worked out for you, it sounds incredibly depressing).

      • kronopath says:

        It was okay, though I probably would have gone mental if my SO hadn’t moved in with me. I tend to be a bit more solitary, and I partially substituted it with virtual interactions, which was kind of nice because it let me get in touch with more distant friends. But I am planning to put out a general call for people to hang out once I’ve had my second dose.

    • Catweazle says:

      The US is probably a (laisser-faire) outlier in the developed world. This is of course reflected in the case counts. I have friends and family in Canada, Western Europe and UK, and most if not all have physically met only a handful of people in the last year. Easily less than five.

      • remizidae says:

        That’s terrible. I really worry about people like that. Do you think those people believe even an outdoor, masked interaction is too risky? Or are they following government rules even though they disagree with them?

      • Bobbo says:

        In Ontario, Canada, it’s illegal to socially visit anyone, indoor or outdoor, unless you live alone, in which case you are allowed to visit one household only. The gov’t said they were going to randomly stop people and ask them where they were going, but it has backed down on that one. 14 million people live in this province.

      • Catweazle says:

        remizidae, people believe the misinformation from their governments. Including: masks are harmful, travel bans are racist, AstraZeneca is bad for you over 65, AstraZeneca is bad for you under 55, outdoor socially distanced contact outside of your household is harmful and are forbidden, campgrounds are harmful and are forbidden, and I’m leaving out a few.

        My personal favourite: when entering a hospital, take off your top-grade KN95 mask, you can wear only this flimsy surgical mask we’re giving you. It happened to me – January 2021, Toronto.

    • J.S. Bangs says:

      This comment needs to be amplified. After a brief period of total lockdown in April 2020, I have had basically the exact same social life that I did pre-COVID, modulo some not-very-onerous restrictions like masking in public places. My experience is entirely typical of my social circle. I hear about some people who haven’t had in-person meetings with more than a handful of people for a year, but the only people who seem to be doing that are extremely online folks in big coastal cities, which seem to have turned into those dystopias where every person must spend eight hours a day giving themselves strong electric shocks”.

  7. Sandeep says:

    Came to this because didn’t want to create a lesswrong account for this. I am a stranger and realize my long comment may be deleted. Some general pointers:

    1. The point about Kumbh Mela from Chaostsician above is wrong. It probably contributes, but the surge started well before Kumbh Mela and in a different state (Maharashtra), though it is possible that the state with Kumbh Mela (Uttar Pradesh) does a poorer job of testing. Remember, religion can be a factor, but also gets attacked more than other factors like election rallies simply because religion is a soft target in intellectual circles.

    2. I don’t know the source of that cremation graph; how did they ensure that it was the covid victims’ cremations and not the usual cremations? Do we know by how much cremations have surged?

    Pro-tip: You do well, in fact very well, to be skeptical of Government statistics. But you don’t do so well in being insufficiently skeptical of anti-Governmental statistics. India is a country where a lot of liberty is taken with facts, it is there in Indian culture, but this makes a case for being suspicious not only of Government supporters, but also the anti-Government folks including news media.

    3. Test positivity may be overrated. Serosurveys show that only a tiny fraction of the actual cases ever get detected, so maybe if you choose testing samples better, test positivity goes up.

    4. Something anecdotal: It is claimed that many relatively well-off Indians who don’t need to be hospitalized are using their influence/connections to get hospitalized, depriving genuine cases of hospital beds. The famous (retired) cricketer Sachin Tendulkar was hospitalized, but I don’t know if anyone knows he needed to be.

    5. Sorry for being a bit harsh, but India is composed of several states, the COVID situation varies considerably from state to state, and it is a bit silly to analyze the country as a whole without going state-by-state. For instance, things were very bad in the city of Mumbai, but it seems to be past the peak, according to this academic (warning: some consider this academic to be on the Government side):

    Another example: Kerala had topped India’s covid charts for a while, and people didn’t worry about it. In my view this is partly for valid reasons and partly due to politics; but were you even aware of those considerations? I refrain from explaining more because this is not of concern to you.

    6. The point about blaming US for not “helping” India. I am not aware of Indians themselves blaming US for not giving us vaccine, but the CEO of the Indian company who made 90% or so of the administered vaccines blamed US for banning the export of vaccine raw materials to India. I don’t know how justified such claims are, but I would believe that deserved more of a mention than the bit about not “helping” us by not handing vaccines over.

    • Sandeep says:

      Sorry looks like I misread chaostician. Apologies. But the clarification still stands (and they had requirements of RTPCR negatives etc.)

    • TheZvi says:

      Thanks, and I certainly welcome long comments like this that are thoughtful and trying to figure things out.

      I fully admit that I haven’t been following India almost at all and don’t understand its internals, and I’m happy people who know more are providing better information in the comments. To get a picture of India on my own that’s remotely close in accuracy to the one I have in the USA would take a prohibitive amount of time, since I don’t have the background.

      • Sandeep says:

        Fair enough. I so wish there was someone who could analyze India like you analyze the US. Certainly beyond my abilities to do the sort of tour de force that you (or Scott Alexander) do.

  8. Craken says:

    The Advisory Committee on Immunization Practices appears to have voted to resume J&J vaccinations with no restrictions, only a new warning. This seems like the most reasonable course of action. Some might argue that because most people do not understand statistics and, anyway, will not have looked at the relevant stats–that the government ought to restrict their choices for their own good. I think that would further erode trust in these agencies.

    Besides, looking at the big picture, the J&J vaccine is much safer even for young women than a Covid infection with all of its possible complications (women have a higher incidence of long Covid). The new warning ought to be as simple, clear, and concise as possible. Also: the warning ought to be delivered up front when people make their appointments or at the beginning of lines for walk-up locations.

    Of course, the even bigger picture is that the J&J vaccine would save many more lives in India or Brazil than it will in America. America is deep into diminishing returns in terms of lives saved per million vaccine doses administered. Among over 65s, 90% of those willing to be vaccinated have had their first doses.

  9. Yanky Landau says:

    If what’s happening in india is the result of a new highly contagious variant, shouldn’t the US (and the rest of the world, I guess) be preparing for the variant to arrive? Do we have a model for how we expect this variant to behave of it does?

    • Craken says:

      The latest from genomic analysis in India shows that B.1.1.7, B.1.351, and B.1.617 all have the same rate of growth–logistic growth of 0.3 per week. The B.1.617 variant is considered the “India variant” only because it had a head start on the other 2 variants. It is at 45% prevalence now versus about 22% and 10% for B.1.1.7 and B.1.351. In the nature of such things–evolutionary competition–it’s likely that one of the three will win out. But, in Indian conditions, they appear thus far to have a similar level of contagiousness.

      As for our response, it might be prudent to limit travel from India. But since it’s already here and current vaccines appear to be effective against it, this probably won’t do much. It may be a harbinger of oncoming risks, though, inasmuch as we’ve given the virus huge scope for human focused evolution. The more genetic permutations it is able to attempt, the more likely it will eventually hit upon a really dangerous mutation: perhaps some combination of vaccine-associated immune escape, contagiousness, virulence.

  10. FYI it’s Zeynep, not Zaynep

  11. Catweazle says:

    @TheZvi what do you think of microCOVID’s statement that vaccine protection against hospitalization or death is way below 100%?
    https://www.microcovid.org/paper/13-q-and-a#2-if-a-vaccinated-individual-contracts-covid-how-much-less-or-more-likely-is-this-to-result-in-negative-consequences-increased-budget

    Issue on microCOVID’s github questioning this:
    https://github.com/microcovid/microcovid/issues/837

    • TheZvi says:

      I think this is a very strange reading of a lot of zeroes, and a lot of good reasons to suspect strongly otherwise. I respect what MC is trying to do in general, but I can’t find a way to consider this interpretation reasonable.

  12. Raven says:

    Got my first dose of AZ last week – never felt terrible, but still feel a little achy. Had to drive into a local COVID “hot zone” to find an available shot, which felt a little wrong on a few levels. Second dose won’t be for about 4 months as we’ve embraced “first doses first” to make up for our lack of supply.

    For what it’s worth, this blog deserves most of the credit for me being vaccinated this early. Until ACX pointed me this way I was in the “wait and see how the rest of the guinea pigs do” group – it took hearing a pro-vaccine message some from Zvi (who criticized the right things) to bring me around. And then the final personalized advice to convince me AZ now was better than “something” “later”.

  13. Dave Baker says:

    The thing that puzzles me about India is why things there weren’t this bad nine months ago.

    Speculative thought:

    Perhaps the explanation for why they were spared previously is widespread immunity in the population from a previous related coronavirus (this is some people’s guess for why East Asian countries have all done at least fairly well). But then the B.1.617 mutation escaped *that* immunity and all of a sudden most of the previously-safe population was dry tinder.

    • Humphrey_Appleby says:

      This might be the most plausible explanation that I’ve seen. (Perhaps, aided by a dose of seasonality).

    • Humphrey_Appleby says:

      Although…if this is true, then presumably we would also expect similar blowups in the near future in other parts of Asia. Maybe not in Singapore, South Korea, or China, which might be able to keep a lid on things with test-trace-isolate, but in, say, Indonesia, Thailand, Cambodia…that would appear to be the falsifiable prediction to follow from your hypothesis. Agreed?

  14. Stan Yellow says:

    Hey Zvi! I have an ongoing discussion with my friend about handling the vaccine-related evidence/hypotheses, and I wonder if you could shed some light on the topic.

    I’m a pro-vaccine person, and my priors for COVID-19 vaccination are strong: it’s way safer than infection, and necessary to return to normal functioning at the individual and social level, all the clinical trials have been successfully completed, rich and influential people get vaccinated, vaccines got accepted by many independent agencies and ministries, and side effects are rather well-reported, given that we stop the vaccinations after identifying blood clots at the levels present in general population. I’m also in favor of considering every possible claim on its own merits rather than blindly following the media-government consensus, especially after its failure in early 2020. At the same time, some reputation-based prioritization is important – as there is not enough time to analyze every single claim, it’s probably good to filter out all the alt-med content, hoping that the rationalist diaspora will serve as a reasonable contrarian watchdog.

    My friend seems mostly on board will these claims, but he’s afraid of losing the tiny but critically important signal in the sea of alt-med/unreasonable contrarian noise. Let’s take one of such websites – https://archive.is/gefs3 – it’s clearly bonkers, but what if they (semi-)accidentally got one point right (e.g. something related to #3 and https://www.statnews.com/2017/01/10/moderna-trouble-mrna/), and then we (both the media-government consensus and the sane contrarian watchdogs) unjustifiably dismissed it? What if there’s some valid argument about the possible side effects of the mRNA vaccines occurring after a couple of years, but it got associated with the alt-med circles and discredited by MSM? I think it’s very unlikely, and I still intend to get vaccinated – but I’m curious how to handle it best from the methodological perspective, so we won’t end up in a similar situation as once with cigarettes, high-sugar/low-fat diets, or thalidomide.

    • TheZvi says:

      I just fished this out of the pending comments pile, WP seems to have held some stuff without informing me.

      My response here is basically, there will always be a bunch of FUD out there, and there’s always *some* chance some of that FUD is based on something real, but there’s no reason to be looking at these particular concerns and mostly-to-entirely-crazy people rather than other concerns. It’s already gotten way, way too much attention relative to the level of evidence and concern.

      I do not see this as remotely similar to any of the 3 examples you list, one of which is ‘the one drug people always cite when saying things might be unsafe, and which also wasn’t ever approved by the FDA,’ one of which is transparently obviously bad for you, addictive and was being pushed by commercial interests (I mean COME ON), and one of which is nutrition where no one knows anything.

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