Covid 4/29: Vaccination Slowdown

Compared to expectations, excluding inevitable self-inflicted cratering of our vaccination rate, this was mostly a best realistic case scenario week. Johnson & Johnson was unpaused. India’s rate of case increases probably slowed down (they’re maxed out on testing capacity so it’s hard to know for sure). Biden seemed to come around to providing meaningful help to India and the world, at least to some extent. 

Most of all, cases in America were down a lot, and it’s now clear that things are steadily improving. Unless something changes, we’re going to beat this thing at least in a large portion of the country, and do so on schedule.

The decline looks really bad though. Like the situation in India, it’s Malcom Reynolds-level worse than you know.  When you look at first doses only, the lines are going straight down. If they go all the way to zero, many states and local areas won’t get to herd immunity from the vaccine. 

Let’s run the numbers.

The Numbers

Predictions

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

Result: 

Once again, Washington Post, your numbers don’t make sense together, but this is still clearly a big miss. 4.4% positivity rate is amazingly great in context. Johns Hopkins has the positivity rate declining from 4.7% to 3.9%. It’s worth noting that this ties the all-time low by their metrics.

As always, there’s the worry this ‘got ahead of ourselves’ somewhat, but I don’t think that’s the case. I think it’s more likely we’re making rapid progress, especially in the areas with higher rates of vaccinations.


Prediction for next week: Positivity rate of 3.9% (down 0.5%) and deaths decline by 6%.

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Mar 11-Mar 1714921010321714027121
Mar 18-Mar 241823957289512946969
Mar 25-Mar 311445976256412626247
Apr 1-Apr 71098867178911604914
Apr 8-Apr 1410701037162111454873
Apr 15-Apr 21883987174711684785
Apr 22-Apr 287521173160911104644

I looked for an explanation for the jump in the Midwest, but there does not seem to be a data anomaly. It may be somewhat random, but it’s likely the delayed result of the local surge in cases in early April before things stabilized. While looking for a potential issue, I instead noticed that West Virginia reported -159 deaths one day, which I changed to 0, bringing their weekly total in line with expectations. 

Overall the result is another small drop, which matches expectations. We should see progress accelerate from here within the month.

Cases

DateWESTMIDWESTSOUTHNORTHEAST
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
Apr 22-Apr 2854,88788,97397,48278,442

For another look, here is the monthly Polimath summary by state

The west stalled out, but the improvement elsewhere was dramatic, especially in the Northeast. The Northeast started off unimpressively on the vaccination front, but now has the best vaccine coverage of any region, likely because the limiting factor is transforming from logistical issues or supply into willingness to take the vaccine. It makes sense that hesitancy is at its lowest in the Northeast, and it’s likely this is now paying off. 

I worry that the South, and some other areas with similarly high vaccine hesitancy, will stall out at a place that still requires a lot of preventative action to contain the virus. If that happens, will such action be sustained? 

Vaccinations

Whoops.

This map now looks similar enough to the blue vs. red tribe map that the exceptions like the Dakotas stand out quite a bit. Presumably conditions there were bad enough that hesitancy is lower than it would otherwise be. The map also makes it that much more surprising that Georgia voted the way it did.

What’s clear is that vaccinations are cratering, and it is due to the massively destructive, completely needless pause in the J&J vaccine. The damage is done, and resuming isn’t going to reverse that much of it. See the section Pausing Vaccines For No Reason Still Doesn’t Work for more discussion of that. 

The question is whether we still have enough momentum to get to the finish line. If the above graph was proportional to first doses, I’d say strongly yes, we’re going to be fine. Unfortunately, the declines are much more pronounced in first doses and it seems plausible we will stall out not too far from where we are now.

If that happens, will it be enough? Or will we have essentially destroyed normal life in substantial parts of the United States indefinitely because of one death and six blood clots? It seems clear that the Northeast and other low-hesitancy areas will make it. It is not at all clear that the high-hesitancy states and areas are still on track to make it. 

India

The straight line up continues, but there was never much hope that things would suddenly reverse. The best case scenario was that we’d see this and it would represent a genuine slowdown in case growth, which could then level off within a few weeks. The share of positive tests is also increasing more slowly than before, so I think it’s probably a genuine improvement in the sense that things aren’t getting worse as fast as one would have expected. 

They’re still actively getting worse, though. This might be good news, but that only means the situation is terrible and getting worse, rather than even more terrible and getting even worse faster. It’s a horror show.

Oxygen is running out and the situation is increasingly dire. Without oxygen, a lot more Covid patients die. What happened?

Exponential growth happened. When you’re using half your oxygen capacity (and far more than half your available capacity given industrial needs) you’re less than one doubling away from disaster. Plus all the calculations likely exclude a lot of the people who are buying oxygen privately, and the supplies lost to looting or profiteering. 

On top of that, the logistics of distribution are all designed based on lower levels of consumption, so shipping, storage and delivery all have inadequate capacity given current demand, and also there’s uneven distribution between regions as one would expect. 

Marginal Revolution links to this update on the situation as of April 23. It’s worth posting the bulk of it:

What are we who are here in America doing about this crisis?

Mostly, we’re urgently pleading, with mixed success, for us to stop withholding life saving medicine that isn’t going to otherwise be used, and to stop using nationalistic barriers to prevent shipments of vital supplies.

Sarah is lowballing here with hundreds of thousands. We are already sitting on one hundred million doses. If we used a First Doses First approach (in this case, we’d better), and compare the situation with those doses to the one without where marginal cases have no oxygen and no hospital bed, we can likely save over one million lives that way alone. Add in donations of oxygen, our doses of Johnson & Johnson (let’s face it, that ship has sailed here and we don’t need them much anymore, but it’s not too late for India) and all the other raw materials and supplies, along with lifting export controls, and even without the obviously correct push to increase output of vaccines we can still work miracles here. There’s time left to be heroes, and also help ourselves. Or we could choose another path.

It’s not that we’re doing nothing helpful. We’re putting out Official Diplomatic Statements saying that we’re working around the clock and doing everything we can

Which is great, glad we’re doing all that, the thing is that it still excludes the thing we could have done (make more vaccine doses) and the by far most important thing we could do now (ship them our vaccine doses that are sitting on shelves unused). As a result, a lot of people are going to die.  

You can say the right things…

But that doesn’t change that Biden’s failure to devote a few billion to getting the world vaccinated is more striking each time he proposes a multi-trillion dollar new spending bill. 

It’s one thing to give away the surplus vaccines and capacity you happen to have once you’re finished vaccinating your own country. It’s another to engineer a worldwide solution on purpose rather than incidentally. 

The good news is that the pressure has gotten to us, and we’re going to do the right thing. Like classic Americans, we’ll do it after having exhausted all alternatives, and thus we’re still going to delay this to the ‘coming months’ with ‘safety checks.’ Also note that the link here thinks we only have 50 million doses rather than 100 million, but that doesn’t change what we should do with whatever we have. All of this was after fierce internal debate about whether we should guard against a potential vaccine shortage by hoarding vaccines we’ll never approve, or by not exploring the vaccines we haven’t approved for our own use until after we’ve approved them. 

John Cochrane points out that another contributing reason we haven’t been able to export vaccines is the issue of liability. In America, we didn’t pay anything like what vaccines were worth let alone pay tiny amounts of money to allow for the manufacturing for massive additional quantities of vaccines, but we did at least give vaccine manufacturers immunity from liability if something went wrong. Places like India don’t extend those protections, so the pharma companies protected themselves by not allowing exports to places where they could be sued into oblivion for things the vaccines didn’t even cause, or things so rare they don’t matter. 

As John points out, either the pharma companies are worried about something real, or they aren’t. If they’re worried about a fake problem, then the federal government should indeed assume the liabilities, or it should insist that other countries issue the same waivers. If they’re worried about a real problem, then they really need to do those exact same things, or that’s that. Otherwise, it could plausibly become actively unprofitable to develop vaccines, which is not a place we want to go. 

I have a hard time believing liability concerns are a True Objection to the exporting of vaccines. If we offered donations on the basis of a liability waiver, and India said no, that seems like true political (and literal) suicide. 


Then again, I can see a world in which the optics of our offer would be the dealbreaker here. That it would look so bad to be ‘demanding protection for our fatcat companies’ or something that it’s simply impossible to ask, and thus we let a million people die. Or, we would hope, India waves the liability issue on its own first, without being asked, but we can’t ask or we’re blameworthy. 

We could also be worried about the look of ‘giving up our castoffs’ and giving India the ‘not as good’ vaccines we aren’t willing to approve ourselves, and have to explain why they’re good enough for Indians and not good enough for Americans. Either they’re good vaccines or they’re not, and giving them away puts us in a bind. We’ve already given away a few to Canada and Mexico, so the seal on this might already be broken, but this would be a much bigger spotlight. 

The safety concerns could also be legitimate, because we’ve been letting the vaccine sit on the shelf for months. Thus, having already failed to protect anyone in the meantime, we might also have let the vaccines go bad, and we have to verify that this isn’t the case. That could partly justify the current delay, but of course it makes our earlier decisions that much less excusable.

Another problem was that India literally refused to authorize the Pfizer vaccine without a trial done on Indians in India. Pfizer had to withdraw its application. Now that there’s a crisis, India is doing the commonsensical ‘approve anything anyone trustworthy has approved’ approach. When such vaccine nationalism is present, and combined with demands to wave patent protections (which Pfizer already said they wouldn’t enforce) and the implicit demand to do full uncompensated technology transfer that would go well beyond Covid in its implications, one could think that we’ve been put in a difficult spot. But again, the bad behavior of others (and by all accounts, the Modi government has done plenty of not-so-great things across the board) does not excuse your own failure to help the people of the world.

Vaccines Still Work

The CDC is tracking breakthrough infections and deaths, meaning ones that happen post-vaccination. This Slate article summarizes the early findings: that such events do happen but they are extremely rare. Even Eric Topel notes that there are fewer such cases than we would have expected. I did a little work on the original CDC data as of April 20, and got about a 99% reduction in deaths for the fully vaccinated group versus the general population, as measured in deaths per person-day over the last few months. That calculation had to make a few assumptions regarding exactly how everything was being defined and measured, so it’s possible it’s off a bit in either direction, but 99% feels like a reasonable real-world reduction given what we know and all the behavioral changes that happen after vaccination.

Zeynep analyzes an outbreak at a Kentucky nursing home, which included one of those breakthrough deaths, and explains why she thinks it should be seen as encouraging news about vaccinations rather than bad news. One would expect the vaccines to be less effective in that context than overall, as it was pretty much the worst case scenario – older patients whose immune systems no longer work properly, in close indoor quarters for extended periods. Yet the vaccines still worked very well. 

As with all vaccine news, what is good versus bad news depends upon your previous epistemic state. If you previously thought vaccines were definitely super duper effective, hearing evidence they are only super effective, but without the duper attached, is bad news. Whereas that’s still great news from the perspective of anyone with bigger doubts who isn’t sure if they’re even super effective, let alone super duper effective. This means that a large portion of the time, what the media says is ‘good news’ is something I view as neutral or bad news, but it is still usually helpful in updating people in the correct direction.

Thread by Natalie Dean about the difficulty of avoiding bias in observational vaccination studies. Vaccinations aren’t given out at random, and people are told to act differently both directly prior to vaccination and after vaccination has taken effect. I worry that such de-biasing efforts are relatively robust in the ‘don’t overestimate vaccines due to selection effects’ direction but much less robust in the ‘don’t underestimate vaccines due to behavioral adjustments’ direction.

If you’re still looking for an appointment, vaccine spotter is this week’s website that might help if you haven’t tried them yet (HT: MR).

Or you can walk into a site, at least in some places, and it’s all good:

Pausing Vaccines For No Reason Still Doesn’t Work

Johnson & Johnson is back. After only 10 days, permission has been given to resume vaccinations. I explicitly said last week I didn’t expect the resumption to happen this quickly, so count me as pleasantly surprised at the news. On reflection, I was likely being too cynical here. 

How big is this risk, in the end? 

The problem is that the FDA successfully convinced Americans that the Johnson & Johnson vaccine is not safe, with a majority saying it was not even somewhat safe during the pause (WaPo). The question is, how much of that effect does resuming permission undo? Are people taking their queues here assuming the FDA is on the ball (and thus, it becomes safe again once permission is resumed)? Are they largely accepting that ‘safe’ literally means ‘is allowed by the FDA’ because they view such words as performative deference to authority? Or did they get the message that there’s something wrong with J&J in a way that one cannot magically undo by saying ‘never mind’?

Presumably it’s a mix, and time will tell us which of these groups dominate.

Nate Silver points out the obvious, which is that ‘what the “experts” are actually saying’ has remarkably little to do with when people demand that you ‘listen to the experts.’ He lists several examples of such experts, which you can click through to read and say the obvious common sense things. Thing is, ‘listen to experts’ actually means ‘listen to experts who agree with our elite Very Serious Person opinions in the current context.’ 

This one isn’t by an expert, but is similar, figured this was the best place to put the link. 

What was the result? You can see it in the vaccination graph, but you can see it much clearer in the first doses graph:

Or you could group by age:

This definitely passes the ‘you don’t need statistics because check out this chart’ statistics test. Marginal Revolution gives us another look at the same data:

Yeah, there’s no way this is a coincidence. 

Youyang Gu looks back on his machine learning projections. Like the Covid Tracking Project, he decided to stop midway through because ‘other people have this handled’ and then our world got much worse, because other people very much did not have this handled. The basic messages are ones you’ve likely heard before. He also looks at his final predictions on returning to normality, and finds we are very much on track.  

I mention this here because when you look at his projection, you can see the impact of the J&J suspension very clearly by comparing it to the counterfactual.

He did expect a gradual slowing down of vaccine progress at about this time, but this was a line still going up exactly on schedule suddenly reversing on the spot into a hard decline. 

A good thread of dog in a fire memes that are relevant, for those interested. 

Long Covid

The big known unknown of Covid has always been long Covid. There’s short term obvious reasons to be scared of Covid, but what about long term impacts? Data was always sparse. Now there’s a (preprint of a) nature paper about the matter that offers more concrete data. 

Taken at face value, it looks like Long Covid is a really big deal. This would be the strongest signal yet that you really, really, really don’t want to get Covid even if you’re relatively healthy, and that taking big precautions to avoid it was a reasonable decision given that the vaccines are now here.

This study was in the Veterans Administration, so the population in question was relatively elderly and in relatively poor health. They attempted to find similar controls, but I am profoundly unsatisfied with the methodologies listed here. 

They also prove far too much. Almost everything is worse in the Covid group, and the rate of extra deaths is far too big when compared to the number of excess American deaths. In general, if things were this bad, it would show up in tons of other statistics in ways that it simply doesn’t. 

My conclusion, after discussion and analysis, is that this study is largely measuring selection effects, and this makes it all but impossible to know how much of the effects are due to Log Covid versus the people who get symptomatic Covid and have that diagnosis confirmed starting out as sicker to begin with. 

That does not mean that the Long Covid effect isn’t real. I’m convinced that at least some of this effect is real, but I don’t think we get to update on that much from this study.

What we can update from this study is the evidential value of having had Covid. In important practical senses, if you test positive for Covid, you face the same situation no matter how much of your health issues will be caused by Covid versus revealed by Covid. What matters is you know your expected future health is much poorer across the board. There’s more reason to focus on one’s health, and to prepare for potential trouble. 

If you haven’t had Covid yet, there’s a big difference, because it’s still not clear how much you need to be avoiding Covid out of fear of Long Covid. We know the answer is ‘enough to matter’ but magnitude is important, and I sadly do not think this study should update us that much on that question. 

In Other News

Inside the pro-vaccination advertisement effort.

The first ad showing grandma hugging everyone seems very good, aligning with the above quote. The second one promising the facts seems less good and more done by committee to look good to Very Serious People, and my guess is it convinced approximately no one. 

They settled on the slogan “It’s up to you.” I certainly can’t argue with that in general, but also no one involved believes it. It’s up to you to make the right decision and come to the right conclusions, and we’ll do whatever it takes until you do exactly that. I happen to think that their selected ‘right decision’ is in fact the very right decision on all levels, but I do worry that in an important sense this is a coincidence. We have examples of other cases where the decision wasn’t right, or was socially good but locally harmful, and it’s hard to see much difference in messaging approaches. Hence much of the hesitancy.  

This does not sound like a final check designed to discover the truth. It sounds more like it was designed mostly to give the answer they wanted, along with some mix of a desire to see if they’d made some gigantic horrible mistake and a desire to have a plausible story that they checked for that.

It is also exactly what the campaign sounds like to me. When I saw ‘it’s up to you’ I totally, totally interpreted it as ‘it’s optional.’ Otherwise, what’s up to you? And the answer, of course, is that for such people, it’s ‘up to you’ to make the voluntary choice to do the things you’re told to do. That’s how such people think, and how they envision freedom and democracy. It’s an entire authoritarian mindset where everyone is free to do whatever they want but also disobedience is your fault and you should get punished for it. 

It’s also what the ad needs to be interpreted as to be successful. They talk about this later on, saying that conservatives need to have their autonomy respected. People aren’t stupid. Either something is optional, and they have a choice, or it isn’t and they don’t. You can try to send both messages but you’ll fail. So yeah, it’s optional. Or at least, for now it’s optional, until it isn’t. 

As is their standard operating procedure, the Biden administration then decided instead to ignore all of this respect for those it disagrees with and instead project a superficial message of unity by going with the slogan “We Can Do This.” I wonder how they think that will play out. 

Tabarrok responds to Cruz follow-up question on vaccine passports, points out that partly open is worse than completely open, but better than completely closed. Still leaves open the question of whether passports might lead to slower full reopenings rather than faster ones.

The framing here seems exactly right. 

Dr. Fauci admits his previous statements in this area were blatant lies (which as we all know are the best kind) and notes that he expects to no longer need this particular untruth soon, but he’s not quite ready to let go of it yet.

Biden administration puts Andrew Cuomo, who we all agree is the worst, in charge of weekly briefings for the governors. That’s how much they care about the pandemic. 

Your reminder that Biden’s 100 days of wearing a mask expire on April 30 (tomorrow), and he hasn’t explicitly extended that. 

Brazilian regulator rejects Sputnik’s application. It looks like they had very good reasons for doing so. The Sputnik vaccine has serious problems, and the data presented has additional serious problems, and either you’re going to have regulations that stop this kind of botched operation from moving forward or you don’t. It’s very reasonable to turn this application down. If I had no alternative options, though, and lived in India or another place where things were looking bad, I would still be fine with getting it and much prefer it to doing nothing. I’d still be surprised if the vaccine wasn’t effective, and I’d still be surprised if it was sufficiently unsafe to make the cost/benefit of taking the vaccine be remotely close. Still, I do understand that these are not the standards we must use, and that to let this slide would be very bad precedent. 

This was going around this week, no comment seems necessary:

It is worth noting that there are some comments in the second article that effectively say ‘I was wrong, travel bans do work’ and we should definitely applaud everyone admitting that.

This MIT paper on ‘guideline to limit indoor airborne transmission’ was also going around this week:

That’s quite the spherical cow you have there. This assumes the absurd conclusion of automatic uniform mixing in indoor spaces, and then concludes that relative location in those spaces doesn’t matter. If my grandmother had wheels she’d be a trolly car.

So of course the media acted responsibly, as they always do.

Of course, as the NY Post shows us this time, it can always get worse:

And then they use this photo:

Then this one:

The actual content of the article notes that the worries about indoor spaces, but for some reason this type of thing is inevitable. All media must post pictures of people outdoors as being irresponsible, because they look scarily like they’re alive and might even be having fun or living life. Unacceptable. Insinuations must take place right away. The public must be warned. 

Then, if necessary, fall back on the story that ‘no this is the way you’re supposed to distance, it only works outside.’ Assert that we were never at war with Eastasia, and it was always unsafe in any indoor space regardless of distance. 

Meanwhile, we have cross-country runners in mandatory masks. Which certainly isn’t not insane. And YouTube pulls videos for having “disinformation” when they agree with European mask policy instead of American blue tribe mask policy

And here are the CDC guidelines for camps. If you’re wondering how ‘spend most of our time outdoors’ changes their recommendations compared to those for schools, I’m here to report that the answer is that it doesn’t. There’s a recommendation to shift things to outdoors, but doing so doesn’t change what you have to do, it’s a pure additional obligation. For example, everyone should stay ‘socially distanced’ at all times, except when eating and thus not wearing masks (and often likely indoors), because that needs to be an exception. Outdoor child masking is otherwise fully mandatory. Paranoia over surfaces is unchanged. If you took these recommendations seriously you wouldn’t have a camp worth going to, rendering such rules worse than useless. 

Robin Hanson points out some of the dynamics that doom us to always have ‘elites’ saying ‘more must be done’ and calling for more government oversight, and claiming to have the expertise to argue about details they don’t understand while not trying to understand the more important meta-level. He is right that it is important, when arguing details on the margin, to point out that the arguing of details on the margin is not a way to make good policy decisions. Hopefully I’ve found the right balance of pointing this out and not belaboring the point. 

See this Zeynep thread for good detailed analysis. Bottom line is that this is trying to make an important point, that in poorly ventilated spaces the virus can build up over time rendering distance insufficient for safety, but is making it in a terribly misleading way. 

Not Covid, but how would you know that without breaking the regulations, since the European Union is proposing to regulate Bayes Rule

Arthur’s wise reaction:

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48 Responses to Covid 4/29: Vaccination Slowdown

  1. Another data point for vaccine distribution taking a nose dive. Currently in Idaho. When I went to a vaccination clinic on the first of april it was full of people, at least fifty either being vaccinated or sitting in the waiting room after vaccination.

    Went back on the 27th at about the same time of day. Almost a ghost town. I was the only non-personnel at the vaccination stations when I went in to get the shot. The waiting room I came into afterwards had 6 patients.

  2. Jonathan Monroe says:

    You say “no comment seems necessary” on the Julia Belluz articles, but I think it is worth saying that the second article does include specific admissions that they previously held the other opinion, both by Belluz and by one of the experts she is quoting. This is rare and should be applauded. In the case of the journalist, I personally think it qualifies for a full exemption from mockery. The epidemiologists (who should have known better) still deserve a partial exemption.

    The behaviour we want to punish is writing “Oceania will always be at war with Eurasia” in January and “Oceania has always been at war with Eastasia” in February while hoping nobody notices the inconsistency.

  3. SamChevre says:

    On vaccine availability: here in Massachusetts, the vaccine became available to the general public April 19. Last week, I felt very lucky to get an appointment–there was an appointment available here and there but not that many. This week, I looked for someone else–and every pharmacy had pretty much all it’s appointment times available. I bet you could walk in to any Walgreens and get vaccinated as quickly as you could fill out the paperwork.

  4. Rahul Nandkishore says:

    New theory (A): Vaccine hesitancy is self amplifying. i.e. there are large numbers of people who don’t want the vaccine, but also don’t want to be the lone holdouts. The `pause’ gave a critical mass a plausible excuse to refuse, and kicked off a vicious cycle as more and more people feel there is `strength in numbers’ to refuse.

    Alternative theory (B): Scarcity is well known to increase demand (get it while you can!). The end of vaccine scarcity in itself reduces the urgency, as people feel `I’ll get it at a time convenient to me, when I don’t mind being maybe under the weather for a couple of days’ as opposed to `got to get it when I can, who knows when I’ll get another chance.’

    If theory A is correct…we’re basically out of demand. If theory B is correct, we’ll keep going for a good while longer. Really hope its B.

  5. Alsadius says:

    I would wager that they mean “it’s up to you” as “it’s your responsibility” – the Smokey the Bear of covid PSAs.

    Yes, this is very silly.

  6. Dave Baker says:

    Is there any information on the correlation between vaccine hesitancy and previous infections?

    Extrapolating from the death rate, probably about 25% to 30% of Americans have previously been infected. So even if there were no correlation between previous infections and vaccine hesitancy, you should add an extra 12-15% onto the percentage of people who are immune.

    But I expect the situation is better than that, because disinterest in vaccination is likely correlated with previous infections. For one thing, many people likely think there’s no point to being vaccinated if you already have antibodies. Additionally, previous infections are probably a good predictor of not caring much about COVID.

    But this is all speculation, and I’m curious what actual information is out there.

    • TheZvi says:

      I haven’t seen any such information. My guess is that vaccinations are highly correlated with having taken low risk during the pandemic, but also from what I’ve heard those who think they got Covid have been eager to get vaccinated, kind of because they respect the disease and want to be sure, if that makes sense.

      I agree we have a lot of immunity beyond the vaccinations, but it’s hard to differentiate that from the current background rate of infections, if we assume the correlation with vaccinations isn’t that high. My guess is it’s negative but not that large.

  7. AnonCo says:

    @Zvi, I was REALLY hoping to hear you opinion on the interview with Geert Vanden Bossche & Bret Weinstein.

    Bossche was on Bret’s Darkhorse podcast last week.

    I updated from: I assume this guy is a kook because he is being shared widely around conspiracy theory circles.

    To: This guy an intelligent scientist working on precisely this problem and he makes a scary amount of sense. Bret agreed.

    Please weigh in!

    • AnonCo says:

      I should have mentioned, the entire conversation was a very technical discussion of the potential for vaccine escape and the selection pressure we are putting on the virus via worldwide vaccination.

      This is why I assumed you might have heard the conversation and comment on it in this week’s Covid update post.

      • Hareeb al-Saq says:

        We’re obviously putting selection pressure on the virus- any useful action does- but we’ve already had multiple at-least-partiallly immune escaping and quite transmissible variants appear before vaccines, so the non-vaccine world isn’t “safe” from that, and we’ve given over a literal billion shots now with no breakthrough variants reported anywhere yet, so the odds of fading a vaccine-escape variant going wild are far above zero, and it’s also not clear that one emerging and getting vaccine 2.0 online quickly would even be that bad compared to his alternative. It’s conceivable that our world turns out to be one where his path is better, but it’s basically impossible to reconcile observations so far and putting a significant probability on that coming to pass.

    • TheZvi says:

      I got linked to it last week, and responded based on the description given, because video/audio is a terrible format for such things. The argument for things going the other way seems strong to me – that not vaccinating gives the virus far more room to mutate and screw us over than vaccinating does, this particular selection pressure be damned – and I haven’t heard any new information that would change my mind, but I haven’t actually listed to the podcast in question. Plus I haven’t heard a case for why we couldn’t adjust the vaccine and go again if it did happen.

      And… what’s the proposal?

    • Craken says:

      The risk of a vaccine resistant variant remains. The question is how to balance this risk against the other risks. Bossche thinks we should let the virus run through the global population until herd immunity is attained–and assumes it will die out in just the way the 1918 pandemic did.

      First, this would cost ~30 million lives if done slowly enough to permit hospitals to remain functional and if the virulence of the virus remained stable. It might cost many more lives than that if either hospitals are overwhelmed or the virus becomes more virulent as it transits through billions of people and plays with its evolutionary potential.

      Second, this would require global agreement to seek herd immunity in every country and to refrain from vaccinating in any country–which is a complete non-starter for many reasons.

      Third, Covid is a different type of virus from the Spanish flu–coronavirus vs. influenza virus. This means there is no guarantee that infecting everyone would end the pandemic, since Covid could mutate to become resistant to the post-infection human immune defenses. Actually, even if Covid were also an influenza virus, which mutates more readily than coronaviruses, there would still be no guarantee.

      Fourth, if the virus does escape vaccine-mediated immune protection, it is not likely to be difficult to produce a new vaccine that restores protection quickly enough to prevent serious human and economic costs. It’s also distinctly possible that one of the current vaccines would protect against a variant that is resistant to other current vaccines.

      In looking at the balance of risks, it looks like the Bossche plan is vastly inferior to the plan to vaccinate the world as quickly as possible. I was surprised Bret didn’t push back on Bossche’s approach; he ought to know better given his background. If you do a quick check of his comments section, very few display any doubts about what Bossche said. They just implicitly assume that if the powers that be are trying to exclude Bossche from their platforms, it must be because he is a bearer of suppressed truth. I sympathize with the sentiment in these bad days, but it’s a kind of ignorant cynicism to which they’re falling victim.

      • Alsadius says:

        And fifth, mutations are basically proportional to cases. So if there’s billions of extra cases, there’ll be way more mutants – indeed, infecting the maximum possible share of the human population, like this entails, creates the maximum possible mutation risk. If the virus goes away because of widespread vaccination, that risk is as low as possible.

        Yeah, that’s just a deeply foolish plan.

  8. A Leap at the Wheel says:

    “we” is a word you use often in this article, when you really mean “people in the federal government whom I voted for” or “people in the federal government whom I had no hand in legitimizing.” I think I picked this up from Russ Robert’s Econtalk podcast. Not sure. In any case, even though it seems like semantics… well, it is! But its important semantics. Here’s why:

    If you, the zvi, held back from India millions of vaccines you have in your underground bunker, you would be a monster. And because you would be analyzed as a single agent with moral competency, everyone would know it. But when government officials do the same thing, they skate. Because Government is Just The Name For Things We Do Together, and because Blue Lives Matter, and because social desirability bias, etc etc etc. From your writings, its abundantly clear that you know this.

    But when you call their actions as our actions, it gives them cover to kill more people. You don’t even need to take the crazy libertarian approach that says government can’t morally do anything its individual citizens can’t do (but it doesn’t hurt). You just have to say that the government can’t morally kill people in our name, which is a bridge I think most people are ok crossing when spelled out. And refusing to call them ‘our actions’ spells it out.

    UNRELATED: I have a friend who is so normcore she doesn’t know what normcore is. She’s not a conspiracy theorist, she’s not a Q, and she laughs at my jokes about chemtrails.
    And there is nothing in the world that will convince her to get vaccinated right now. Not even her husband begging her, nor the fact that she knows she’s thousands of times more likely to die driving to the vaccine location than she is from the vaccine.

    • A Leap at the Wheel says:

      Oh, and the unrelated isn’t meant to have any larger point than what’s right there there. Its just a public lament.

    • TheZvi says:

      I considered doing a section unpacking this but decided to keep focus elsewhere.

      I don’t think it’s obvious which way this should go, because not using ‘we’ language potentially lets everyone else off the hook, and also it’s not obvious to me how much it lets the government officials off the hook. But I do think I’ve slipped into using it too often, and without thinking about it, so I’ll be more deliberate in thinking about when it is and isn’t the right term.

      Sorry about the unrelated. If you’re interested in saying more: Do you think there really is nothing in the world? E.g. what would be her Cheerful Price? Would any new evidence be convincing if found? What would happen if she wasn’t allowed to leave the house otherwise? How deep does this go? And, if you know, what’s causing it?

  9. shakeddown says:

    > the map also makes it that much more surprising that Georgia voted the way it did.

    I think this makes sense – Democrats won Georgia mostly because of black voters (they gained a lot with educated whites but still did poorly with them on an absolute scale). AFAICT it’s educated whites that make blue states more likely to take vaccines – most black voters vote Democrat but aren’t really blue tribe, and are pretty vaccine hesitant.

  10. u8k says:

    I feel like it’s worth noting that the J&J pause happened the same week that many states opened up the vaccine to everyone. Which is exactly when you’d expect the vaccine rate to peak anyway. I’m not saying that the J&J pause had no effect. It did and it was stupid. But had there been no pause, I wouldn’t have expected the vaccination trend to be much different than it is anyway. I expect that the week you open up vaccines to everybody, we see peak vaccinations as everyone who wants one asap jumps for a spot to get one. And then those people were vaccinated and rates are going to tail off after that. I don’t know how to separate the effect of that tail off with how the J&J pause effected things.

  11. myst_05 says:

    In regards to Long COVID, I think we finally have some good data thanks to the UK government. They estimate around 700k people are currently suffering from Long COVID for more than 12 weeks: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/1april2021. Presuming 30% of the UK was infected, we can estimate that around 3.5% of all COVID patients will eventually develop long-lasting symptoms. Its also interesting to see that around 37% of long COVID patients don’t limit their day-to-day activities, meaning that their symptoms are not too bad.

  12. yotann says:

    Another vaccination search to keep an eye on: https://www.vaccinatethestates.com/

    They’re working on pulling as many lists of vaccination locations as possible, especially in the states that don’t have pharmacies everywhere.

  13. Dax Diamond says:

    According to Scott Gottlieb (5/2 Face the Nation), reported positive test rates are inflated because of at-home testing – only positives get reported.

  14. Carlo Martinucci says:

    Dear Zvi, a reader from Italy here 👋

    I love your articles and I want to thank you for intellectual honesty and your constant struggle to seek the truth.

    Sometimes I find it a little hard to follow you on policies: to be specific, what do you think should be considered safe regarding outdoor behaviors?

    • TheZvi says:

      One reason it’s confusing is that “safe” is not a Boolean even when all aspects of the situation are well-defined. There’s degrees of risk, and many approaches to dealing with that risk – e.g. one can have a risk budget, or one can draw a line between allowed versus unallowed, or do other similar things, none of which are always sane.

      But to answer the question in practice, looking for a yes/no rule of thumb, I’d say:

      If you’re vaccinated and outdoors, ‘don’t do stupid stuff’ but otherwise it’s all good and you don’t need a mask. So no yelling in faces, no hugging or handshaking, but if you want to go for a walk with a friend and chat or have a picnic or go to a playground or park, go for it.

      If you’re unvaccinated, I’d wear a good mask around other unvaccinated people and do some amount of social distancing, but mostly outdoor stuff with the basic precautions is fine depending on your risk tolerance. So basically everyone wears a mask if you’re going to be interacting outside your pod, and lower the bar on what counts as “stupid” to include talking to each other at close range. Obviously you can adjust that to your risk tolerance, and to local conditions, and it’s better to compromise and do less safe things outside if it saves you from having interactions inside.

      Any reasonable implementation of outdoor dining seems fine, so basically anything that isn’t what a friend calls a “Covid box” is fine – if you have walls around you, you’re not really outdoors anymore.

      • Dave Baker says:

        Why no hugging or handshakes? What’s the evidence that these are any more dangerous than having a conversation? I’d expect them to be less dangerous.

      • TheZvi says:

        Part of it is I don’t see them as *necessary* in the same way, so the cost-benefit is different – it’s kind of an unforced error, especially for handshakes. It’s possible that fomites are so bad at spreading Covid that even handshakes/hugs are mostly fine, but that cuts down on the number of steps (e.g. instead of you->surface->my hand->my face->me, we skip 1-2 steps), which makes them from first principles a lot worse than other surfaces, especially if one doesn’t want to be careful about face touching. And also it would nullify the advantage of being outdoors – with contact you get little or no bonus for good ventilation.

      • Dave Baker says:

        I grant the point about necessity, but it seems to me that when we’re talking about risking a Covid infection if you’re vaccinated, we’re talking about risks that are comparable with risking contracting the flu, which never stopped me from hugging anyone before unless I knew they were sick.

        Regarding the handshake and fomites, isn’t the number of steps the same? With the handshake it’s you (that is, your breath) -> your hand -> my hand -> my face -> me. And the skin of your hand is a porous surface, which probably transmits fomites less efficiently than a smooth hard surface. (Granted, it seems possible that you would end up with way more virus on your hand than on another surface since it spends a lot of time within range of your breath.)

        With a hug, if you do it the way we normally do it I don’t see how you’d pick up any fomites from thumping your bro on the back. So the issue is being close enough to breathe in someone’s exhalations. But viral dose is a function of time, too. You might take two or three breaths in during an ordinary hug. Is it realistic to suppose that two or three breaths would bring in enough virus to infect you? Seems doubtful to me even if you aren’t vaccinated.

  15. Brett Bellmore says:

    My personal impression here in South Carolina, talking to co-workers and friends, is that vaccine hesitancy comes from three sources:

    1) A fair number of the people we know have suffered bad enough side effects to be out of work a couple days. (And they’re not malingering, they had to eat vacation time to do it.) That’s a LOT worse than your average vaccine.
    2) A significant fraction of our workforce has already had Covid, and don’t see much point in risking even more likely side effects for a marginal increase in resistance to reinfection. (Put me in that camp.)
    3) A rising distrust for the medical community in general, and government medical advice in particular, after a year of being showered with BS with no end in sight.

    • TheZvi says:

      That all makes sense, thanks for the update. It’s good to gather as many such impressions as possible, especially since my social network doesn’t have any vaccine hesitancy to go off of (which is great).

      My hope would be that those worried about side effects (so both #1 and #2) would just take J&J, but, well… *mumbles* *rages*… whoops.

      • Brett Bellmore says:

        I might personally get at least one shot, as a booster, in a few months, once there are better statistics on side effects in people who’ve already had Covid. (I’d already been under advice from my doctor not to get the vaccine too soon after my bout with it.) The numbers I have seen suggest that the serious side effect rate for people who’ve already had Covid is roughly twice the rate for the general population. Unsurprising given that the side effects are due to an aggressive immune response to the shot.

        I think there might be less reluctance to get vaccinated if they’d just stop insisting that vaccinated people continue wearing masks and social distancing. It gives the impression that they don’t really think the vaccine works… And I’m getting pretty irate about them pretending that only vaccination can give you immunity to a virus, not having already had it.

        Sure, I understand that they’re just trying to avoid a situation where people who’ve neither had Covid nor been vaccinated pass themselves off as immune, but all this lying to us for ‘a good cause’ has been incredibly destructive to their credibility.

      • TheZvi says:

        I guess my response to you in particular would be: Yeah, they’re lying assholes. True that. But it’s not about them, it’s about you, and you have better information sources than what’s implied by the lying assholes who are trying to manipulate people. Nor do you need to follow their advice. Form your own opinion!

        My model says it’s still worth getting one shot, that having been infected is somewhere between 1 and 2 shots and the extra shot can get you to even better immunity than vaccination alone. Even with doubled side effects I think that’s a good deal (and I hadn’t heard about the doubling) but you might disagree.

      • Brett Bellmore says:

        See, for instance: https://www.medrxiv.org/content/10.1101/2021.01.29.21250653v1.full.pdf

        Like I said, I’ll probably get a least one shot, as a booster. I’m just waiting on better data. As I’ve already had Covid, and it wasn’t any worse than a bad head cold, this does not strike me as a particularly risky delay. The current evidence is that, if you’ve already had Covid once, even if you do get reinfected it’s unlikely to be severe.

        As you doubtless know, ‘immunity’ has never meant that you couldn’t get reinfected, just that the second infection would be so short and mild you’d likely not notice it. So I take with a grain of salt reports of reinfection that don’t mention severity; We’ve never before subjected this many asymptomatic people to PCR tests that would detect such reinfections.

  16. alchemy29 says:

    States are starting to ban private businesses from enacting vaccine requirements. That includes healthcare facilities, restaurants, and service workers like barbers and masseurs. I don’t even understand how such a self destructive idea managed to make it to governors desks. It baffles me. I thought I was a realist in 2019, but I maybe was far optimistic about our institutions.

  17. alchemy29 says:

    Re: Travel bans. My tentative thought is that complete, airtight travel bans works. Halfhearted travel bans, and travel bans with countries with similar or lower active infection rates do literally nothing.

  18. Quixote says:

    Re the Vietnam experience. Its uncertain if the border closure was actually what caused their amazing levels of succses. Their covid levels were so low as to be almost outside the bounds of plausible intentional policy outcomes. Like, things seldom ever really work that well.

    Vietnam is not an island like New Zealand, the level of border control need to produce a smashing result like this would mean the capacity to have no drug trade, no smuggling, no black market goods, etc. I haven’t been there myself, but I don’t think that matches travelers observations.

    During the time of small pox, herding communities didn’t get small pox because of cow pox being protective and widespread among those populations. I’d gut feeling give at least a 15% chance that it later turns out the Vietnam population had a high baseline level of natural immunity due to some random less dangerous covid type virus that was endemic.

    • Eric fletcher says:

      100% no-crossing is easier to maintain than “people can cross, but not certain kinds of people or goods.” And even if some smuggling still happens going from 100,000 new faces entering the country every day to 100 (numbers made up but plausible) is still a huge reduction in risk.

  19. Hirsh says:

    Dear Zvi, I have 6 important questions, and your answers would be extremely helpful for me and other readers!

    1. I’m a 30-year-old guy prone to anxiety, and I expect to get a Pfizer vaccine in a month. How much should I worry about the cases of myocarditis (https://www.lesswrong.com/posts/PK93RKpsKkCP4d6s8/myocarditis-after-pfizer-biontech-vaccine)? Should I consider switching to another vaccine? :(

    2. Other than due to formal requirements, (why) should everyone get a second shot of Pfizer/Moderna (https://www.lesswrong.com/posts/AtgZzk8pgonjcHYuW/for-mrna-vaccines-is-short-term-efficacy-really-higher-after)?

    3. How much immune escape do you expect in Europe/US over the course of the next 12 months? Do you expect Pfizer to remain effective against the nastiest consequences of infections with new mutations (severe and lethal progression, long Covid-19)?

    4. What are your expectations regarding the development of effective and safe anti-Covid-19 drugs, such as PF-07321332?

    5. I would really benefit from information about the probability of getting infected after 2 shots of Pfizer vs. when unvaccinated – and then, if infected, the probability of an a) asymptomatic, b) mild, c) moderate, d) severe, e) lethal course of Covid-19 and f) the incidence of long Covid-19. Extra breakdown by age and gender would be awesome. Do you happen to have good estimates, or do you know where I could search for them?

    6. In general, how do you feel about such sophisticated masks that are supposed to ensure full comfort of breathing?
    https://www.razer.com/concepts/razer-project-hazel
    https://www.shopmask.com/respirator-lg-puricare-mask.html
    https://www.indiegogo.com/projects/uvmask-complete-protection-for-the-new-normal#/

    Thank you for all your great work! I’ve converted my family to a small Zvi fan club.

    • TheZvi says:

      1. None, and no. Get Pfizer rather than Moderna if you’re worried about short-term side effects.
      2. I do not think 1-shot efficacy is as high as that model suggests, and at minimum there is model uncertainty there. First shot is much more important than second shot, but second shot is still well worth it while Covid is a going concern.
      3. Escape is possible but there’s no sign of it yet, and I think it’s a large (but not gigantic) underdog to arise in the future via mutation.
      4. Not looking carefully enough into that to comment usefully.
      5. Best guess reductions are something like: 95% less infections, 99%+ less lethality (my best guess is maybe 99.5%), curve extrapolates like you think but extra precision along it would be heat rather than light. No large gender/age differences.
      6. Think about what’s physically happening to decide how much protection they give, but also it matters how people will react to you, especially post-vaccination. In general many such masks don’t protect *others* very well.

      • Hirsh says:

        Thanks! To sum up: get two shots of Pfizer and assume the death risk is 4,000 (1/(5%*99.5%) lower than without the vaccine, so regardless of your age/gender/age, return to normal life with basic precautions (mask indoors + distancing)?

        I’m kind of worried about the remaining sense of social disconnection and constant vigilance that may last for years. :(

      • TheZvi says:

        Oh, I was saying 99.5% lower death overall rather than 99.5% on top of the 95%, so 1 in 200 rather than 1 in 4000.

        But yes, regardless of age/gender/health I would at least return to normal life with *at most* basic precautions – basically I’m in “don’t do stupid stuff” mode but mostly partying like it’s 2019 modulo observing expected norms. If they expect/want a mask, sure, mask it is, it’s a small cost.

        I agree that the social disconnection and paranoia are the real problem from here.

      • Eric fletcher says:

        I (a fully vaccinated not-old person) wouldn’t bother with a mask unless going to a hospital / doctors office (ie places with an elevated risk of having an infected person present) or visiting with someone unvaccinated and elderly/ill (ie someone who would be seriously impacted if I happened to be infected and transmitting). And even that is only until infection rates fall to the background rate of measles/mumps and COVID-19 is just one more regularly scheduled vaccine given to kids that continues to kill hundreds to thousands of people each year, but that’s less than .01% of total deaths so “we” can go back to curing cancer and preventing heart failure.

  20. h says:

    I’m not sure if I understand it correctly. Did you mean that infected and vaccinated people have a 10x lower mortality compared to infected and unvaccinated people? 20x less infections after vaccination * 10x less deaths of infected and vaccinated = overall 200x lower mortality?

    It would mean that a vaccinated and infected older person has a 2% chance of dying, and that vaccinated and infected young people may have 1-5% chances for a nasty long Covid-19. It doesn’t really encourage resuming normal activities…

    BTW, what do you think about Seychelles (70% people vaccinated, rising infections)? Is that a negligible effect due to their small population? https://graphics.reuters.com/world-coronavirus-tracker-and-maps/countries-and-territories/seychelles/

    • TheZvi says:

      Seychelles is a tourist area is probably a lot of it, as is that they used lousy vaccines (e.g. the Chinese one is by all accounts not that effective).

      And yes, I’m saying 95% less infection and 90% less chance of dying conditional on infection.

      If you want to not resume normal activity with those odds… well, I mean, it’s your call.

      • Geoff says:

        One more thing is that the individually reduced infection risk due to the vaccine contributes to the decreased baseline risk; it’s way safer in Israel (62% vaccination rate, 37 cases per 1M last week) than in Uruguay (35% vaccination rate, over 5200 cases per 1M last week). The case for vaccines is robust.

        On the other hand, Hungary seems weird. They had almost 3000 deaths per 1M in total, so 30-50% of their population had Covid-19, they have a 44% vaccination rate (though including Chinese/Russian vaccines), and they still had 83 Covid-19 deaths per 1M in the last 7 days.

      • TheZvi says:

        I think we have enough evidence to conclude the Chinese vaccine is much less effective vs. infection than the mRNA vaccines, based on such population-wide results.

  21. AnonCo says:

    >we would learn to use better precautions when researching and storing deadly viruses, which we should clearly do regardless of the true origin here (if you look at the precautions they were taking, they clearly weren’t sufficiently robust, and the history of lab leaks is long)

    Zvi, I see you as one of the top voices on the entire internet in modeling risk. I have seen other smart people make this same argument about the lableak that boils down to:

    -It doesn’t matter because we couldn’t do anything about it either way
    -We should be more careful with the labs.

    Why is everyone skipping the MOST OBVIOUS and important response and distinction if it was a lab leak? That is actually actionable and actually lowers real risk.

    Namely: If it was Lab Leak: We should just stop doing this research!

    There is mounting evidence that the Gain of Function research produces viruses like Covid19 that would never have evolved these capabilities naturally. Never = many orders of magnitude less likely. Astronomical.

    Given the appalling history of lab containment failures, Why is nobody saying: WE SHOULD STOP DOING THIS RESEARCH AT ALL!

    • TheZvi says:

      When I say ‘it doesn’t matter’ I mean more in terms of how we handle the pandemic once it’s out shouldn’t change much.

      Depends what you think we get out of the research, but yes ‘be more careful’ likely includes ‘stop doing gain of function’ or at least ‘if you do gain of function use stupidly more robust defenses.’ One could argue that such lab work has also stopped potential pandemics, but I’d like to see that made more explicit.

      My worry about diving too deep into what should be done for safety is that I anticipate the new rules and procedures mostly being counterproductive to research in general…

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