Covid 6/10: Somebody Else’s Problem

Logistics note: This week’s post includes some non-time-sensitive items from last week, including much of the section on the lab leak hypothesis, as my available time last week was limited. Also, I’ll be in NYC from 6/11 until 6/16, so if you’d like to chat, let me know – I promise asking will cost you at most zero points.

Covid-19 is not quite done with the United States of America. The Indian variant (“Delta”) delivering a ‘one last scare’ moment is plausible. But unless there’s a new variant that can escape from the mRNA vaccines and we are unable to respond rapidly enough, a possibility I now put at most at 10%, Covid-19 is mostly done with the United States of America. 

There are essentially three things left.

  1. Live life. There’s the question of how we can safely transition back to a normal life here in the good old USA, and what that new normal life will look like. This includes how worried we should be about potential future strains or issues of seasonality. 
  2. Rest of the world. Covid-19 is probably mostly done with the USA. Other countries without our vaccine access are not so fortunate. It is quite plausible that the majority of deaths from Covid-19 are in the future rather than the past. 
  3. Postmortem. There’s the question of how we can learn from what happened. We need to adjust our models of the world, and what methods we can use to make sense of it or change it for the better. We also specifically need to do what we can to deal properly with the next pandemic or other crisis. Thus questions like the origins of the virus and what to do about what seems like the absurdly terrible idea that is Gain of Function research. 

It is easy to view almost all of this as Somebody Else’s Problem. One could say, I’m vaccinated and can go live life, give or take a few medium-term mask requirements. If someone else in America isn’t vaccinated, one can decide they made a choice. We can leave others to prepare for the next pandemic and go back to not caring much about what is happening overseas. 

Or, if to one’s credit one wants to be or remain in the habit of caring about somebody else’s problems, one can balance such cares between all the various problems we have. There are a lot of problems out there. I do think the Covid-19 endgame, and how many people will end up vaccinated versus infected, is still for now sufficiently up in the air and still looms large enough to deserve attention. For better or worse, that might not remain true much longer.

Let’s run the numbers.

Predictions

Prediction from last week: Positivity rate of 1.8% (down 0.3%), deaths fall by 12%.

Results: Positivity rate of 2.0% (down 0.1%), deaths fall by 4%.

Prediction for next week: Positivity rate of 1.8% (down 0.2%), deaths fall by 9%.

Both numbers this week were disappointing. That happens more often than it ‘should’ given that deaths represent past cases. I expect the trends to mostly resume, but still one must adjust the expected future path a bit. There is a small chance this week’s numbers were outliers and we’ll see larger-than-normal drops next week. That’s also happened a few times.

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Apr 22-Apr 287521173160911104644
Apr 29-May 5943122014409714574
May 6-May 12826106913928554142
May 13-May 19592119412778113874
May 20-May 2661594812796313473
May 27-June 252783811704562991
June 3-June 97208179154312883

Disappointing progress, but mostly still progress. The rise in the West comes from California. I doubt it is ‘real’ but it does not seem to strictly be a backlog situation, so I don’t think it can be adjusted, any more than the South’s number is too low. I’m not convinced we got ‘ahead of ourselves’ the last few weeks given the drops in case numbers, and I expect deaths to continue dropping. 

Cases

DateWESTMIDWESTSOUTHNORTHEAST
Apr 29-May 552,98478,77885,64168,299285,702
May 6-May 1246,04559,94570,74046,782223,512
May 13-May 1939,60145,03063,52934,309182,469
May 20-May 2633,89034,69448,97324,849142,406
May 27-June 231,17220,04433,29314,66099,169
June 3-June 925,98718,26732,54511,54088,339

Total numbers (from WaPo) to put it all in easier-to-see perspective:

Those are disappointing numbers, with “only” an 11% drop in cases, indicating that it is likely we did get ahead of ourselves a bit last week. The Delta variant is still only 6% of cases, so it doesn’t yet explain the change. Presumably some of this is the continued lifting of restrictions, both officially and unofficially. 

Vaccinations

The recent vaccination stats are very good news. Previously, we had seen a very clear mostly-constant upward slope until early April, followed by a mostly-constant downward slope until the beginning of June. A sensible projection was that this trend would continue. Instead, we have a very hopeful upward trend. Alas, it is likely that this upward trend is mostly second doses rather than first doses, so it is likely this won’t be sustained.

If we can sustain even this level of vaccinations going forward, there’s little to worry about. Progress will be slower than we might like, but progress is progress, and we will get there. Mostly, vaccination efforts now shift to overseas, where there is a lack of supply.

Delta (Indian) Variant in the USA

Washington Post reports that it is 6% of new cases. This was so inevitable I haven’t even belabored the point. There’s a more infectious strain, so it’s going to eventually displace the old one. That’s how it works. If this causes cases to go up again for the ‘one last scare’ you get at the end of a horror movie, we will find out in about a month. 

Warning about the danger, Fauci called for more vaccinations, using this logic:

Other things we cannot let happen include death and also taxes. I can guess what Fauci is attempting to convey here, and I know what he is attempting to accomplish, but there is no set of possible (let alone plausible) actions that will prevent Delta from ‘taking over’ what is left of the pandemic in America, or anywhere else. That’s not how this works.

Living Life

(This assumes you’re vaccinated. If you’re not and you can be, go take care of that, I’ll wait. If you’re overseas and can’t, this doesn’t apply to you yet, and I’m sorry.)

You may not have had Covid-19, but the virus has still been living rent free in your head for over a year. Kick it out.

It is important to live and embrace life. It’s your life, and (pending heroic efforts to the contrary) it’s ending one minute at a time. If you’re vaccinated and in a place with the virus under control, go out there and live yours! 

That does not mean going back to your old life, if that’s not the life you want.

This is the time to take stock. Figure out where you want to live, what you want to do with your life and who you want by your side when you do it. Do things that matter, and things that bring you joy. Go on a trip, see the world, start a business, fall in love, start a family, go out and talk to people in person. And other neat stuff like that.

You’ll be asked to wear masks for a while. If you’re asked, wear them. It’s fine. 

If you are asked for much more than that, take your business and your life elsewhere.

That’s all there is to it. That does not mean forgetting what happened, or that it’s not important to learn from the experience and update our models, actions and precautions. It also doesn’t mean dismissing the situation overseas as a pure Someone Else’s Problem, or that keeping an eye on things every so often isn’t prudent – so long as it stops screwing up your life. 

Rest of the World

Control systems are powerful. Before I fully understood this, it seemed suspicious that Covid-19 was in a nightmarish range of virulence and lethality. Under that theory, if Covid-19 had been more virulent it would have been impossible to stop and we’d have all gotten it and moved on, if it had been less lethal we would have chosen not to stop it, and if it had been less virulent or more lethal we would have stopped it. So under this model, there weren’t that many configurations of (virulence, lethality) that would be worse than what we got unless both variables were much higher.

With a better appreciation for control systems, it is now clear that the range of configurations that result in ‘we adjust to remain stuck in limbo for a year’ was remarkably large. There were a lot of knobs humans could turn to contain things, and they could do so at different prevalence levels based on lethality. It would take quite a lot to fully break that equilibrium in either direction, and that did not happen until the vaccines showed up.

In the meantime, the vaccines are holding strong, but with the current Indian ‘delta’ strain the virus has become quite a bit more virulent and quite a bit more lethal, and any given nation’s ability to sustain countermeasures only lasts so long. Will control systems increasingly break in the other direction, with results far more disastrous than was possible earlier?

The numbers for the new variant are increases on top of increases for the English strain that inspired my claim that We’re Fucked, It’s Over. I am very happy that we outperformed the math on vaccinations, and that combined with the various warnings from lots of people collectively were a sufficiently self-preventing prophecy that it was not, in fact, over. It was closer than it looked, but we got there mostly in time, and instead of a huge final wave we saw a brief blip.

If we’d had to deal with another similar ramp up in virulence on top of that? We had moves left we could have used, such as fractional dosing, first doses first, approving additional vaccinations, finally rolling out rapid testing properly and shifting focus further to ventilation and away from surfaces, along with some amount of additional restrictions and marginal citizen behavioral adjustments. There’s some chance we wouldn’t have fully lost. But there’s (almost) no way we would have almost fully held the line like we did.

One counterargument is India.

It was a shockingly rapid hockey stick graph. It looked like India was potentially headed straight for full herd immunity. The hospital system broke down. Oxygen ran out. It was a disaster that looked like it would only get worse. 

Then the curve turned around, and cases started declining again. 

Thus, we have curves such as (one country per graph because scales are so different):

India:

Taiwan:

Japan:

Bahrain:

Then combine that with the levels for third world countries having previously stabilized at relatively low numbers. Conditions in India got quite bad, but that was largely a reflection of its lack of public health resources. Here’s the world, to scale:

And that same graph with deaths instead of cases:

India peaked substantially lower than North America or the European Union, and was barely higher than South America at the time. Yet it quickly reversed its trend, which I completely did not expect. If you think you could have predicted most or all of those last two graphs, I don’t believe you. If you can explain most of it in hindsight, that’s still a super hard problem. 

Some areas have so far managed to completely contain Covid-19 via lockdowns. That’s a super scary position to be in, with no immunity built up. What would happen at this point if there was a serious outbreak in China? With China’s vaccine not looking that good at preventing spread, it is probable China’s only option would be an extremely hard lockdown and hoping it was good enough. Australia’s vaccinations have been slow enough for a similar pickle. 

South America is quietly in a terrible situation, and that’s where we need to be rushing our vaccine doses at this point rather than India, provided they have the ability to distribute them. 

I’m less worried about other areas like Africa, because their control systems should have a lot of slack left given what we’ve seen so far. That doesn’t mean something like this isn’t scary:

…but keep in mind, also, this graph, and remember what happened in India:

Our continuing failure to scale up vaccine distribution remains a horrible scandal, but it’s also worth noting that the issues of distribution in many places are very real. Many third world nations got modest allocations of vaccine doses from Covax and proved unable to put those shots into arms. Handing over doses, on its own, will not always be enough, and that’s a problem I haven’t paid enough attention to. 

Zeynep cautions us that there is a real chance that the majority of Covid-19 deaths could come after we had the vaccines, or even after we had enough copies. In her Twitter thread, she is even more explicit. Her emphatic demand, that we do everything possible to gather every dose we can of any vaccine, and vaccinate as many people around the world as fast as possible, is clear and overdetermined, and we should absolutely do that. 

This is by far the most important remaining issue: Getting vaccines, any vaccines, out to as many people as possible, as fast as possible, until we’ve vaccinated the whole world. Period. Better vaccines (mRNA) are better if we have them and can deliver them, but any vaccine is far better than none. 

Where I don’t fully agree is with her warning that otherwise we are likely to see the majority of deaths after we had sufficient vaccine supplies (as opposed to most deaths being after we had the vaccines, which is simply true, because we had the vaccines in two days and could have easily confirmed they were safe and effective within a few weeks after that.) I agree that this is still possible if China loses containment. I do not think it is a favorite, but if I had to put a number on Covid causing 7.5 million confirmed deaths worldwide (roughly double the current level) I’d still put it at 15%, which is much higher than I’d like. However, I disagree that this is increasingly likely, because of the turnaround in India. When Indian cases and deaths were a straight line up, I would have put that probability much higher, at least 25% (but it’s hard to have a good post-hoc measure of what your probability of something was in the past, if you didn’t think about it explicitly at the time). Seeing things there not only stabilize but quickly start improving was very, very good news. 

And of course, the faster we finish the job, the less likely we are to face a variant that’s even worse than the Indian one, potentially one that requires a booster shot. 

Postmortem

A large percentage of these posts have been focused on postmortem. There is much work of this type left to do, and in particular the topic of the month can no longer be avoided.

It’s time to fully talk about the origins of Covid-19, and the lab leak hypothesis. 

I wrote a section about this two weeks ago. To close that section, I said I would do my best to not talk further about the question of Covid’s origin. 

My best was nowhere close to good enough. Too much new information has come to light and additional events have occurred, and with that plus time to reflect, it has become clear the implications are important. So here we are. 

(Summary of section from last time: I was 40% this was a lab leak of some kind, almost certainly like many other accidental lab leaks that have happened before, which would then have been covered up without need for a broad conspiracy. Press suppressed dissent, and has now been trying to quietly rewrite history. I’d been ignoring it because it seemed like finding out it was a lab leak would make things worse.)

Escape from the Lab 

The media’s stance, as far as I can tell, is now to deny that they ever treated the lab leak hypothesis as ‘debunked’ in the first place, while now calling it a ‘conspiracy theory’ and trying to claim it comes from Donald Trump, in order to make it impossible for anyone to be seen taking the hypothesis seriously, and also arguing that the political implications of investigating would be bad so we shouldn’t investigate. 

This has successfully kept all reporters who desire to have ‘credibility’ (as opposed to credibility) away from the story, and leads to exasperated reactions like this one:

Nate Silver notes the explicit bury-the-truth-because-politics argument (Link to Nature). I don’t know why Nate is surprised that people think that advocating for something for explicit political reasons think that doing so makes them ‘look good’ in the sense that they care about, given how things work these days.

This is an explicit call for scientists not to say true things or investigate questions, if doing so would be bad for science funding and/or for geopolitics. I do appreciate the explicitness, as does Nate:

Vanity Fair offers an account of what happened. Their story starts in straightforward fashion: 

It’s not clear how much The Lancet statement and other accusations of racism mattered, versus what was happening with Tom Cotton’s claims and the distortions of them (which this piece argues was central, and it documents the ways in which what he said was twisted around), versus worries about what Trump might do, versus stories told by defenders of gain of function research like Dr. Fauci or fears that our funding of it could look quite terrible, versus general media information cascades. The suppression of the lab leak hypothesis seems overdetermined. 

It’s also not clear how distinct those causes are, as the Lancet letter seems to have been organized and largely signed by those with a vested interest in gain of function research, before it was used as a justification for suppressing dissent on Facebook and elsewhere.

The Vanity Fair story is excellent, but very long. This passage also clarifies the situation:

Even if we take Shi Zhengli at her word, these are not the actions of someone who thinks that a lab leak is not a plausible explanation, or whose view of the safety of her work implies she should be allowed to keep doing it. 

Also, there’s this, which certainly feels like strong (although of course in no way conclusive) evidence.

The lab did at least allow for rapid sequencing of the virus, once the problem became clear, which seems completely distinct as an action from any ongoing research that might have been dangerous (including gain of function research):

Even now, places like the Washington Post are trying out various rhetorical ways to suppress and doom dissent, with one recent attempt being to associate it all, once again, with the Bad Orange Man. You see, this is all about ‘distracting’ from ‘Trump failures’ that actual no one (except Trump himself, probably) was still talking about. They warn about the dangers of a ‘false narrative’ of what happened, where all the blame for everything isn’t pinned on Trump, and thus anything that doesn’t do that must be a Trump op. Play into any other narrative, they say, and you’re helping Trump, who cares if your statements are ‘accurate.’ Classic stuff. Play the hits.

So, basically, they started out gaslighting us, then switched to gaslighting us about whether they were previously gaslighting us, while continuing to gaslight us further using different words.

They are also explicitly saying that when the truth conflicts with politics we should bury the truth, with explicit calls to scapegoat anyone who fails to do this.

Which was also the playbook on so many other issues.

Biden is launching an ‘official investigation’ into this, because he had no choice but to do so, but he is doing so by asking the people whose job it is to decide which secret things to keep secret because of ‘national interests.’ When they come back with nothing, I will update very little.

It seems that every day I see new individual data points that look highly suspicious. Some of them have plausible alternative explanations, while others are clearly suspicious people acting suspiciously. 

The American people are having none of it (YouGov).

(In other news, I took a poll to see what most people think most means in context, and most of them couldn’t agree on it.)

Not only that, 42% think it was created in the lab, and 24% of Americans think it was both created in the laboratory and then released on purpose, versus only 13% (!) of Americans buying the line that this was a natural mutation that occurred in the wild. 

Here it is broken up by education level.

But, of course, it’s not like pursuing this matters that much to people, as judged by Biden’s approval on the issue, which is quite good:

There is a correct answer to the question of Covid’s origins, from the perspective of those answering this survey, and it is: Not Sure. The confidence level that should be required to select something other than Not Sure in such a survey is highly unclear, but I can’t see how (barring having material nonpublic information) one can have sufficient confidence to pick an explanation, at this point. That’s especially true given the lab hypothesis gets split here into three subcategories.

The majority believing the lab leak hypothesis is probably true is new, but there have always been a lot of Americans who believed it, even when it was officially ‘debunked’ and being censored and suppressed across platforms. Here’s two Aella polls, from August 28, 2020 and then recently on May 25, 2021.

This seems like a very reasonable amount of updating on new information.

I’ve left a bunch of stuff out, because I felt it was bringing more heat than light, or there were plausible alternative explanations, or to keep length at a reasonable place. This accounting is nowhere near complete.

The question one must ask is, was all this new information more likely in the worlds where there was a lab leak, versus the worlds where there wasn’t one? Do most of the people involved in this know what happened any more than we do? Or is this all the kind of covering up and automatic suppression of wrongthink that would happen regardless of the underlying facts?

I mean, sure, stuff like this

…and that’s all true as far as it goes, but we already know China can’t provide better evidence than that or it would have already done so, so none of that is news

Mike Solana later fleshed out his views more fully here, documenting how deeply messed up the whole discourse around the lab leak hypothesis has been.

This (via MR) thread seems like a reasonable case arguing for a zoonotic origin for Covid-19. I don’t agree with many of its points, especially the framing that a lab leak requires lies upon lies and a very narrow path, but I do still see no strong reason this couldn’t have been zoonotic. 

Thus, I’m not changing my probability all that much. I’m now at something like 55%, up from 40%, now that I see more about how this all went down, but it could still easily have gone down either way. 

All right, suppose it did come from the lab. Does it matter?

Yes, quite a lot.

Here’s MR (with a quote from Ross Douthat) explaining some ways it matters. 

One big reason is it transforms our view of the pandemic, in terms of what stories various nations can tell themselves about what happened, and what it implies for international relations. 

Another big reason it matters is Gain of Function research, which on reflection seems increasingly like a completely bonkers insane thing to do, and also the need for better lab safety protocols in general.

Against Gain of Function Research

Whether we ban Gain of Function Research will be a key test of our civilization.

Even if we could somehow prove that Covid-19 definitely was a natural mutation in the wild and no laboratory had anything to do with it, that does not change the fact that doing Gain of Function research seems to be completely and utterly James Bond villain level insane.

The concept of Gain of Function Research is to take a virus that could potentially mutate or be engineered in a lab into a future pandemic or bioweapon, and engineer it into that new more dangerous form first, in the lab, so we can learn from it. 

Regardless of the origins of Covid-19, here’s the Wikipedia article, this is totally a thing we actually do and not the prelude to a new posthumous Michael Crichton novel. 

If you want to make a new vaccine to stop a deadly pandemic, normal procedure requires careful phased trials and years of study. Getting approval to release it into the wild took ten months and that timeline was considered a major miracle.

Making a new potential pandemic in the first place requires, well, let’s quote Wikipedia:

Some forms of gain of function research (specifically work which involves certain select agent pathogens) carry inherent biosafety and biosecurity risks, and are thus also referred to as dual use research of concern (DURC). To mitigate these risks while allowing the benefits of such research, various governments have mandated that DURC experiments be regulated under additional oversight by institutions (so-called institutional “DURC” committees) and government agencies (such as the NIH’s recombinant DNA advisory committee). A mirrored approach can be seen in the European Union’s Dual Use Coordination Group (DUCG).

Importantly, the US and EU regulations both mandate that an unaffiliated member of the public (or several) be “active participants” in the oversight process. Significant debate has taken place in the scientific community on how to assess the risks and benefit of gain of function research, how to publish such research responsibly, and how to engage the public in an open and honest review. As of January 2020, the United States is convening an expert panel to revisit the rules for gain of function research and provide more clarity in how such experiments are approved, and when they should be disclosed to the public.

Does that make you feel better? That there’s an ‘unaffiliated member of the public’ present? Or that we’re gathering an ‘expert panel’ to reveal exactly when such experiments should be disclosed to the public, which implies they often aren’t disclosed? 

The steelman of the other side is that the information is valuable enough that it is worth the risk. Why don’t you take it away… Dr. Fauci? Is that you? Huh (original op-ed)…

Yep, it’s him, arguing explicitly that we should engineer deadly viruses that could evolve in nature, with the stated goal being to better be able to identify them should they evolve in the wild, giving us more time to respond. 

I’ve also heard the similar argument that another lab might engineer such a thing as a bioweapon, so in order to know what we might be up against and plan against it we need to engineer it first, which is totally (1) exactly how the world is going to die from an AGI if we don’t stop being this level of grade-A stupid, (2) being done under conditions whose track record of accidents does not, shall we say, inspire confidence, (3) exactly how someone tricks you into making it so they can steal it out of your lab, have you not seen any movies or shows, like, ever, and (4) exactly what someone making a bioweapon in order to have a bioweapon would say. 

If the argument is purely to defend against a future pandemic, then (1) yeah given how we safeguard such things it’s still exactly how we are going to die of an AGI if we don’t stop being this level of grade-A stupid, (2) being done under conditions whose track record of accidents does not, shall we say, inspire confidence, (3) exactly how someone tricks you into making it so they can steal it out of your lab, have you not seen any movies or shows, like, ever, and (4) exactly what someone making a bioweapon in order to have a bioweapon would say. 

That alone isn’t definitive proof we shouldn’t do it. One can imagine a world in which our safeguards are good enough, and the threat of a natural pandemic bad enough, and the ability of such research to help us prepare for and prevent that pandemic sufficiently stronger than our alternatives, that (with some sufficiently strong level of precautions) we should go ahead and do it anyway. 

To be clear, ‘some sufficiently strong level of precautions’ is something like ‘do it in Antarctica and the quarantine for leaving a 100-mile radius around the lab is a year or more,’ not ‘do it in China next to a city but have additional protective equipment and a second observer present.’ 

Can you imagine the ‘environmental impact statement’ involved if these risks were being taken seriously? Can you imagine getting ‘informed consent’ from everyone put at risk (by which we mean, actual everyone)? How is this remotely consistent with how we handle potentially dangerous decisions in other realms? 

We literally couldn’t put a few enthusiastically consenting 18-year-olds into a room to find out how Covid-19 actually spreads or whether our vaccines worked, instead choosing to lock everyone up for a year doing an unknown mix of some of the sensible actions combined with a bunch of superstitious nonsense, and you think making the virus that could infect us is the low-hanging fruit that makes sense?

Also, at this point I have zero faith that if we decided on reasonable precautions that were actually reasonable if followed, that those procedures would get followed, even by those who said they were following them. There would also be those who saw this as permission to do the research without even saying they would use the precautions. Either you ban this, or you don’t.

A sane civilization could reasonably decide that pandemics are a really big deal, and we are willing to take big swings and accept big risks in order to prevent or contain them. Such a sane civilization would be investing billions in pandemic preparedness across a variety of fronts, including building vaccine manufacturing capacity and laying the groundwork for rapid experimentation and human challenge trials. We’d have plans in place to detect a new pandemic as soon as possible, to implement testing and tracing, and to get vaccines going, and we wouldn’t (as we in fact did in 2019) cut what little such funding we had the moment we had a budget to balance and several years of quiet. Not only did we put a level-4 biolab in Wuhan, we then cut the funding that would have let it actually do its job.  

As it is, even if this gain of function research was fully successful at getting us the information it is looking for, with none of the downside risks, what would we even be able to do with that information? Do we have any examples of gain of function research doing us any good and helping us stop a pandemic? 

If we’d taken care of such matters first, both establishing benefits and establishing that we’re taking all (or at least most of) our free actions, then I’d be willing to entertain a cost-benefit analysis on research of this type, and whether we could figure out reasonable precautions.   

As Scott Sumner puts it, which lab is responsible matters little. As does whether a lab was responsible for this particular incident. What matters is that this is a crazy thing to be doing that is likely to get a lot of people killed at some point, and it must stop. 

If we do manage to ban gain of function research, that will give me at least some hope that we can take reasonable actions some of the time. At a minimum, directly after a pandemic that shut down the world for a year, we are capable of stopping people from intentionally creating the next one and hoping it wouldn’t fall into the wrong hands and that there wouldn’t be an accident, despite a long history of accidents, and an unknown history of falling into the wrong hands (since many of those wrong hands would not talk about it or do anything we’d yet know about.)

If we don’t manage to ban gain of function research, even after everything that has happened, then that’s quite a reason to lose hope. It’s not only about letting labs go ahead and create the next pandemic or bioweapon. How would we possibly hope to ban dangerous AI research in the future, if we failed at this much easier problem? How would we ever get anything worthwhile done?

I do not expect us to pass this test, but I don’t think our failure is inevitable. I have wide error bars on this, but if I had to guess I’d give us a 25% chance to effectively ban gain of function research by the end of 2022. 

Suppose we do fail, and gain of function research continues. What’s the plan then, other than ‘hope the actual gain of function research turns out non-disastrously’?

That’s a good question. I don’t think the answer is full despair. We ban lots of things for stupid reasons. If we can’t ban (or render sufficiently toxic that it’s an effective ban) the things that need banning for smart reasons, the ‘get others to do it for dumb reasons because we have our own smart reasons’ plan does not seem obviously doomed. It’s likely actively harder than banning purely for dumb reasons, because people with power will be worried that there might be smart reasons or that others might think they cared about such smart reasons. That’s unfortunate, but it still might be better than the alternative.

We could also use what time we have to try and fix the fundamental problem, by building up new mechanisms for changing public opinion and/or elite consensus, or otherwise reforming how things work. Things might be broken now but that doesn’t mean they have to stay that way.

The next fallbacks after that are rather ugly, and deserve longer treatments, so I won’t go into them here. 

Credit where credit is due, such as to the Cambridge Working Group that has been fighting to stop this:

Here’s Kelsey Piper, who has also been advocating against this for a long time.

There is the worry that things could go too far. This thread explaining what virology is comes from a place where the author is noticing calls for banning virus research entirely, and feeling the need to explain that labs need to experiment on real and dangerous viruses in order to learn how they work. If ‘study of existing function’ research gets shut down, that would indeed be quite bad. If a bunch of people who can’t tell the difference call for it anyway, the same way there’s been extreme reactions against nuclear power, that could be useful as a way to motivate better safeguards, but mostly that would be something we’d have to put up with and quietly ignore, since we can’t stop studying viruses. Then again, we also couldn’t stop using nuclear power without releasing an epic amount of extra carbon into the atmosphere, which people think is kind of a big deal, and yet here we are. So it’s a concern.

In Other News

Biden has announced we are buying 500 million doses of Pfizer to give to other countries. A good start. Better late and insufficient than never.

The J&J pause was so disastrous we now have to worry about doses expiring (WSJ).

Moderna outright knows that fractional dosing works fine, and plans to use it on any future versions of the vaccine, but for now we continue not to use it, wasting a large percentage of our capacity (MR). What the mix here is of regulatory concerns and profit maximization is unknown, but my guess is it is mostly or all regulatory.

FDA approves an Alzheimer’s drug, aducanumab, that its own advisory board did not want to approve, and which everyone whose judgment I respect that has weighed in on this says probably doesn’t work, as in

Standard explanation is that this is the FDA caving in to lobbying from patient groups and justifying it based on transparent statistical manipulations. You know what? In principle, I’m totally fine with that. Provided the drug is safe, which no one seems to be challenging, why should we deny it to patients that want it? 

A fine answer is ‘it costs a lot of money and because of health insurance the rest of us will be paying for it.’ Given how much they are charging for the drug (which, in our current system, is pretty much ‘whatever they want’ because of various reasons) this could get quite expensive:

I gotta say, statements like this, at this point, mostly make me giggle:

Cause, I mean, sure, fair, absolutely, I hear you all the way, but seriously, after everything that’s happened, this is where you draw the line? How did you miss all the previous memos?

When mask guidance isn’t based on physical reality, what to do?

Fractional dosing of AZ to be tested in Brazil (MR).

Some small signs of progress on rapid testing (MR).

Texas hospital suspends 200 workers for refusing Covid-19 vaccine. This seems obviously good and right. Governor has vowed to stop this sort of thing, so we’ll see how that goes.

Indian village refuses Covid-19 vaccinations and also payment of their power bills, power is shut off. Given how big a shortage of vaccines India has, the reaction seems more than a little extreme, but at some point the electric bill does have to be paid.

Thread of reports of people being charged (<$100, but still) for the Covid vaccine.  

United Airlines joins Delta, won’t hire new unvaccinated workers. I recently hired someone without asking about their vaccine status, but I’m very confident they’re vaccinated, and also I’m not an airline. Asking seems massively overdetermined.

CDC attempts to scare adolescents by claiming hospitalizations among them are rising are blatant lies. The charitable interpretation is that adolescents are a larger percentage of hospitalizations due to who has been vaccinated so far, which is true, but that does not seem like the relevant data to any decision one might make.

FDA Delenda Est News

It seems this happened:

I mean, it sure does look like it (study):

This seems completely bonkers. Why would one actively request a shift from measuring actual infections in the lab to measuring patient reported symptoms? That seems designed to introduce extra noise and ensure that the efforts fail, and likely to have a large chilling effect on future research. 

As in, in the phase 2b trial results quoted below, they measured both, and found the ‘patient reported infections’ number didn’t have sufficient power, and then forced them to switch to that metric for phase 3:

This was sufficiently flagrant ignoring of the advisory committee that two of its members resigned. Seems a lot like the FDA is picking which things it wants to approve or disapprove for reasons other than ‘following the science.’ 

It’s worth noting that 20% of the time the FDA ignores the advisory panel, but it’s almost always the panel saying to approve and the FDA refusing, which it seems does not lead to protests and resignations. This provides clarity on the dynamics involved.

What does ‘following the science’ mean to these doctors? It means following the FDA:

It’s a ‘completely separate issue’ whether or not to offer a drug (that costs $56k/year) to patients, versus whether to approve the drug, you see. Once it is ‘approved’ then ‘ethics’ demand that the drug be offered, and that the rest of us pay the price, even if you think the drug does not work. That tells you what people mean when they talk about ‘the science’ and it’s not making an accurate physical model of reality.  

Not Covid or the FDA, But Relevant To My Interests

538 looks back on its 2020 election predictions, no great new insights, but linking because of my ongoing interest in predictions, prediction markets and modeling. As I’ve said before, I think the criticisms of 538’s forecasts and claims that the markets outperformed it were misplaced, and Nate’s public analysis is accurate as far as it goes, but I worry that his public analysis is superficial and fails to ask the important questions.   

Wizards of the Coast bans Time Warp in Historic, which makes me sad without actually accomplishing anything. Completely missing the point. Morale will not improve.

Tyler Cowen asks whether gambling and prediction of outcomes in sports should be distinct from the operation of the sports themselves. I think Tyler is right to be concerned, but is concerned about the wrong things. The biggest thing I worry about is actually the advertising. Unifying the NBA with NBA betting would mean more and more obnoxious pressure to convert fans to gamblers, making the experience of watching or attending a game worse – I love a good gamble but the advertising of gambling (including fantasy sports) is obnoxious at best and usually highly toxic. Soccer has gambling websites getting placements on jerseys, which is where this ends. 

Concerns about integrity seem reversed, as bookmakers highly value the integrity of their events. Concerns that leagues might create more gambling events via offering more exciting games also seems reversed, as the reason that creates more gambling is that it creates more excitement and fun. Regular seasons of endless mostly pointless games aren’t good, and our choices are to either make the playoffs harder to reach in order to give those games meaning (which isn’t going to happen), use relegation to give those games meaning (which is going to happen even less), or play less such games and/or more games that have other things going on. 

The other big thing to worry about is modification of the sport or how the teams play it. Nascar has effectively butchered itself in the name of creating exciting events within a game, with lots of catch-up mechanics that seem good for board game night but render the idea of the first half or more of the event being a true ‘race’ somewhat moot. I’d worry about media breaks and play structures being moved around to accommodate more live betting. I’d worry about more catch-up mechanics designed to prevent blowout games from losing interest, but then again it could also mean you wouldn’t need them if you were fighting over the halftime line or point spread – remember the famous line “there’s still some business to be decided.” 

I’d also worry for the gamblers. Prices are likely to be much higher, and practices generally less customer focused, with the leagues running the show. 

Mostly though I think the whole thing is good. Capturing much or most of the revenue from gambling will make sports more profitable, which will result in reasons to have more teams, more leagues, higher pay all around and higher quality play. There will be that much more reason to give a better experience to fans rather than a worse one, since fans are now more valuable. Teams asking for public subsidies for stadiums or otherwise can be told where to go. That’s even more true at the college level, where being a bookmaker can enable schools to pay the players and make sports do a better job funding the university rather than being a money pit. 

Finally, there’s an interesting post out on better crowdfunding (dominant assurance contracts) that I hope to respond to with a full post later this cycle. 

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40 Responses to Covid 6/10: Somebody Else’s Problem

  1. Humphrey_Appleby says:

    Zvi: a comment on rate of vaccinations. The uptick in daily doses does look promising at a first glance, but note that this is NOT accompanied by a rise in first doses (which the CDC also tracks). However, there WAS an uptick in first doses ~3 weeks ago when the 12-18 year old crowd became eligible. So I think this week’s uptick in total doses is just the 12-18 year olds getting their second doses, in terms of people initiating vaccination, we are looking at a continuing slow slide.

  2. Humphrey_Appleby says:

    Do you have any insight into relative risk of `Delta’ to kids under 12? There was some scare about this with `Alpha’ but I think it turned out to be a false alarm. But `Delta’ is more severe. Have you seen any data?

    • TheZvi says:

      I have not seen any specific data on that question but on priors there is no reason to think that relative risks have changed, and every reason to think that if they do change there are people who will notice and be loud about it. Keep in mind that if kids 12 and under faced 3x previous risk, that’s still very tiny risk relative to older age groups, and is similar to the effect of them being 4 years older.

      • Humphrey_Appleby says:

        Yes, as long as the `3x’ risk comes from uniformly shifting the age-adjusted risk curve up, that’s still very tiny risk. The thing to worry about is if we were not looking at a uniform shift – but I guess I agree about `every reason to think that if (this does happen) there are people who will notice and be loud about it.’ Thanks.

  3. JSK says:

    On the virus origin poll, I’ve been firmly in column red (accidental release of a virus which evolved by zoonotic means) for over a year, though recent news has made that less firm. There were three factors there:

    – Zoonotic evolution: An analysis that was (I think) before the imposed consensus came down, examined the DNA of the original Wuhan strain and concluded that gain of function was extremely unlikely and the results looked completely in line with previous bat strains seen in other provinces.

    – Lab release: The prior in favor of a lab release was enormous. There is one lab of BSL 4 in all China, and less than 1000 labs of BSL 3+. There are at minimum tens of thousands of markets of the kind that the ‘purely zoonotic’ release supposedly came from. If there was no lab involved, the prior for origin in Wuhan was tiny, 1:10,000 against. If there was a lab involved, origin in Wuhan was the most likely candidate, from around 4:1 if you think a dangerous release should definitely be from a BSL4 lab to closer to 1:100 if you think a BSL3 lab is nearly as likely as a BSL4. Wuhan being the first detected source is at least a 100:1 update toward a lab release.

    – For the Wuhan lab specifically: Released internal cables from the US State Dept. from IIRC 2019, where a US sceintific observer expressed concern that the Wuhan lab was not actually following any of the safety procedures and was routinely exposing their scientists to bites, scratches, etc. from their animals; an accident waiting to happen. Though, again IIRC, the same release of documents also showed no deliberate gain of function research was taking place there at the time.

    The recent blowup about suppressing evidence has given me some doubts about whether that first virus analysis was truth-tracking or political. I wasn’t paying close attention to the political winds then (or ever) and it was shared as a Twitter thread so I don’t have it acessible now.

  4. Seb says:

    Have you played against Jeskai Turns in Historic? Absolutely miserable.

    What would you have done if you were the B&R guy?

    • TheZvi says:

      Banned Brainstorm for sure, then something to further hurt Jeskai Turns that would be more targeted than Time Warp. Could be convinced to do either big red spell, at least.

      • Seb says:

        Brainstorm DOES seem to be too powerful. Though I’m playing mono black aggro with hand disruption, so Mizzix into Time Warp is the play that makes me scoop.

        By the way, I’ve never commented but I followed you here from Coolstuff simply because I loved your 3 or 4 Stompy articles and those were the basis to my favourite recent decks.

        Thank you for all that you do here. I’m a historian of science who now works for a major bank and this has been an excellent source of good data and analysis for me. I truly can’t thank you enough. If you’re ever in Toronto for any reason, I’d love to buy you a drink or a meal!

  5. Chris says:

    Too bad Trump isn’t in office anymore, we could hear all about how he pushed FDA to approve aducanumab for profit since he owns a mutual fund that owns shares in Biogen.

    • Anonymous-backtick says:

      Hey, at least now that that particular side of the moral panic is over, this blog has gone back to *not* fearfully pulling its punches.

  6. sbyrnes321 says:

    In I think summer 2020 George Church tweeted a link to this (superficially-sketchy-looking) lab-leak document – https://www.independentsciencenews.org/commentaries/a-proposed-origin-for-sars-cov-2-and-the-covid-19-pandemic/ – with the “Mojiang Mine” theory. I’m totally unfit to judge it, but whatever, I’ve always liked it :-P Of course I heard nothing else about this theory for a whole year until like two weeks ago, and now it’s in the news. This theory is notable for *not* involving gain-of-function research. Instead there was some poor miner who was sick for four months in 2012, and the theory is that COVID evolved into its human-compatible form during that four-month period, inside his body. And (of course) samples from his body were brought to WIV and put into storage…

    Well, anyway, I might suggest that *not only* should we ban gain-of-function research, but we should *also* talk about banning laboratories from storing and studying samples of brand new zoonotic viruses which never had an opportunity to widely circulate among humans because patient 0 was successfully isolated. (Or patients 0,1,2,3,4,5 in this case.) Hey, maybe let’s ban experiments on smallpox and Spanish flu while we’re at it.

  7. Curious says:

    Zvi, any insight about the recently published evidence that Covid-19 accelerates biological aging?
    https://www.mdpi.com/1422-0067/22/11/6151

    I don’t understand what mechanism is supposed to be causing this, if it is simply a result of damage from having symptoms, or if being asymptomatic and infected can cause this. Depending on the mechanism, couldn’t the mRNA vaccines also have a chance to cause this effect?

    • TheZvi says:

      Quick take: This implies a *huge* *permanent* boost to the death rate of infected individuals from all-cause mortality, especially from cancer, so one can test the hypothesis that way. Huge if true. It also implies that biological age is highly sensitive to infections (of various kinds) based on their reasoning, which implies in turn that age is highly changeable, and we should be funding ways to do the opposite quite a bit.

      In terms of the vaccine, no, there’s zero way that ‘immune response to something’ can do this, that doesn’t make sense, and even if it did, the mRNA vaccines wouldn’t do it in worlds where other vaccines didn’t; once again that seems like pure FUD based on the biological situation. Nor can ‘biological reaction without symptoms’ be a class that does this kind of damage in general, because then everyone would be dead much sooner. Et cetra. So this is claiming a *gigantic* effect in symptomatic cases that defies reasonable belief.

      My guess is their markers aren’t doing what they think they’re doing.

  8. Adam Brown says:

    By my calculation, the average reproduction rate of COVID in the US since the first lockdown began is R=1.058. That is, as you say, impressively close to the “critical” value of R=1. Interestingly, pandemics are not the only systems that “self-organize to criticality”, there’s actually an entire scientific field about this phenomenon and how biological systems make use of it:

    https://en.wikipedia.org/wiki/Self-organized_criticality

    (Showing my working: 14,900 new cases today, 400 on the first days of lock down, 64 weeks since lockdown began, reproduction time of 1 week -> R = (14900/400)^(1/64) = 1.058.)

    • Eric fletcher says:

      That is… not how R works. If you did that calculation from a different start and/or end date, you would get wildly different results – so you inadvertently cherry-picked numbers that happened to come out close to 1.

      A more proper calculation is
      First US case: ~Week 1, 2020
      Now: Week 23 of 2021, so 75 weeks later
      Total US cases: 33.4 million (using the number Google gave me)
      Average R = 75th root of 33.4M = 1.26

      I could be wrong about my method being correct or even reasonable.

      • Adam Brown says:

        Cherrypicking the dates will make less difference than you might imagine. E.g. if you somehow convinced yourself it was fair to cherrypick the end date to be the peak day of the US pandemic (8 Jan 2021), you’d still get = (251k/400)^(1/43) = 1.16. That’s still pretty close to 1.

        And cherrypicking dates (or taking the average in the way you propose, which locks in the cherrypicking) misses exactly the point that this statistic is meant to illustrate, which is that there is a “control mechanism” or “self-organization” with a multi-week delay that ensures that even if fluctuates away from 1, it is then driven back towards criticality R=1.

  9. Hello m'RNA says:

    Hey Zvi, how can I check whether I’m in the unlucky 5-10% of people who didn’t develop a reasonable level of immunity after getting the mRNA vaccine? What should I do in case I’m in the said unlucky group?

    BTW, do you have any opinion about the claims about the suppression of ivermectin use and vaccine controversies? Bret Weinstein and his guests seem quite credible and don’t qualify as conspiracy theorists, through they may obviously be wrong:

    • TheZvi says:

      I notice that the majority of my “what do you make of this claim by this person who doesn’t seem like a conspiracy theorist’ claims, across many different types of claims, come from Bret, and he uses exclusively video format which makes engaging expensive. His vaccine comments in particular have made me more inclined to dismiss him as endorsing every theory of a certain type he can find that has a superficially plausible advocate he can talk to, rather than him thinking critically.

      In terms of Ivermectin, I have not investigated the science on that, and don’t have a position either way. I encourage others who have the time to look into that and form their own opinions.

      For checking immunity, if you want to be paranoid you can get antibody tests, with the caveat that doing so involves enough noise that it will cause a lot of stress for no reason in many worlds. I don’t think there’s a reasonable way to do better than that.

  10. Matty Wacksen says:

    “Yet it quickly reversed its trend, which I completely did not expect. If you think you could have predicted most or all of those last two graphs, I don’t believe you.”

    Idk – if you’re stuck in a SIR-type model where infection rates are constant and things like “virulence” are well-defined then sure, the slowdown in India is surprising. On the other hand, if you take into account that
    (a) the situation in India was about as bad as anywhere else in terms of anecdotal evidence regarding how many people were actually infected.
    (b) the official numbers coming out of third world countries are *not* random samples and subject to all kinds of weird effects.
    (c) regression to the mean exists

    then things like “the official numbers change completely” don’t catch you by too much surprise. My prediction for Uganda, btw, is that we don’t see crazy exponential growth, I’m happy to make bets on this. What such numbers are driven by I do not know, but it may well be something like “how many rich people decide they want a test”, Africa (w/ exception possibly of South Africa and possibly some regions of North Africa”) is almost certainly at something like “herd immunity” (whatever it means) by now, and large growth is probably mostly spurious. I don’t claim to have predicted things, but “unusually large growth followed by less growth” is really not surprising at all.

    • Matty Wacksen says:

      With “about as bad as anywhere else” I mean that it was about as bad as the worst cases of large scale outbreaks we have seen, suggesting that it would be very unusual if it got worse in India.

    • TheZvi says:

      I do not think ‘whether people get tested’ does as much work as you seem to think. Yes, it obviously matters, but deaths will tell the story, and even if they also miss those, eventually excess deaths become a thing – exponentials will erase any such things in the end if they get big enough.

      India didn’t actually get worse than other places that didn’t rebound, before rebounding, and turned around on a dime; I don’t think you can say this was easy to see ‘on priors’. I do agree with you on Uganda at this point, as noted.

      • Matty Wacksen says:

        > I do not think ‘whether people get tested’ does as much work as you seem to think.

        It isn’t as much “whether people get tested”, but “who gets tested”, especially in highly non-uniform countries like India. It doesn’t make sense to talk about “people” in general here.

        >Yes, it obviously matters, but deaths will tell the story, and even if they also miss those, eventually excess deaths become a thing – exponentials will erase any such things in the end if they get big enough.

        I don’t think we had good deaths or excess deaths statistics for india, but correct me if I’m wrong. Exponentials only make sense when exponentials make sense, and it isn’t clear to me whether there is a good case for “covid-19 spread” following exponential trends anywhere. Did we ever see something like “100% excess deaths” anywhere?

        >India didn’t actually get worse than other places that didn’t rebound, before rebounding, and turned around on a dime; I don’t think you can say this was easy to see ‘on priors’.

        I don’t understand what you are saying. Just based on anecdotal evidence from Indian people, it seems like covid-19 was *very* prevalent there, much worse than in many other places. I don’t see any evidence it “turned around on a dime”; I mean we’re talking about something as flimsy as “official covid-19 numbers” when really what we care about is “number of people infected”, can we at least acknowledge that these differ probably by at least an order of magnitude?

      • Humphrey_Appleby says:

        Matty Wacksen: Clearly COVID did crash the medical system in India, but this could be done with case loads much smaller than have been seen at various times here, just because of much lower medical system capacity. So crashing the medical system does not in itself establish that case loads were higher than (say) New York in early 2020 or Los Angeles in January ’21. Anecdotal evidence does suggest that COVID was extremely prevalent for a while, but the same applies to anecdotal evidence from e.g. New York in April 2020, or Los Angeles in January 2021. So I don’t see how you can conclude that it was much worse than has been seen elsewhere (in terms of caseloads). It might have been. Or it is possible that case loads topped out well below New York April 2020 levels, and the medical system collapse was more a function of limited system capacity. I don’t think you can say at the moment. Eventually excess death data will tell.

      • Matty Wacksen says:

        @Humphrey_Appleby: “crash the medical system in India” is a *massive* oversimplification of what happened; India is after all a country of 1 billion people. There were a couple of concerning things that happened in some places, but I’m not familiar enough with India to claim to have a clear picture. But media in general is far less accurate in poorer places, and therefore the situation is much less transparent for outsiders.There is less of a paper trail, and people don’t talk to journalists as much.

        It’s a bit hard to spell out my thinking exactly, but I think you’re wrong. All else being equal, I’d expect large cities in India to be the kind of place where diseases spread more effectively than in (say) NYC, and you’d also expect it to get a bit worse. I hate to say “control system” here because it’s not obvious to me that the “control system” is to blame and not some other factor like “the SIR model is dumb, correctly taking into account heterogeneity and sparse social networks would give far more accurate results”, but whatever it is that stops SIR from being accurate I’d expect to work slightly worse in India. So it would be quite surprising if actual case loads ended up being less than those in NYC. I also think that the media focuses very heavily on places like NYC or LA, if your anecdotal evidence is from the media then I think there are obvious selection effects going on.

        I don’t think excess death statistics will tell us much, because even if they are accurate, I don’t think excess death statistics are as useful as everyone thinks.

  11. Craken says:

    Approving that Alzheimers drug creates an obscene moral hazard: why should pharma companies work hard to find effective drugs when ineffective ones deliver huge profits? And this is a drug for people who are by definition cognitively impaired. They can’t understand that it’s ineffective. The only excuse for this is to transfer money to the pharma sector to finance real research. But, will that happen instead of moral hazard? Even if it did, they are corrupting the scientific process in making this payoff. Just do a federal grant instead.

    The defining characteristic GOF research is that it is dual use. I think the deep state decision makers are perfectly cognizant of this fact. Further, I believe this is the motivation for partnering with China–a natural geopolitical competitor–on this research. I suspect this partnership is intended to convey this message to the Russians: we also have bioweapons capabilities in addition to superior biodefense capabilities. We know from defectors (eg, Ken Alibek) that the Soviets supercharged their bioweapons research and development program in the wake of signing the Biological Weapons Convention in 1972. At the least, the Russians retain the impressive capabilities Alibek outlined based on his work through the late 80s. Given rapid biotech advances since that time, with modest effort they could have further enhanced those capabilities. The Sino-American partnership in this area may be intended to create mutual transparency on these proto-bio-weapons. I have no idea if that’s a reasonable expectation, considering that biolabs can be quite small. Nuclear weapons programs cannot be concealed from competent observers, but bioweapons programs can be–the Soviet program was concealed until after the fall.

    Those polls on Covid origins show how uncomfortable agnosticism is for most people and how overconfident of their sources most people are. Most info sources are fatally defective in multiple ways. Imagine coming to believe the least likely scenario, that it was both created in the laboratory and then released on purpose. This is mostly a kind of tribal rebound effect against the endless lies of the mainstream (mostly Democrat owned) propaganda sources. The postgrad group has the highest adherence to mainstream propaganda doctrine. These are people who are proud to read and recite such propaganda to their ingroup of other postgrads–most postgrad degrees do not require a high IQ, much less epistemological sophistication. A million (!) of these degrees are awarded yearly. If these postgrads were Americans chosen purely based on IQ (not close to the case), the minimum IQ would be ~108; it’s a bit higher in reality due to foreign students.

  12. I’m a bit alarmed by the heightened emotion around the lab leak discussion. I can almost read the palpitations through the lines. Are you OK?

    You dislike the media, so why would you want to encourage them by playing the ‘story’ game? Surely, it doesn’t matter what story who will be able tell. Anybody can tell any story they want. Facts have never gotten in the way. Here are the facts as I see them – as certain as anything barring major lies or incompetence.

    1. Virus with certain unfortunate properties of virulence and mortality caused the pandemic as we know it. It was not a hoax, not invented to let Bill Gates implant chips in us, etc.
    2. The virus was first identified in China and almost certainly originated there.
    3. In reaction to its spread, China introduced draconian, often inhumane, policies of containment and mostly succeeded in getting life back to normal even without vaccines within a few months.
    4. Several other countries managed to do the same (with more or less draconian measures – less in absolute terms, more relative to the usual measures they take), most others did not. The impact of the virus varies in not yet understood ways among the countries that didn’t successfully contain it – ebbing and flowing with seasons, waves and mutations.
    5. Vaccines were developed and some work better than others but all work better than no vaccines. Some countries – UK, US – later EU – were able to deploy them swiftly and are on the same track as China in getting back to their normal.
    6. Future is unknown but looks like it will take at least one more year for things to settle across the globe barring new more virulent and/or vaccine-evading mutations. We should help it along by giving away billions of vaccine doses.

    That’s the “story” as I see it. I don’t see how it can be told in any other way with or without the lab leak being true.

    Lab leaks happen. Pandemics happen. Most pandemics happen without lab leaks (in fact, most of them happened before labs existed). Most lab leaks don’t cause pandemics. Most likely no lab leak has ever done so but it is possible one will do so/has just done so. Lab leaks happen where there are labs: in the US, Europe, Russia, China. The chances of any one lab leak causing a global pandemic are tiny but if one does, it will be as part of a random collection of circumstances that will lead to a chain reaction. We will then tell a story about how a feature X of the system is at fault. This story will amplify whatever prejudice we can graft onto it bolstered by no end of facts, conspiracies, conversions, all the usual things that typify the corrupt epistemology that is the media. So it goes. But why would you want to be a part of that?

    Also note that in one breath, you call for less and more regulation. Less of regulation of vaccines by the FDA, more of GoF research by, presumably, the FDA or some global version of it. But the bad vaccine misregulating FDA is the result of this once reasonable call for a good Gain-Of-Function regulating FDA. Overall, I’m all for regulation but not as a precautionary principle for rare events. Regulation is a necessary part of a complex society both for good and for ill. But regulation will never prevent black swan events just like ethics boards don’t prevent unethical behaviors and the balancing of government budgets is not achieved by eliminating government waste!

    The Chinese should have more lab security, gain of function research should be more scrutinized, we should have better processes for rolling out vaccines. Nobody should EVER kick a puppy. But there WILL BE another pandemic. In one hundred years or fifty or five. No story we tell about it now or regulation we put in place will change that. Complex systems have their attractors. One of the attractors of the complex bio system driven by natural selection in which we live are pandemics. Sucks to be us.

    • TheZvi says:

      I am fine. I can see how you could interpret my statements the way you did, but seriously I’m not even surprised (or impressed) at this point, I’m simply laying out things I think are important to note. I agree that the core ‘story of the pandemic’ mostly doesn’t change either way, which is why I waited until recently to talk about this, and why I’m not going deep into the biology at all.

      And yes, one is allowed to call for “more” and “less” of something as broad as “regulation” at the same time, when my “more regulation” is “stop intentionally producing deadly viruses,” that seems entirely reasonable to me, and doesn’t seem like it should translate to “require endless red tape to approve a vaccine” to get it, or anything? There isn’t one knob to turn here or anything like that. Nor does ‘eventually things will go wrong’ change whether we should try to make that less likely or happen less often.

      I do think there’s a clash with the Alzheimer’s issue vs. the vaccines, but that’s mostly a matter of the purchasing system being so broken that approval means paying infinite money for a drug of this type – if you’re going to make approval=payment, then mostly I blame whoever did that, but…

      • danohu says:

        “the purchasing system being so broken that approval means paying infinite money for a drug of this type”
        This is a mostly-solved problem in the UK, where there’s a body that approves treatments based on cost per quality-adjusted life-year. It’s not only reasonable in decision-making, but has also been largely resistant to political pressure — they were forced into some exceptions for cancer drugs, but nothing too extreme https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence
        Not knowing so much about how US healthcare, I wonder why there isn’t (/can’t be) something equivalent with insurance. i.e. they promise to cover everything cheaper than $X,000 per life-year saved, and maybe let people pay higher premiums to increase X

  13. Dave Baker says:

    Zvi, do you have a sense of how concerned parents should be about children developing long-term problems from Covid? My 8-year-old nephew’s guardians are very worried about his catching the virus, and are thinking of keeping him out of in-person school until he’s able to be vaccinated. My gut tells me this is likely an overreaction given the mild symptoms in kids, but I’ve been unable to find any relevant science, which makes me wonder if there are just too many unknowns to form an informed opinion.

  14. J says:

    Hey Zvi, sorry for bothering you with lengthy questions, but they seem very relevant, and I learn so much thanks to your extensive knowledge!

    1) How much would you worry about the delta and “Vietnamese” variants in Europe? Would they justify returning to extra caution (even to the point of disinfecting the parcels shipped from high-risk countries or groceries)? For example, I assume that an old person with health issues has a 40% chance of hospitalization and a 20% chance of dying from Covid-19, mRNA vaccines lower these risks to 4% and 2% (once a person is infected), but the nasty variant can then increase these risks to 10% and 4%. I’m also worried that as many as 20% of hospitalizations in the UK concern vaccinated people.

    2) Is the nature of these new variants a strong predictor of significant immune escape over the next months/years, indicating a likely necessity of frequent booster shots? I’m strongly pro-vaccine, but I’m kind of worried about getting frequent doses of mRNA producing (parts of) different spike proteins.

    3) How much should Americans and Europeans worry about these black fungus infections present in India and Oman?

    4) I’m not sure how to interpret the 95% (infection) & 90% (hospitalization/death) coverage of mRNA vaccines. What is the likely distribution of immunity? It could mean 90% of super-immune people with negligibly small chances of getting infected/very sick (0.1%?) and 10% of not-at-all immune people (and you don’t know which group you’re in), but it could mean 5% of not-at-all immune people and 95% of highly immune people with a more evenly distributed, rather small but significant (5-10%?) risks of getting infected and becoming seriously sick, now likely increased by the new variant.

    5) I’ve heard that a single dose of Moderna vaccine is more effective than a full dose of AstraZeneca (Khoury et al, 2021), and that a single dose of Pfizer is just 33% effective against the Indian variant (BMJ 2021;373:n1346). Moderna and Pfizer seem very similar, so either the results of these studies are conflicted, or the Indian variant can quickly lead to a horrible fourth wave. Am I missing something?

    6) If ivermectin and fluvoxamine were eventually proven to be really very effective, would you expect them to be eventually recognized, recommended by mainstream health organizations, and widely used in national healthcare systems (e.g. in the next 3-4 months), even in the absence of strong financial incentives? I have doubts, but it seems to me that the current evidence suggests they’re much more than just a “Weinstein’s contrarian thing” – see C19early website. If, hypothetically speaking, you were infected and started experiencing at least moderate symptoms, would you consider following the FLCCC Protocol (from the covid19criticalcare website)? I have mixed feelings, but I’m leaning towards trying it in the – hopefully unlikely – event of symptomatic infection.

    • TheZvi says:

      1) Delta will be Covid within a few months, everywhere, one way or another. What justifies caution depends on the math you believe, but I believe that the vaccine is more protective than that vs. delta.
      2) One could argue that there being new variants but them *not* having immune escape could go either way in terms of expectations. I don’t know why one should be worried about getting booster shots, if it comes to that, as annoying as it would be.
      3) Not following that, need more data to comment. Haven’t seen anything.
      4) You seem confused about what this means? The 90% vs. death is a guess conditional on infection, so it’s multiplicative with the 95%. So something like 95% (immune), 4.5% (not immune but stays relatively mild), 0.5% (infection proceeds normally, roll as if you were unvaccinated). Not anything like that simple but that’s kind of the idea. Thus the not worrying.
      5) Those are in direct contradiction, yes, and the 33% number is likely bull****. But also AZ is much better vs. death than infection, hence the situation in the UK, and one-dose Pfizer/Moderna vs. Delta could have related dynamics, maybe? I’d also check a bunch of other details. Also, Moderna doses are too large, which might make them stronger after only one dose than Pfizer.
      6) I would ask people I trust to look into it (since I would be sick and not in a position to do so myself) based on what we knew at the time. I do think it’s plausible that such protocols are better than not using them, and that our system is biased against noticing that. BUT Bret is being a giant asshole about every possible claim simultaneously, and his ‘this makes Covid so trivial that the vaccines are a scam to make profits” angle is horrible enough that he’s probably actively hurting his cause here rather than helping.

      • J says:

        1) So the Fall-Winter 2021 season is likely to be pretty painful.

        2) Getting a shot is nothing, short-term side effects are tolerable, but I’d worry about the risks of accumulating various spike proteins, potentially accelerated aging, overstimulating immune system, etc. Many of these are purely hypothetical, and vaccination is way, way better than getting infected, but regular Covid-19 shots probably won’t be neutral to the health of a substantial fraction of the population. I’m not sure if Steve Kirsch from TrialSiteNews is a credible source, but even if 10% of his points are true, and he otherwise belongs to the “tinfoil/nuts” category, these concerns should be taken into account, obviously in a way that won’t interfere with the pro-vaccine message.

        3) Wiki has a decent article on Mucormycosis. I keep on worrying that Covid-19 might have started a feedback loop of extra infections, increased health risks, and various social problems.

        4) Sounds reassuring, especially if this could be combined with an effective early treatment.

        6) I agree that overall, Bret may signal a bad message here. But the FLCCC stuff looks quite legit, and I would prefer to start a more effective treatment early rather than hope for my state not to get worse, so I would have to go to the hospital and obtain a less effective treatment there. This is why I’m curious whether respectable clinicians would endorse the protocol.

  15. LB says:

    “Better vaccines (mRNA) are better if we have them and can deliver them, but any vaccine is far better than none.”

    Given the situation in Chile, I am afraid that non-mRNA vaccines suck in preventing severe symptoms from the P1 variant. Is this a reasonable concern?

    Here is why it matters:

    I live in a region where P1 variant is prevalent and vaccines are given through a queue. When my name is called, it’ll be 90% odds to be a non-mRNA vaccine.

    I could decline and wait another 2 weeks to reroll. If I do get the shot, I can’t enter another queue.

    I live alone and can self-isolate well. I am only concerned about my personal situation here, not the behavior of others.

    I plan on rerolling for awhile in this scenario, but a sanity check would be welcomed.

    • TheZvi says:

      At 10% chance of mRNA you get your shot once every 20 weeks. That’s a lot of weeks.

      If you’d feel the need to (or choose to) mostly self-isolate anyway with a non-mRNA vaccine, you might as well reroll, regardless of whether it would make sense to self-isolate. You need to know thyself.

      I don’t think either decision is crazy from a purely selfish perspective, if you don’t expect things to change much any time soon.

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