Covid 7/29: You Play to Win the Game

Few things warm my heart more than playing to win the game. Few things sadden me more than observing someone not playing to win the game. 

Usually, that means they are playing a different game instead, whether they admit it or not, and whether or not they know it themselves. The game, from this perspective, is simply that which you are playing to win, and your revealed preferences define the game’s rules and objectives.

This week saw some excellent playing to win the game. The NFL, many parts of the government and a number of corporations began imposing vaccine mandates, hopefully causing a cascading effect. It’s at least a start. There’s a lot of ways in which we collectively are revealing ourselves not to be playing the game of ‘get people vaccinated’ let alone the game of ‘prevent Covid while minimizing costs.’ The lowest hanging fruit remains fully approving the vaccines, which we somehow still have not done.

A central question continues to be how effective the vaccines are against Delta. The Israeli claims turn out to probably be the result of basic statistical mistakes, so those scary numbers are now mostly off the table, although that still leaves us a range containing meaningfully distinct answers. 

Another central question is Long Covid, for which we got some actual data, so there’s a section analyzing that.

The big mystery remains why Delta suddenly peaked and turned around, first in India, and now in the UK and the Netherlands. These turnarounds are excellent news, and I presume we will see a similar turnaround at a similar point, but what’s causing them to happen so quickly? I don’t know.

Meanwhile, the numbers got worse slightly faster than I expected. Let’s run them..

The Numbers

Predictions

Prediction from last week: 360,000 cases (+50%) and 1845 deaths (+10%)

Result: 392,000 cases (+62%) and 2042 deaths (+21%). 

Prediction for next week: 610,000 cases (+55%) and 2,450 deaths (+20%). 

Things got worse slightly faster than expected. I doubt things are ready to turn around, but there are signs of the control system starting to act which should accelerate, and between vaccinations and infections (most of which likely do not result in positive tests and therefore known cases) immunity is building up, so I continue to expect the pace of growth to drop off a bit. I’d be unsurprised by numbers between about +40% and +70% for cases.

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Jun 10-Jun 163686119613142254
Jun 17-Jun 235294438312632066
Jun 24-Jun 305504597061861901
Jul 1-Jul 74593296121281528
Jul 8-Jul 145323986891451764
Jul 15-Jul 214343417321701677
Jul 22-Jul 2849138510091572042

Deaths are going up slower than cases, but faster than one would have hoped. I interpret this partly as last week’s number being artificially low, and partly as the South having a problem with its most vulnerable being partly unvaccinated, and thus we see a rise focused on the South including as a share of the cases. 

Things will continue to get worse until several weeks after cases turn around. The question is if we can continue to see deaths lag behind cases, as they continue to do so in the UK. My guess is we won’t do as well as some other places, especially in the South, but will still be doing better than our case counts alone would suggest.

Cases

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Jun 3-Jun 925,98718,26732,54511,54088,339
Jun 10-Jun 1623,70014,47225,7528,17772,101
Jun 17-Jun 2323,85412,80126,4566,46469,575
Jun 24-Jun 3023,24614,52131,7736,38875,928
Jul 1-Jul 727,41317,46040,0317,06591,969
Jul 8-Jul 1445,33827,54468,12911,368152,379
Jul 15-Jul 2165,91339,634116,93319,076241,556
Jul 22-Jul 2894,42960,502205,99231,073391,996

Vaccinations

People respond to incentives. With the costs of not being vaccinated rising on all fronts, more people are making the decision to get vaccinated. The remaining people are harder to get, but efforts benefit from the growing social proof and social pressure from previous vaccinations. It also helps that previously reluctant politicians, with notably rare exceptions, are increasingly getting with the program.

Vaccination Effectiveness

This thread takes the Israeli evidence (that likely was a quite sloppy statistical error, see the next section), combines it with antibody measures, and suggests that antibody counts decay with a half life of a few months, so under this hypothesis vaccinations continue to protect you from severe symptoms and death but after five months lose half their effectiveness at protecting against infection. I hate the smugness and overconfidence here, and also based on the clinical trials and result of one dose it doesn’t make any sense that a 75% reduction in antibodies would cut protection against infection by 50%. Nor do I buy that there would be a threshold effect big enough to cause the curve she’s analyzing here. 

Also, this isn’t a half-life:

Even if we take this fully seriously, it’s a steady state that we get to in 3-5 months, and the median gets to its low point after three (which is likely random variance, but the point stands that most of the effect is in place after month three). It certainly doesn’t seem anything like ‘half life of 100 days’ the next link in the thread cited, so I notice I’m confused.

I am noting such arguments here for completeness, but I do not put much weight on them. As usual, when one has a new hypothesis, one must then reconcile it with all the different data points, and alarming ‘vaccine stops working’ theories keep implying, well, that vaccines aren’t mostly working, when they obviously mostly are. You can’t both argue that we suddenly don’t think vaccines work as well against Delta, and that vaccine protections fade rapidly over time, and also that Delta is so much more infectious to begin with among the unvaccinated, because such claims combine to not be even slightly compatible with the observed data in other places.

Then on Wednesday, Pfizer came out with data that the vaccine remains effective after six months. That’s the headline. The actual data is not as encouraging:

Contrary to Pfizer, that’s quite the drop in effectiveness. The protection against death remains robust, and yes 84% is still quite good compared to what we would have asked for a year ago, but ‘remains effective’ is giving the wrong impression if this data holds up. 

The other news here is that Pfizer plans to be calling for booster shots. It seems that a three dose regimen is much more effective than a two dose regimen, now that we’ve had the ability to test such things, and some places are moving to implement this already. The data here suggests that the third dose will bring things back to at least the early stage 96% effectiveness and plausibly even higher. If I am offered a third dose, I will happily accept it.

There is the concern that giving people third doses while others have not had the opportunity even for first doses is not ethical. I respect that perspective, but do not share it, and will leave it at that. 

On That Israeli Data on Delta’s Effectiveness

Israeli data has been suggesting remarkably low effectiveness of vaccinations against Delta. This thread suggests this comes from… using the wrong denominator. The explanation is, the Israeli outbreak started in very highly vaccinated areas, and the effectiveness numbers came from the percentage of cases that were among the vaccinated, but they were comparing that to the overall population numbers. So, whoops.

If true, as I believe it probably is, that would explain things and be on some levels comforting, but on other levels it’s the opposite of comforting, because this is saying that the Israeli outbreaks started in highly vaccinated areas. So, whoops again. 

I’m inclined to believe that such simple mistakes were happening here, because the Israeli numbers simply didn’t make any sense. They were incompatible, even with each other, let alone with what we were seeing elsewhere. And I’m definitely at the point where such stupid mistakes aren’t surprising. This one is rather stupid, but that’s the way such things seem to often go.

Delta Variant

For those who need it: Thread explaining basics of how vaccine protection interacts with spread of Delta. 

CDC has reversed course on its mask mandates. Masks will be back in schools, where I’ve learned first hand and the hard way that schools feel compelled to follow the guidelines. They’re suggesting indoor vaccinated masking in ‘areas where there is a surge’ which doesn’t really make a lot of sense and will cause some confusion, but perhaps the hope is it will make intuitive sense to regular people. It’s good that when the facts change, the CDC changes its mind, at least.

There are two central facts about Delta one’s model must explain. First, the dramatic takeover of the pandemic and rise in overall cases across countries. Second, the sudden reversal of those trends in many places, including India, the UK and the Netherlands:

The Dutch numbers are down by half, the UK is not far behind. 

If you zoom out, the case numbers are still large. 

But the death numbers barely register:

It will take another week or two for the UK/Netherlands death numbers to peak, but this is what vaccinating the vulnerable looks like where it counts.

Here’s some data from Minnesota:

If we take this at face value (it’s not normalized sufficiently so there’s a bunch of reasons not to, but they point in various directions), it suggests about the same ratios in effectiveness for Delta between the vaccines that we saw for the older strain. Moderna’s effective dose is higher than Pfizer’s, which potentially could be responsible for that differential, although I’m still mostly inclined to treat the two as the same until we get a lot more similar data points elsewhere. Normalizing properly for exactly when vaccinations were in effect is tough, but for context Minnesota at the time had just under 30k confirmed infections since May 1.

The data below from San Diego is better normalized, and I’m going to say that this is enough non-normalized data points. 

This graph is pretty bizarre when taken at face value, and I presume it shouldn’t be, and is only the county of San Diego, but still seems worth noting:

Details:

At the lefthand side, we have about 3 cases per 100k among the vaccinated and 9 among the unvaccinated, a ratio of 3:1. That’s a surprisingly small ratio. 

At the end of May, cases among the vaccinated level off, but cases among the unvaccinated continue to drop until about June 10.

Then the cases among the unvaccinated shoot up, and at the end, we have 16 unvaccianted cases per 100k and 2 vaccinated cases, for an 8:1 ratio. In July, this is most definitely representing a pandemic of the unvaccinated.

The question is, why would this ratio suddenly get much bigger?

If Delta is, as everyone now fears, reducing the effectiveness of vaccinations, you’d expect the ratio to go down rather than up. Whereas this new 8:1 ratio implies a much higher effectiveness level, unless one can explain it via other factors.

One possible explanation is that early on the vaccinations went to highly vulnerable people, whereas now they’re more evenly distributed, but that would only explain contrasting March with June, not June with July, where that effect is going to be small.

Another is to claim this didn’t happen:

If we look at the ratio that had emerged before that period in early June, we do get a different picture then, but that period where the unvaccinated cases are going down but vaccinated cases went up is super weird for its own reasons, and the contrast with the left side of the graph is still clear. At a minimum, a constant ratio does not suggest any decrease in effective immunity.

A third is to say that San Diego’s numbers are quirky because someone’s are going to be quirky.

Here’s another Tweet that shows Marin County:

Looking at that, I see a ratio of just over 4:1 rather than 8:1. I don’t see a big shift to higher ratios in July, but I also don’t see a shift to lower ratios either.

I tried briefly to find similar charts or data for larger areas and it wasn’t obvious where they were. If anyone can link to one it would be appreciated. The normalizations here make the data much more useful but I’d prefer a much bigger and ideally more representative area.

Vaccinations are great, but what matters is immunity, and vaccines are only one way to get immunity. Antibodies are not a perfect proxy for immunity, but they’re likely the best one available, and the numbers in the UK on antibodies are very, very high…

When this many people have antibodies, it’s both scary that cases for a while were going up anyway, and also easy to understand how there might be a rapid peak followed by a reversal. It’s especially easy to see this if the serial interval averages two or three days instead of five, so things that happen tend to happen fast. 

If 90% of people are immune, then each additional 1% that becomes immune reduces spread after that by a full 10% even if everyone is otherwise identical. Whatever vectors still remain for the virus to spread burn themselves out rapidly, until there isn’t enough left to sustain the pandemic. 

It is possible that this is simply what it takes to turn the corner on Delta. If so, then if the USA has roughly 70% of adults having been vaccinated, than we would turn the corner when about two thirds of the unvaccinated have been infected at some point sufficiently to develop antibodies, with the understanding that many Covid infections don’t lead to a positive test and therefore don’t show up in the statistics, and also a lot of them already happened over the past year and a half. 

It still doesn’t explain the full extent of the rapid turnarounds in India and the UK, but it helps explain it. Lag in the control system also helps, but again I notice my model remains surprised by this. 

You Play to Win the Game

Last year, the NBA figured out how to do Covid testing. This year, it’s all about vaccinations, and the NFL is stepping up. 

As we all know, in the NFL and also in life, You Play To Win The Game

Winning isn’t everything, it’s the only thing.

What does it look like to play to win, when it comes to Covid-19?

It looks like this. Here’s the key operating principles. 

Here’s what would trigger a forfeit:

In other words:

If your vaccinated players force us to cancel the game, we’ll try to do the best we can for everyone involved.

If your unvaccinated players force us to cancel the game, f*** you. You forfeit the game for all purposes where you want to win, the game is cancelled for all purposes where you wanted to lose, and the league will focus on ‘minimizing the financial and competitive burden’ exclusively on the other team. Not you. You’re on your own.

Oh, and regardless of vaccination status, if there’s an outbreak that cancels the game, the players on both teams don’t get paid for that game:

That’s what it looks like when you play to win. 

Some NFL players are less than thrilled with this situation.

For example:

Yes, it turns out that not protecting yourself against infectious disease can put you in a position to hurt your team. Who knew?

Who else we got?

I hope someone compiles all of these together, and then continues in the sacred tradition of arranging them into a YouTube montage video set to Taylor Swift’s I Forgot That You Existed

Good luck, Mr. Hopkins and all the rest of you, in all your future and hopefully far away endeavors.

The Pac-12 is considering following suit. It does make a lot of sense the way the commissioner George Kliavkoff put it:

Most of the Pac-12 schools have vaccine mandates in place in any case. Washington State is currently trying to figure out what to do when its coach refuses to get with that program.

We need more of that ‘can do, and if you choose not to do that’s on you that you didn’t do it’ spirit.

Others Playing To Win the Game

The good news is we are indeed seeing more of this spirit, and there seems to be momentum behind these efforts.

New York and California are requiring government workers who don’t get vaccinated to get weekly tests and wear masks indoors. New York at least is not providing a testing option for health care workers, it’s vaccination or you are (very understandably) fired. Virginia is mandating vaccinations for health workers, as is the veterans administration.

From Bloomberg’s daily newsletter:

Reports are that Biden will follow shortly with a similar rule for federal employees, if he hasn’t already by the time you read this.

Companies are now able to get in on the act:

My hope is that this effort continues and spreads, and more and more private employers will be emboldened to enact similar policies. If I was a private employer whose employees were interacting with each other in person or with customers in person, I’d hope to be more worried about what would happen if I didn’t mandate vaccination, including legal consequences, than what would happen if I did, and this transition will go a long way. As usual, we blame people via Asymmetric Justice for action but not inaction, so the less a (soft via testing and masking requirements) mandate seems like a bold choice to take action and more like a default state that protects the employer from liability or an outbreak among the other employees, the better. These things matter.

And once again, we gotta get full authorization as soon as possible. A huge amount of the lack of mandates is the lack of full authorization. If we got it, this cascade could kick into high gear quickly, and give a justification for a change in policy. At this point, any efforts to get people vaccinated that don’t involve a demand for full authorization are impossible to take seriously. How can we be mandating vaccinations but not be ready to fully approve them?

A bonus is it creates positive selection in employees. If anyone quits or otherwise goes ballistic about the situation, that was likely a time bomb on your team in one form or another, they’re definitely bad at risk management, and this gives you the opportunity to be rid of them. It’s hard to hire right now so that could be short term trouble, but identifying and getting rid of bad employees is both highly difficult and valuable. 

Many other countries also continue to get with the program. Here’s Israel this week, playing to win:

I more than fully endorse this take on all of these developments:

Long Covid

We finally have some real data to look at. 

The original paper is here.


Headline findings:

This raises, and/or lets us more usefully address, multiple questions. Should we believe the results of this study? Do these effects seem real? If they are real, what can either an individual or our society in general do about this? Does this change anything if it is true?

First, no matter what the flaws here, a big thank you for running this at all. It does seem like this is a big advance in information value over previous sources. This stuff is hard, and doing something concrete is better than not doing it. This does seem to rise to the level of something useful. 

Second, as usual, studying such things is really hard and there are lots of problems, so let’s get right to some of those.

First off, baseline methods.

There is an obvious concern here. People were recruited to do an intelligence test by offering them an intelligence test. Which, yes, right on, very on the nose and efficient incentivizing, but we do have to worry about the selection effects from that and whether the standard controls handle them.

Here’s what they controlled for: “Nuisance variables were age, sex, racial-ethnicity, gender, handedness, first language (English vs other), country of residence (UK vs other), education level, vocational status and annual earning.”

Handedness! So other than the bonus handedness, this is your basic check of control variables for basic demographic information and socio-economic status. 

Before going further, there are three potential confounding factors here that seem like big issues.

The first is that choosing to take the test could be a function of one’s situation and practical intelligence. If I had Covid and fully recovered and felt fine, I would not be so curious about taking an intelligence test. If I had Covid and had continued problems, then I would plausibly be much more interested to know how I did on such a test. In theory, this could be the whole situation, since those who feel stupid due to non-Covid reasons or due to lockdowns wouldn’t feel the same curiosity and wouldn’t opt in, whereas those who had Covid and happened to also feel stupid recently would take the test. 

The second is that being intelligent helps prevent Covid-19, after controlling for the other factors. The study was done in 2020 so vaccination isn’t relevant, but plenty of other decisions matter. How and when people decided to mask, including how much care was put into doing it properly with a good fit, determines both how likely they were to get Covid and how severe their case was likely to be. Social distancing is similar. As is making a wide variety of other good decisions about how much risk to take. Intelligence also correlates with the type of work that can be done remotely, even controlling for income and education, which improves ability to social distance. Intelligent people tend to be more rule abiding in general, including when the rule is dumb, which in this case is net useful. And so on.

The third is that it looks like they’re using self reports of Covid-19. 

It makes sense to worry that people would conclude from their long term issues that they likely had Covid-19, or from a lack of such issues that they likely didn’t have it, which could once again confound the results here.

In theory, one could have controlled for all this, by having people take the test before Covid-19. Even now, one could attempt to measure the impact level of the second effect by then following up with the people who took the test and seeing which of them later got Covid, although changing conditions will change the size of the correlation – so it’s more of a ‘check if this is a substantial effect or not’ check than anything else, and now with vaccination everything is different. For the first effect, again, you’d need to find a way to measure things in the other order, possible in theory but not easy or cheap. For the third you could do antibody tests since this was pre-vaccinations. 

But all of that is tricky and expensive.

The huge advantages of doing what they actually did were that it was practical, it was ‘ethical’ and it was relatively inexpensive. I point out issues, but I think the study was likely done roughly the right way in context, picking the low hanging fruit. From a civilizational perspective we could and should have done far better, but that’s not the fault of the people doing what they can.

Looking ahead, it does seem like intelligence didn’t have too big an effect on chance of getting Covid, based on a follow-up test. This could still eat up the whole observed effect, but I’m less concerned about it than before reading about that. Also a little sad that this effect turns out to be so small, for other reasons.

I also approve of their methods for analyzing the results, especially combining the nine tests into one number. There are a lot of worries I conspicuously don’t have here.

Here’s the breakdown by symptoms and gender:

I’m noting it because that righthand column is pretty strange. It’s lower average age, and suddenly it’s very male whereas the other groups are increasingly female and older as symptoms became more serious. Low sample size is presumably the answer (44 people) but it’s still kind of weird.

Lower in the same table, it’s clear that almost none of these people had a positive Covid-19 biological test, so this is almost all self-diagnosis:

Then we look at the headline chart. 

One standard deviation in an IQ test is about 15 points, so this is an average of about 0.5 points or so for the first group, 1 point for those not requiring assistance, 2 for those getting help at home, 4 for those hospitalized and 7 for those who went on a ventilator. 

The first thing to note is that this effect that grows as symptoms get more severe makes a hell of a lot more sense than the mysterious ‘Long Covid doesn’t care how bad your case was’ nonsense. I’m far more willing to believe a proportional effect that grows with symptoms than a blanket ‘nope, you technically got Covid and now you roll versus this other thing at constant odds’ hypothesis. And of course if you’ve been in the hospital on a respirator, it’s not going to be good for your cognitive performance. 

So that adds a lot of credibility to the findings. 

This is their explanation of why we shouldn’t worry about pre-morbid differences (e.g. how smart people were before):

I find this helpful but not fully convincing. One worry is that they’re claiming that those that were ill should have otherwise had higher cognitive performance. I don’t find this plausible, so it makes me skeptical their controls are sufficient. It does mean that I’m no longer concerned that the intelligence differences are too big here, since presumably Covid doesn’t help cognitive performance and that caps the differences at the effect sizes. The second check, following up with a questionnaire to see who later got Covid, is also helpful in capping the effect size of ‘smarter people get less Covid’ but doesn’t address the other concerns. I’m also sad we didn’t ask those people to retake the tests.

I also am skeptical that this effect could fail to partly fade with time or as symptoms fully go away, whereas they are claiming to not see such effects. 

As always, also, there’s the question of whether this effect is unique to Covid or is a general property of many infectious diseases. In some sense it does not matter, but in other senses it matters a lot – or at least points to our failure to be consistent, with several potential ways to address that.

This is their note that the effect size here is indeed a big deal, which it is:

The line that the 0.47 SD drop is more than 10 years of decline in global performance between 20 and 70 is very interesting, because it suggests an intuitive way to measure how much we should care about this effect – we can think of this as similar to aging.

Every year, we all age one year, and a lot of stuff gets harder. For those of us over the age of 25 or so, it’s kind of terrible, and we need to put a lot more effort into making it stop. 

So, in theory, this is suggesting that relatively mild (but still symptomatic) Covid is still doing something of similar magnitude to causing our brains to age two years, and as it gets more serious things get much worse. On average over all symptomatic cases we’d be looking at about three years.

If that’s all true, that’s really bad! Once again, you do not want to get Covid. And one can now think about how much life not lived would be justified in the name of not catching Covid, if one is at only small risk of death. 

I don’t find it likely they are underestimating the size of this particular effect, and I can see how the effect could be smaller or not be there, so that somewhat reduces the expected effect size. But then one must also account for other distinct problems. 

Then there’s the question of how this interacts with vaccinations and children. If you get long Covid roughly the same way you get other symptoms, that’s going to be a big reduction in risk, especially for the very young. My prior would be that this protection is somewhere in between the protection against infection and protection against death. 

You’d also want to adjust for Delta, since all this data was from 2020. My presumption is degree of symptoms mostly controls for that, but it’s plausible that this doesn’t fully control for that. 

This Long Covid effect definitely would still be a bigger danger for most people than death, even before vaccinations. I’d much rather take the very small risk of death than accept this level of accelerated cognitive decline, plus any longer term non-cognitive effects, and it isn’t close even under relatively minimizing assumptions, and multiplying for the uncertainty that this effect is real.

The question then remains, what costs are worth bearing to reduce the probability that this happens to you, individually or collectively.

Which in turn, as always, depends on one’s ability to change that number. Postponing the problem isn’t worth zero, but it’s only worth enough to care much if it buys time for a permanent solution, or there’s a permanent solution you’re willing to implement. That’s true both individually and collectively. Postponement can also help if it is ‘bending the curve’ in ways that matter, but that doesn’t impact Long Covid much. 

There’s the temptation to say ‘oh no, this is terrible, something must be done, this is something, therefore we must do it’ where the something is an effort to kick a can down the road at very high cost, and which may or may not be able to do much of even that. 

Vaccine Hesitancy

This LA Times piece looks at those who are getting vaccinated now in a local community, and finds highly reasonable thinking going on. Of course, these are exactly the previously hesitant people who then did get vaccinated. So it makes sense that such people would seem more reasonable, and would not be at all representative of those who still haven’t gotten their shots. It is consistent with the model that there are a bunch of people doing cost-benefit calculations who are relatively easy to get, and then a bunch of people who are much harder to get. 

This thread compares anti-vax people to victims of a con, with resulting implications for how one should communicate with them if one is attempting to persuade and convince rather than make one feel better about having taken the proper symbolic action. Cooling the mark via people in the community that have earned people’s trust is so crazy an idea it just might work, but requires that such people be convinced first.

Note of course that such framing explicitly assumes the conclusion, that not only are vaccines safe and effective and the right thing for everyone both socially and individually, but that the evidence for this is so sufficient that if you don’t believe it, you’ve been conned. I don’t think that’s right. Many have effectively been conned by misinformation or the need for tribal signaling, but others are doing a calculation with different information and getting a different answer. I strongly believe they’re wrong, but it seems plausible that treating such people as con victims is (at best) highly condescending and that they would notice. We are doing a rather terrible job conveying the information about vaccines in a way that is accessible, understandable and credible to such people, and the fact that vaccines happen to be highly safe and effective doesn’t excuse that.

This paper provides an interesting model of vaccine hesitancy (via MR). In it, people are effectively doing an approximation of a cost-benefit analysis on vaccination, so the more prevalent the disease, the higher the willingness to vaccinate, which is clear from past outbreaks. 

One consequence of this is that if you reduce the number of cases, vaccinations go down. Thus, this model claims vaccine passports are ‘ineffective’ in the sense that they don’t increase vaccinations, and could even backfire, because they reduce prevalence. I find their math to prove too much and therefore am confident they’re technically wrong to draw their conclusions so broadly, but accept the underlying dynamics as things that are real and that matter. 

Oddly, Tyler thinks this makes a strong case against such passports. I would claim the opposite, because reducing prevalence is a good thing. If we can do something that both incentivizes vaccinations and prevents cases at the same time, that’s good, and if the reduction in cases means we don’t on net cause vaccinations, then that seems fine. Otherwise, you are in the world where you outright want more cases in order to show the bastards and own the reds, which is a bullet I really hope no one is biting.

Regardless, under such a model, lowering costs of vaccination is the obvious choice for getting people vaccinated, and it continues to be a highly efficient strategy. Drive that cost negative. More precisely, one wants to reduce perceived costs, which can involve changing people’s models of vaccine effectiveness and/or safety, and/or changing the difficulty and costs of vaccination. 

Periodic Reminders (You Should Know This Already)

In case you need a short video explanation for how the mRNA vaccines work and were developed, we got you.

Your periodic reminder that our travel restrictions make absolutely zero sense (MR).

And yes, a sensible system would be entirely feasible:

This explanation rings far too true:

Your periodic reminder: The FDA and cost benefit analysis are not on speaking terms, nor does the decision process much correspond to what is safe and effective let alone what is in the public interest. Hence, we approve $50,000 drugs that don’t work and then are forced to collectively pay for them out of the public treasury, but can’t fully approve the same Covid vaccines and definitely can’t mandate them, and so on. Yeah, yeah, same old, FDA Delenda Est, stop using such procedures to tell people what they’re legally allowed to do, also stop using such procedures to decide what we pay for without looking at costs against benefits, and at a bare minimum stop equating those two decisions. The suggestion from the link of letting government officials choose what is mandatory and paid for versus what is forbidden on an ad hoc per-item basis seems to miss the point of ‘are those our only choices?’ and I’m not sure if it’s better or worse than status quo. 

In other FDA Delenda Est it’s-not-news-but-it-was-news-to-him non-news:

WaPo reminds us that Japan is failing at vaccinations by doing the things you would do if you wanted to fail at vaccinations. This includes insisting on distribution by only doctors and nurses, holding out until way too late for a homegrown vaccine, a labyrinth approval process and demands for domestic testing of the vaccines, confusion about rules and a general lack of urgency, among other things.

(If for some reason you want to financially support these weekly posts and/or my writing in general, you can do so via my bare bones, no rewards of any kind Patreon that is set up exclusively for that purpose. On the margin this does shift my time a non-zero amount towards these posts. However: I do not in any way need the money, please only provide funds fully understanding I already have plenty of money, and if and to the extent that doing this would make your own life better rather than worse.)

The whole blood clot issue around AZ was never a thing. Of course Pfizer has similar instances of blood clots to AZ, given that not getting vaccinated at all also has similar instances. Also Covid-19 itself actually does cause blood clots, but hey. 

The term ‘genuine’ fury is interesting here, since we knew all this already. It also does not matter, for the purposes of the EU’s motivations, whether or not the concerns turn out to be valid. Their perception of the situation at the time would remain unchanged.

Also happy to see this report properly label the people opposing AZ as anti-vaxxers, from anti meaning against and vax meaning vaccine:

To what extent is it true that the European backlash against AZ was due to spite resulting from Brexit? My guess is this was not all that central, but was a substantial contributing factor on the margin. That doesn’t especially make this better or worse, it merely notes that the European Union countries were inclined to make such a self-destructive move for overdetermined reasons. 

Very Serious People do not care about physical world models, a case study (Warning: Someone Is Wrong On the Internet):

Sir, the virus did not mutate among the few remaining infections in Israel. The current pandemic in Israel is not causally related, at all, to the few remaining cases of Alpha or the original strain that were still present in Israel. 

It comes from Delta. If Israel had achieved actual zero Covid but not also instituted large new measures to keep Delta out, Delta would still have arrived from overseas, same as it arrived from overseas in every country except one. And if anything, it would have spread faster, because they’d have gone even more fully back to normal, so there’d be a worse problem now instead of a better one. 

Feels wrong to pick on such statements, but for a while I’ve been feeling the need to pick out a clean example, and this fits the bill. Also points out an important dynamic – local containment only matters for the medium to long term up until you cycle strains. There’s a strong instinct to contain the virus ‘in case it mutates’ but if it mutates elsewhere all your containment efforts mean nothing, so this only matters to the extent that you stop the mutation from happening at all, anywhere. Which is an important consideration, but not for stomping out the last few cases in one place while things continue to rage full blast in others. Much better to help out those other places.

In Other News

Scott Alexander’s post Things I Learned Writing the Lockdown Post is excellent and from my perspective is much better and more interesting than the actual lockdown post. I don’t have the bandwidth to respond properly this week, so noting here that I haven’t done so.

There’s this great highlighted comment at AstralCodexTen and I have nothing to add:

In the monthly links post at ACX, Scott also points to the poll that showed remarkable support for permanent lockdown in the UK:

But then reminds us that if you ask the questions with slightly different wording, people act more sane, and a permanent lockdown then only gets the 3% support you would expect from the Lizardman’s Constant:

They have a graph but it’s hard enough to read as it is so I’m not putting it in directly.

That makes this most of all a manufacturing consent story. Merely by changing a few words and giving people the correct word associations, you can get many people to agree to give up their freedoms and way of life, permanently. That’s scary. Not all of them, not quite this easily, but quite a lot of them. 

You love to see it: UK changes guidelines to emphasize outdoors and de-emphasize surfaces. 

Standard disclaimers that this like everything else is in no way medical advice and not to do anything illegal, but also this happened and further investigation seems logical:

I am not the biggest fan of psychedelics in practice under current conditions, but there’s a ton of potential upside. Our refusal to investigate their potential properly, for this and many other things, is a colossal expected value error, potentially our biggest one. 

Incentives matter, so this is mostly great (via MR), but remember that if it’s $200 to get them to sing it might be considerably more to make them stop:

Incentives matter, dominatrixes requiring vaccination for dungeon entry edition. Seriously, incentives matter, stop pretending this is all so difficult.

The standard check for whether mask mandates are back says yes:

Not Covid

The lighter side presents:

Interesting whether or not they are transitive survey results of the week:

Taken together to see what happens, these imply that about 90% of people think billionaires have lives they’d rather live, and about 70% support for the superiority of the life of the True Philosopher even when you exclude the 21% who implicity endorse it by already claiming to live it. Of course, Robin is an economist and Agnes is a philosopher, and have followers accordingly, but let’s not let that ruin our fun.

Especially given this:

Mostly I find this rank ordering sensible. Olympic, Pulitzer and Academy Award winners get the glory but their overall lives don’t seem like they should automatically be all that tempting to most people, whereas billionaire or nobel prize winner seems a lot more tempting. I’d like to live in a place where greatness was widely considered worth its price, so I worry about people not seeing things that way.

The other thing to observe is that this implies that for the samples in question, life is pretty damn good. If it wasn’t, there would presumably be a much bigger willingness to switch tracks to people who very clearly ‘made it’ and have a lot going on. I tend to agree. My life is pretty great, too, whether or not I count as a true philosopher. 

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72 Responses to Covid 7/29: You Play to Win the Game

  1. lunashields says:

    If you want a third dose – you go and get a dose. No one is tracking anything, so tell them it’s your first, and you’re done.

    • Garrett says:

      What if getting vaccinated becomes mandatory for your job later this year and you can show proof of two doses but not the third? You’d then have to go get a fourth right? Would that be ok for your health?

      • Denis says:

        why wouldn’t you be able to prove? You’ll have 2 paper slips with 2 doses on one and one on the other.

    • Humphrey Appleby says:

      I wonder – if you signed up for a third dose, and declared honestly that you had already received two (but many months ago), would you be allowed to get it? I suspect you would.

      • Hallie says:

        I was turned away from a free clinic in California after disclosing that I had gotten two doses of Sputnik V in February. However, Walgreens (local drug store) was happy to give me a shot of Pfizer.

  2. Alciabiades says:

    Blaming the EU for the AZ fakery is naive. The whole affair has the fingerprints of Fauci, Topol, and the rest of the US public health bureaucracy all over it.

    Remember the ‘botched trials?’ Remember the ‘exaggerated’ protection rate? They tried many lines of attack before finding one hard enough to disprove that it worked.

    The Global American Empire strikes again, and the 3rd World suffers.

    • bugsbycarlin says:

      What do you think the Americans have to gain by sinking AstraZeneca? Market share for Pfizer and Moderna? They’re already making money, so much money. Keeping the third world down? But to what purpose?

      • Alciabiades says:

        I’m not speculating based on motive, just pattern of behaviour. Which major country has yet to approve AZ for use at all?

        Maybe when you’re a global hegemon you can’t afford to be outdone on matters of great importance.

        Or maybe Pfizer and Moderna ‘played ball’ by delaying their announcement until the Orange Man was gone, ande ow reaping their just reward of having all competition crushed/ignored.

        Or maybe the motive is something we cannot even imagine. Most likely the latter.

      • Alciabiades says:

        I mean, imagine the counterfactual where Sinovac is the best COVID-19 vaccine in existence. Do you think American Public Health would admit that and start using it?

      • David J Baker says:

        The motive seems to be retribution for not conducting some studies in the way the FDA preferred.

  3. Anaxagoras says:

    “I’m noting it because that righthand column is pretty strange. It’s lower average age”
    Could some of this be survivorship bias? People who ended up hospitalized and ventilated for COVID-19 have a decent chance of dying, and even conditioning on being ventilated, age is a significant risk factor, so the people who lived to take the intelligence test who got ventilated will skew young.

  4. Catweazle says:

    I remain wholly unconvinced that the AZ blood clot fiasco is related to Brexit spite in the EU. For starters, contrary to what is generally believed in Ango-Saxonia, the EU has moved on from Brexit, seeing it as a distraction. Whereas Brexit/vaccine success vis-a-vis the EU is crucially important to the UK’s self-image. As witnessed by the Education Secretary’s remarks when AZ was first approved:

    Gavin Williamson: UK is ‘a much better country than every single one of them’. Education secretary lauds vaccine rollout saying scientists in UK better than in France, Belgium or US.
    https://www.theguardian.com/society/2020/dec/03/gavin-williamson-britains-a-much-better-country-than-all-of-them

    I live in Canada, which does not know or care about Brexit. Yet when AZ blood clot reports hit in April 2021, we too saw near-daily reports in the news of people dying from AZ-related blood clots. Nothing was heard of Pfizer or Moderna. Public health authorities kept dialling up their AZ risk assessments. In May, AZ was cancelled as a first shot. In June, NACI advised AZ recipients to receive an mRNA second shot – although they knew full well the trouble this would land them in regarding international travel. None of this media hysteria played out in the UK.

    Canada does not meaningfully know or care about Brexit either way, so I suppose we can use it as a neutral baseline.

    It seems much more likely that when the AZ blood clot reports came out, the world got swept up in a media-driven mass hysteria, irrespective of the merits of the evidence. Brexit Britain was largely immune from this hysteria for identity and nationalist reasons.

    Now that we have more evidence, it turns out that the Brits were right, and the rest of the world was wrong. Actually, does it? Or should we keep a healthy scepticism when hearing the British talk about the success of their Oxford/AZ shot Which Must Not Fail For Great Country Reasons?

    • Seb says:

      As a fellow Canadian, I can confirm that basically nobody here cares about Brexit.

      The AZ pause here was certainly a mistake on NACI’s part, though. They got a bunch of things right (first doses first, mix and match, etc) but that one was still egregious.

      • Bobboccio says:

        I don’t think we cared about Brexit in Canada, but we sure got a lot of media reports from Europe about blood clots. This could have impacted Canada’s own slow-down of AZ.

    • NoPie says:

      You are forgetting that AZ had some initial problems with scaling up production at the EU production site and the EU who at that time had planned to rely on AZ vaccine was furious about missing deliveries. They demanded that AZ hands over UK stock which AZ refused citing contractual obligations. But also correctly informing that UK stock volumes are smaller due and make up only a small part of missing deliveries anyway.

      Somehow it inflamed anti-UK tensions despite the fact that AZ is partly Swedish company. One can imagine that this mishap was a big blow in the face to EU leaders. Only then the blood clotting side effects surfaced. It seemed genuine concerns at that time. Now if it is indeed the same as with Pfizer vaccine, it may be that the general hysteria at that time caused increased scrutiny and possibility that if you look too close you can find many rare irregularities that happen merely by chance.

      • Timandrias says:

        Mostly this. As I remember, the timeline of the AZ-Europe thing went like this:
        – The European body taking care of the vaccine procurement, leaded by some useless german politician, set a contract with AZ to provide the initial bunch of vaccines to the whole Europe. [0]
        – AZ fails to deliver in their promises, they say there are production issues. It gets mixed with Brexit politics as they deliver the vaccines to UK without a glitch, and the UK starts vaccinating massively way ahead of the rest of Europe.
        – The blood clot thing happens when the other vaccines start to be available EU-wide. As a Canadian commenter says upthread, this was not a EU exclusive issue.
        – The bureaucrats are not particularly happy with AZ making them lose face, and use the blood clot thing, plus the fact that they fucked up some vaccine approval testing, to seriously limit the orders for the rest of Europe.

        I’m ignoring some of the initial “herding cats” drama in the unified vaccine response that, though it led to some delays in placing the orders, don’t think it changed much the picture.

        [0] I consider this the BIG blunder in the whole COVID response of the European bodies. No matter of what AZ did, putting all your eggs in one basket was a terrible idea. Even if there no other pharma in the whole Europe that presented themselves for selection at that point, there where many vaccine national initiatives that could have been nurtured from the beginning. I have drastically updated my opinion on the usefulness European level politicians after following the whole thing closely.

  5. remizidae says:

    People who are freaking out about FDA regulation of NAC need to chill. It is not banned. You can still buy it on Nootropics Depot, Walmart.com, etc. Because it’s not banned. FDA sent out a warning letter which raised prices and caused Amazon to stop carrying it. This is unfortunate, and I’d be stocking up if I relied on this drug, but IT IS NOT BANNED. Stop getting your pharmaceutical regulation news from randos on Twitter with very little understanding of the subtleties of the regulatory state.

    • McKenzie says:

      I used to buy my NAC in-person from CVS. The day after the FDA’s action, I went to all my local CVSes/Walgreens/GNCs, and all of them said they’d pulled their remaining stock off their shelves and cancelled all future orders. Not sure why Walmart.com is still carrying it, but perhaps I should check a brick-and-mortar Walmart.

    • Dan Elton says:

      The FDA essentially said they think the law says it should a prescription drug, since it went through FDA approval in the 60s (IIRC). So, the FDA said it is banned and they threatened enforcement actions. So far the FDA has not done any enforcement, which is why many places are still selling it, but the FDA has made clear they think it is banned. There is ongoing litigation to get the FDA to change their mind but overall it doesn’t look good.

      A lot of people think the reason for this is that people were taking it to help prevent or treat COVID-19 even though there isn’t any scientific evidence to support it. The folks at the FDA have a very “nanny state” mindset and have been cracking down on what they view as ineffective supplements people are hyping as COVID-19 cures, so this theory makes a lot of sense.

      So basically William Eden hit the nail on the head.

      As to whether NAC should be added to Tylenol, I don’t think so, because it has some psychiatric effects.

      The main use that seems scientifically justified is as an antidote for paracetamol (Tylenol) overdose, as a liver-protectant, and as a hangover treatment. There’s a lot of other people using it for other things (like anti-aging, ADHD, autism, as a nootropic, etc) but those are questionable (largely harmless tho!) .

  6. James Cropcho says:

    It’s a real shame that the leadership of seemingly so many organizations and governments seeks to force their varying-degrees-of-voluntary subjects to receive a medical intervention. This is a scary path to go down (unless of course one is heavily invested in these companies’ stock). I hope that whoever has the conviction and the financial means to walk, will walk, regardless of the medical procedures’ favorable safety profiles. I mean, come on, people, at least let the iatrogenic causalities sue…

    The NFL move (severe punishment based not on viral transmission outcome but whether these specific and favored interventions were mandated at the team-level) is particularly egregious and sets the wrong precedent.

    That said, I can at least stomach the “carrot” (versus “stick”) approaches and I agree it seems (?) foolish for the FDA approval to be so slow.

    The LSD thing is pretty cool! I wonder if the Lion’s Mane would also help.

  7. Tom W says:

    Looked into this out of curiosity and it is trivially easy (even easier than I thought it would be) to fake a vax card in the US, and sloppy record-keeping means that even if people decide to start checking harder for mandates they will have to choose between letting through potential fakers, or shutting out people who actually got their vaccines but cannot prove it through central records.

    It looks like a fair degree of vaccine fakery is already happening, most uncatchable, and we can expect there to be more if the [redacted] impose more mandates. As far as I’m concerned this is a great thing overall (it should not be anyone else’s business what risks, say, an NFL coach wants to take with their own health), but should be kept in mind when seeing statistics about “vaccine breakthroughs” and “outbreaks among vaccinated populations”.

  8. lifter4545 says:

    One day the people who you’re celebrating being forced to get the vaccine will be in power.

    Since this authoritarian precedent (across institutions) has been set, what do you think they’ll make you do?

  9. Craken says:

    On the British Covid IQ study, there is one more known confounder: physical health is positively correlated with IQ. (All good things, except myopia and autism, are positively correlated with IQ.) Those who were hospitalized or ventilated had worse physical health, all else equal, than those infected but not hospitalized. It’s likely they also averaged lower IQs, when holding all but their physical health constant. This confounder adds to the one noted by Zvi that the pandemic was an IQ test, though maybe less of an IQ filter than I would have expected according to the study. But, the IQ-health correlation better explains the differential impact on IQ seen among people with different degrees of Covid illness.

    I don’t mean to imply that Covid had no IQ effect. After looking at this study–a good find!–I would guess serious cases have an effect size half of what this study shows. Also, only ~2% of Americans have been hospitalized for Covid and well under 1% ventilated. Plus, most of these hard hit individuals are elderly–out of employment, watching TV, playing golf, etc.–not engaged in cognitively demanding activities. The typical mild to moderate Covid case might cost 1-2 IQ points, if that. That would equate to a 1-3 year jump in cognitive aging. Still, this modest effect ought to be added, provisionally, to all the other known and suspected harms of Covid infection.

    I had reason to read a study some years ago on IQs of patients with cardiac degeneration, mostly valvular. Their IQs declined modestly (iirc 5-7 points) as they progressed toward the threshold for open heart surgery. They took a further hit to their IQs (2-4) when tested a few weeks after surgery. Then their IQs recovered almost all of the lost ground (adjusting for age) after successful surgery. The analogy with Covid is that the surgical patients’ fitness/oxygenation levels worsened pre-surgery, then they had the shock of surgery (including micro blood clots coming through the heart-lung machine).

    I do not celebrate the increasing institutional coercion being applied to unvaccinated people. The excuse is, what, to protect people from themselves? But, they most want protection that they won’t get–from the arrogant, incompetent managerialist class. This coercion is bad in itself and clairvoyance is not needed to see that it’s a bad precedent–one which those who own America’s institutions will surely not forget to deploy at their convenience. Given the intensifying insanity of the American ruling class across a broad front, prudent people with sufficient resources ought to have an escape plan beyond internal exile. These rulers are much crazier than the Soviet apparatchiks were in 1928 when Stalin took the reins. Stalin was the precondition of Stalinism. Whether America’s “Cathedral” class requires such a figure to achieve an even more comprehensive and deadly totalitarianism than his masterwork may be doubted. That America is a one party state cannot be doubted even slightly. The Party, the State, the Ruling Class are one and the same–and it believes in absolutely nothing but itself. One of the few consolations is that their evil and their incompetence go together; as they totalize their power domestically and run through their pre-determined sequence of moral panics, their relative power in the world will slip away, much to their surprise and confusion. The parasite will finally cripple the host.

    • TheZvi says:

      Good call. I totally forgot that IQ and health are correlated to begin with, and the background on cardiac patients is enlightening as well, moving me farther towards the yes-this-screws-you-up-a-bit-but-not-in-unique-way position.

      To respond to everyone at once: I find the sudden large chorus of ‘soft vaccine mandates will lead to general authoritarianism’ takes surprising, given it’s rather standard to mandate vaccinations, and the other stuff government already gets up to – there’s a much stronger argument for mandatory vaccinations than e.g. requiring 200 hours of official training and a license in order to cut hair, and medical professionals can already treat you without your consent and then bill you for everything you own basically whenever they feel like it. Meanwhile, your kids are imprisoned every day at the barrel of a gun which is used as justification for giving them tons of vaccinations (and the problem there is not, in my opinion, in any way the vaccinations.) Also, allowing employers to mandate whatever they want, and employees to walk if they want, is to me the pro-freedom position, not the anti-freedom position.

      My guess is that a lot of this is that I picked up a bunch of new readers this past week, so welcome, glad you’re commenting, and happy to have this kind of disagreement.

      • Matty Wacksen says:

        > it’s rather standard to mandate vaccinations,

        Since when?

        >here’s a much stronger argument for mandatory vaccinations than e.g. requiring 200 hours of official training and a license in order to cut hair, and medical professionals can already treat you without your consent and then bill you for everything you own basically whenever they feel like it.

        Seriously, is “it’s not as bad as X so why are you worried” is the argument you’re going with? Can I tell you why you shouldn’t worry about covid because there are deadlier diseases out there? Apart from “yes these things are obviously bad”, each of these affects only a very small subset of the population directly; each have only highly localized effects in time, none of these can easily be avoided a priori.

        > Also, allowing employers to mandate whatever they want, and employees to walk if they want, is to me the pro-freedom position, not the anti-freedom position.

        It’s complicated, unless you accept “employees being allowed to lie about their vaccination status is the pro-freedom position, not the anti-freedom position”. I mean “allowing employers to discriminate based on whether their employee has visited a psychologist/psychiatrist in the past” is also the “pro-freedom position”, but it doesn’t seem particularly ethical…

      • TheZvi says:

        Responding to Matty, after which I’m going to stop discussing this in the comments at least for the week:

        The first vaccination requirements began in the 1850s to control the spread of smallpox.

        My case for ‘mandatory’ vaccinations is that lack of vaccinations have negative externalities both locally and non-locally, and thus allowing people to choose not to associate with those who are more likely to impose costs and make people around them sick, and to make the pandemic worse in general, seems like the least one could do – the alternative is to ban people from not associating with those who put them at risk, as some areas have done, and I don’t see how that’s better on any important axis.

        The reason I bring up other things and cases is because of the rhetoric that this will lead to an authoritarian state or this is a huge leap in state power or the justification of such power, and that’s not the case if many much authoritarian things are widely done and accepted, with far less justification.

        I will not go into why psychiatric care has special privacy protections that don’t apply to vaccination status, because I presume you know the answer. Nor do I think I need to go into why making fraud permissible would not be the pro-freedom position. If I’m wrong, I’m sorry that I did not have time for such matters.

      • Matty Wacksen says:

        Replying to Zvi:

        >The first vaccination requirements began in the 1850s to control the spread of smallpox.

        Just because something exists/has existed does not make it “standard”, especially when we are talking about the past. I don’t know about the US, but the fact that the measles vaccine was made mandatory in Germany several years ago is/was very controversial.

        >My case for ‘mandatory’ vaccinations is that lack of vaccinations have negative externalities both locally and non-locally,

        Externalities are notoriously hard to measure. If me and my friends decide not to get a vaccine and are sick at home for a week, is that a negative externality? If so, how does it compare to smoking? Please be more precise, what externality exactly are you talking about?

        >choose not to associate with those who are more likely to impose costs and make people around them sick,

        The vaccine is safe and effective, who are the unvaccinated people making sick if not (mostly) other unvaccinated people? If the vaccine were only mediocre at preventing severe covid I would understand this argument, but given that it is very good at doing this I don’t fully buy it.

        > and that’s not the case if many much authoritarian things are widely done and accepted, with far less justification.

        I understand the argument, but it’s not a particularly strong one and I’m pretty sure you realize this.

        >because I presume you know the answer.

        I don’t; I assume it is because we value a certain degree of privacy. There is also the fact that we don’t want to incentivize people to avoid psychological help.

        >Nor do I think I need to go into why making fraud permissible would not be the pro-freedom position

        It’s not so obvious. In plenty of places you are allowed to lie e.g. about whether or not you plan on having a family even though an employer certainly has an economic interest in knowing about this. It’s not clear what “fraud” is, lying about your family planning situation certainly isn’t. I’m thinking of James Richardson’s “You have the right to lie when they have no right to ask” and it’s not obvious to me whether someone has the right to ask about your medical situation when it comes to vaccination. The idea that allowing more things is pro-freedom shouldn’t fail once allowing more things (lying about your vaccination status) is against the things you like.

      • Alcibiades says:

        I at least am an old reader (long before COVID-19), and I am disappointed by what I see as your decision to carry water for a regime you obviously have no faith in (because it deserves none).

        Clearly you see all currently possible alternatives as worse than what we have. You are very likely right. But I don’t see that as a reason to do the regime’s dirty work for it. We can keep our hands clean while building or waiting for something better.

    • Fermion says:

      Oops, part of the post seems to be missing — here that part again without bullet points:

      On the UK Situation: I am very confused by the quick turn-around, I did not think there was a big change in immunity over the last weeks. Vaccinations are on the 250 deaths/day) went down to 22% from ~ 40% 10 days ago.

  10. Seb says:

    Zvi, unrelated to this week but we did talk about it a few weeks back – Brainstorm is soft banned in Historic, and once again you seem to have been correct.

    • TheZvi says:

      Yep, saw that, good to see them realize it. Their explanation wasn’t great, but I’ll take it.

      • Seb says:

        Yeah I’ll take it too. I’m currently playing Standard with the deck that Flores is calling “Zvi StOmPy” though, so it hasn’t affected me too much yet.

  11. Yrro says:

    On unvaccinated coworkers… Man, I have one guy who is determined to be the outlier here. He is one of the smartest guys I know, an excellent co-worker, good friend, etc. He kind of hates getting shots, hates being told what to do by the government, and is essentially as fed up with the “official” story on COVID from the FDA and CDC as you are, for most of the same reasons.

    He has taken the following logic:
    1) At his age and health, he is at low risk of significant effects from COVID.
    2) Vaccines are widely available to anyone who *is* at risk.
    3) Therefore, what risk he takes on himself is his own problem, and people who are vaccinated shouldn’t be freaking out that he isn’t. “You guys are all safe, I’m the one who’s potentially at risk, and I’m ok with that.”

    I don’t agree with that — but the disagreement hinges pretty strongly on either appeals to the welfare of the limited number of at risk people who can’t get vaccinated (and how much pull they should or shouldn’t have over his behavior, not to mention that none of them work for me) and risk/reward to him… which is kind of his business, not mine.

    He said if we require vaccines for work, he’ll get a shot but be grumpy about it.

    I’m really not sure how to handle him, given that the entire rest of the office is vaccinated and at least pre-Delta, I’m not sure (at least relative to risk in the office) I have a slam dunk counter to his position. He’s not quoting bullshit data about vaccine risks or anything like that, and at least now that Delta has significant escape there isn’t even really a knock-down argument about herd immunity.

  12. AT Natenshon says:

    One note on the Billionaire/True Philosoper/Ideal life idea, I wonder how many of the people who choose their actual life have kids. Having kids has dramatically changed the calculus of dreaming of a ‘perfect life’ if it meant I wouldn’t have my kids anymore (assume I would have kids in the different world but they wouldn’t be the ones I have now) and so I don’t want to pick any life that didn’t have my kids in even as a daydream.

  13. Triskele says:

    Do we know how well distributed Astra Zeneca trials were in countries versus Pfizer? My theory is that Pfizer was never 95% effective at fully blocking covid from inducing _any_ symptoms, and this was an illusion propagated by having most of the test sites run in the US where people were probably more cooperative in social distancing and stuff versus the AZ trials which as far as I know were more well distributed in like South Africa and Brazil (Pfizer did have sites in those countries but it’s like 130 sites in US vs six sites in SA and Brazil). Is this a fair assessment?

    Now that social distancing and masks are out, we’re not seeing ‘decreased effectiveness’ so much as results in the real world. Not that this is a bad thing – I’m still in the pro-vaccine camp, but 90+% always smelled a little. Even if it was 90+%…from an engineering perspective, I’m pretty sure I’d never want to publicly stamp the maximum possible load on a surface as the expected performance!

  14. A1987dM says:

    But wouldn’t “social distancing and stuff” also reduce infections in the placebo groups, rather than just in the experimental ones? If anything, I would expect their effects to be larger in the former, as some of the people in the experimental groups could probably guess from the side effects that they weren’t given a placebo and started being less careful as a result.

    • Triskele says:

      I thought about that too, but gets into more mind-reading than I’m comfortable with! My point was, it’s possible that AZ’s trials were conducted under more realistic ‘battlefield conditions’ than Pfizer…but, I’m happy to be wrong!

  15. Dave Baker says:

    I’m sure you’ve seen this, Zvi, but it sounds as if this report on spread in big events in Provincetown, MA area was a factor in the CDC recommending masks for vaccinated people: https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm?s_cid=mm7031e2_w&fbclid=IwAR2N9nNFeQNVNpB0VRXEk6nVikW0OSklxRjZQRutVjNDU8BOYUnGd0tWUV0

    “During July 2021, 469 cases of COVID-19 associated with multiple summer events and large public gatherings in a town in Barnstable County, Massachusetts, were identified among Massachusetts residents; vaccination coverage among eligible Massachusetts residents was 69%. Approximately three quarters (346; 74%) of cases occurred in fully vaccinated persons (those who had completed a 2-dose course of mRNA vaccine [Pfizer-BioNTech or Moderna] or had received a single dose of Janssen [Johnson & Johnson] vaccine ≥14 days before exposure). Genomic sequencing of specimens from 133 patients identified the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, in 119 (89%) and the Delta AY.3 sublineage in one (1%). Overall, 274 (79%) vaccinated patients with breakthrough infection were symptomatic. Among five COVID-19 patients who were hospitalized, four were fully vaccinated; no deaths were reported.”

    These numbers aren’t great and should probably cause at least some reduction in our estimate of vaccine effectiveness against delta. But there are lots of possible selection effects here, which I don’t trust the CDC to keep track of. In particular:

    –Partiers may have been more or less vaccinated than the general population
    –Vaccinated people are older on average than unvaccinated people, which is likely the explanation of the comparatively many hospitalizations among the vaccinated
    –Vaccinated people are almost surely more likely to get tested, whether symptomatic or asymptomatic

    These mean that we should expect the vast majority of positive testing cases, and maybe even the majority of hospitalizations and deaths, to be among vaccinated people going forward. (E.g., even if the vaccines are very effective at presenting death, age is “very effective at causing death,” so if 100% of people 65+ are vaccinated, then most people who die of Covid will be vaccinated.)

    • Dave Baker says:

      It sounds as if they did extensive contact tracing in Provincetown, so that does mean it’s much less likely that many cases were missed due to people not getting tested. But so few asymptomatic cases is surprising if they really did catch all the cases. I have no idea what to think.

      • Triskele says:

        By the sounds of it there are some…details…missing from the CDC report, which can be hinted at by the 80% male cases.

    • TheZvi says:

      Will analyze for next week (or maybe do an additional post on this first).

  16. Catweazle says:

    @TheZvi do we have any studies on whether being infected with existing diseases such as influenza or varicella, also has an effect on IQ ?

    Infectious disease specialists know that many common diseases also carry a “long tail” risk.

    Is the long Covid analysis flawed because it considers long Covid in isolation, ie. does not attempt to compare to pre-existing long tail risks including IQ losses?

  17. Stefano says:

    (Copy-pasting my comment under the previous post, since there might be something really important here:)

    Any thoughts on this tweet?

    I find it weird due to 3 reasons:

    1. In general, the population fatality rate (PFR) should be much higher because of delta (I heard it’s 2-3x as transmissible and may be 2x as deadly as the previous variants).

    2. The IFR for young people (18-35) is ~0.2%, the PFR in this group is defined as 0.001%. That’s a 200x difference, and if PFR=(risk of infection)*IFR, it should mean that only 0.5% of young people contract(ed) Covid-19. As far as I know, that’s not the case, and in most countries, >10% of young people got infected. Or maybe they adjust for the vaccination-related reduction in transmission, but the effect shouldn’t be this big.

    3. If I’m <30, the vaccine lowers my overall death risk (PFR) from 0.002% to 0.0001%, so by 0.0019%. It means that – neglecting the population-wide effects – I shouldn't get vaccinated if the vaccine itself kills more than 19 young people per 1M. Does it? Probably not, but I haven't seen any reliable estimates of a vaccine-related mortality.

    Please let me know if I'm making any silly mistakes here.

    • TheZvi says:

      None of the FT’s info here is new or surprising. It’s a guess on quantifying it in a way that’s helpful, nothing more.

      If you are purely selfish, and care only about risk of death, then yes you should get the vaccine if and only if it net lowers your risk of death. I’m tired of pointing out that the vaccines do not kill people, but I’ll say it again, that number can be rounded off to zero.

      • Stefano says:

        Please don’t worry about changing my mind for the worse – I take protective measures, I’m already vaccinated due to both personal and social reasons, and I recommend it every day based on the benefits outweighing risks.

        I just care about precision, and it seems to lack in all these considerations. Is my chance of dying after getting infected now closer to 1 in 500, or to 1 in 50,000? How about the severe course, long Covid, and potential permanent health damage after getting infected – closer to 1 in 100, or to 1 in 10,000? OK, the number of vaccine-related deaths can be rounded off to zero, but by whose standards? Is it closer to 1 in 50,000, or to 1 in 1,000,000?

      • TheZvi says:

        I find the framing interesting – taking less precautions isn’t automatically worse, and more isn’t automatically better!

        If you’re double vaccinated, and you’re unknown age but in the range 18-35, without diabetes or obesity, my best guess (roughly, but picking numbers is better than not picking them) for your CFR is .0005%, or 1 in 200,000, versus .016% or 1 in 6,000 without vaccination. Adjust for age and comorbidities accordingly (see https://thezvi.wordpress.com/2020/05/10/covid-19-comorbidity/).

        My guess for the number of vaccine-related deaths in that age range would be 1 in 1 million or less.

        My guess for long covid that’s enough for you to notice and care about would be on the order of 2% (but for most of those not to be anything like ‘crippling lifelong issue’).

  18. Matty Wacksen says:

    >I presume we will see a similar turnaround at a similar point, but what’s causing them to happen so quickly? I don’t know.

    I kind of resent this being called the “control system” in this blog given that this suggests that something other than the “normal” spread of the virus is happening. Have we seen *any* place that follows standard epidemiological curves (such as produced by the SIR model or its variants)?

    Does this not suggest that we just don’t understand epidemiological spread of this virus? Early on (last year) people were speculating that e.g. (i) small amounts of viral particles from the environment help prime your immune system, (ii) pollen slows viral spread, (iii) heterogeneity of social networks means that SIR-type models don’t apply, or (iv) the existence of epidemiological ‘dark matter’. While I am not qualified to assess the validity of (i)-(iv), I wish there more of this kind of speculation because of the admission that simple models don’t fundamentally seem to describe the spread of covid-19 very well.

    > Another central question is Long Covid, for which we got some actual data

    Correlation is not causation. See e.g. https://twitter.com/KaiSchulze_/status/1418913699297996803 , since when is this kind of study taken seriously in rationalist circles?

    >If that’s all true, that’s really bad! Once again, you do not want to get Covid

    What kind of data would make you say “oh, covid is much less dangerous than ‘riding a motorcycle’ for subgroup of people X, I guess it’s not such a big deal”? I don’t understand the kind of logic going on here. You (and most people reading this) are certainly vaccinated, why are you still afraid of covid?

    • Matty Wacksen says:

      Sorry, I submitted the comment by mistake by pressing some button while editing, my bad.

      I’m also disturbed by the whole “You Play to Win the Game” rhetoric, I would certainly classify it as authoritarian/coercive. We have a disease that is (probably) no more dangerous than the other coronvirudae (sp?) to the vaccinated, and the opportunity for everyone(*) to get the vaccine. Yet people like yourself are trying to make choices for other people with regards to how much risk they should be taking. There is no reason why a NFL game needs to be cancelled because a player tests positive for coronavirus; the “problem” is entirely artificial. People who pressure others into vaccinating by structuring “incentives” (the wording is rather Orwellian, if I make someone an ultimatum then that is not an “incentive” in the usual sense) think they are doing the right thing; but what authoritarian system doesn’t start with good intentions? Of course, you think you “know better”, but based on posts like “We’re fucked, it’s over” and the fact that you cite studies like the IQ test one above, your expertise seems quite limited. Why shouldn’t all the arguments you make about covid not apply equally to “moral pollution”?

      I’m sorry for the large amount of criticism here, but I wish the whole “the vaccine is safe and effective” crowd were more honest about vaccine side effects. These are (probably) not serious in the long term, but the fact that I personally know people who have been completely knocked out for a day or two after getting the vaccine worries me since nobody seems to openly say “getting the vaccine can be really unpleasant; possibly more unpleasant than covid-19 for young people under X years old”. What is the correct value of X here? Are we in a place where it is ok to be dishonest about the severity of vaccine side-effects in order to pressure people to do things for the “greater good”?

      (*) I’m talking about the US here. The fact that children can’t get vaccinated doesn’t really matter because they are not really at risk of serious disease, fight me anyone who disagrees. I know immunocompromised people exist, but don’t think they change the calculation.

      • TheZvi says:

        I responded to your comment in another thread above.

        The first question seems like a claim that, since what happens is hard to predict by some standard, we should assume there’s hidden reasons it’s happening that are outside our control or understanding, rather than attempting to build a better model. I’m confused by this claim, and have been very clear on e.g. the limitations of SIR.

        I looked at the study in question while noting it’s not great, as the best thing we have at all, noting reasons to be more and less skeptical at various points. If you think I took it too seriously, by all means discount those conclusions. I’m not “citing” it as proof of anything.

        There’s a bunch of additional stuff here that I could respond to as well, but I’m mostly going to choose not to. People can evaluate the logic behind my predictions and model, and how well it did, and I encourage them to do so – if anyone thinks I have little expertise or ability to figure things out, and that thus no one should listen to me, then by all means that person shouldn’t be listening to me, and that’s fine.

        If you think the NFL’s actions are entirely optional and teams should just play with whoever is lying around that isn’t being isolated due to contact tracing no matter who tests positive, either you do not understand football and/or you do not understand the dynamics of the situation, at all. Sure, there’s decisions on the margin of when to field a crippled/weakened team and accept some Covid risk versus cancel the game, but only on the margin.

        If you think I’m in favor of lying or misrepresentation by officials or anyone else, I dunno what to tell you at this point. Shrug.

        Finally, I’ll conclude by saying your framing seems like a fully general argument that it is authoritarian to use incentives to get people to do things, and I don’t know what to say to that. Beyond that, I’m going to cease engagement in the interests of time.

      • Matty Wacksen says:

        Replying to Zvi’s reply:

        >I responded to your comment in another thread above.

        Yes, different points made there.

        >I’m confused by this claim, and have been very clear on e.g. the limitations of SIR.

        I agree that we should try to make a better model, isn’t this exactly what I’m saying. But if SIR consistency produces incorrect results then we should stop using SIR (and things derived from SIR) as a model instead of using it until we figure out what a better model is.

        >then by all means that person shouldn’t be listening to me, and that’s fine.

        You’re making a number of policy suggestions so in some sense you do seem to think people should be following this kind of expertise. I think it’s not entirely defensible to have a bailey of “I think people society should be forced to do X” with the motte of “just don’t listen to me if you don’t like it”.

        >Sure, there’s decisions on the margin of when to field a crippled/weakened team

        I notice I am confused. Is a team of vaccinated players crippled/weakened if they are exposed to someone who might have covid (let’s strengthen this and say the other player also tests negative)? Most young fit people aren’t particularly hard hit by covid to begin with, if they are additionally vaccinated then where exactly is the danger and why is it worse than the flu?

      • Matty Wacksen says:

        Also replying to Zvi:

        >I’m confused by this claim, and have been very clear on e.g. the limitations of SIR.

        Maybe I’m being too harsh here because you do mention that SIR is very limited and people relying on overly simplistic models of disease spread is a bit of a pet peeve of mine :) So much reasoning “basic reproduction number”, “herd immunity threshold”, etc depends on models like SIR implicitly (cf. https://necpluribusimpar.net/lets-have-a-honest-debate-about-herd-immunity/). My comment here re: SIR-type models was because you mentioned you were surprised at the quick fall in cases of the Delta variant which suggests you had some model which did not include this kind of quick fall as a possibility.

  19. *sobbing quietly* says:

    According to FT, the risk of catching and dying from Covid-19 is the same for a vaccinated 90-year-old person and an unvaccinated 60-year-old person; it’s also the same for a vaccinated 60-year-old person and an unvaccinated 40-year-old person. My family members (vaccinated ~90Y & ~60Y) wouldn’t leave home during the past peaks if they were unvaccinated and 60/40 years old. Delta is obviously more transmissible, is said to have a higher IFR, and the vaccine might give less protection 5-9 months after its administration. Does it mean that my family members should come back to a strict self-isolation?

    • TheZvi says:

      There’s a difference between what makes sense short term versus long term – I doubt a 40yo would choose to not leave home *forever* in order to not get Covid, and I’d think that was a pretty crazy decision if they had normal levels of desire to leave the house. If you isolate now, when is it going to end? And if that level of risk is unacceptable, shouldn’t we abandon our cities? Etc.

      A concrete suggestion: If anyone is seriously considering self-isolation while vaccinated, you should look into getting a 3rd shot as a booster.

      • sigh says:

        I felt quite bad for a week or two after each shot. I would probably go for the third one in Q1 2022 if it was updated for the recent variants. Eh, maybe – for the sake of one’s mental health and limited lifespan – it’s time to ignore everything that’s below the 1% risk for severe course and the 0.1% risk for death?

      • TheZvi says:

        That’s far above the average reaction size, and definitely enough to make me consider not going back for a 3rd shot if I was young. I’m guessing you got Moderna, given the magnitude of those effects, and I’d make an effort this time to get Pfizer instead.

  20. MaxF says:

    About the sudden turn-around in the Netherlands: On June 26, we opened up nightclubs (and that packed outdoors-but-not-quite-totally-outdoors festival) for people that were vaccinated or had a recent negative test. At that time, vaccination appointments were just starting to open up for younger people. (I’m in my early thirties and got the first injection on June 28.) There was also no waiting period after vaccination: You could get the Janssen vaccine and go to a disco on the same day. Two weeks later, nightclubs were closed again due to the rise in new cases.

    I don’t think that this tells us anything about Delta. Do you think that the quick turn-around requires some additional explanation?

    • TheZvi says:

      I don’t think that holds up, for many reasons – nightclubs would have to be *most* of the exposure in the whole country, for it to go directly from doubling every cycle to halving every cycle, 75%+, which doesn’t seem plausible. And also the curve has the exact same shape, magnitude and timing as the UK, which didn’t have the nightclub issue. So while that could be some part of the solution it can’t come anywhere near explaining the whole thing.

  21. sigh says:

    Re: above – I had these reactions after Pfizer. There was no fever or shivering, just a strong sense of inflammation and weakness. Or maybe it lasted just for a couple of days, and the rest was stress-related. :(

  22. alesziegler2 says:

    I see a huge difference between private employers mandating vaccination and government ordering every citizen to get vaccinated. While I am completely ok with the former, latter really is somewhat unprecedent restriction of personal liberty on the grounds of public health, given low danger of covid for the vaccinated and for kids. This is not smallpox, or indeed covid in pre-vaccine era.

  23. Ponder says:

    Something to consider: I’m a physician. My colleague recently saw a case of severe idiopathic (that is to say, unknown) hepatitis (*) requiring admission to the hospital that is chronologically associated with taking the COVID-19 vaccine — and not linked to anything else we could identify (but that’s not to say it couldn’t have been random or actually linked to some other exposure the patient didn’t recall). Had it been a different new medication, he probably would have written a case report had this association not been known, and/or reported it to a monitoring database had this been a new medication.

    But, being in a major city, and at an academic institution to boot, all my (vocal) colleagues are uniformly left-leaning. Jokes were made about how if this got it would be all over Fox News, etc. — all in good jest — but ultimately, no case report was filed, no reporting was done, and I can’t help but think that was influenced by the baseline perception that sharing potential side-effects of the COVID-19 vaccine was tantamount to identifying as politically red.

    At the end of the day idiopathic is just that. For the elderly and the sick (including obesity), it would take an enormous bias to change the vaccine calculus. And given herd immunity depends on vaccination rate in the herd, it may not change the calculus as to whether society should strongly incentivize the vaccine. But for a perfectly healthy and selfish (not in a negative way, just talking about the calculus used to decide on the vaccine) 15 year old? 25? maybe 35? possibly 45? we are talking about weighing probabilities on the order of single digit severe incidents per ten-thousand to per million, and I could definitely see a bias in reporting changing the outcome of that calculus.

    This is a super long-winded way of saying: where there is systemic bias, my confidence in any conclusion that relies on fractions of percentages is quite low.

    • Ponder says:

      * – changed details slightly just in case one of my colleagues reads this, however improbable.

    • alesziegler2 says:

      There are other countries, though. Any systemic bias would have to be global in the same direction, or it would get blown up pretty quickly by reports from e.g. Israel or Singapore or wherever.

  24. ConnGator says:

    Caleb Dressel said he was absolutely miserable while winning all those gold medals. So, that’s a tough sell.

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