Covid 8/12: The Worst Is Over

Good news, everyone! Andrew Cuomo has resigned, and Andrew Cuomo is the worst. 

I will damn well take it, because it’s not like he doesn’t also deserve to resign in disgrace for the stuff that officially got him, and again, also to say it for what is hopefully one last time, Andrew Cuomo Is The Worst. Hence, The Worst Is Over. Sing it high, sing it low. (HT: Meme source)

The title this week does not as reliably or fully refer to the Delta variant or the Covid-19 pandemic. Things are still steadily getting worse. But the turning point is plausibly in sight, as case growth slows, and I doubt we have more than one doubling left before things peak. 

Main event this week was continued arguments over mandates, both for vaccines and for masks and other NPIs. I’m making one last attempt this week to explain my reasoning on vaccination mandates, as I continue to get people disagreeing for a variety of reasons, and disambiguating the disagreements seems worthwhile; I tested it out in the comments last week and it seemed productive. 

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 855,000 cases (+45%) and 4,100 deaths (+40%). 

Result: 744k cases (+26%) and 3,725 deaths (+35%).

The case numbers are very encouraging. They’re still increasing, and there’s always the chance this was a data fluctuation that will be actively undone, but it probably wasn’t and represents either the control system kicking in or us nearing a natural peak. I still expect a similar increase next week, but I’d estimate a 35% chance that within two weeks we get about as high case counts as we’re going to see in this wave, and 55% it happens within three weeks.

I’m still predicting a +35% rise in deaths, as the cases from the last few weeks make their way through the system, and hope to be pleasantly surprised.

Prediction for next week: 900k cases (+21%) and 5,028 deaths (+35%).

[Note added 8/19: 5,028 deaths is actually a prediction of +48%, which would have been more accurate, but the intent here is clear from context, and I meant to do +35% and somehow gave an incorrect number. So even if it’s a better prediction, it’s unintentional, and I shouldn’t get credit for it. Damn. ]

Deaths and Cases

Grouping these together, because there’s a combined mystery to solve. 

Here’s the case numbers.

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
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
Jul 29-Aug 4131,19786,394323,06348,773589,427
Aug 5-Aug 11157,553110,978409,18466,686744,401

This is a substantial slowdown in new cases, cutting the growth rate in half. We might be peaking within a week or two. 

Here’s the death numbers.

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Jun 24-Jun 305504597061861901
Jul 1-Jul 74593296121281528
Jul 8-Jul 145323986891451764
Jul 15-Jul 214343417321701677
Jul 22-Jul 2849138510091572042
Jul 29-Aug 469347714153042889
Aug 5-Aug 1170560521812343725

(Note: California reported -352 deaths yesterday, I changed that number to 0. Last week Delaware dumped 124 deaths on us, presumably a backlog, which is why the NE number last week was so high. I’m choosing not to correct for that for now but might smooth it back for next week as it is potentially importantly misleading.)

The death number was modestly better than I predicted, but definitely not good. This NYMag article (sorry about linking to Topol so often, world is strangely small) highlights the negative perspective of the American death rates not dropping this wave the way they did in other countries. Yes, the CFR is down a lot, but the bulk of that is lag due to cases rising so rapidly. If you undo the lag, you see something else…

[Lagged = cases from 3 weeks ago. Lagged and averaged = cases from 0.1*(1 week ago) + 0.2*(2 weeks ago) + 0.4*(3 weeks ago)+ 0.2*(4 weeks ago)+ 0.1*(5 weeks ago)], chosen quickly to be not crazy. Originally had 0.5 instead of 0.4, which was dumb, it is now fixed.]

At the very beginning the CFR was much higher, but once we got adequate testing and reasonable care, things haven’t changed much on this chart. This is not at all what we see in the UK, where the CFR is clearly down a lot.

The uptick at the end represents the UK having declining case counts, rather than a higher death rate. The Netherlands looks similar to the UK but made the graph hard to read.

A simple theory is it has a lot to do with this, the positive test rate:

We went from 2% positive tests to 15% positive tests, which indicates our testing is not keeping pace with our cases. In fact, it’s not keeping pace at all?

Seriously, what the hell, people? It’s one thing to not keep pace, it’s another thing to be testing less now than we were when cases were at their lows. That means that, conditional on not having Covid, the chances of a given person getting tested have gone down a lot, despite their reasons to worry they have Covid having gone way up. Much higher chance they have a known contact with someone positive, and much higher background danger.

One possibility is that people are now increasingly using at-home tests first. We did this last week, when our four year old had a cough and we were asked to exercise an abundance of caution – it was annoying to stick that thing up his nose for a while, but it was cheap and quick, and got the job done. Whereas when we looked into getting a non-rapid non-home test, it was clearly going to be a pain in the ass to get. One of my friends posted a similar experience, where she couldn’t get her child tested for several days unless she got a test at a pharmacy. Both of us got negative results, and neither result counts in the charts above. If one of them had come back positive, it’s not clear how often that would have made it into our statistics either. If there was no need to escalate to official medical care, there’s no default mechanism to get those results into the statistics. 

Whether or not that’s the main mechanism, I am confident that a large majority of cases, especially asymptomatic or mild cases, are being missed entirely by the system. The true IFR likely has not dropped here quite as much as in other places, but our vaccination rates are not that much lower and our medical care is quite good and holding firm, so it’s likely falling almost as fast here as elsewhere. Our CFR staying high says more about our rate of case detection than it does anything else.

In some ways, this undercounting of cases is very good news, as it puts an upper bound on how bad the pandemic can get and moves us more rapidly towards the turning point. In terms of hopes for containment, however, it’s very bad news. If cases have grown much more rapidly than our numbers naively indicate, then our hopes for containing this in a meaningful way, rather than waiting for enough people to get Covid that things die down afterwards, are much worse. 

Vaccinations

Here’s Zeynep, on point as always, on vaccine hesitancy and the reasons behind it, which are far more reasonable than they’re usually made out to be. 

Also, it turns out that having a Bachelor’s or Masters makes you very likely to be vaccinated, but if you go on to get a PhD, you’re now in the least vaccinated group of all. 

This week’s thread on relative infectiousness of the vaccinated versus the unvaccinated. As you would expect, when you do random population samples, you find lower average viral loads in vaccinated people. 

The can-do spirit:

Also, perhaps we could try publicizing this more? Ask 24 out of 25 doctors if vaccination is right for you? Maybe take the crosstab of Republican doctors which is presumably still over 90%? Playing to win the game takes many forms.

Baltimore’s anti-Covid ad posters. No idea if they’re effective but at least they’re playing.

The can’t-do spirit:

This seems to me like it should be a rather large scandal. If people in Alabama don’t want the vaccine, and it’s going to expire, then it’s imperative to recognize that and send it elsewhere where people do want it. Worst case, you cycle out old vaccine to places cycling through what they have, and then move in new shipments so there’s still stock around when and if people change their minds. Also, ‘expired’ vaccines might not be good enough for us, but they doubtless mostly still work, so I’d still send ‘em off to whoever wants them. 

Yet I see almost no discussion of such matters. Shame!

The Isreali can’t do but therefore do what you can spirit:

And the can’t get paid enough spirit, I too blame capitalism for all these vaccines:

Vaccine Mandates

Nate Silver broke down people’s current stance on Covid into a categories, and I think this is mostly accurate:

Jacob offers an alternative theory of Group A:

My guess is this is indeed a substantial percentage of Group A, but I’d be rather shocked if it was anything like a majority.

One thing we can do is compare this to last week’s survey results on mandates, which found that 62% favored the maximally coercive policy of a universal vaccine requirement. That would roughly be Groups A+B, which is 55%, and some of Group C1, then only C2 and some of C1 are vaccinated but don’t then favor a full mandate on others. 

There aren’t that many people in the daylight between ‘willing to get vaccinated myself’ and, well, this:

I’d like to take one more stab at addressing various arguments against vaccine mandates, explain my perspective on it, and then move on to what’s actually happening. 

There are a bunch of different arguments against vaccine mandates, and it seems the only one that convinces a lot of people is the argument that (A) one shouldn’t take the vaccine, presumably (I’d hope, anyway) with the implication that the vaccine also shouldn’t be mandatory. 

(B) would be that bodily autonomy is super important, and thus vaccinations are in a different class from things like masks and lockdowns, and either (B1) allowing this is an escalation of authoritarianism, and will greatly expand authoritarian power and perception and lead to tyranny and/or (B2) this is going to piss a lot of people off, destroy their dignity, is generally bad on object level, and so on. And the claim that (B3) an employer mandate is authoritarianism and against freedom, as opposed to all the other things jobs require, and thus we should suspend freedom of contract or punish those who use it in this way. 

So basically not buying into arguments like this:

There’s a lot of vocal support for both of these, both in my comments and in general. I’m sympathetic to these types of arguments, but not convinced, because mandating vaccinations to stop infectious disease has correctly been standard procedure for a while, and such precautions as a condition of employment or close physical proximity to many others are exactly how free people react to such situations. And if the choice is between ‘no indoor dining (or other X) for anyone’ and ‘no indoor dining (or other X) for the unvaccinated’ I know which one I’m choosing, and which one leaves me more free.

There was a lot of talk earlier worrying about tracking, but we’ve moved past vaccine passports and people just flash their cards, so that’s not a concern, and also a common alternative is ‘contact tracing’ which involves keeping a lot of records of exactly the type we’d worry about. Instead the concern here is the flip side of that, which is that (C) vaccine cards are easy to fake. That’s true, but also there’s a central database that knows the answer that already exists. I’d rather not push people to lie and commit fraud, but this doesn’t seem like that big a concern here.

A real concern is that (D) they got this one right, vaccines happen to be safe and effective, but it’s not clear that we wouldn’t be in a similar position in the future where the thing in question wasn’t safe and/or wasn’t effective. In this case, I actually don’t think this is true. I think both that the vaccines are safe and effective based on the evidence, and also that if the evidence did not strongly say they were safe and effective, we wouldn’t be contemplating such policies. The level of pushback we have now is when, scientifically, the case is overwhelming, and if the vaccines were instead not safe but still much safer than not getting vaccinated, we’d not only not make them mandatory, they’d be forbidden. We ran that experiment.

Finally, there’s (E) that more vaccinations won’t change the path of the pandemic at this point, so why are we bothering, choices have consequences, the unvaccinated will get sick but the vaccinated will mostly be fine, so all we’ll be out are a few medical bills (which will effectively get socialized, because insurance can’t discriminate and if you don’t have insurance mostly the government pays). I don’t buy this, there are a bunch of immunocompromised people, even for vaccinated people getting Covid is worth avoiding, and in practice if there’s lots of Covid out there the result will be lots of lost living of life. 

Another disagreement I’ve found is (F) the idea that an individual is only responsible (in various senses) for either literally themselves, or only those who that individual infects directly, rather than the marginal cost being every infection that results from your actions that wouldn’t have otherwise happened (there’s a control system, and some people would have gotten infected later anyway). 

Finally, there’s (G) that the mandates are covering people who already had Covid and thus don’t require vaccination. There’s the counter argument that vaccines are more effective than immunity from prior infection, but antibody tests could check and even worst case I doubt prior infection is that much less effective than J&J which we consider to fully count after one shot despite it not making much logical sense. I don’t find that convincing. I also don’t think the evidence that vaccination after infection is still worthwhile makes this sufficiently effective to convince me either, although it’s still a substantial additional reduction and I personally would still get the shot. What I do find convincing is that lots of people are wrong about whether they’ve had Covid, or would fool themselves or lie about it, and thus there’s no reasonable way to make this (otherwise correct) exception short of getting a confirmed antibody test, and the complexity costs and messaging and such involved make it not worth it. Sometimes you gotta suck up stupid things in the name of simplicity, but of course if anyone does want to make such exceptions that seems totally fine.

The high correlation of positions on all these points is, of course, both expected and suspicious, on all sides including my own. 

Other times, incentives matter, and people enjoy using hyperbolic language. I don’t really know what he was expecting. 

One cost of lack of vaccination is putting more strain on the hospital system, as they once again are forced to cancel elective surgeries, thus reallocating medical care from those who need it because life to those who need it because they are unvaccinated. The cost here is not purely monetary. 

In conclusion, I’m strongly in favor of employer mandates, and on imposing the kinds of restrictions we’d otherwise impose on everyone (e.g. travel, indoor dining and so on) only on the unvaccinated, although of course we should be smart about it, and I’m happy that so far no one I’ve seen is suggesting excluding the unvaccianted from beaches or playgrounds. 

I’m definitely in favor of letting gyms mandate vaccinations rather than masks, as opposed to being required by law to mandate masks instead as they are in Washington DC

For now, lack of FDA approval is holding many mandates back, even as increasingly many go forward anyway. 

If I knew the FDA was going to get this done in a few weeks, I’d be inclined to announce new restrictions but make them conditional on full FDA approval, so as to benefit from the cover that will provide and give them that much more of a nudge to hurry. Alas, while I hold out hope for it, I currently have no faith in that timeline, and we don’t need them to tell us what we already know. 

I now consider that out of the way, and won’t be discussing it further unless something changes. So, what are this week’s new mandates?

Here’s an interesting local one that turns out not to be the full corporate policy, and a reminder that this is how attention works on the internet, and it looks like about one out of every thousand people who saw the original post saw the clarification that it wasn’t the whole chain.

CNN’s mandate showed it has teeth. Which is how it has to be. Once you have a mandate, for many reasons it needs to be properly enforced.

Meanwhile, the question as always with children is, should we forbid vaccinations as horribly unsafe, or should we stop doing that and turn on a dime to mandate them outright, with not vaccinating as horribly dangerous?

Yelp is doing something interesting, which is that you can search restaurants by ‘All Staff Fully Vaccinated’ and by ‘Proof of Vaccination Required.’ I verified this, while also noticing that Yelp’s rating sorting algorithm leaves something to be desired (e.g. having a 5-star average on 2 reviews seemingly puts you in the top 10 for all of NYC, whoops). This is sufficiently cool that I’m going to play around a bit more with Yelp, since I’m working on my list of places to go in NYC once I get back anyway. 

The San Francisco Sheriff’s Deputy warns that when the full vaccine mandate is imposed, officers will quit en masse, whereas they wouldn’t if they only had to have a swab up their nose every week instead like the state suggests:

I wonder if this is a place where approximately zero people would be sad to see many of those 160 deputies go. The blue tribe locals are anti-police and will see these as bad actors and even outgroup members, and be happy to see them go. The red tribe will see this as the latest talking point in what they see as SF’s descent into crime and anarchy. The rest of us find out how many officers actually quit, which will be great data. Everybody wins?

In contrast to NYC’s teachers, the head of the American Federation of Teachers came out strongly in favor of a mandate.

France implements its Health Pass requirements with little fanfare, despite weeks of protests (WaPo). Sounds right.

Think of the Children

The request here comes from the American Academy of Pediatrics, representing 67,000 physicians.

As Alex Tabarrok puts it:

It is quite the rebuke. Well said. When concerned physicians tell you to stop demanding so much child safety data and Get On With It, that is the opposite of the mistake they are most likely to make, and thus this is strong evidence that a lot more Getting On With It is urgently needed. 

This thread points out the obvious, which is that anything picked up in the large sample, that wouldn’t have been picked up by the small sample, wouldn’t be big enough to make the vaccine not worth taking. Thus, the bigger sample is actively worse, because it is capable of finding rare effects that would scare either regular people into declining or scare the FDA into not approving, and such decisions would almost always be mistakes.  

When tackling the question of schools, if you are going to take the position that children are at sufficient risk from Covid that they can’t be put into rooms together with one adult, one should notice it’s strange to also forbid them from being vaccinated, and it’s heartening to find advocates that at least realizes that much (and of course wants to go directly from forbidden to mandatory, as I am confident we will do for children).

So at least there’s that. Of course, this is in the world where even fully vaccinated children can’t safely be put into the same room without masks.

I’m also happy to see air quality mentioned as a key issue (as a reminder, air quality improvement in schools would be urgently necessary and worthwhile even if it didn’t matter for Covid or the moment to moment experience of breathing the air). The core of the argument, later in the thread, is the risk of Long Covid. You have to raise the specter of Long Covid when talking about children, since the risk of anything else is clearly not worth worrying about even without vaccinations, and here the proposal is to worry about it even after vaccinations. 

As usual, the procedure in this thread was to gather together every possible symptom, of any severity, and any duration longer than a few weeks, that happens after someone has Covid (and that may or may not actually have anything to do with Covid) and count them all as Long Covid together, with no attempt to quantity what it means for someone if they get it. Also without any practical plan for how long proposals to avoid it might last or under what conditions they would be willing to stop using them. 

The New York Times was also its usual self and did its best scare piece on Long Covid in children, but it’s only one of a chorus of such claims. That doesn’t mean Long Covid isn’t real, it’s clearly a thing and the primary risk factor for younger people, but it must be kept in perspective. Here’s a thread pushing back, and the related post from Gaffney:

It could be worse, and usually is. The standard line is that Delta is even more dangerous for children because they have a higher percentage of infections, hospitalizations and deaths than they did previously. Which is absolutely true, and can be explained by the fact that they’re mostly not vaccinated.

From post in question, ya don’t say, might I suggest something we might do about that?

This CNN post is similar and typical. It cites increases in cases in children similar to increases in cases overall, then has to explain why anyone should care. Its first reason is that this is critical to keeping them in school, because if we don’t protect kids from Covid then we’ll have to take them out to protect kids from Covid, and then we’ll be forced to detain them at home instead. The second justification is that the kids might spawn new variants, which is technically true but seriously, come on. Then they hold up the specter of MIS-C, with a total of 4,196 cases, which is at least a specific issue rather than generic Long Covid, but again, math. 

Meanwhile, if you took Remote Schooling, treated it and its side effects as a pandemic, and ask what would happen if it was spreading across the country, I think the answer is full Australia-style stay-in-your-house lockdowns as needed. 

I do get that this is now a strange position to be in, and if you’re deciding on school policies independent of the FDA, you’re in the same position you’d be in if this was a wait on manufacturing and distribution instead of regulatory approval – the kids will be vaccinated, but can’t be now, and the fact that other people could change that if they wanted to does not give you that option. And if there are enough cases you will be forced to go to remote learning no matter what you know about its consequences. 

Tyler Cowen asks how many children are killed by school anyway

As for how many are killed by Covid-19.

That could maybe change by an order of magnitude before it’s all over, but that’s an upper bound. 

From an excellent post about the question of what to do for kids who it is illegal to vaccinate, here’s a chart of what happens if they do get Covid.

That death risk is consistent with what I had, and for those under 12 it will be lower still. I’m skeptical of the 1 in 50 line, but the word ‘any’ does strong work in such situations, so… maybe? 

Long Covid is real and important, but so is Long School. Most people I know are permanently traumatized by it, many people have nightmares about it, and so on. Suicide attempts drop dramatically for young children when school is out, in a way that suicides of older people don’t. It doesn’t end when you’re allowed to leave. There’s also Long Vehicle Accidents, Long Suicide Attempts, Long Cancer, Long Drowning and so on, as one might expect. 

We do the same thing with school shootings, where we force kids to take place in ‘live shooter drills’ and scare kids so much that they expect a school shooting to happen around them, whereas such things are exceedingly rare, schools don’t have more of them than the rest of life and the damage done by scaring everyone is orders of magnitude the bigger concern (and is probably doing far more to give kids ideas and causing such events than it is to prevent anything, if I had to guess). 

One could also compare the moral panics over ‘stranger danger’ to the fact that most kidnappings of children are by family members, and most abuse is by people they know well.

The problem, in all these cases, is that some threats are put in a special category where any bad events are unacceptable, whereas other things are part of life, such as getting lots of people into close proximity in this thing we call a ‘city.’ 

Kids are not in a good place right now. We’ve disrupted their lives and kept them socially isolated for over a year. Making their new school year largely about Covid, and forcing them behind masks, will make things that much worse. 

I am thrilled to see that lots of parents intend to home school their children for the coming school year. In-person school is bad enough, but choosing remote learning over home school is a true tragedy, either of misunderstanding the situation and/or a lack of sufficient resources to deal with the necessary obstructions, paperwork and actual educational efforts required. My heart goes out to anyone who knows and simply can’t do it. 

At some point we will need to learn to live with Covid, or make an extraordinary effort to somehow live without it by vaccinating everyone and then moving on. Or we could doom ourselves to a young adult dystopia in yet another way, the same way kids are no longer allowed to play outside and are told not to talk to strangers and pretend periodically to hide from gunmen roaming the building, plus whatever you consider a baseline ‘school’. That’s also an option. 

Mask and Testing Mandates

There’s an old improv game called standing, sitting, bending. May I present a new one: Eating, drinking, dancing:

Ministry of Truth

Even when the actual implementation in a given example seems fine, it’s important to focus on the reasoning, for this tells you what the ministry is looking to do next. 

Facebook’s War on Supposed Misinformation continues, and has produced the following ‘fact check’ of ‘misinformation.’ I wouldn’t be focusing on Something Wrong On The Internet, except this type of ‘fact checking’ from this exact source is being used to censor Facebook and Instagram. Although in this case, the post wasn’t censored, merely given a warning label (and one assumes also a massive Streisand Effect), that’s not always the case. 

The Covid survival rate is clearly over 99%, by the CDC’s own estimates. The CFR is 1.7% and the CDC conservatively estimates half of infections have been missed – I’m guessing there are at least twice as many as that, perhaps more. 

Saying this is known to not have a CFR under 1%, as your headline that is then quoted around, or that survivability is known to not be over 99%, is blatant lying and scaremongering. 

What’s this all about?

It’s about the new definition of misinformation, which as far as I can tell is information used to lead to a conclusion we don’t like. 

The fact check admits that the data comes from CDC modeling estimates, and then uses those best guesses as best guesses. But because you can’t prove those are the correct numbers, and the conclusion is one they don’t like, the ‘fact checker’ thus concludes the claim is ‘false.’

What’s funny is that the exact claim being evaluated I too think is actually false. I’ll get to that later. But that’s not a fact that’s correlated with any of their reasoning.

There’s so many different things dangerously wrong here. 

  1. Unproven or unknown does not equal false, and by a sufficiently strong standard we “know” almost nothing, paging various philosophers. And by this standard, since I can choose not to offer proof, I can get them to say (almost?) anything is false, and thus by flipping the sign say almost anything is true, provided it serves their purposes. Neat trick.
  2. Using the CDC’s numbers from their modeling is an excellent source of reasonable approximations. It comes (as per the fact check post!) directly from the CDC and is being used to predict things, so it’s a forward-looking estimation. When I disagree with such assessments because I think I know better than the CDC, which I do here, that’s because I’m the arrogant one who thinks he’s better than the CDC, not the other way around.
  3. The general survival rate for Covid is clearly over 99% as discussed above via the CDC’s own estimate of the true case count. That doesn’t then automatically extend to ‘most age groups’ which is why I end up thinking the claim as categorized by the fact checker is false, but that’s not how the original post categorized anything, so the actual disagreement is over exact numbers for particular age groups. 
  4. Evidence that isn’t of the correct form or from the correct source (even within exactly the correct overall source, the CDC) is being selectively dismissed when it doesn’t suit them, which makes it easy to find a ‘lack of sufficient evidence’ to find something to be false.
  5. They do not cite what numbers they do believe, or any evidence for or against any numbers whatsoever except a general FUD about believing any numbers at all. 
  6. Up front they are clear why they are doing this – it’s because the claim is being made in order to minimize the importance of vaccination. The fact is a soldier for the wrong side, ergo false.
  7. Again, in their conclusion, they’re judging their characterization of the central claim as false, rather than disagreeing with any particular claim or giving an alternative model. 

Here’s the argument that if you have the best data available, you should ignore it, because there’s some factors it didn’t account for, and thus you should throw out all numbers and have no idea whatsoever. Which is a fully general argument against ever knowing anything at all: 

This is not how knowledge works, unless you are banning forbidden knowledge due to its Unfortunate Implications. Yes, of course you should use data on how many people have survived Covid-19 to predict your own chances of surviving infection. What the hell else would you use as a starting point? And the whole idea here is to then condition that on age, which is by far the biggest risk factor, and then condition on vaccination status (where I think their 94% number is somewhat low, but it’s well within the range of Numbers Used By Official Sources To Scare People The Proper Way Depending on Context, and also not a crazy estimate, I just think defense against death is somewhat higher.)

Whereas the post is indeed taking overall estimated forward-looking numbers, then adjusting them by age, and also listing vaccine effectiveness. If one wanted completeness yes there are other factors but they’re far less important – see my graph below for my ranking of the next two in line (diabetes and obesity), and how much less important they are than age. 

The advantage of telling people to throw up their hands is that you can simultaneously say vaccines are super effective and important (without specifying numbers) when telling people to get vaccinated, then turn around and tell them to be terrified of Covid afterwards anyway, even if they’re young.

Yeah, people are skeptical of authorities these days for some reason, can’t imagine why. 

Next, I’m going to actually fact check the chart, since I think my estimates are better than the CDC’s estimates. Are the ratios by age here correct? 

I actually think no, they’re too aggressive. Here was the result of my comorbidity work, which was pre-Delta and pre-vaccinations, and have younger people at more risk than this by an order of magnitude or so. 

To compare apples to apples you should look at the All Pop column on the right, and focus on ratios between groups, and also remember that there aren’t many people over 90 when combining the top group together. With that adjustment, my conclusion is that the post above is underestimating risk to the young by about a factor of 10. 

Now, let’s look at the actual post, and, huh, ok, I see it now…

(Note: That font and color scheme in the graphic is very recognizable as coming from Fox News, the outgroup’s relatively mainstream news source.)

Yeah, that’s… a very reasonable warning. This is indeed missing context and could mislead people, and the warning isn’t claiming it’s false, merely that it’s missing context. In particular, this is framed carefully to imply that the vaccine would replace the existing immune system rather than supplement it, and thus the vaccine would increase risk rather than decrease relative risk. 

So in the context of the post, the label is at least understandable. It sets a bad precedent even if the written justifications for it had been relatively good, so I’d rather not do it, but certainly one can understand it, especially when combined with the numbers here being so aggressive, although the extra 9 likely doesn’t change the message here much. 

As opposed to the reasoning in the justification post, which is… different.

I’ll also note that clicking on the warning doesn’t go anywhere when I tried it, which seems like a missed opportunity if one did want to communicate context.

More generally, the official reasoning remains the supremely broad claim that any disagreement with health authorities is not allowed. As we are periodically reminded, this is despite the health authorities changing their opinions over time as (A) the facts change, (B) we get better evidence and (C) they update to take into account new information and incentives and priorities. Usually their truth tracking improves over time on a given issue (and stays the same on average because they add new issues), but not always. Also you can’t contradict multiple health authorities, including the WHO who still refuse to admit Covid is airborne, and those different authorities frequently contradict each other. In the case above, the CDC’s numbers can’t be used in a way that wasn’t intended. By the standards that are being used to censor a United States senator who is raising a perfectly valid scientific hypothesis in the link earlier in this paragraph, you could censor not only at least most of my Covid posts, but almost anything remotely useful anyone might say, whether they were trying to provide useful information or trying to figure things out. If I wasn’t Against Facebook I’d probably be banned from it by now, and I’m curious to what extent they mess with those who post these weekly updates there.   

Provincetown Follow-Up

Nate Silver offers some thoughts on exactly how hard it is to compare vaccinated to unvaccinated people, even in relatively ideal conditions for such comparisons.

Provincetown was the opposite of an ideal situation.

It seems very clear at this point that the Provincetown study did not mean anything like what the CDC was representing it to mean. This was a situation filled with activities that carry extreme Covid risks, among a unique and often immunocompromised population. The outlier results at most describe what happens in circumstances like that, and also fail to control for the population baselines appropriate to that situation.Despite that, there were zero deaths, only seven hospitalizations, and most vaccinated participants were not infected. The vaccines did their job. In hindsight, while I had a strong prior that the study wasn’t going to mean what the CDC was claiming, that prior wasn’t strong enough, and I gave the whole situation too much respect.

Thus, the focus shifts from the study and its claims to the actions of the CDC and media, and updating on what they did in response to this information. How much of this failure to update was due to people being afraid to point out the nature of the gathering, given today’s political climate, until enough others had done so first? Or was the narrative what everyone wanted to go with anyway, so it was too good to check regardless? Or was it that the CDC is no longer capable of reading scientific studies and analyzing data about the physical world in a reasonable way? Perhaps this was all kayfabe at the CDC and they knew exactly what they were doing, and were simply lying, and the media went along with it to show their deference to power and get clicks? Or was it something else?

Could the CDC actually be this bad at communicating about risk? 

There’s being bad at talking about probability and risk, and then there’s treating everything as an absolute. 

No matter what the cause, it is yet another reminder that the data all fits together into one physical world that runs with one set of physical laws and biological properties. Something that doesn’t fit and contradicts the data and results observed elsewhere must be treated with extreme skepticism, and any model must explain those other results and data points. 

Delta Variant

Vaccines work on it, J&J massive study edition, as in n=500k participants:

One J&J shot remains very good protection against death and good protection against infection and hospitalization, but not as good as two mRNA shots or one J&J plus one booster, and the logic of getting the second shot of mRNA is the same as the logic for an mRNA booster after getting J&J. Of course, if you request an mRNA booster after having had J&J, it might be tricky to get it, because the FDA and others are tying themselves up in knots denying the obvious is sufficiently obvious.

This isn’t the exact thing we most want, which is how effective the mRNA vaccines are against Delta, but it suggests only a small decline in effectiveness is likely. 

Also, about the way the CDC goes about the business of gathering its data:

I would like to hold the CDC to higher standards here than I can afford to have writing these posts, but that option is not available at this time. 

In Other News

What’s the difference between an EUA and full approval? Hundreds of thousands of pages of paperwork and a bunch of site inspections, among other things.  

About a week and a half ago, Scott Alexander wrote a righteous post everyone should read on how horrible the FDA is and in particular how they are way, way too slow to approve drugs and also getting them approved costs eleventy billion dollars each (realistically something like 100 million). One thing that caught everyone’s attention was the infant fish oil story, where the FDA for years let children get sick and die rather than let fish oil get added to an infant formula, as he detailed in his first follow-up, then he wrote a second follow up when a critic pointed out that those involved in that story praised everyone at the FDA. Scott points out that yes, the individual people at the FDA did their jobs in this situation, but that doesn’t make it better, the system was working as designed and the design sickened and killed a bunch of babies and that’s the thing to be focused on. If anything that’s worse, if it was the people letting us down we could go fix that. He’s being careful not to outright say FDA Delenda Est, but as his alternative he’s holding them to the impossibly high standard of ‘better than the man on the street.’  

I do think this concise statement of the argument goes slightly too far, but only slightly. 

It’s no wonder that no one wants to be FDA commissioner:

Well, no one who counts, anyway, where one who counts would be someone without trouble getting approved. I certainly get it, in the sense that when I think of my life if I was made Commissioner of the FDA, in terms of my lived experience, oh my would it be infinitely worse. I’d happily do it anyway, because someone has to and if I don’t do it then someone else will, and also it would open doors to do additional important things after, but I have to assume it would be a nightmare. 

If you’re someone who ‘you won’t have trouble getting approved’ then presumably you’re looking to run the FDA the way the FDA is traditionally run, which means someone has to but also someone else would if you didn’t, and if you’re doing it honestly it’s a giant paycut, so why take on all that trouble? 

Did the NIH do better (MR)? Here’s the WSJ, here’s the full report, here’s part of MR’s summary, note the top line especially:

So, not that great, only a handful of billions while missing entirely many of the things we most need studied. The grant process isn’t working. In other distributional news, happy to see Aging get this attention, although it’s telling that it’s right behind Rare Diseases, even if they’re not in cute puppies.

Again, could be worse, you could be the WHO analysts and still, this week, be telling people Covid isn’t airborne. Delenda est indeed.

Obama had a birthday party, outdoors, with vaccinations and Covid tests required, but didn’t require masks, so naturally a bunch of Justifications are required for this living of life as if physical reality was exactly the way it is. 

What happened was that Obama has a brain and occasionally thinks about physical reality, but to explain this in those terms would destroy the rest of the narrative, so what they say ends up sounding not great. 

But seriously, how’s it going out there?

You can, of course, get an anecdote to say almost anything, for example “Idaho Covid ICU patients are already at an all time high” when the stats say that clearly isn’t true. Treat local reports with generous helpings of salt before generalizing. 

When cancer survivor Anthony Rizzo was traded from the Cubs to the Yankees, life was proven unfair, and also there were many who noted that he was unvaccinated, which turned out to be unrelated to his cancer – he simply declined the vaccine. A few weeks later, he’s on the Covid injured list

Israeli data seems to show that previous infection is not only highly effective at preventing reinfection, in their samples it looks even more effective than vaccination. This is the opposite of what is found in other reports, but definitely worth keeping an eye on. 

Perspective on Louisiana hospitals being full. Looks like this is essentially by design and didn’t require that many Covid patients for it to happen.

You’re about to spend trillions on ‘infrastructure’ that is mostly transfer payments to people you like, to be paid for by people you don’t like, in the wake of a huge pandemic, and aside from potentially banning large areas of software development by requiring theoretically impossible tax reporting, how are we doing on spending on actual pandemic preparedness? Oh…

Not Covid

I’m putting this here because from time to time, it will be needed.

I finally tried Storybook Brawl this week, and it is excellent. Highly recommended to anyone who likes playing games of any kind, give it a shot, it’s already Tier 1 even though it’s in Early Access. I definitely have thoughts on it, but we’ll see when I get around to writing those down. In the meantime, great fun.

I’ve also been greatly enjoying Across the Obelisk. This is a unique roguelike deckbuilder, in that it is trying and largely succeeding at being like a lightweight D&D rather than being a lightweight Magic: The Gathering. You have a lot more control than in most such games over what your deck looks like, so it’s up to you to decide how to keep it fresh after a while, but there’s a bunch of viable options and this is great stuff, again even though it’s still in Early Access. I’d put it at Tier 2 in its current state. If you’re up for what’s being described, check it out.

I finally saw a movie, Black Widow, in a theater for the first time since the pandemic began. It would have felt ritually impure to have my first movie back be anything else. By waiting for several weeks, I got a mostly empty theater, so social distancing was excellent. As much as I was looking forward to it, I didn’t realize how much I missed the movies until I finally got to go. Excellent experience, can’t wait to go again, don’t think I have time to see Free Guy or Suicide Squad tonight but I’m not ruling it out. My review of the movie Black Widow is: Exactly meets expectations. 

In Free Britney news, the system is even worse than you think. There was serious risk of having Britney Spears committed involuntarily, because of the supposed mental health strain of trying to free herself in court, and the strain of having her father as her legal enslaver against every scream she can muster:

A judge then refused to expedite the hearing, of course. One cannot rush such proceedings. The FDA would approve.

I’d also like to point out another parallel of horribly inefficient action that got highlighted this week, which is the War on Bags:

I am reminded of when my teammate Patrick Chapin went to get croissants from a gas station in Belgium (which were really good croissants, Europe has its advantages) and some other food, and was given an obviously horribly inadequate number of terribly flimsy bags. When he offered to pay unreasonably large amounts for additional bags, he was chastised for how little he cared about the planet. Then was forced to spend an hour getting back as the situation fell apart on him multiple times. 

You know what costs vastly more energy and carbon to produce than paper bags? Food. Even a tiny risk of food being wasted is much worse than using extra bags. Yet what happens when bags break? Food containers break open, food is dropped on the ground and made dirty, and both lead to food being thrown out. That’s in addition to the hours upon hours of lost time. 

And finally, in case you missed it, too good not to share and also insightful:

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71 Responses to Covid 8/12: The Worst Is Over

  1. Basil Marte says:

    Lagged and averaged = cases from 0.1*(1 week ago) + 0.2*(2 weeks ago) + 0.5*(3 weeks ago)+ 0.2*(4 weeks ago)+ 0.1*(5 weeks ago)
    Either I’m a complete idiot, or the weightings sum to 1.1 (which shouldn’t cause a qualitative problem, just throwing the CFR off by a constant -9%).

  2. Dave says:

    Nothing about Iceland?

  3. J says:

    Hoping you’re right about peaking soon, but school is starting up again in the next few weeks so I’m gonna guess another few weeks beyond that.

  4. oskar31415 says:

    The number of actual cases per positve test seems likely to be far above 4. It was around 4 for Denmark per October (where there was a big randomised antibody test (it found 2.2% had antibodies half of which didn’t remember being sick)), but Denmark has tested far more than America, so the number is likely far higher there.

  5. remizidae says:

    I didn’t see my reason for opposing mandatory vaccination listed. Some people will not get vaccinated, regardless of mandates. (And realistically, “mandates” only means that they get shut out of some jobs and blue-state restaurants and theatres.) So the question arises: given that 100% vaccination will not happen, how do we want to live with the unvaccinated in the future?

    Do we want to create a new stigmatized and shunned underclass? Is additional hatred and division what our society needs?

    We have to live with unvaccinated people, for the rest of our lives. I will not shun my unvaccinated friends and family members, and I think it’s horrific how many people have. The unvaccinated are taking a risk—but it’s their risk to take. They are imposing some cost on society—but it’s much less than the cost to ALL of us of creating that new hated underclass, in a society that is already desperately deprived of community and unity.

    • D says:

      This is my reason too. I might well support mandatory (weakly at least) vaccination for zombie-measles-ebola, but that’s because there would be no equivalent segregated, alienated underclass left over afterwards. I think carrots and very gentle sticks are fine as far as they go in the very short term, but the goal has to be actually pushing vaccination rates up for socialized-benefit reasons, at least mostly-voluntarily. Once that’s no longer happening we have to stop, backtrack, and figure out how to live with the world that actually exists. The socialized benefits of vaccination will be minimal once everyone gets immune one way or another and we get to the fabled endemic steady state, and all of the justifications for the sticks stop applying. Kicking anyone out of their job makes patching society up afterwards that much harder whether or not their reasons for not getting vaccinated are silly.

      On the other hand, we’re at well over 80% of eligibles in my corner of Canada and our path to endemic steady state looks different than in any part of the US. We have our own social problems, but not the same level of tribal, geographic, urban/rural, and partisan segregation here, despite some of my compatriots’ attempts to import American culture war via the Internet.

    • Tom W says:

      I would add that a) the “bodily autonomy” type arguments include the fact that vaccines are not reversible, unlike any other mandate. If your employer makes you wear a mask, or wash your hands every hour, or take a rapid test on the way in–yeah it probably sucks, but at least you can take the mask off on your way out, and none of these things will have a long-term effect on your health. Taking a medication that has at least one intended long-term effect is something you can’t undo later.

      There’s also b) the fact that much of the country/world has apparently decided to go into “permanent war footing” against covid, a virus that by any sane analysis will continue to mutate, surge, fade out, and surge again for the rest of our lives. As Zvi correctly calls out through many examples in this and past posts, many people still seem to consider that No Cost Is Too Great To Combat The Virus, and while they don’t explicitly say they intend to do that forever, As Long As It Takes is going to be quite a lot longer than we will be alive. These people, as we have seen above, are not to be swayed by anything as malleable as “data” or “cost-benefit analysis” or “the existence of other priorities”. They push mandates now because it’s the current version of Whatever The Cost, but there is no mandate that will satisfy them. There is no level of vaccine rates, or daily cases, or empty hospital beds, that will get them to stop hysterically shrieking that every unknown variable is guaranteed to be the worst possible case scenario, or that your neighbor’s backyard barbecue is a Dangerous Superspreader Event, or that children will ever be safe again with their noses visible to the world.

      Vaccine mandates, pushed on those we know to be low-risk, or those that have made a conscious (if mathematically questionable) choice to substitute one risk for another, are another expression of this attitude. We Must Do Everything, No Matter The Cost, To Stop This Virus. It will not end there. It will never end until we make it end.

    • Eye Beams Are Cool says:

      “Do we want to create a new stigmatized and shunned underclass? Is additional hatred and division what our society needs?”

      I think the US could use more stigmatization and shunning, personally. For example, I think the war on drugs is one of our most wrongheaded policies you can name, but I still wish there was more stigmatization and shunning of drug use amoung my devistated-by-drug-use appalacian culture.

      Hating an underclass because their parents came from a particular country or because their nose is too big is pretty shitty because you can’t do anything about that. Stimgatizing and shunning antisocial behavior that can be changed at the drop of a hat has a long and glorious history up to about the summer of 1967 or so.

    • > They are imposing some cost on society—but it’s much less than the cost to ALL of us of creating that new hated underclass, in a society that is already desperately deprived of community and unity.

      This argument is also an argument against shunning petty thieves. Do you think that one shouldn’t shun them, or do you think that there is an important distinction? If latter, what’s the distinction?

      • D says:

        One distinction would be that there aren’t ~any petty thieves with an honest belief that petty thievery is the right thing to do, even a delusional one. Not getting vaccinated because you’re lazy and antisocial is a different thing from a good-faith, if silly, belief that changes the cost-benefit calculus sufficiently. I don’t think we should shun honestly deluded kleptomaniacs beyond what’s necessary to mitigate the harm they cause. (And the convalescent folks really do have a point, even if it’s heresy to admit that you can be immunized the hard way rather than the easy way.)

        I’m still for preferentially opening up what vaccinated people can do as a strategy for maximizing total freedom while keeping the health care system intact in the short term, but I’m concerned that “short term” will be interpreted liberally for political convenience and unvaccinated people will be treated as a moral problem in ways that can’t be undone easily. Much of the culture war rhetoric I see basically wishes for a boot stamping on the faces of the hick plague rats forever, and that just isn’t the kind of world I want to inhabit.

        Maybe Americans are just more comfortable with this kind of radical outgroup division?

  6. AnonCo says:

    Thank you for taking the time to address the mandate arguments again. I still do not agree with your opinions, but they are at least mostly coherent and consistent now as presented.

    I consider these two questions to be “moving on to what’s actually happening” and not rehashing the arguments, so I hope you will consider them.

    1. re: argument D. “We got it right, so mandates are fine. If we got it wrong, we wouldn’t have mandates.”
    Going forward, how do you square this with the Ministry of Truth situation?

    Say “they” get it wrong next time. Now “The System” has learnt the ability to squash alternative discussion and evidence very effectively (even when it is contradictory) and push only “the” narrative. What would it look like if they got it wrong, but still pushed the party line? How would we know? Who’s evidence would you still trust?

    2. re: argument E “vaccines still matter because of immuno-compromised people”

    It looks like the second order effects of this are actually worse for people who legitimately cannot get vaccinated, from a pragmatic perspective.

    -Say we get mandates mostly everywhere
    -It will still be easy to fake cards, it will still be haphazardly enforced
    -But it will be just bureaucratic enough to stop some people doing some things (Flying, Blue state restaurants or venues, etc)
    -There will be no officially recognized or standardized approval for “Legitimately cannot get vaccinated” people
    -No one would be believe them even if there was
    -and there will immediately be a secondhand market of hack doctors faking that as well
    -Net, the people who need everyone vaccinated the most and play by the rules will suffer the most day to day life consequences of not being able to themselves under a mandate

  7. thechaostician says:

    You have a misplaced quote, in the section “Our ruling”, point 4, in the middle of the word “to”.

  8. Basil Marte says:

    Nouveau riche guy goes to the farmers’ market.
    – What’s this?
    – Apples.
    – Give me a kilo, wrap them individually. What’s this?
    – Oranges.
    – Give me a kilo, wrap them individually. What’s this?
    – Raisins; they are not for sale.

    If I were willing to be ridiculously charitable, I could suppose that the decision was made by extrapolating a real pattern off a cliff. In ye olde time, almost everything was shipped as general cargo (a.k.a. break-bulk), but as per the Baumol effect, this started to become untenable (in addition to having a chronic problem with pilfering). In the first wave bulk cargo handling, in the second wave containerization have started to eat general cargo, and they already got pretty far. If someone were making this argument, it would be merely stupid rather than unreasonable of them to predict/enforce a continuation of the trend into retail food transportation. (And in an equally absurd counterargument, it could be pointed out that lean/just-in-time is also eating everything because “people” don’t want to pay the costs of keeping even weeks of stocks, which we could generalize to households not wanting to take delivery of food by the TEU.)

    This is similar to “arguing for” universal daycare on the basis of extrapolating the Industrial Revolution’s sundering of the home. Even ignoring that 80-90% of the population were farmers, an urban artisan would have a shop-front and a workshop in his house on the ground floor, residing on the floor above. People used to produce/consume healthcare at home, etc. We’ve moved most of these functions to various dedicated spaces (most of them equipped with the appropriate mechanization) for enormous productivity gains, therefore, the trend will continue until the only function remaining under the label “home” will be that of the dormitory. Orphanages for everyone!

    • bugsbycarlin says:

      While I suspect the value of this comment is high, the legibility is very low. Could you provide some wrapper context, or another phrasing to help get the main points across?

  9. Brockenborings says:

    Anybody know why the Oxford team cited by WHO think that COVID is transmitted by droplets and contact? The Telegraph article is paywalled (and I doubt they go into that anyway).

  10. J says:

    Maybe this has all been beaten to death already, but it’s surprising to see the same guy who taught me about simulacra levels advocating for handing a weapon shaped thing* to governments acting at higher simulacra levels. Shouldn’t our entire analysis be based on how this power can be used by politicians to show that they only care about power, and explicitly irrelevant how we would use it if we were in charge and operating at level 1?

    *: ability to force medical procedures on people at regular intervals by means of detailed controls on wide swaths of industry

  11. Adam says:

    If I am fully vaccinated, and I get a mild/moderate cold/flu, what should my prior be on whether it is covid?

    • Humphrey Appleby says:

      You don’t need a prior, you can pick up a rapid test at your local pharmacy for ~10 dollars, and then you’ll know. (Whether you should care whether it is Sars-Cov-2 or a different common cold coronavirus, I don’t know).

      • Eye Beams are Cool says:

        My old engineering professor once explained the difference between scientist and an engineer by saying that whent he curtains are on fire, the scientist looks for a thermometer and the engineer looks for a fire extinguisher. This is a great real-world example of that dynamic. Thanks for providing Adam with a great answer and me with a better joke.

  12. A1987dM says:

    What Is “potentially banning large areas of software development by requiring theoretically impossible tax reporting” alluding to?

    (not a rhetorical question, I actually genuinely haven’t heard of that)

    • TheZvi says:

      I’ll let other answer on the details, it was the blockchain tax reporting rules that are worded super broadly in ways that have implications that I’m presuming no one intended.

  13. A1987dM says:

    The “terribly flimsy bags” thing is supposed to incent people to use reusable (e.g. canvas) bags instead, though I agree that outright banning decent single-use bags rather than just heavily taxing them is silly.

    • Laura says:

      I don’t think the crappiness of modern paper bags is a deliberate punishment. I think that since banning plastic bags, stores need a lot, lot, lot more paper bags, and they cost more money and take up an order of magnitude more space than plastic bags. The result is them buying the cheapest ‘representation’ of a bag possible. This doesn’t explain the a**hole in belgium refusing to give extra bags – but it is why the quality of paper bags fell off a cliff at exactly the smae moment that plastic bags were banned.

  14. Matty Wacksen says:

    >(F) the idea that an individual is only responsible (in various senses) for either literally themselves, or only those who that individual infects directly,

    Since you seem to think this is weird, let’s do a thought experiment – someone reads your blog, gets angry over it, commits some crime out of anger. Are you reponsible for the crime? Obviously not. You are definitely in the causal chain of events though, so if we count the marginal effect of your blog you are obviously responsible. Let’s make a small continuous deformation – someone reads your blog, gets angry over it, decides to infect someone else with corona using a vial in their fridge. Are you responsible? Again not.. Someone reads your blog, gets angry about it, decides not to get vaccinated out of anger, gets infected and infects someone else. Are you responsible? Obviously not. Another deformation – you have corona, accidentally infect someone else, they know they have corona and go out and infect someone on purpose. Are you responsible? Absolutely Not. You infect someone else, they decide not to get vaccinated for the purpose of infecting someone else, infect someone else, are you responsible? No, they could have prevented it with the vaccine. Last step – you infect someone else because you are not vaccinated, they infect someone else because they are not vaccinated – and suddenly you are responsible? About as ridiculous as you being responsible for the crime in the first case, even though they are both part of the “marginal effect”.

    >but if you go on to get a PhD, you’re now in the least vaccinated group of all.

    Maybe if you have a PhD, you know how full of shit “science” is. At least that’s the effect it had on me.

    >vaccines happen to be safe and effective

    See “safe” is just a weasel word here that means nothing, what is truly “safe” or “unsafe”? And do you really think anyone really knows what is safe or not less than a year after it gets created? Vaccines are about as “safe” as most drugs, but it’s silly to say this makes them “safe” in some metaphysically obvious way. If it were truly 100% obvious that the vaccine were safe, why are the pharma companies’ lawyers all over the contracts making sure liability is not with the pharma companies? Because there is alway *some* risk of things going wrong, “to err is human” ,etc. Are people not allowed to doubt anymore, does Socrates now have to say “I know that I know nothing, except that the vaccine is safe and effective that’s beyond doubt”?

    > I don’t buy this, there are a bunch of immunocompromised people

    Who are similarly affected by the flu. I know some of them personally, flu season comes and they have to be really careful. It’s horrible, but I’ve never heard them say we need to lockdown everyone to prevent the flu. I thought blogs like this one were “utilitarianism grand central”, does “immuocompromised people exist” suddenly change things?

    >And if the choice is between ‘no indoor dining (or other X) for anyone’ and ‘no indoor dining (or other X) for the unvaccinated’ I know which one I’m choosing

    Well yeah, if the choice is between “full 1984-style police state” or “big brother only watches you sometimes”, I know which one I’m choosing. Come on people, learn to love big brother can’t you see he’s *good* for you?

    >would be that bodily autonomy is super important, and thus vaccinations are in a different class from things like masks and lockdown

    One is temporary, the other is not; I don’t think either makes sense. In the last thread, I compared to a circumcision mandate; do you at least thing circumcision mandates would be wrong morally?

    Sometimes I feel like those who want vaccine mandates treat everyone else as beneath them, at least intellectually or in terms of reasoning ability. I mean look at this thread “people enjoy using hyperbolic language” is how seriously you take their feelings. That, while this blog has been unreasonable virus panic grand central throughout (“We’re fucked, it’s over”). Lot’s of people really fear the vaccine and people like you want to harm them for it because you see them as their enemies. The people who are your enemies are people like me who got vaccinated but won’t forgive the authoritarians who pressured them into it. I’m voting for the most anti-everything party I can find and am now firmly anti-science, did you factor *that* into your calculation? The people who are unvaccinated are also vulnerable, fearful people who maybe had a bad experience with a vaccine before and don’t want to take the risk, and people like you want to take their jobs away from them because you think you’re helping the “vulnerable”.

    To quote Dostoyevski, “But it has always happened that the more I hate men individually the more I love humanity.”, and I see this love for “humanity” in coronavirus policies everywhere I look. No sympathy whatsoever for real people.

    • Matty Wacksen says:

      Since it may have sounded wrong; just to clarify the “enemies” comment should not be misconstrued as me wishing you any harm personally; what I mean is that I will do everything in my power to make sure “experts” and “scientists” and people like yourself who think they understand data do not have any say in society.

    • Anonymous-backtick says:

      Very well said.

  15. bernie638 says:

    Thank you for the blog, always enjoyable and informative. I disagree with you about the vaccine mandates due to a severe lack basic competence by the people implementing it. I’ll admit to leaning libertarian, but I got vaccinated as soon as it was universally available (First shot early April), I’m 50 so I was young enough that I wouldn’t be able to look myself in the mirror if I had cheated to cut in line, but old enough to protect myself when given the opportunity,
    heck, after reading Derek Lowes blog on how the mrna vaccines work I bought five shares of Moderna stock!

    I still cannot support any type of vaccine mandate after seeing how poorly any of these things are operated in reality and a lack of universally accepted standards. Example, how many people improperly were put on the “no fly” list? How long before one or more business trade organizations start putting together a list of people known to use fake vaccine cards and how accurate will that list be?

    Soon we will fully open back up so I have to ask, which vaccines count? Does Sputnik? What about Sinovac? AstraZeneca? Do all countries have a vaccine card, and if so, which ones count? Will businesses accept an Italian vaccine card, do they know what that looks like?

    You may take comfort from the idea that these vaccine cards are easy to fake, but I’m old enough to remember when that was true for a drivers license, then one day the government decided to get serious and I had to get a new one with anti-faking features like a little hologram and odd patterns.

    On a personal note, How do I get a legitimate replacement vaccine card? I didn’t predict this development so I didn’t keep my first shot card, I have my second one, with only one signature on the “second dose” side. I work at a nuclear power plant, so doing anything untrustworthy could get me fired so I’m not willing to get a fake card, but I have family scattered across the country and worry that I wouldn’t be able to take an emergency plane flight if God forbid something happened to one of them.

    I don’t like to disagree with you, but hey, I have yet to find someone I agree with on every issue.

    • Vaccine tracking is probably a lot better than you (or I) thought it was. I had a primary-care visit last week, with a new provider, and they were able to see- automatically- not only that I’d been vaccinated against COVID, but also that I’d had a typhoid shot that I got at a Walgreens in 2019. I’d expect that you could get a printout at the local health department, your doctor, and maybe even a drug store.

    • Laura says:

      You can certainly get a medical record of the vaccination from the clinic or pharmacy you were vaccinated at. I don’t know if they will rewrite a card for you, but they might. If you live in NY state you can get the excelsior pass app on your phone, since there is a statewide database. NY state took excellent records. I’m not sure if other states have similar apps.

  16. TheZvi says:

    General comments note: By all means continue to post your reasons why you oppose various vaccine mandates, private and/or public, and discuss among yourselves, but I have indeed said what I have to say here. Have fun.

  17. David W says:

    On the test positivity question: at this point, choosing to be tested is a vote for lockdowns forever. This is particularly true if you’re asymptomatic, and double if you’re vaccinated. Getting tested is only wise if it will affect your treatment plan or if you intend to self quarantine.

    I wish we had a polity where being a ‘case’ without being anything serious in the statistics meant people relaxed, but instead it appears that causes more worry. Granted, like any other vote it’s unlikely to be decisive.

    • Humphrey Appleby says:

      This is only true for `official’ tests. If you just want to know whether e.g. your cold might actually be COVID, so you should avoid visiting grandpa, then you can just get a rapid home test, make your decision based on the result, and that’s that. It doesn’t enter the testing statistics one way or another.

  18. Alsadius says:

    Presumably, test counts have dropped so low because there’s two basic groups of people.

    1) Those who worry about covid. We’re basically all vaccinated now.
    2) Those who don’t. Why would they bother with tests?

    A lot of the tests a few months ago were probably back when that was mandatory at more jobs, or the like. So as that goes away, there’s little demand among the populace to get tested unless they’re actively ill.

  19. alesziegler says:

    I feel that a discussion about “mandates” would benefit from an acknowledgment that there is a conceptual difference between vaccine mandates imposed by the government (whether universal or e.g. for certain professions or venues) on the one hand, and mandates which are exercises of its contractual rights and freedom of association or of enterprise. Yes, there is some overlapp (e.g. government acting in its capacity as an employer), but nevertheless those are different categories, just like a distinction between red and white wine is not invalidated by the existence of rosé.

    Of course this a point that has been raised ad nauseam in interminable discussions about the concept of “censorship” and I learned that some people just do not see this as a meaningful or important difference, so.

  20. W says:

    The WHO has acknowledged airborne transmission since April 2021: “The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols remain suspended in the air or travel farther than 1 metre (long-range).” (https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted)

    Zeynep Tufekci wrote on this: https://web.archive.org/web/20210507235123/https://www.nytimes.com/2021/05/07/opinion/coronavirus-airborne-transmission.html

    • Seb says:

      “Can also be spread via aerosols under ideal conditions” is not “is mainly spread via aerosols” though.

      And don’t think for a second that they aren’t keenly aware of this difference.

  21. ConnGator says:

    Two comments on testing: can’t we combine traditional testing numbers with number of at home tests sold?

    Anecdote: Was vacationing in Hiawassee, GA when daughter got a cough. Wanted a covid test but there were ZERO available within two hour drive. Ug.

  22. Alcibiades says:

    Thought this was a great post, definitely added some clarity around vaccine mandate opposition.

    I remain a convinced (D) er – not only in the future, but already They have been catastrophically wrong. Remember, these people made COVID in a lab because they thought their fun, cool experiments were ‘protecting humanity from viruses.’

    I want to point out that you have already probably believed lies about the (AstraZeneca) vaccine. Credit for pointing out when that changed.

    I think you underestimate how distorted your inputs are. For example, if a patient reports side effects after vaccination, they can be easily dismissed because the doctor ‘knows’ the vaccine wasn’t the cause. Hospitals can do the same. That dynamic can go on for a long time (though I about not forever, and probably not as long as the 8-9 months since vaccine rollout).

    Finally, do you really think the announcement from the AAP is motivated by disinterested concern for the health/well-being of children? Correct or not, it’s pure conformity to Power. The set up for catastrophe is unmistakable.

  23. myst_05 says:

    “even for vaccinated people getting Covid is worth avoiding”

    Realistically speaking, for how long could they avoid it, given that Covid is guaranteed to become endemic? Unless we keep on living with perpetual masks and social distancing, I just don’t see how Covid won’t spread to 100% of the population. Previously there was the argument of “let’s wait for vaccines” – and that’s now done. Then there was the argument of “medical care will get better” – but it doesn’t seem like much progress is being made these days anymore, as all attempts to develop an effective treatment have stalled out. If so… what do the vaccinated win from postponing their infection by another year or two?

    In a parallel universe we would’ve already churned out 16 billion shots for all 8 billion people on the planet, plus a steady supply of ever-adapting mRNA boosters… but that’s not the universe we live in.

    • Yeah, I agree. Of course an assumption that covid is guaranteed to became endemic might be incorrect – but many smart and knowledgeable people are saying that.

      • Craken says:

        Nature of viral immunity:
        https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1009509
        A concise summary and comparison of Covid to 20 other viruses–comprehensible to laymen.
        “Seasonal CoVs, which cause approximately 20% of common colds, remain endemic, even though demonstrating only limited antigenic evolution in epitopes targeted by neutralizing antibodies. Although there are only 4 circulating seasonal CoVs, infections frequently recur, even yearly, likely related to waning antibody levels.”
        “Infection with none of the common endemic human respiratory viruses consistently induces durable immunity.”
        However: “natural respiratory infections with measles or variola (smallpox) viruses, famous for inducing life-long immunity to disease, do not prevent respiratory reinfection, which though asymptomatic and nontransmissible, can be detected by increased antiviral antibody titers.”
        Conclusion: highly likely to become endemic, but degree of future virulence uncertain.

      • Craken says:

        I meant to add that measles and smallpox contrast with Covid in that they disseminate “from the initial infection site via lymph and (secondarily) blood as an obligate step in pathogenesis or transmission.” Vaccines effectively prevent this step, but Covid skips it and goes directly for mucosal infection.

      • TheZvi says:

        Even if it is endemic, the number of “expected infections” you avoid by getting it now is going to be substantially less than one in almost any scenario, because boosters will come online and immunity fades over time (if it doesn’t fade at all, then it’s likely that Covid-19 doesn’t become endemic).

      • Dave says:

        But isn’t it likely that only your first infection is a significant danger to life and limb?

  24. Ben says:

    Is there a universe where the wave hitting the south now doesn’t hit the rest of the country (presumably in the fall)? If high vaccination rates stopped it then why is it happening in Israel and Iceland? If delta could be stopped by lockdown, masks, and social distancing it wouldn’t have hit the UK (I think they were pretty locked down until right before their delta peak). I am running out of variables that would exempt the North and Northeast from having a significant increase in cases just like Florida and Texas. The most likely reason it hit there first is because it is hot enough there that people are all indoors. When fall comes up north and people go indoors it seems inevitable to have a Florida/Texas situation from Detroit to Boston. The only difference will be less hospitalization and death because of increased vaccination rate but the case increase is going to happen and deaths and hospitalizations will be about what Florida is seeing as their vaccination rate pretty well tracks the median rate in the country. I would love for someone to think of something I haven’t here but I live in Michigan and think Florida is my near certain future.

  25. UK wasn´t locked down before their Delta peak. They were on Step 3 rules, which is something halfway between full lockdown and normality. Rules are here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/986738/COVID-19_Roadmap_Posters_STEP_3_2021_digi.pdf.

    Since 19 July they are on Step 4, which means that things are normal except for (pretty severe) border restrictions. There is some vague plan to require government issued covidpasses for nightclubs etc., but it is something considered for the future and hasn´t been implemented so far, as far as I know. But schools are currently closed for a standard non-covid national summer break (16 July to 1 September in England).

  26. Lambert says:

    >One possibility is that people are now increasingly using at-home tests first.

    Why wouldn’t that be affecting the UK’s official testing rate in the same way it affects America’s? You don’t even have to buy one at a pharmacy here, the NHS will post them to your house for free.

    And I don’t think the issue with carrier bags is so much the resources needed to produce them as their potential to become litter.

  27. Zack says:

    Question for anyone who might know the answer, because I can’t find any good resources online:

    Does an infection show up on a rapid test before one would be contagious? Put another way, if I test negative in the morning, can I be confident I won’t spread the virus until at least the end of the day, or so?

    • TheZvi says:

      You unfortunately cannot be confident of that, and the extra hours wait matters too – it’s 8 hours out of 2-4 days it would take to become contagious. At-home tests simply aren’t studied/reliable enough to be *confident* of much of anything. It’s good Bayesian evidence, but if your prior before was pretty high (e.g. you had some very close contacts and are not vaccinated) I wouldn’t feel good about exposing others for another few days. Alas.

      • Zack says:

        Sure, but the timelines for contagion vs testing positive might be different, right? Is the viral load necessary to test positive smaller than the amount that results in contagion? Obviously the latter isn’t really a binary so it might be hard to say. Do you know of any data on this? In this case I’m talking about the rapid PCR test, so I’m less worried about the at-home tests failing.

  28. Dave says:

    Good Wallace-Wells article with thoughts from Topol and the great Michael Mina of rapid test fame. https://www.google.com/amp/s/nymag.com/intelligencer/amp/2021/08/breakthrough-covid-19-cases-may-be-a-bigger-problem.html

    Both think symptomatic breakthrough infections are now common; Mina suggests that immunity from vaccines is starting to wane.

    • I feel this framing is exactly backwards. Thanks to Provincetown, everyone (even over here in Europe, since we unfortunately have a high regard for CDC) is freaking out about the inevitability and the horror of breakthrough infections, and it is actually a talking point fueling vaccine hesitancy – why get vaccinated when you will inevitably get it anyway?

  29. Daniel Speyer says:

    I’m missing your cause for optimism. Even if the control system is kicking back in, that will only stabilize the case count at a high level. How is anything good going to happen short of herd-immunity-the-hard-way?

    • David Speyer says:

      I am similarly puzzled. And the US states that are peaking now are the same hot weather ones which were peaking in late summer next year; it seems to me that we should expect a similar peak in the northeast come Fall.

  30. Dave says:

    Surprising anecdatum: A former student (~early 30s, healthy) now has a *second* symptomatic case (symptoms worse than the first time she says) after having had Covid in Fall ’20 and also getting fully vaccinated. I suppose weird shit happens, but I would not have expected symptomatic post-vaccination reinfections to be common enough that I would know someone who had one.

  31. etheric42 says:

    Have you tried Trials of Fire yet? https://store.steampowered.com/app/1038370/Trials_of_Fire/

    It’s similar to Across the Obelisk in that it has longer scenarios and more RPG-like design. It uses hex-based tactical combat. It actually has a lot of similarities to Card Hunter. The UI makes a lot of stupid choices like reflecting the sunlight of the environment, and managing three hands can get a little overloaded, but it’s a fun deckbuilder puzzle.

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