Covid 8/26: Full Vaccine Approval

Great news, everyone. The Pfizer vaccine has been approved. Woo-hoo!

It will be marketed under the name Comirnaty. Doh! 

(Do we all come together to form one big comirnaty? Or should you be worried about the comirnaties of getting vaccinated, although you should really be orders of magnitude more worried about the comirnaties of not getting vaccinated? Did things comirnaty or was there a problem? Nobody knows. Particle man.

My understanding is that if a doctor were to prescribe the vaccine ‘off label,’ say to give to an 11 year old or to get someone an early booster shot, then they could potentially be sued for anything that went wrong, so in practice your doctor isn’t going to do this. c

A reasonable request was made that my posts contain Executive Summaries given their length. Let’s do it!

Executive Summary of Top News You Can Use

  1. Pfizer vaccine approved under the name Comirnaty. 
  2. Vaccines still work. If you have a choice, Moderna > Pfizer but both are fine. 
  3. Boosters are still a good idea if you want even better protection. 
  4. Cases approaching peak.

Also, assuming you’re vaccinated, Krispy Kreme is offering two free donuts per day from August 30 until September 5. 

Now that that’s out of the way, let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 1,000,000 cases (+14%) and 8,040 deaths (+45%).

Results: 935k cases (+7%) and 7,526 deaths (+35%).

Prediction for next week: 950k cases (+2%) and 9,400 deaths (+25%).

I was confused how there could be such sharp peaks in other countries. It looks like we won’t get one of those. The trend lines seem clear, and it looks like we are approaching the peak. It would be surprising if we were still seeing increases week over week by mid-September, with the obvious danger that things could pick up again once winter hits.

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
Jul 1-Jul 74593296121281528
Jul 8-Jul 145323986891451764
Jul 15-Jul 214343417321701677
Jul 22-Jul 2849138510091572042
Jul 29-Aug 469347714153042889
Aug 5-Aug 1170562921812343749
Aug 12-Aug 1891285133943885545
Aug 19-Aug 251281104546925087526

Deaths continue to lag cases. News was slightly good, so adjusting expectations slightly in response. Peak should still be a month out or so.

Cases

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
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
Aug 12-Aug 18183,667130,394479,21478,907872,182
Aug 19-Aug 25188,855152,801502,83291,438935,926

Vaccination Statistics

How much will full FDA approval matter? Survey says not much.

I am more hopeful than this, and expect more than a 10% increase. Some of this will be people for whom this really was the true rejection. Other parts of it will be as mandates are handed down and people anticipate further mandates. 

Vaccine Effectiveness

I continue to find this very telling in terms of vaccine effectiveness versus Delta:

The argument is simple. The Delta vaccines are designed and would be easy to get approved, yet there has been no move to manufacture them quickly. The only reasonable explanation for this is that there isn’t actually much if any difference with the old vaccine. Or at least, that’s what the pharma companies that have every financial incentive acting against this are revealing they believe.

A new paper on vaccine effectiveness concurs (preprint).

I will for now accept the principle that a single dose provides substantially less protection against Delta than Alpha, but this is another data point that Delta isn’t different from Alpha once you get your second shot. I always find maddening the ‘confidence intervals overlapped, so nothing here’ reaction to differences like 67% vs. 79% – yes, you can’t be confident in that, but that’s mostly saying your study was underpowered, since that’s the kind of difference one would expect if there was a difference, and again, the word evidence does not mean what they think it means. 

The paper’s findings then get worse, if you believe them, claiming rapid reduction in effectiveness over time.

They then go on to say this, which given how vaccinations were timed seems likely to be confounding indeed:

There’s no one good money quote on it, but the findings robustly say that vaccinated people’s cases tend to be lower viral load, less dangerous and less severe.

Looking at their section on statistical analysis, they’re doing some of the necessary and reasonable things but I can’t tell if it’s enough of them. Such studies are better than nothing if treated with caution, and this seems like a relatively well-done one, but I’m still more focused on the population numbers and what makes the models work out. 

When I see things like this:

My core reaction is, the very idea of a 22% decline in vaccine effectiveness per month doesn’t make any mathematical sense, until I figured out it meant a 22% increase in vaccine ineffectiveness. As in, if you are 99% effective in month one, and then you have a 22% ‘decline in effectiveness’ you would be… 98.8% effective. Or if you were 95% before, you’re 94% now. Which doesn’t sound to me like a 22% decline in effectiveness, even if true. 

Israeli data continues to suggest extreme fading of vaccine effectiveness if you look at it naively, along with yet another reason to, as post puts it, proceed with caution. 

New data from Denmark:

One presumes that the improvement against hospitalization in Pfizer is a data artifact or failure to control for something or some such, which shows how easy it is to get misleading results, especially since infection went the other way. And this big Pfizer versus Moderna difference against Alpha isn’t found elsewhere, which makes me think that once again there’s confounding going on all over the place.

Here’s a thread analyzing some of the results, and takes the declining protections and other study data fully seriously, putting the burden of proof on finding something specific that is wrong with the studies, and otherwise taking their results and details seriously and forming the model around that. As usual, the broader context of what such results would mean for all the other data we see isn’t incorporated – but again, I don’t see anyone doing that.

Here’s another good long thread explaining what vaccine effectiveness means then listing lots of different findings and real world results. Putting them all together like that makes it striking how much the different numbers don’t agree if you take them all at face value. 

I continue to think that the decline in vaccine effectiveness over time is in large part a mirage, and for practical purposes the decline is relevant but small. 

This week’s representations of how those vaccines are doing, after having vaccinated about 70% of adults and most of the elderly.

Virginia offers a dashboard:


Doesn’t look like vaccines are losing effectiveness.

Houston, via PoliMath:

And another:

And another:

That’s disappointing at face value since it’s only a 90% reduction in deaths but after correcting for age it would look a lot better. Weird that so much of the vaccine advantage here seems to be coming after hospitalization. 

A worry is that the studies are selecting for ways to show vaccinated people are at risk, and another worry is that the real world statistics being reported are selecting for showing that the vaccines are super effective, because they are the same information but the Official Story is on two contradictory propaganda tracks and is pretending not to notice that this is a physical world question with a correct answer (whether or not we are confident we know what it is). 

Anecdotal in Tampa, Florida

:

Here in New York:

Meanwhile also this:

Note that yes, we are excluding the first wave infections here as per her follow-up note, but note the graph and adjust accordingly, and I think the point stands.

That does bring up that UK cases are clearly rising again, so we can no longer use that as an important signpost that things will turn around rapidly and that will be that. If anything, it’s now making the case that such a turnaround is unlikely. I don’t know of anyone who has offered an explanation other than a shrug for the decline followed by a reversal here.

As for the reinfections versus vaccine effectiveness, my hypothesis is that this is not a case of ‘immunity from infection holds up but vaccine immunity is losing ground.’ Remember when we were worried that natural immunity faded with time but vaccines solved that problem? The actual difference is in the methods of observation. When similar observational methods are used, we seem to get similar results. 

How infectious are breakthrough cases? We now have two studies for that. They found that vaccinated people who get infected are still infectious, but their viral loads are substantially lower, so this was what we previously expected. And also they clear the virus faster, which was also expected. 

Weirdly, they’re two different studies that find the two different results, although depending on how you measure, fading quickly implies lower average viral loads, so the results are compatible with the graph and it’s possible what we’re seeing is a shorter period of infectiousness rather than less at the peak. That seems unlikely to be the whole effect to me, but could easily be the majority of the benefit. 

How much comfort that brings depends on the situation and on what you previously believed. If you’re as bad at this as the CDC and were saying the vaccines ‘prevent transmission’ full stop and now that they ‘don’t prevent transmission full stop’ it gets confusing. 

Vaccine Hesitancy and Mandates

Formal approval is in, so here… we… go.

I saw this about one minute after I saw the FDA had approved the Covid vaccine, perhaps someone planned something in advance for once:

On her first day on the job now that The Worst Is Over, our new governor lays down the law:

She also raised New York’s total death count by 12k, which once again highlights that maybe Cuomo went down in a similar way to Al Capone (who was indeed guilty of tax evasion).

Although she’s also mandating ‘ethics seminars’ so you win some and you lose some.

LSU is going to mandate vaccination or a negative test for all fans at Tiger Stadium. 

Whereas the University of Georgia is going the other way.

Here’s the owner of the Dallas Cowboys:

Who else we got (WaPo)? They found CVS Health, Deloitte and Disney, but so far, not an impressive set of additional mandates. It seems not many were standing by ready to go. 

Delta Airlines is charging unvaccinated employees $200 a month extra for health insurance, on the very reasonable premise that every hospital stay for Covid costs them an average of $50,000 and they end up in the hospital for Covid more often. Insurance companies can’t do this, but it seems corporations employing you can do it. 

NYPD has threatened to sue if the city attempts to implement a mandate.

Texas Governor once again mandates against vaccine mandates, this time ensuring it applies despite FDA approval

When you’re fully anti-vax, you’re anti-vax, and it’ll be hard to tell you different, as Donald Trump learned:

Others are less fully anti-vax, but still unvaccinated, thanks to various ways we botched things.

As Ranu notes there are two distinct things here. First, we botched the logistics, and could have done much better if we’d made sure to beware trivial inconveniences that aren’t always trivial. Second, our authorities are untrustworthy so people don’t trust them. This is framed here in the standard blue-tribe way as ‘the system fails such people and they remember the legacy of all that’ with it being ‘hard to make up’ during a pandemic, rather than the simple ‘these people lied about the pandemic over and over again’ model. Both are presumably relevant, but my guess is that handling the pandemic in a trustworthy fashion would have largely solved both problems. Yes, such people will absolutely ask why you weren’t helping them before, but that’s different from turning your help down if you’re here now.

One aspect of vaccination decisions is that patients in America do not pay for their health care. Almost everyone who can get it has health insurance because if you don’t the medical system bills you personally and attached some number of extra zeros to the bill because they can, so you can’t opt out. For a while, they even waved ‘cost sharing’ on Covid, so you didn’t even pay the fraction you normally pay, but that’s increasingly no longer true. Would be good if more people knew. Incentives matter, but only if people are aware of it. One could note that this policy could be taken farther, if the government permitted this, so we’re doing mandatory mandates with one hand and mandatory massive subsidies to those who don’t follow those mandates with the other. 

State employees, you will get vaccinated as many times as is legal, or else.

This is an explicit ‘everything that is not forbidden is mandatory, and everything that is not mandatory is forbidden’ rule. You can get exactly this many shots at exactly these times, and you either get them or you’re fired. There’s no concept of a booster that is optional, based on someone’s situation, and the full mandate applies to teleworkers.

This is where things are going to be tricky. Requiring ‘full vaccination’ so far has been simple. You get two shots and that’s it. Now there are signs that this in many places is going to morph into getting periodic boosters with different places (at a minimum, nations, Austria and Croatia are already setting expiration dates) having different requirements, and those boosters will have a much less slam-dunk risk-benefit profile. 

I will happily take the third shot without any need for outside incentives, but it is a very reasonable position to not want the third one, and it seems likely that requiring boosters will have far less robust support than requiring two shots. 

A cheap shot, but I think a necessary one so putting it here anyway, without any need for further comment.

One can definitely say shots fired:

Masking, Testing and NPIs

This is nuts, actively counterproductive on every level, and what must be fought against:

To be fair, it is only required ‘when social distancing is not possible,’ most of the time this will definitely apply, and I assure you that it’s always possible. 

It’s always adorable when people think the constitution is a meaningful limiting factor, and all recursive mandate sentences are fun.

In practice, this is technically true, but there is a known way around it known as withholding federal funding. And another easier way around it, called ignoring the constitution, since presidents mostly do what they want without any actual legal authority under the constitution and mostly no one calls them out on it. Eviction moratorium, anyone? 

If you’re in NYC and either old or immunocompromised, make sure you know about this:

You can also buy one at the pharmacy, although not like in Europe where the tests are super cheap and abundant. FDA Delenda Est.

Also, a periodic reminder that the reason younger children can’t get vaccinated, which in practice is causing super massive freakouts although there’s almost zero risk there, is that the FDA moved the goalposts to require additional data. Thus we almost certainly won’t get this before the end of 2021, and I’d double check but this market sure looks a lot like free money.  

Here’s a graph of how afraid people have been over time:

The lack of an increase in fear over the winter surge is the most surprising thing here. Otherwise it all makes sense, with fear going down when things were improving, then fear starting to go back up as cases rise. Fear isn’t a perfect proxy for the private control system, but changes in fear likely predict marginal changes in private actions and we’re back at levels similar to April.

Here’s a survey on activity:

As one would expect by now, vaccinated people are taking more precautions than unvaccinated people. Almost half of vaccinated people are ‘avoiding people as much as possible’ and they’re claiming it’s because of the pandemic. However I share Nate’s skepticism here minus the word ‘little’ because math:

Perhaps ‘as much as possible’ means until one is hungry, or has somewhere to go. It’s on the margin. 

Study does some modeling and finds that according to its model masks work, ventilation works even better.

From the study:

Filters win out here over windows, if one has to choose, and of course if possible you’d do both. Also you can’t cheat on the windows, you gotta actually leave them open. When we’re considering actions like mask mandates or shutting down living life entirely I find it odd that people worry about energy costs this much, but there you go. Also fresh air remains a Nice Thing. As always, one must be highly skeptical when translating such results into predictions for actually preventing cases. 

A potential issue with price controls:

An argument against weaning masks on the margin, and a good question about presenting that argument.

I found the tweet more compelling than the full post. Getting into the details mostly highlighted places I disagreed with Bryan.

Booster Shots

Governor of Texas gets a third shot as a booster. I have no issue with people in high positions getting superior medical treatment when there’s a supply or resource shortage, but meanwhile we have vaccines expiring in some places. That’s from Scott’s post with further comments on the topic of FDA Delenda Est, which is interesting but inessential. 

The new argument against booster shots is that they… might cause us to produce too many antibodies against Covid, and then maybe Covid mutates and the antibodies become dangerous or unhelpful because they’re overtrained? When it’s not Officially Sanctioned even antibodies are labeled bad, it seems. Meanwhile this is doubtless supposed to make people worried about Delta, but this worry definitely does not apply to Delta, and an additional customized booster would be necessary in the cases being described either way. Don’t worry, such arguments will go away once the Official Sanction comes down, which is coming soon.

Meanwhile, an argument for booster shots is that the first two doses were so close together that they count as a primary immunization, claiming it looks like this:

Which is so insane it doesn’t even bother putting any impact from the second shot into the chart at all, and puts the peak of the ‘primary’ response more than halfway down the graph when it’s almost fully effective. There’s obvious nonsense available on all sides.

Think of the Children

We really do have a large class of Very Serious People, with a lot of influence on policy and narrative, who think that living life is not important, that the things you care about in life are not important, and that our future is not important, because saying the word ‘safety’ or ‘pandemic’ should justify anything. 

This week’s case in point, and like my source MR I want to emphasize that this is not about the particular person in question here.

If anything, I’d like to thank Dr. Murray for being so clear and explicit. If you think that safety trumps the need for love, for friends and for living a complete life in general, then it’s virtuous to say that outright, so no one is confused. 

In case you think she doesn’t mean that (or that others don’t mean that), no really, she does:

Ellie Murray does not believe that school is terrible, so she is simply saying that the claimed benefits of school are not important relative to the marginal impact of schools on Covid-19. 

That reply was one voice in a chorus, as the replies are what you’d expect and rather fun to read through. Nate Silver sums this up well:

There was also a side debate over whether school is the future of our children and our children are our future, or the alternate hypothesis that children are also people and school is a prison and dystopian nightmare. The thing to remember is that this view is not driving most of the anti-school rhetoric. Such folks mostly think school is vital to children, but don’t care.

Yes, I was aware, and I’d rank my concerns regarding school in this order:

  1. Kids going to school. School is a prison and a dystopian nightmare.
  2. Kids not going to school. Remote school as implemented is somehow so much worse.
  3. Getting Covid. I’d rather not get Covid.

But yeah, we can beat that take this week, because the The Times Is On It:

Technically I’m sure it is true that masks represent an ‘educational opportunity’ in the sense that whenever anything happens you can use it as an opportunity to learn. The main such opportunity is to learn about those making the decisions.

In Other News

Have you tried using a market clearing price? No? Well, then.

I strongly agree that lawn care is a terrible use of water when there’s a limited supply, but the way we figure such things out in a sane world is we charge more money for water and if desired or needed give people a credit to avoid distributional concerns. Yes, I know, don’t make you tap the sign, go write on the blackboard, etc etc. 

Biden still hasn’t appointed anyone to head the FDA, but at least he floated a name. The name is someone who said that living past 75 is a waste, but hey, pobody’s nerfect, right?

Obama literally hired a doctor to ensure everyone was vaccinated and safe and his party was still a huge issue, so now everyone in Washington is afraid to throw parties. Also for other reasons, I’d imagine, but those are beyond scope.

A calculation of whether the benefits of exercise in a gym exceed the risk of Covid finds that it very much does in her case. Often the choice really is between going to the gym or not exercising. Her calculation did depend on the lack of other people in the gym, however, so if the gym had sufficiently more people in a tight space the calculation could have gone the other way. She has a spreadsheet you can play around with if you’d like to explore this more.

Denmark gives up on the mystical ‘herd immunity.’ Usual misunderstandings here but I suppose this is better than the practical alternative of not giving up.

Thread reminding us that the control system has many facets, and they work together at least additively and often multiplicatively. You don’t need any one factor to control the virus or get you mystical ‘herd immunity’ on its own, you care about the combined effects. 

Zeynep reminds us that plastic barriers are likely to be net harmful because they interfere with airflow. I got this one wrong early on, same as everyone else. The key is to update.

Monoclonal antibodies are free and effective against Covid, but few people are getting them (WaPo).

From MR: You can get flown home if you get Covid while abroad, but you’ll need a special service

Germany moves to using hospitalizations as the primary measure of whether Covid is under control. This makes sense for policy, since what matters is whether the hospitals are overwhelmed and whether people are sick and dying. 

Australian stockpile of AZ continues to grow, over 6 million doses (via MR).

Australians who are vaccinated overseas can register that vaccination, but only if the vaccine was approved in Australia at the time of vaccination. Which was not a rapid process.

I like how transparently the ‘at the time’ restriction is purely harmful. No fig leaf.  

Also via MR, due to continued Covid restrictions down under, they shot dogs due to be rescued by a shelter to prevent shelter workers from travelling to pick them up. Meanwhile, they’ve uncovered people getting fresh air. It’s becoming an epidemic of fresh air getting after 200 days in lockdown. 

But good news, if you’re fully vaccinated, you’re about to get new freedoms!

So, how do you think Australia did, all things considered?

Poison control is lonely work. Not many people call, and when they do, it’s usually something like ‘I took prophylactic Ivermectin that was intended for animals, thinking that was a good idea.’ We have some news.

General warning for anyone who needs it: Animal formulations of a given medicine are often different from the human version, and could be highly dangerous to humans. Do not perform this regulatory arbitrage assuming that the two things are the same. 

Also, this:

They didn’t know the two things were different, and it’s a perfectly reasonable hypothesis that a thing could be vastly cheaper and easier to get if you can do an end run around the FDA, or around pharmacists earning praise for refusing to fill prescriptions for Ivermectin. This simply was not one of those times.

Also note the numbers. One individual was told to ‘seek further evaluation,’ and 85% of the cases were mild. The definition of ‘mild’ can be whatever people want it to be, but if it’s ‘no need to seek further evaluation’ it seems like there were six poison control calls out of eight total calls? I’m guessing it’s higher than that, and please if you decide to take Ivermectin make sure you’re sourcing and dosing it safely and properly, but this isn’t an epidemic of cases, and this was going around enough it felt important to point that out, even if I’m highly skeptical that Ivermectin does anything useful. 

Rob Bensinger offers his advice on what to personally do about Covid. Not endorsed.

Inessential but fun case of an elected official saying very much the wrong thing.

Not Covid

Reminder, purely about actual cars:

Remember that if you own an Oculus, and your Facebook account gets suspended because of reasons (such as saying facts that contradict local health authorities) you will lose all your games and save data permanently, no refunds, no fixes. Might want to consider a secondary Facebook account for this purpose, unless you’re using your Oculus to recover your Facebook account, which is also a thing.

In Scott’s recent post, he reckons with his struggles to not make mistakes despite the need to quickly produce a lot of content. I have this problem as well, and last week failed to check something I should have checked. My solution so far has essentially been to state my epistemic confidence in my statements, and to carefully put conditionals on statements that I haven’t verified. So last week I wrote “I am not aware of any X” and it turns out there are a bunch of common Xs and I really should have known that already and also should have checked even though I didn’t know, but I did know I hadn’t checked so I wrote I wasn’t aware. I ended up editing the paragraph (on pregnancy) a few times. There wasn’t anything false when I wrote it but once it was pointed out it obviously needed to be fixed quickly. This occasionally happens, also there are occasional typos, broken links and other stupid mistakes, and occasionally one of the sources turns out to be fake, as was the case with a British account a while back. 

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53 Responses to Covid 8/26: Full Vaccine Approval

  1. idk just some guy says:

    You keep misspelling Comirnaty.

  2. Eye Beams Are Cool says:

    What are the risk of CVD outcomes that have comirnaty with obsesity caused by eating two donuts a day. Asking for a friend.

    • The Null Hypothesis says:

      stole my thunder. maybe one month free membership at a gym would send a better message about being prepared for exposure to virus that disproportionately affects the obese.

    • TheZvi says:

      If it was sustained it would be… not small, same as you would be. Luckily this doesn’t last THAT long. I’m hoping to get to do it once on principle once I get to NYC but there’s no store in my current area.

      • Eye Beams are Cool says:

        Oh, I was being totally facetious, but now I’ve done the math. Each original Krispy Kreme donut has 180 calories. Assuming you eat two a day for a week durring the promotion, that’s 2660 calories. Using the back-of-the-envelope worthy 3500 kCal per lb of bodyweight gained/lost, that’s a wopping 0.75 lbs gained. That’s about two sixpacks of beer. Or two burritos from Chipotle. Now, 180 kCal per donut seems crazy low to me, and some from Krispy have twice that. But again we are still talking a lb or so. For most weight-stable people, I would expect more of an uptick in non-exercise activity thermogenisis than excess fat storage.

        So, probably no more destrictive to your health than a weekend of drinking or a road trip where you pick up lunch and dinner on the road.

        And if I was being really, really facetious, I’d point out that being hypercaloric has been correlated with incrased influenza rates and being hypocaloric with decrased influenza rates.

      • TheZvi says:

        It always boggles my mind how many calories are in those burritos.

  3. steven says:

    Almost all of the captured images aren’t working in this post. Is that just me?

  4. ADifferentAnonymous says:

    > Weird that so much of the vaccine advantage here seems to be coming after hospitalization.

    Hospitalization is often gated by the patient’s decision, right? I’d expect vaccinated people to be more likely to seek hospitalization for any given level of symptoms, even after adjusting for age/comorbidities.

    (The test of this would be to compare the infection:hospitalization:death effectiveness ratios between trials and observational data, or maybe see if mandated vaccines are more effective against hospitalization than voluntary ones)

  5. rohdewarrior says:

    This seemed pretty logical and informative to me, but if you have a different take please let me know: https://cspicenter.org/blog/waronscience/why-covid-19-is-here-to-stay-and-why-you-shouldnt-worry-about-it/

    • TheZvi says:

      Mentioned in the comments last week and I looked at it before that too. It’s a mixed bag, enough technical inaccuracies I decided not to link.

      • Dave says:

        It looked directionally right, if a bit smug. I don’t see core disagreement between you two about where you see this heading. I expect inaccuracies in the virus/immunology stuff because that isn’t really something he (or I) knows much about, but does any of it call the conclusion into question the basic conclusion that, contra delta paranoia, we’re nearing the end of the process of transitioning back to a world with boring old endemic viruses that shouldn’t cause us to interrupt our lives much? I recognize some areas of the US aren’t there yet but vax rates in some other places are so high that the official right-thinking advice is even starting to acknowledge this.

  6. Alex Barry says:

    Thanks as ever! Been reading for a while, and while keeping up with COVID is now a lot more optional from where I am in the UK, it’s nice to have somewhere I can rely on to have good analysis.

    One thing I’ve been surprised you haven’t discussed more is the situation in Australia (although I know you have mentioned it in passing often). I think there are a couple of interesting things here:

    1. NSW’s failure to contain their outbreak despite how important this was in the context of Australia’s zero COVID policy really surprised me. In particular, my (very rough) impression is that much of it seems driven by terrible political decision-making to not go into strict lockdown quickly enough, and to message this effectively. Another lesson in the ineptitude of governments, and a point against Australia doing better due to rational policy I guess.

    2. I think about 4-6 weeks ago (when NSW was first reaching 100-200 cases per day) it was possible to extrapolate out that they would probably not be able to get back down to zero cases before their vaccine rollout hit its ~80% target to allow a move away from zero COVID policy in ~early December. My reasoning here is based on 100-200 being about 7 doublings from 1, and me finding it unlikely that they could get their halving times down to much below two weeks given the ineffectiveness of NSW’s earlier lockdowns.

    This has the implication that NSW (or at least the affected parts of Sydney) would likely need to be in continuous lockdown until Dec, but I don’t think this was a prediction many people were making at the time (at least not publicly). I’m a bit late to all this (having not really been paying much attention to the Australia situation at that point, and only noticed this when it started hitting 400-500 cases per day a couple of weeks ago) and so it now seems very overdetermined that this is the path they will have to take if they stick to zero COVID, but I think thoughtful predictors could have seen it coming quite a lot earlier.

    I don’t think I’ve seen any serious attempts to compare the costs of NSW needing to lock down continually until Dec vs them lifting some of their restrictions and having resulting massive COVID wave (which would also affect the rest of Australia and NZ), but the downsides of needing continuous lockdown for 4+ months seem large enough to warrant discussion.

    I can understand why you haven’t discussed this given your US focus – but I’ve been feeling pretty disappointed in not seeing it discussed anywhere. Also interested if there is a great Aus COVID discussion location I’ve missed!

    • TheZvi says:

      I mention it somewhat this week, but yes I understand the frustration. I think it makes sense to ‘see it through’ once you start such a plan, but on net they’d be better off if they hadn’t gone down the path.

  7. benquo says:

    My understanding is that if a doctor were to prescribe the vaccine ‘off label,’ say to give to an 11 year old or to get someone an early booster shot, then they could potentially be sued for anything that went wrong, so in practice your doctor isn’t going to do this.

    Seems both totally unsurprising and also totally batshit insane that our society is willing to demand that docs face substantial physical danger to care for potential COVID patients, but not the comparatively mild financial danger of prescribing a COVID vaccine for an 11-year-old.

    • TheZvi says:

      Well society actively wants the doctor NOT to give the vaccine to an 11yo, the goal of that policy is to prevent it. Whereas society wants doctors to treat people with Covid.

      I agree that the liability imposed on the doctor in the second case is insane, but the response does not seem insane to me at all.

  8. Charlie Sanders says:

    Curious if you keep up with Kaiser Fung at Junkcharts. He’s an extremely credentialed statistician/data analyst, and his conclusions about mRNA vaccine effectiveness are the opposite of yours.

    To quote a recent post:
    “It is well past time to admit that the real-world vaccine studies have dramatically over-stated the effectiveness of the mRNA vaccines. This is a failure of science. Not only, it is a systematic failure because I do not know of a single study that has committed the opposite error of under-estimating the VE! It’s clear science has not fielded an A team in this crisis. ”

    https://junkcharts.typepad.com/numbersruleyourworld/2021/08/receipts-from-a-year-of-blogging-the-pandemic.html

    • TheZvi says:

      I am not following his stuff. Looking at that post, it looks like it’s not new/different information than I’m already considering, and it doesn’t contain responses to the core argument for the other way, which is that it explains all sorts of other data far better.

      • Charlie Sanders says:

        Sorry, I don’t follow. If that analysis is not looking at different data than what you are, then how could there be other data that you’re claiming exonerates the vaccines? Either it’s different data, and your data is better and shows exculpatory trends, or it’s the same data, and you’re interpreting that same data differently.

      • TheZvi says:

        I am saying that he is quoting a subset of the data I am looking at, and also interpreting it differently.

  9. Brockenborings says:

    Remember when we were worried that natural immunity faded with time but vaccines solved that problem? The actual difference is in the methods of observation. When similar observational methods are used, we seem to get similar results.

    This is my understanding these days as well. Is there a reason that natural immunity is not enough for granting a vaccination card/passport/get-out-of-jail-free-card? Or is it OK and I just haven’t found any instances of it?

    • TheZvi says:

      Seeing Like a State. There’s no way to document who has and hasn’t had it, and a lot of people who think they’ve had it haven’t had it (and of course, even more people had it and didn’t realize).

      • Matty Wacksen says:

        I agree with your general point, but for what it’s worth noting that many European countries have pulled it off via either requiring positive PCR tests or some form of antibody test.

        The reason I suspect everyone likes to denigrate natural immunity is that (a) it sets the “wrong” incentives but more importantly (b) if now suddenly “natural immunity” works and has worked all along, lockdowns have interned O(10%) of the population without good reasons so it’s a bit embarassing to admit to having carried out such a massive human rights violation.

    • David W says:

      Remember all the outraged articles last summer about ‘Covid parties’? https://en.wikipedia.org/wiki/COVID-19_party The premise was that young people were deliberately contracting covid, so they could go back to living their lives without worrying about such things as ‘killing Grandma’. It was a particularly dumb media cycle, because it was likely happening but none of the reporters actually found a real example. It could have even been a good idea; if it got official sanction we could have also run vaccine challenge trials and covid transmission trials to solve the questions on droplet/aerosol, etc.

      I think the policy of not counting natural immunity is a reaction to that. If you deliberately give yourself covid, then you’re making the numbers go up, and the governor wants them to go down. You’re also getting closer to the end of the pandemic in a way he can’t take any credit for. So he’s not going to reward you for it by giving you back some of your rights. It’s an authority thing, not a science thing.

      • TheZvi says:

        Yeah, this too, just forgot about that angle. Getting Covid is a Bad Thing, so if we “reward” it in some way, we’ll be encouraging such things. And I do think this is a legit concern.

      • David W says:

        Certainly if it became even as popular as, say, the ice bucket challenge, someone would have died from a self-inflicted case, and someone else would have fundamentally misunderstood and infected a whole nursing home, and there would have been at least somewhere a hospital was overwhelmed. It wouldn’t have operated like the thought experiment where we smoothly gained a class of people able to fill all the essential jobs and act as firewalls.

        I personally think public officials should tell the truth anyway, but it’s hardly the first time they chose to focus on getting the desired behavior in the short term instead of long term credibility.

  10. Alexander Gordon-Brown says:

    “That does bring up that UK cases are clearly rising again, so we can no longer use that as an important signpost that things will turn around rapidly and that will be that. If anything, it’s now making the case that such a turnaround is unlikely. I don’t know of anyone who has offered an explanation other than a shrug for the decline followed by a reversal here.”

    UK resident, so I’ll try. Two things happened in England (when you look at UK data you’re mostly looking at England data) in quick succession: 16th July was the last day of school for most of England’s schools, and then on 19th July all legal restrictions on gatherings were eliminated. Cases then peaked on 21st July.

    A clear contrast for the ‘schools matter’ hypothesis is Scotland. Their schools follow a different timetable, last day was Friday 25th June. Their cases peaked about a week later, and then between 4th – 18th July England’s cases approximately doubled while Scotland’s cases approximately halved.

    The explanation for the reversal is less clear, and I didn’t predict it, but I suspect that while closing schools has a pretty immediate impact on transmission (one day millions of kids are in school, where ‘in school’ includes things like ‘kids travelling on crowded buses to get to school’ and ‘parents mingling as they bring their kids to school’, 1-3 days later that’s all stopped), elimination of restrictions is more gradual. Here the elimination had already been delayed once, originally scheduled for June, so it would make a lot of sense to plan your wedding/party/pub crawl for August rather than say 20th July. As the superspreader events creep up, so does transmission. Maybe. Direct data on e.g. restaurant bookings would be nice.

    P.S. Scotland’s schools reopened last week, and their cases are soaring; they had an all-time-high case number yesterday. I expect the UK to follow an have a significant bump in R in early September.

    https://coronavirus.data.gov.uk/details/cases?areaType=nation%26areaName=Scotland#card-cases_by_date_reported

    • TheZvi says:

      The USA should give us another good test of the school theory, as you say it is suggestive in some places but seems like a bad match to the data in others in the UK. And I do think we have the bookings data here, which shows full recovery to pre-pandemic levels (which is one of those ‘so obviously the reports that vaccines stop working don’t make any sense’ statistics, because math).

  11. Tom W says:

    So, the mandates we get are sloppy, annoying, inconsistent, easily cheated, and unlikely to have any major effect on real, measurable vaccination rates, let alone positive cases. Is anyone surprised?

    • AnonCo says:

      “This is an explicit ‘everything that is not forbidden is mandatory, and everything that is not mandatory is forbidden’ rule….This is where things are going to be tricky.”

      We are 2…3(?) weeks into mandatory vaccines in some places and it’s already failing???

      I am shocked. SHOCKED!

      Who could have possibly foreseen this being impossible?

  12. PeeDee says:

    I thought you might be interested in looking briefly at the situation in NZ – successful with elimination (COVID? What COVID?) until very recently – really weird living normally (live mass performances, “normal” school, NO masks) etc. for over a year while the world went up and up. But Delta (and “bubbles” with AU) eventually defeated the border quarantine. Unlike most countries where it’s very hard to tell what the infection rate is and how the spread happened because there are just too many sources in the wild, NZ can still mostly track every single case to a location and infector. The prime minister’s press briefing (transcript provided) is surprisingly well informed: https://covid19.govt.nz/alert-levels-and-updates/latest-updates/covid-19-media-conference-26-august-2021-at-1pm/

  13. Pee Dee says:

    After a late start (complacent? thrifty?) sitting nationwide at 20% two jabs, 20% one jab of Pfizer…

  14. dillonplunkett says:

    Thanks for this, as always! I think the “Israeli data” link might be pointing to the wrong place. I’d be curious to see what that was supposed to be, if so.

  15. TM says:

    Link to the article about the Israel Data points to a Twitter post

    • TheZvi says:

      Messed that up somehow. Unfortunately I don’t save the links elsewhere once I put them in so I’m not sure how to easily get this one back. Deleted the link for now.

  16. myst_05 says:

    Wanted to put down $1k on that Polymarket prediction but I’m seeing they charge a ton for withdrawals? “Send at least 0.0763 ETH ($238) to the following address to pay the Ethereum network fee.” Does this mean one must either keep money on Polymarket for a long time or bet *a lot* of money to make things cost effective? Though I guess technically if I put down $1k on the child vaccine approval, I’m up $400 and will still pocket $170 minus whatever fees I’ll lose on fiat conversion.

    • TheZvi says:

      I’ll talk to them about that. My hope is that this is a maximum – an amount that you can be sure will handle it – but if it isn’t, then yeah, that’s pretty painful. Of course, there should be additional Free Money elsewhere after that, so one option is to cycle it through.

    • bmcfluff says:

      Note that the global Ethereum network fee changes wildly over time, and presumably that’s being passed on to the user by Polymarket. Right now it is ~3x higher than it was 4 days ago (see e.g. the “Average GasPrice” table at gasnow.org), so hopefully it returns to sane values soon.

  17. Craken says:

    The case against boosters is that they produce only a temporary effect on antibodies:

    The reasoning in the study at least implicitly admits infection produces largely the same immune effect as vaccination.

    I thought it was notable, though expected, that the American intel report on Covid origins settled on an agnostic stance due to lack of Chinese cooperation in the investigation. I see no reason to change my default position that it was an accidental lab leak, nor to assume that lab leaks are now any less likely than they were 2 years ago. Indeed, with a seeming cover-up and no accountability, lab denizens or their bosses with certain agendas may be encouraged to design a new pandemic. After all, it may be necessary to design a pandemic in order to defend against it. I wonder what sort of pandemic would render a Taiwan invasion most effective or advance global population control ambitions. I consider this a larger threat in the medium term than AGI, since it can be done surreptitiously and now.

    Not all of the officially-sanctioned experts were pleased with the Pfizer approval this week. The BMJ published an editorial to this effect: https://blogs.bmj.com/bmj/2021/08/23/does-the-fda-think-these-data-justify-the-first-full-approval-of-a-covid-19-vaccine/ Overall, it’s tone is polemical, and it’s data selection favors the sources least flattering to the Pfizer vaccine’s long term efficacy. He’s saying follow procedures to maintain credibility, yet never mentions the potential benefits of increased vaccine acceptance post-approval (which benefits I think will be modest at the individual response level). He makes some good points, however, including the fact that Pfizer’s latest publication, on which full approval is based, does not update their phase 3 vaccine trial data past March 13. This makes calculating the waning immunity issue unnecessarily difficult. Of course, plenty of independent studies provide evidence that the most important form of immunity–against severe disease–holds up well. But, why didn’t the FDA approve soon after March 13?

  18. Endering says:

    Think your link for “earning praise for refusing to fill prescriptions for Ivermectin” is going to the wrong place, no mention of refusal to fill prescriptions where it goes

  19. alexhutcheson says:

    More evidence that everything that isn’t mandatory is forbidden, at least until an arbitrarily chosen date when it becomes mandatory: https://www.virginiamercury.com/2021/08/27/some-virginians-are-trying-to-game-the-system-for-early-covid-19-booster-shots/

  20. A. Mouse says:

    Ellie Murray… I’ve heard that name before. Epidemiology Twitter has managed to be completely wrong for over a year during the one thing they’re meant to be across, and should be moved to the corner and given a box of crayons. https://twitter.com/RokoMijic/status/1246509433145917443

  21. myst_05 says:

    Interesting article for next weeks post: https://www.nature.com/articles/d41586-021-02110-8

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