Covid 9/2: Long Covid Analysis

I’m going back to New York City, baby! Tomorrow’s the big day.

Oh, yeah, the pandemic. That’s still a thing, and one still has to deal with the various ways people are dealing with it. Cases continue to rise slightly, likely due to increased testing, and we certainly aren’t seeing a big improvement on the horizon.

The big Covid development this week was about Long Covid, as we got multiple analysis posts on the subject and some extra data as well. My conclusions on magnitude have not changed much, and I continue to believe that Long Covid is a thing worth some effort to avoid, but it is not as severe or common a thing as some reports would suggest, and that it is not a big enough issue that one should make big changes in life to avoid it, when you compare it to the effects of long-term Covid prevention. This is one of those cases where you are encouraged to run your own analysis, draw your own conclusions, and then choose how best to apply them to your own life.

Executive Summary

Quiet week.

  1. Vaccines still work.
  2. Case counts did not peak yet, but positive test rates likely have peaked.
  3. Long Covid writeup from Scott Alexander.

Let’s run the numbers.

The Numbers

Predictions

Prediction from Last Week: 950k cases (+2%) and 9,400 deaths (+25%).

Results: 1.04mm cases (+10%) and 9,290 deaths (+22%).

Prediction for next week: 1.1mm cases (+5%) and 11,150 deaths (+20%).

The rise in cases here is deeply disappointing. However, if we look at positive test rates, we see a different story:

I’m not convinced the number of actual Covid cases is still rising, but that is certainly possible with case counts rising. Schools are going to reopen soon, which may cause trends to change. If things start to get much worse again before November, I’ll assume that was likely the reason.

For now, given we didn’t peak yet, on average I still expect a small rise in cases, if only from increased testing.

Other people’s predictions, Tabarrok calls the peak on August 30:

Deaths

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
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 251291104547135087557
Aug 26-Sep 11578125658925649290

Deaths are as expected, and I see no reason they shouldn’t continue to follow cases.

Cases

DateWESTMIDWESTSOUTHNORTHEASTTOTAL
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
Aug 26-Sep 1215,502180,441545,84797,4801,039,270

Cases haven’t fully leveled off yet due to a rise in testing, so it’s unclear how to interpret this. My guess is that without school we would clearly be at or near the peak, so the question is whether school will change that. My guess is no at least right away, because when we look at last year we don’t see a rise happening in September.

You can see hospital utilization statistics here. The numbers below are from late last week.

Vaccinations

Our two sources are contradicting each other on whether we’re seeing more or less vaccinations than before, not sure why, but WaPo has proven in the past it can’t do math so I’m inclined to believe Bloomberg. Either way, it does seem like it’s not going to be a big increase in the wake of full approval of the Pfizer vaccine.

Israel has moved to a three-dose standard:

Perhaps the word immune is being asked to do too much work. 

Vaccine Effectiveness

It turns out Pfizer’s vaccine can survive storage for (at least) nine months. 

Bloomberg newsletter’s way of summarizing the blood clot issue, even if you assume the ffect is fully real.

This preprint from Israel is the latest evidence for the new ‘natural immunity is much stronger than vaccine immunity’ position, replacing the old ‘natural immunity fades at the number of days there has been a pandemic plus one but vaccines are super dope and last indefinitely’ position back when that was the convenient thing to back. 

I continue to be highly suspicious of all Israeli evidence that claims the vaccines fade quickly or aren’t that effective, because I’ve seen enough Israeli data that turned out to be the result of bad statistical practices and/or that did not make any sense in the context of what we observe elsewhere or what studies elsewhere report. If Israeli data keeps coming back as if it is from a different universe, even when they claim to have controlled for geographic area and age and so on, I can only conclude that either no they didn’t control for the necessary things or something else is unique about Israel and I won’t speculate here on what that might be.

That said, there’s enough evidence that I’m willing to update. I now believe that natural immunity via previous infection is stronger than immunity from vaccination, plausibly much stronger. That doesn’t mean my estimates of vaccine effectiveness are moving down that much, it’s more that my estimates of immunity from previous infection are going up. At this point, personally, if I was confident I’d previously had Covid-19, I’d be treating myself as close enough to fully immune as to be entirely ignoring the pandemic on a personal level, beyond respecting the requests of those around me. 

This also feeds back into the model. If we are missing the vast majority of past infections, and reinfections are extremely rare, then our immunity is increasing rapidly, far more rapidly than the vaccination numbers would indicate. 

This post is mainly about the question of whether Biden is ‘listening to the science’ properly enough or not, and whether he is ‘undercutting’ the FDA and CDC by using the executive branch of government to set policy based on his model of physical reality and his view the political situation and needs of the people, And That’s Terrible. The tactic here from Very Serious People is that if the President suggests he is going to do anything in the future that hasn’t already been approved and announced by the agencies, or states any information about the world without letting them do it for him, then he’s undercutting them. 

It also reinforced that unforced errors and absurd statements are a lot of why things have gotten so muddled, in particular the CDC taking the position that “vaccinated people do not transmit the virus” along with relaxing their masking suggestions, which then established a baseline from which to scare everyone once again, whether or not that was the plan. 

The term ‘spoke broadly’ here still left room for updates back from a rather obviously false presumption back to the previous baseline, which could then sound like a horrible new development. And when you get ‘immense pushback’ and you backtrack in response, that’s not ‘of your own accord.’ 

Good thread analyzing one of the studies that argues for fading immunity, that concludes we should not update much on the study in question. I agree with the reasoning. 

Vaccine Mandates

Duke University lays down the law, and promises to remember. 

There is a vaccine mandate at the World Series of Poker

I’m boycotting too. If you ban the sucker from the table why am I even showing up? 

The blaster points both ways: Spokesperson for the National Religious Broadcasters fired for statements supporting vaccination

Various bullets are available to be bitten into, from various sides, and you can draw your own conclusions.

Are there vaccine mandates I am definitely opposed to? Yes. Yes, there are (news article that notes decision was then reversed). 

My understanding of custody law is that this is how it works in everything, all the time. The mother having a damn good reason doesn’t matter, because ‘best interests of the child’ as determined by whim of the judge is all that matters. Essentially the judge decides whatever they want, for any reason they want, there are no rules about what is relevant, and we justify all that with ‘best interests of the child.’ Which often amounts to something isomorphic to ‘I didn’t like their stupid face.’ And the judge could mandate actual anything as a condition, and they often do, and there’s nothing you can do about it. If you don’t comply, or the judge continues not to like your face, well, sorry, you don’t get to even see your child. 

The people publicizing the decision as a great idea are another matter, but one can hope that they are from the same portion of the onlineverse for which such expressions are no surprise. 

Meanwhile, in unusually explicit direct transitions from forbidden to mandatory on the basis of zero unexpected information whatsoever:

May I suggest that perhaps we can repeal the mandate of non-vaccination more than five minutes before it makes sense to impose a mandate? Anyone? 

There’s the argument that vaccine requirements and punishments to the unvaccinated represent an unprecedented and dangerous expansion of governmental powers and violations of freedom. Another argument is (aside from places where there are calls for coercion to stop people from making private choices on who to associate with) that what such violations mainly do is highlight existing patterns of violations and the systems behind them, and make them easier to notice, by creating clashing intuitions and jolting people out of acceptance.  It’s a new intuition pump.

Mask and Testing and Other NPI Effectiveness and Mandates

A thread discussing new evidence on effectiveness of masks via interventions in villages in Bangladesh, a post linking to the source, and the full paper. Funding came from GiveWell, because the world is small. Data needs more analysis to translate it into good effectiveness numbers, as these situations get complicated quickly. If you see a given reduction in cases over eight to ten weeks, how do you take into account compounding effects over time, and factor in control system adjustments, and measure how much of infection is within-village versus across villages? Also worth noting that the intervention’s effect on Covid case levels (along with its impact on mask wearing) faded over time, some of which I’d speculate was due to running out of usable high quality masks.

Here’s another thread on the topic. Gotta love this note:

Naturally, there’s plenty of ‘masks work!’ energy to be seen in response, and yes this makes it clear that masks definitely do help somewhat, especially with proper (in this case surgical rather than cloth) masks, with the impact concentrated among the elderly. 

Is that because the mask wearing got concentrated around the elderly, which would make total sense from the perspective of the villagers trying to help save lives? Which would imply very different conclusions about what caused what and how.

I also worry about multiple hypothesis issues here, on top of the other concerns. 

It’s also worth noting that this week we have a new study that KN95/N95 masks offer superior filtration to surgical masks, which matches my priors, so the upper bound on effectiveness here is higher than what you’d find with surgical masks, especially given that cloth masks were much less effective. 

This was a good study and I’m happy we have it, but I’m at a loss trying to translate these results into how much masks work in terms of a given exposure with any confidence whatsoever. I don’t think we can do this:

Ben updated from the study that masks were more effective than he thought, whereas I updated that they were likely somewhat less effective than I thought, which is a good sign since previously my estimate was (and still is) higher than Ben’s. 

There are scenarios where mask wearing puts us ‘over the line’ and Covid gets locally suppressed, resulting in 95%+ reductions in cases. There are other scenarios where masks don’t do this because people adjust behavior or they aren’t enough, and the number of cases is mostly unchanged. And we can’t go from X% reduction here to a Y% reduction in chance of an individual transmission without doing more work.

A hard to move object met a hard to stop force. It looked like this.

Score another one for incentives. Football player Isaiah McKenzie is fined for not wearing a mask. Responds by getting vaccinated to avoid this. Posts his vaccine card to make sure everyone knows it.

CNN is claiming ‘we know’ that masks are 95% effective when used properly. Which is odd, because I most certainly do not know that.

Denmark decides they are sufficiently vaccinated, lift all Covid restrictions. This is the way.

Remember, incentives matter:

Vaccination rates and international travel restrictions are not correlated, which is unsurprising since travel restrictions in the current situation are the goggles and do nothing.

As a good example of the rules being Obvious Nonsense:

Or we can keep it in the country:

University limits payments by professors for mask wearing by students to $50 maximum, preventing many win-win transactions. Others frame this differently. 

One 88-year-old professor quits mid-class over a student not masking at a different university

No, Virginia, you can’t have your booster early. It’s not mandatory yet.

In addition to mandating vaccinations, Duke also tests a lot, with interesting results (article):

In summary: Duke Sucks

Yet Duke is not alone. Amherst is barring its fully vaccinated students from trips into town other than to ‘conduct business’ and instituting endless testing and indoor double-mask mandates (news post).

The stated hope is that these restrictions only last a few weeks, but I am skeptical. 

Think of the Children

CDC issues guidelines for schools that includes (among other impossible goals) getting actual everyone vaccinated except the people the CDC won’t let be vaccinated, notes that schools are not achieving impossible goals, presents information like this:

Study of a particular classroom, where the teacher came in sick and unvaccinated, without a mask, and read to the students.

This is the classroom that drew everyone’s attention so it’s incorrect to treat it as a typical outcome, but it’s still helpful data.

In case you’re wondering how sane and non-dystopian school policies are these days, I have some news

“You must keep it closed for the active shooters.” Sure, if there’s one currently at large in the building. I’d do the math here to figure out how many orders of magnitude this is insane but it would be insulting to even bother.

Let’s do lunch.

Viva la al fresco! The concrete’s not so bad. I ate lunch like that most days in junior high school, I’d grab pizza or something not as healthy as pizza (which I’ll leave to your imagination) and sit on the steps somewhere. Sure beat what was in the cafeteria. So yeah, this seems completely nuts, but unlike most such nuts things it happens to plausibly leave the children better off. Liquids are also a reasonable choice. Save room for dinner.

Long Covid

A post-length analysis of the threat of Long Covid from someone I trust to be a good thinker, concludes that the threat of Long Covid while not zero is not so large as to distinguish it from numerous similar background risks we take all the time with such matters. 

This study in children came out, and yeah, This Reinforces All Of My Priors and all that.

What this did find was a huge pandemic of Long Covid Prevention, which caused a lot of persistently unhappy children:

Imagine if Covid caused this directly and what we’d have done to prevent it, then consider what that implies about what we should be doing.

The main event here is that Scott Alexander has a ‘much more than you wanted to know’ post on Long Covid.

The first thing to note is that Scott views the related news stories as remarkably good, and takes the reports more at face value than I do. Whereas I view the news stories about Long Covid as not very useful, but having slept on it I do notice that they’ve been less sensationalist than one might have expected, so perhaps this is a sign of Scott having good calibration. Stories should be remarkably good as often as they are remarkably bad, unless you think that being good is a relatively unremarkable characteristic. 

Let’s go over Scott’s takeaways and reasoning.

This is an important foundational point for Long Covid, which is that Long Covid is not one thing, it is many things, and it is important not to conflate them. There’s generic being-in-the-ICU-is-bad or being-sick-at-all-is-bad, there’s lung damage, there’s inability to taste or smell, there’s fatigue, and all of it is likely a combination of some real effects, some psychosomatic effects, and some coincidental effects that got misattributed to Covid, and also some amount of fishing expedition. When we focus on a particular risk or harm such as Long Covid, we treat it differently than we are treating all other risks.

His next line is that a percent estimate is ‘kind of meaningless’ but he felt obligated to give one anyway, which I think is net good practice but I’m not sure. What I’m confused by is how he uses the data he reports in this section to end up at 20%, since he quotes studies where (Long Covid percent in Covid group minus Long Covid percent in control group) is respectively at most 28%, 12%, 17%, 13% and 13%, two of which lack a control group. If we naively average that we get 17% minus a few percent for the missing control groups, so maybe 15%. Scott seems to be buying that ‘any symptom at all’ is a reasonable standard here, and that asking ‘did you have Long Covid?’ is ripe with false negatives.

For all of these it’s important to note that it’s confirmed seropositives rather than all Covid cases. Most Covid cases likely remain fully undetected. Then again, it’s possible that some of the effects in the control groups could be due to undetected Covid cases.

It’s also important to note that Covid cases don’t happen at random, and even when there are controls the controls aren’t checking for health profiles in detail from what I saw on spot checks.

The 28% comes from asking if patients have ‘at least one persistent symptom.’ N=234, and the outpatients had a slightly higher rate of Long Covid than the hospitalized patient group. Symptoms that counted included diarrhea, runny nose and ear pain. I don’t know if they were typically mild and they aren’t that big a share of the cases, but that definitely says to me ‘fishing expedition.’  

He shows the above graph, and some other stats. He then shows this from the third study, Haverfall:

There seems to be a clear line here where the first four symptoms are showing up at a meaningfully different rate in the two groups, but the later five are not with sleeping disorders in the middle and I’m guessing a secondary effect of various other problems. The declines in the control group over time represent them being asked how long symptoms persisted. So it can be taken as a kind of ‘how long does this last when it happens for other reasons’ measurement, and it’s reassuring to know that if you (in general as an example) report headaches for two months, which sounds terrible, that by eight months you’re a favorite to have had the problem go away.

I’d go a bit further than Scott and basically say that I’d treat the breathing problems, issues with taste and smell, and the fatigue as Long Covid, and the other symptoms as presumed to be coincidental or as indirect consequences.

Scott also lists this big chart of symptoms, click on it to read in full, I’m going to highlight the mental health area:

The control group numbers here are terrifying. This is a crisis. I mean, WTF? Again, it raises the question of what are the effects of Long Covid Prevention on mental health and general well-being, and suggests that they might be far more serious than Long Covid. 

When we compare the control group to the symptom group, we find essentially no difference. Symptom group is less lonely, which I’m guessing is directly causal – we should treat more than 7% loneliness as a Long Covid Prevention symptom, along with a lot of the other stuff too

The symptom had similar amounts of stress, depression and anxiety to the control group, and I’m going to go ahead and question how bad Long Covid can be in expectation if it doesn’t increase any of these factors, compared to the effects of Long Covid Prevention which definitely did spike them a lot. 

That doesn’t mean it isn’t real here, in particular the respiratory section looks grim.

Not the most helpful conclusion, but about all we can say given the quality of the data. It seems some people recover, some don’t, and the standards change so much everywhere that saying much more than that is very hard. Scott also points out that the rate of recovery from fatigue due to Covid contradicts the general data that fatigue basically never gets better. No idea what to make of that.

Noted more for completeness than anything else, and that seems right. 

As Scott notes, this is important, because the specter of child Long Covid is being used to justify all sorts of stuff.

That conclusion means it does reduce the per-case-at-all rate substantially, since more of the cases will be asymptomatic if one is vaccinated, on top of being less likely to get Covid at all.

This study came out yesterday, and says the risk of Long Covid is cut in half in the vaccinated population versus unvaccinated. My guess is that’s an overestimate, maybe a large one, but that there is some reduction. 

This is the headline number that matters, noting that this is conditional on symptomatic Covid rather than Covid, and terrible is being conflated with serious. He notes the disagreement with the first post I linked to, and tries to then do a Fermi calculation of the chance of getting Long Covid if one lived a normal life, and gets very wide bounds, somewhere between 1 in 150 and 1 in 25,000. I think we can safely throw out the upper part of his range, as I think a 10% chance of breakthrough symptomatic Covid within a year isn’t reasonable if you do a little math, and it’s starting at 25% which seems higher than the studies referenced above would suggest, so I think the range here would be more like 1 in 1,000 to 1 in 25,000. 

I agree with Scott’s view here that our worries about Long Covid strongly imply the need for more worry about Long Disease in general, and also Long Everything. The previous Aceso Under Glass post emphasized this point, that there’s lots of such risks in the background all the time, and this isn’t an especially big one. 

More to the point, Long Covid Prevention has clearly reached crisis levels and really is a big deal, and seems more severe than Long Covid, and a huge percent of the population has this problem, so we need to do what it takes to stop this deadly syndrome in its tracks.

I haven’t yet done a full reading of the Matt Bell post that Scott references. It is long and I do not currently have the time. I hope to read it carefully over the coming week.

I didn’t update much in aggregate, at least for practical purposes. 

Long Covid seems legitimate, and worth a nonzero amount of effort to minimize, but my model says it is mixing a lot of things together, is largely typical of what happens after being sick, is protected against by vaccines similarly to how they protect against symptomatic disease, and in many studies they go on a fishing expedition for symptoms then attribute everything that happens chronologically after Covid to Covid. 


Thus, basically, ‘don’t do stupid stuff’ still applies, but I have no intention of going beyond that rule, or forming a microCovid budget or anything similar to it. 

In Other News

Two ‘heavyweights’ are leaving the FDA and everyone thinks this is because they are mad about pressure from the Biden administration to approve things faster, likely including booster shots. Like in places where the unvaccinated quit, this is both a short term staffing problem and a medium term opportunity for great improvement.

Timeline of the initial outbreak may need to be radically reconsidered, with a virologist in Spike Lee’s new documentary claiming he heard about an outbreak on December 15.  

Tyler Cowen has a podcast conversation with Zeynep Tufecki, self-recommending. I found it good, but less surprising than I expected, so I was disappointed. I take that as a sign of proper calibration.

Thread by Nate Silver on booster shots, the evidence in favor of them working, and the need to retire the term ‘no evidence.’

Thread providing color on what’s going on with people using Ivermectin intended for horses. Another thread providing colorful descriptions, rather than explanations. 

In response to this, there has been a push to fully bury Ivermectin and to further mock outgroup members by calling it a ‘horse dewormer’ or similar, such as here. I do not think such tactics in any way qualify as helping, and urge all involved to stop using them.

One third of common American deer have antibodies to Covid. Deal was already sealed but this makes it even more clear, we’re not getting rid of this thing. 

Ministry of Truth: YouTube gives a strike to a channel for video criticizing anti-vax statements, presumably because it shows a short clip of those statements. 

A rabbi gives Jewish perspective on the religion’s highest obligation of saving lives, via vaccination and preventing Covid. 

Fluvoxamine preliminarily looks good (as in, worth using, see paper) as a treatment for Covid-19. Not good enough to change general behavior much while you’re healthy, and it’s got enough side effects that one wouldn’t want to use it lightly, but I’d be willing to take it if I knew I had symptomatic Covid. Here’s Kelsey talking about what the results mean and what our priors should likely be here. 

An Orthodox Bishop talks about people regretting not being vaccinated.

Visit Cornwall?

Visit Singapore instead?

Australia continues along its path.

But lets down on the gas somewhat in other ways. Such generous, non-dystopian folks.

Max Tegmark reminds a senator we are funding gain of function research, points out it could kill a very large number of people, suggests perhaps we should stop.

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42 Responses to Covid 9/2: Long Covid Analysis

  1. One interesting thing I came across recently is this study suggesting most long covid is a Epstein-Barr Virus (mono) flareup. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233978/

  2. Humphrey Appleby says:

    A very important question is `what is the endgame for COVID.’ I am increasingly of the view that herd immunity is unattainable, even with 100% vaccination. My main reason for this belief is the UK data – you mentioned the UK was at 90% seropositivity among its adult population back in June, then it had one spike (which must have left close to 100% of the adult population either vaccinated or recovered)…and now the UK is having another spike. If COVID is endemic, then the only meaningful choice is between maintaining extreme precautions (isolation when possible and N95 when not) indefinitely for the rest of your life, or resuming normal life and trusting to the vaccine to do its job in protecting you.

    • TheZvi says:

      Yes. In which case, that’s not much of a choice at all.

    • Ben says:

      If this is true (https://www.statista.com/chart/23961/uk-share-with-covid-antibodies/) – 94% of England had antibodies the week of July 26th AND this is true (https://ourworldindata.org/covid-cases) – UK still has a similar level of community positive cases that don’t seem to be rapidly falling, I find your framing inevitable. It’s an incredible tragedy (especially for the immunocompromised) that could only be made more tragic by adding to it the negatives associated with mandated NPIs. I think the best places like England and the US can do now is make sure that all their citizens have a period of time to access free vaccination. A few months would be quite generous. Its also worth noting that the UK death rate currently is 1.44 per million per day. This is pretty close to my calculations for US flu deaths during the winter period of a fairly bad flu season.

    • keaswaran says:

      It seems to me that if covid is endemic, then the natural response is neither of the ones you mention. We can take moderate precautions (masking on transit and in grocery stores, and moving meetings to Zoom whenever local case counts get above some particular pre-determined threshold) in order to ensure that I get covid (which sounds quite unpleasant for a couple weeks even in many breakthrough cases) only once every five years, rather than every year. That doesn’t seem like “resuming normal life” or “maintaining extreme precautions”.

      • myst_05 says:

        Assuming COVID will behave roughly like the flu, only 10-20% of the population will get infected every year. So it will be roughly once every 5 years without any precautions.

      • Ben says:

        Removing mandated NPIs allows everyone the freedom to take moderate precautions in accordance with their specific risk tolerance.

      • Humphrey Appleby says:

        Fine, but at a minimum whatever changes you make should be sold (including to yourself) not as a temporary measure in an emergency, but as a permanent change to our way of life.

        I would be strongly opposed to any legally mandated permanent changes to our way of life, and also to attempts to sue or shame e.g. employers who don’t let white collar employees work over zoom. Whether you wear masks on transit or in grocery stores is up to you. And if we (as a society) are going to implement legally mandated permanent changes to our way of life, these should be passed through legislation not via emergency decree, because see above.

    • Catweazle says:

      Interesting. Assume for a second there’s no herd immunity from vaccination or infection, as strongly suggested by UK data in the thread. We began our Covid journey with a denialist/minimalist administration in charge. To counter, public health/media/opposition aggressively rammed the point home that “covid is very serious you do NOT want to get infected” and “vaccines are the way out of this”. Which was rational at the time.

      The take-away by the public was “after everyone is vaxxed, covid will go away on its own”. Yet it appears that objectively, vaxxes can’t stop the spread, they just make a covid infection relatively harmless. “Relatively” in the sense that yes, some infected vaxxed will still end up in ICU or die, but the rate won’t be much higher than pre-pandemic from RSV, cold, flu, etc.

      Now society has a huge problem, because people have been conditioned by media to be scared, and cannot accept periodic re-infection as the end-state. If the people in charge can’t effectively communicate the new risk profile, or “every death is one too many” prevails, a country may end up in a sub-optimal, irrational state of “masks and school closures forever”.

      Perhaps countries which started the pandemic without a denialists in charge, are better at fully returning to normal? Witness The Netherlands or Denmark, where masks have disappeared now and primary schools never closed. It would be quite remarkable if a country’s pandemic end state were mostly a function of path dependence – the attitude of people in charge in March 2020.

  3. shakeddown says:

    Correction to the new Israeli standard – the new policy starts October (not September), and specifies that the green pass expires six months after your second shot (or recovery) and now requires a third shot to renew.

    (Nothing so far on whether the third shot will also count as expired after six months)

  4. myst_05 says:

    “This post is mainly about the question of whether Biden is ‘listening to the science’” => did you miss a link/screenshot here? Or is “this post” = your actual blog post?

  5. potato says:

    Please: Start using block quotes instead of images of text.

    ——–

    Large numbers of images fail to load with status 403, due to rate limiting from googleusercontent. Best I’ve seen is 21 of these errors in console, sometimes it’s over 100. I and many others have had the same problem for every single one of your recent posts. The same issue is happening on the lesswrong version of this post, so it’s nothing specific to wordpress.

    I know flaky issues like these are easy to ignore, but since the issue seems to be throttling and many of the images are just text, I ask you to try one simple piece of mitigation: Start using block quotes instead of images of text. This will (1) definitely let 100% users see all the text you reference and (2) greatly reduce request rate, probably avoiding throttling and allowing many users to see actual figures and graphs that they currently cannot.

    • TheZvi says:

      Didn’t realize it was a rate/volume issue, or that it was googleusercontent doing it, which implies that it’s copying things over in a strange way (I do drafts in Google Docs then paste over in one go, because the WordPress new editor is so terrible that I basically don’t try to do major edits after that).

      I found readability of the posts went way up when I went to pictures over quoted text, as well as the formatting issues involved, as per both my own instincts and reader feedback. But perhaps there’s a way to do this without the rate issues? If not, then it’s a question of how bad the issues actually are.

      • Error says:

        I can’t speak for the images not loading (I haven’t had that problem), but the pictures of text always raise my hackles. They’re huge relative to their content, you can’t select/copy/paste them, you can’t ctrl-f them, and it’s just annoying all around. Related XKCD: https://xkcd.com/2116/

        (then again, I’m one of those cranks who writes everything in plain text markup and refuses to use word processors, so take my opinion with salt)

      • Tom W says:

        The rate/volume issues showing up lately imply that you have a large readership following these posts–which is well deserved, and a sign that they’re a useful resource for people. Congrats!

        If you want to be able to post images that work for everyone, at the current rate people are reading, unfortunately the only option probably involves finding somewhere to host them that isn’t Google user content. There are lots of places on the internet that allow static image hosting, but there’s going to be tradeoffs of price/reliability/ease of upload for any of them. The best resource for help might be someone else with a popular WordPress blog that embeds a bunch of images?

        As for “how to handle external content” — the problem with pictures of text is that they work well for most people! Trying to embed tweets/articles tends to be a fragile nightmare, and as you point out, there really is something lost in taking a social media post, or article, or even a paper, and turning it into a blockquote. Probably the most “correct” solution would be to keep using pictures of text where it makes sense (such as Twitter posts), but consider blockquotes for longer material like articles, where the formatting isn’t such an important part of the content. And make sure that there’s always a link for people to access the original material, of course.

      • I can confirm from recent personal experience that figuring out website issues can cause major, but usually short lived, decreases in life satisfaction.

      • TheZvi says:

        @Error: If I had a full-stack solution for creating readable block text in reasonable time in context I’d be happy to use it at least sometimes. Current tech is I write on Google Docs and paste into WordPress. I do think the images are actively correct for shorter passages though.

        In terms of the tech situation, as noted above, I write in Google Doc, then paste into WordPress because their new “block editor” is horrible at least for me in practice right now. If there is a similar solution (WYSIWYG editor that can take pasted images, then I can copy into WordPress, or a mode of WordPress that can actually work while taking pasted images) I’d be happy to switch, and willing to pay for the products involved if the price is reasonable.

    • TheZvi says:

      Anyone reading: Consider this an official request for anyone with the technical knowledge that is willing to help me set up a new system that will work here – let me assemble the posts in reasonable time and also have a higher limit to how many people can load it at a time.

      Note that paying a reasonable amount of money (to WordPress, to Google or otherwise) is fine, I’m happy to put some of the Patreon money into making sure people can view the posts.

      Also, I’d assume that if this hypothesis is true then the problem should be a big one right after the posts come out (or when they’re link-bombed) but go away after a few days? Does anyone see this problem persist e.g. on a Monday?

      • Evan Þ. says:

        For myself, I can’t remember seeing the problem more than a few hours after your post’s first come out.

      • AnonCo says:

        >I do drafts in Google Docs then paste over in one go

        This is your problem – due to Google Docs dark pattern. Google docs does not Copy/Paste images in a normal way.

        When you c/p an image from a google doc they blindly switch it from “copy this image” to “copy the code to embed this image, don’t actually copy it”

        So in effect, you are embedding all of the images from your google doc from your Google account – so of course they are getting rate limited, because it is a google doc not a web hosting service. Hence the “googleusercontent” errors.

        It will be unpleasant but the easiest way to fix this without rearranging your whole hosting situation is to manually insert the images the regular wordpress way. (save them, then Insert into Post via WP

        WordPress Classic Editor plugin will get you the old editing experience which should help some.

        https://wordpress.org/plugins/classic-editor/

      • Dominik Peters says:

        There are a few wordpress plugins which after saving a post, go through all external images, upload them to the wordpress library and then replace the external links with internal links. The best one I’ve found: https://wordpress.org/plugins/auto-upload-images/

      • TheZvi says:

        Thanks, Dominik. That gives us a BATNA – we can pay the $300/year or what not, and worst case we do what we do now plus one of those plugins.

        I’m going to try some other stuff for now (e.g. using LessWrong’s editor instead of Google Docs) to try and avoid that first, but good to know a not-too-awful solution exists.

  6. Error says:

    > Thus, basically, ‘don’t do stupid stuff’ still applies, but I have no intention of going beyond that rule, or forming a microCovid budget or anything similar to it.

    What do you think of the microcovid project, incidentally? They’re the only ones I’ve seen trying to numerically estimate everyday risks and showing their work. I’ve found them invaluable even though I don’t use an explicit budget.

    (I think I’ve mentioned before that I’m partially immunocompromised, so I’m not ready to fully relax my guard yet, especially when intentionally doing stupid stuff)

    • TheZvi says:

      Yeah, being immune compromised is a different situation. That sucks and I sympathize.

      My take on mircoCovid is that it’s an actual attempt to do the thing, there hasn’t been another actual attempt to do the thing, and it’s orders of magnitude better than not making an attempt at all. I have plenty of disagreements about the micro calculations, and worry that default use of the system leads to too much paranoia over relatively small issues, but what it does right it does right, and that stuff is super important – emphasize that the big ‘stupid stuff’ is really that bad relative to everything else and point out roughly what it is, and the importance of orders of magnitude.

      Like most such rules, I think of it as a ‘learn the rules then throw the rules away’ type of situation.

  7. rohdewarrior says:

    I apologize in advance in you’ve covered this already somewhere (though I do read all your posts all the way through). I’m curious if you’ve read Micahel Lewis’ ‘The Premonition’ and if you have any thoughts on it.

    • TheZvi says:

      I have not. I’ve read the MR reviews of it, and that seemed like it was enough given my time restrictions. I could be persuaded that it’s worth reading.

      • rohdewarrior says:

        He’s a good writer. It probably covers a lot of stuff you know already (like the CDC is useless). But if you’re not familiar with Carter Mecher and Richard Hatchett I think it’s worth at least a skim-through.

  8. SixU says:

    Poor Australia. Where did it all go wrong for them?

  9. Jordan says:

    I’m starting to like Zvi’s summaries and responses to Scott’s posts more than Scotts posts themselves.

  10. Matty Wacksen says:

    >My understanding of custody law is that this is how it works in everything, all the time. The mother having a damn good reason doesn’t matter, because ‘best interests of the child’ as determined by whim of the judge is all that matters.

    This is so horrible, but it seems like speaking up is hard because then you worry about these kind of people taking one’s own kids away :/

    >A thread discussing new evidence on effectiveness of masks via interventions in villages in Bangladesh, a post linking to the source, and the full paper.
    >I also worry about multiple hypothesis issues here, on top of the other concerns.

    I believe the only non-significant finding are subgroup analyses for surgical masks and/or old people, but I didn’t read the paper. So concern about multiple hypotheses is definitely warranted.

    >CNN is claiming ‘we know’ that masks are 95% effective when used properly. Which is odd, because I most certainly do not know that.

    Yeah I’m surprised how quickly “masks might work or might not, but we should take that risk because of little downside” to “anyone who thinks masks don’t work is stupid”. I blame the science here.

    >In addition to mandating vaccinations, Duke also tests a lot, with interesting results (article):

    I wonder if infection+vaccination gives you a similar immune response to “infection only”.

    >Study of a particular classroom, where the teacher came in sick and unvaccinated, without a mask, and read to the students.

    Oh wow that’s cool, this definitely ups my “low exposure => fewer symptoms” prior though only one datapoint.

    >It’s also important to note that Covid cases don’t happen at random, and even when there are controls the controls aren’t checking for health profiles in detail from what I saw on spot checks.

    Great point that was missed by Scott’s article and many of the other articles too. Though I personally know someone who had smell issues for months after (presumably) getting covid in the first wave, so this form of long covid definitely seems common.

    >The control group numbers here are terrifying. This is a crisis. I mean, WTF?

    Yeah, but we’d need a control group to know whether this is much worse than “normal” or not.

    >That doesn’t mean it isn’t real here, in particular the respiratory section looks grim.

    Well, we’d expect “poor respiratory health” to be a stronger confounder for getting (symptomatic, tested) covid than just “poor health” maybe? So it doesn’t necccessarily have to be “long covid”.

    PS: Does should “natural infection => stronger immunity” change the calculus on whether or not vaccine mandates are sensible?

    • Matty Wacksen says:

      To expand on my last point: If someone is prone to “Fits of coughing” anyway, they’re more likely to take covid tests because everyone is saying “you seem sick, please get tested” and so less likely to end up in the control group (all else equal). Or more likely to be in a care home, or more likely to be in a hospital, etc.. Then again, not sure if this explains such a strong effect, since presumably if you have poor health you try to avoid covid.

  11. Purplehermann says:

    I dislike the “jewish perspective” comment. Conservative and Reform Judiasm isn’t jewish perspective, anymore than Scott’s views are jewish perspective. “Rabbi” Danya has almost certainly come as an ignoramus in jewish thought, hours spent studying the texts etc, and I certainly don’t style myself as a Rabbi.

  12. Ben says:

    To try and integrate into your model of prediction: https://jamanetwork.com/journals/jama/fullarticle/2784013. Apparently the CDC seroprevalence survey results are in and 83.3% of Americans over 16 had Covid antibodies in May.

    • Ben says:

      If I am reading this correctly https://ourworldindata.org/covid-cases from June 1 to now we went from 50% to 60% vaccinated and had another 6 million reported infections (https://ourworldindata.org/covid-cases). I wonder what the seroprevalence actually is right now. So, the question is: Is this good news because we are about to see the virus have no one else to infect and burn out (or at least become like other non-serious coronaviruses) or is it bad news because even with that high of a number (probably over 90% by now) we are still seeing infections that lead to hospitalizations/deaths and can expect our current reality to continue more or less indefinitely regardless of seroprevalence?

      • Craken says:

        The paper found regional disparities in seroprevalence (from 80% in the South to 87% in the NE), and these are reflected now in daily death counts. The South is closing the gap the hard way. If Delta remains the predominant strain, an endemic state ought to develop wherever seroprevalence is ~95%. I expect it to be characterized by less extreme infection waves and maybe no waves at all, just a steady trickle of cases, mostly mild. However, given that it’s still at an early stage in its evolution, a new Covid variant will probably overtake Delta some time in the next couple of years. Delta is nearly domesticated in the US, but a new variant might require a new vaccine.

  13. lifter4545 says:

    I don’t know much about your content and style other than these COVID posts but I would strongly consider switching to Substack. WordPress is just sorta always going to be a hassle. There’s really no magic bullet because of how they’ve decided to build their stack. I haven’t seen you use any features that would suggest you value the “expressiveness” of the WordPress platform so Substack is probably a good choice for the next 3 years until something better comes along.

    You’ve clearly attracted a new audeience with your intellecually honest coverage so there’s also a monetization possibility as well.

  14. benquo says:

    Ben updated from the study that masks were more effective than he thought, whereas I updated that they were likely somewhat less effective than I thought, which is a good sign since previously my estimate was (and still is) higher than Ben’s.

    How do you end up with a higher number?

    • TheZvi says:

      Combination of a lot of sources, including physical priors, I’ll stick to the most important considerations. Most of all, I think that when masks are measured we tend to be measuring them in practice, which means a lot of poor fits, a lot of not using them or taking them off, and a lot of cloth or other relatively ineffective versions, and my guess as to why the effect here is primarily in the elderly is that the people in question reasonably wore their masks a lot more often around the elderly. The good masks worn by medical professionals are scarily effective when used by them in medical settings, they have to be given what we’d see otherwise.

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