Covid 12/9: Counting Down the Days

Omicron is coming. We are not preparing for it. That is the news that matters.

In addition to that, Delta is a growing problem as we face a winter wave. Future problems don’t protect us from current problems, no matter how inevitable and predictable the current problems might be. Here’s where we round those things up.

Note that due to recent events, and the new data on what people actually benefit from and want to share, I think it increasingly makes less sense to focus on weekly posts, and to focus more on addressing particular issues when they appear, so I’ll be transitioning towards being more inclined to split things up.

Omicron Posts: #1, #2, #3, #4, #5 (today)

Last Week’s Weekly Post.

Executive Summary

  1. Omicron is coming.
  2. Boosters won’t be updated in time.
  3. Paxlovid remains illegal.

On Paxlovid, update is that final Pfizer data is expected in a few days, a perfect timeline gets the whole thing done by end of month, the 24% at Polymarket for that is probably somewhat low. Nothing’s going wrong, except for the total lack of urgency.

There’s various fights over masks and vaccine mandates, but game that matters is Omicron.

In the meantime, on with the show. Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 630k cases (+20%) and 8,000 deaths (+26%)

Results: 736k cases (+39%) and 8,355 deaths (+32%).

Prediction for next week: 750k cases (+2%) and 8,800 deaths (+5%).

I was being somewhat cowardly making my prediction. On reflection, I should have been more confident in what was obviously happening.

This week I’m predicting smaller increases because I expect that some of this week’s big increases were due to data dumps, and because I expect some amount of additional caution due to fear of Omicron, whether or not that yet makes physical sense.

Note that Omicron cases aren’t going to be noticeable this coming week.

Deaths

Cases

You’ll want to smooth out numbers over the last few weeks. Either way, it’s clear that the Delta situation continues to get worse in addition to the threat from Omicron. It won’t become a crisis before Omicron becomes primary.

Vaccinations 

Fear of Omicron is working, at least somewhat, and there have been reports of difficulty getting appointments. Getting an appointment for my son’s second shot took a week, whereas my own booster was in my arm an hour after I went online to book an appointment.

Some potentially good persuasion here.

Vaccine Mandates

Boosters work, and are important to protect yourself from both Delta and Omicron, and there isn’t time to wait for an Omicron booster. I got boosted and I suggest you do the same.

That doesn’t mean that I think vilifying those without boosters, or making them mandatory, is a good idea. On the contrary: This is going to make a lot of people very angry, and is widely regarded as a bad move. It’s a tough crowd out there.

Yet it’s going to happen anyway. Here’s a sample opening shot across the bow.

Image

I realize that it’s a universal rule that the answer to any headline in the form of a question will ever and always be “NO!” but every rule has its exceptions. Yes, of course it’s safe to hang out with the ‘unboosted.’ It’s also safe to hang out with the unvaccinated, that’s the whole point (ok, fine, most of the the point) of getting boosted.

The other front is to continue applying the squeeze to the unvaccinated. In Europe this is taking the form of outright mandates. Germany is locking down the unvaccinated.

Here, we prefer to utilize our uniquely perverse system of charging people for medical care, where ‘pay out of pocket’ means ‘we treat you without telling you the price or letting you say no, then we charge you ten times what it actually costs and then take your house.’

The principle behind this makes sense to me. If you choose to accept a risk, you should have to pay the costs of that risk. That would be fine if it was in the form of somewhat higher health insurance premiums, or paying the actual costs involved. In Singapore, where they’re also doing it, it might even be a reasonable policy. But our system is broken so instead what we get is vindictiveness towards anyone who didn’t pay tribute in the form of Official Legible Insurance, which costs double or more if you don’t hold an Official Legible Job, and can’t be adjusted for pretty much anything.

Taleb has an observation.

It’s important to note that this is not an outlier. Vaccine mandates are popular. Even here in America, if you held a vote, every poll says they would pass. That doesn’t mean they don’t effectively constitute a power grab by government, or that they won’t increase government power over time. The follow below gets it indeed. The word “just” is emphasized here for a reason.

Thing is, if you’re worried that doing reasonable things to protect public health is unpopular, you probably shouldn’t worry about that. As a reminder:

Image

Seriously, we’re the weird outlier and every time the yes side still wins.

On his way out, universally disliked New York mayor DeBlasio announced a vaccine mandate on private businesses and extended the vaccination requirements for indoor dining down to five year olds and increased them to two shots. I predict the door will hit him on his way out.

Whereas elsewhere, despite their general popularity, more politicians are souring on vaccine mandates, including democrats like Governor Whitmore of Michigan. What people support in theory and what would happen in practice can be, and usually are, very different things.

New Brunswick gives, among other places, grocery stores the choice to either enforce social distancing, which is not actually possible in practice, or mandating vaccinations. For buying groceries. Get the shot, or starve. I hope they have Instacart.

Also, it seems like Zeynep is reporting many elderly are having trouble scheduling their boosters? Seems like we should be getting on that. In a mitigation scenario, this is where most of the remaining value lies that we can still get to without getting the FDA to play ball.

NPIs Including Mask and Testing Mandates 

Debating whether to attend that holiday party? Let’s Ask Dr. Science, I mean Dr. Fauci, he knows more than you do. He says, if everyone is vaccinated, sure, go ahead. If not, maybe not. Thanks, Dr. Fauci. This logic doesn’t actually make any sense once there’s a lot of Omicron, and it didn’t make much sense before Omicron (a much better rule is that if you are vaccinated or especially if you are boosted, you’re fine, and others can worry about themselves), but it’s a way to maximize the get-vaccinated message, so it’s what gets said.

The testing situation is, shall we say, less than ideal.

What testing we do offer remains often so slow as to lost most of its value, such as in this example.

This is people executing a ‘get tested’ adaptation as a fetish, not people trying to improve outcomes.

Things are much better in New York City, where there are free test tents all around offering PCR with a 24 hour turnaround. I used one today because I was asked to provide a negative test, and it was quick and painless.

Notice, by the way, that the reason to wait to call is that they’re experiencing heavy call and email volume? Model this.

When Paxlovid is finally legal, getting testing that works is going to be that much more important, especially with Omicron on the way. If you have to wait 2-3 days minimum for your results it’s too late for Paxlovid.

Biden’s proposal is to let you then bill your insurance for the costs of your at-home tests, which very much has a “how do you do, fellow kids?” energy to it. If you want tests to be free, as you damn well should, you should make them free in the sense of not charging people money. Maybe some professionals should talk logistics? Crazy, I know.

Twitter had a quote retweet caption contest on this one, and pretty much everyone was a winner.

The reporter says “maybe” which is the exact definition of partial credit. Psaki then replies, “then every American has one test. Then what? How much does that cost?” And then her defense to why we can’t do what other countries do is that our tests are approved by the FDA.

All right then. So…

So… um… I… uh…

…and that’s the problem, maybe we should treat the FDA as damage and route around it?

FDA Delenda Est?

Slow Boring points out some of the obvious low-hanging fruit. If we’re not even willing to make an effort to use Fluvoxamine despite no one raising any actual objections to it that I can find, and we’re not even willing to approve tests widely used in Europe on any time scale, what are we even doing? Seems like our authorities don’t take this pandemic all that seriously as a physical thing in need of actual mitigation.

It seems Missouri commissioned a study of mask mandates, which found that they worked, so they decided to block publication and continue calling upon cities to the end their mask mandates. The study doesn’t seem like it actually proves anything due to design flaws, but that really is not an excuse here.

Think of the Children

Some people are noting that Covid prevention is causing a youth mental health crisis.

Meanwhile, in New York, along with vaccine mandates for five-year-olds, I realize the source is on a crusade but this still seems extreme.

Intellectually I’ve managed to put together how this happened. It still boggles me every time I let it hit me. Seriously. There Is a War.

The war also involves freezing our children, in places they are legally required to be. This is happening to my son as well, as the school is forced to keep their windows open. The example here is from Scotland.

Children are being forced to wear overcoats and blankets in bitterly cold classrooms because of a Government edict to keep windows open to limit the transmission of Covid.

One teacher said that temperatures plummeted to 11C, potentially putting children at risk of asthma attacks and other conditions linked to the cold.

Oliver Mundell, Scottish Conservative education spokesman, said: “We are only at the start of winter, and temperatures will drop. The SNP need to provide more support, so teachers and pupils are not left bearing the brunt of the freezing months ahead.”

As a relaxing nighttime activity, my wife and I are watching Season 2 of Buffy the Vampire Slayer. I’d say it holds up quite well and has been great fun. One thing she has pointed out multiple times is the whole how do children keep going to this school despite everything that’s happening there, and as the whole thing gets steadily less-well covered up as the year goes by. But we’re putting our kids into freezing conditions, making them wear masks all day, forcing them to eat lunch outside on the sidewalk, in addition to the traditional stuff like forcing them to get permission to go to the bathroom and be constantly taught that life is about following arbitrary orders. Also, see the school shooting incident this week, and our reaction to such things of literally forcing our kids to endure periodic ‘live shooter drills’ designed for maximum terror. None of that seems to bother all that many parents.

So my brain mostly no longer wonders why Sunnydale High School stays in business. Where else are you going to go, Detroit?

There’s also the question of windows. Schools commonly have windows that can’t open, also known as fake windows, or lack windows altogether, as it is, due to stupid safety paranoia. Now with laws saying any windows must be opened, I wonder if we’ll get something similar to what happened when ancient kings imposed window taxes, with attempts to destroy as many windows as possible so no one can force them to be opened.

Permanent Midnight

I think they’re more likely wrong, but it won the poll, might want to be worried.

There is a war. We are not winning.

In Other News

Did you know that if you get sick with Covid-19 we can treat you? As in, give you medicine, and we have those, even if Paxlovid remains illegal? Yet somehow no one talks about any of that?

I mean, yes, this does feel very punitive and like it is, as we called keeping Paxlovid illegal, another case of murderous madness. Simply saying nope, we’re not going to bother ensuring medicine gets to people when they need it, if we talk about that people won’t care enough about not getting sick. I mean, that’s their argument. It seems to be:

  1. We have life-saving medicine.
  2. But if we tell you about it, you might not get vaccinated or do enough prevention.
  3. So we won’t tell you about it much.
  4. And we won’t much use it.
  5. So there?
  6. Profit?

So we get responses akin to this actual reply:

Which is saying (aside from the usual hating on Florida without any good reason, which is also part of the pattern) is, yes, technically the thing you’re suggesting actually works, instead of the thing I’m continuing to misleadingly mock despite it not being relevant, but also if you get pneumonia we shouldn’t worry overly much about treating it because you probably went out in the cold and therefore you deserved it?

Does this remind you of anything else we tend to blame people for when they get hurt?

FDA extends monoclonal antibody treatment to infants and newborns just in time for monoclonal antibodies to stop working due to Omicron (until we get the new versions, assuming they’re permitted, I have no idea if that’s another graveyard we’re looking at or not). Should still be good for another month, might last two.

Paxlovid development benefited from previous work on SARS. A similar story to mRNA vaccines, we’re able to develop things quickly now because we already did a lot of the work. Research and development pays even better than you would think. Imagine what we could do if we got out of the way.

Credit where due. Hochul administration actually tries to get through to those who attended Anime NYC and urge them to get tested. Then will do nothing useful with that information, which is far too late to stop any infections or probably to even tell us anything useful about Omicron, but at least their head is in some game, somewhere, trying to win it, no matter how irrelevant to the playoffs.

Also credit for trying, even less reason to be trying, Italian man brings synthetic arm to vaccination to try and fake getting the jab.

A thread about the problems with third world vaccination campaigns. In many places including South Africa there aren’t near term supply shortages, but that’s because they didn’t ramp up their logistical capacity or attempt to generate demand due to a previous lack of supply and anticipated supply. The part that frustrates me most is where they ‘didn’t want to generate demand that exceeded supply,’ which is a way to be sure you won’t have enough demand once supply later increases. Thus, the supply is now sufficient, even if this supply wouldn’t have been sufficient had a larger supply been anticipated.

Thanks to the WHO and other muddled sources, there’s still a lot of sources going around saying Covid-19 isn’t airborne, such as this app from the Indian government, which calls Covid-19 being airborne a “myth.”

Finland’s Prime Minister, also Finland, living their best lives.

The case against Molnupiravir, based around the worry it will cause mutations. I’m largely convinced that this objection is big enough, but you still need to come out and say it. Instead, it seems like we’re holding the drug in limbo? Speculation that even if the FDA does approve Molnupiravir, very few patients will be given access.

Supply chain issues finally reach critical level requiring bold action, as New York bagel shops are running out of crème cheese. This time, you’ve gone too far. I told you, I told you, I told you, I told you.

Not Covid

I feel the need to say some words about this week’s school shooting.

Not because I have anything to say about gun control or am trying to make any traditional political point. I feel the need to mention it because it’s a clear illustration of the Law of Earlier Failure where things go wrong for far stupider reasons than the reasons you think they do.

Think less Law & Order where you pound the pavement let alone a Sherlock Holmes mystery, and more like Castle or Lucifer where the killer leaves obvious clues and confesses for no apparent reason, and the outsider whose mind isn’t even fully present with no actual training still figures it out half the time because they’re thinking at all rather than following procedure.

Rather than there being no fire alarm there’s usually an apartment actively on fire while you sit around drinking coffee saying “This is fine.”

Cause seriously, this is real life and how it works:

So, as the saying goes, let me get this straight.

The son bragged about having a gun on social media.

The mother posted about the gun on social media.

Son seen by teacher searching for ammunition on line; mom was contacted – Mother texted her son, “lol I’m not mad at you you have to learn not to get caught”

On morning of the shooting, teacher spots son’s drawings of gun, bullet and person shot, along with lines like “the thoughts won’t stop” “blood everywhere” “the world is dead” and a laughing emoji.

The parents were called in to get the son counseling. They resisted taking him home, so the school sent him back to class. The son had the gun with him in his backpack which was never checked, and the parents never thought to ask where the gun was or, as far as we can tell, point out that there was an actual gun.

That afternoon, son exists a bedroom, starts shooting and kills four people. Here’s a timeline of the whole thing. The parents have since been criminally charged, after ‘leaving town for their own safety’ according to their lawyer. I am not a lawyer but that seems highly appropriate.

As for whether we should blame the school, I mean, come on, these are hard questions.

“While we understand this decision has caused anger, confusion and prompted understandable questioning, the counselors made a judgment based on their professional training and clinical experience, and did not have all the facts we now know,” Throne said.

Determining whether a student’s behavior constitutes a threat is enormously challenging for school officials. Some experts said they could not blame Oxford school officials for not predicting the violence they would face.

“Hindsight is 20-20,” he said. “I’m sure everyone involved in this is deeply wishing they had made different decisions in this situation.”

What even is an expert?

Presumably all that is quite unfair, and aside from ‘the kids shouldn’t have been in a school in the first place’ I don’t have much in the way of solutions to offer. That’s not why I’m mentioning this.

The reason I mention all this is that this is how the world works. This is what history sounds like when it’s reported accurately. This is to help you, yes you, stop spinning stories where everyone is competent and things are done for sensible reasons, as opposed to (as Dominic Cummings describes it as actually literally happening, seriously, this is not me making this up) the Prime Minister of the United Kingdom deciding what policies to enact by turning to random 9am television programs and then letting the spirit move them. As opposed to no one thinking to check for a gun in the backpack, or thinking of it but deciding not to force the issue, and sending the child back to class to avoid social awkwardness, because the parents would get mad. Then again, hey. They have at least one gun and aren’t entirely stable.

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33 Responses to Covid 12/9: Counting Down the Days

  1. Brett Bellmore says:

    I’m honestly not seeing any obvious problem until the day of the shooting. While, trivially, nobody without a gun commits a school shooting, it you’re looking for school shooters, “has a gun” is a test with a starkly absurd false positive rate. It’s perfectly useless unless your real goal is nobody having guns, which admittedly is a real goal for some people. And, yeah, shopping for ammo is a pretty normal activity if you’ve just gotten a gun, that’s fairly innocent. I’d have given my son the same advice.

    And I’d add that Oxford, (I used to live not far from there.) is in a fairly rural area, which makes “Teen given a gun for his birthday” even less of a flag for trouble, though a .22 rifle would have been a more conventional 1st gun. And 15 is hardly an absurd age, I was rabbit hunting with my father by that age myself.

    I’m not saying nobody screwed up. The day of the shooting both the school and the parents should have taken things much more seriously. And I suspect that a more detailed examination of the record will show that there were earlier warning signs that were blown off. No disciplinary record? Yeah, right. How strongly do you believe that?

    • H. says:

      These parents will be lucky to stay out of jail. Assuming the reports are accurate (a biggie) I think there’s evidence that they were criminally negligent.

      They can kiss whatever assets they have goodbye.

    • John Schilling says:

      “though a .22 rifle would have been a more conventional 1st gun” is I think a bit of an understatement. I’m all in favor of the average teenager having a .22, in any community where there is reasonable opportunity to use it. A 9mm Sig-Sauer as a first gun, for a 15yo in the suburbs, is I think solidly in “what were you thinking?” territory. That’s a weapon with very few legitimate applications for a suburban teenager, and those few are mostly for the teenagers who have been handling .22s for a few years while their parents are keeping an eye on what they do with it.

    • Ninety-Three says:

      Seconding this: The day of the shooting contains obvious screwups, but if you characterize “teen and mother brag about gun ownership” as building_on_fire.jpg, it seems like the thing you are objecting to is people having guns at all.

    • Andrew Mlot says:

      Giving a teenager unfettered access to an handgun is an huge red flag.

    • Justin says:

      I grew up in Lake Orion, the next town over. Have acquaintances with kids that are in Oxford schools/friends that teach there and such. While the choice of gun is a little odd, it’s certainly not out of the realm of things that happen pretty frequently. I know at least 3 people that had “their” own pistol at that age, and if I quietly asked around could probably find quite a few more.

      Also, there are something like 20 shooting ranges/facilities (public, private, member only) within a 30m drive, which is about as many as google/yelp reports for Southern California, At ~ his age and living in that area I worked a shooting range supervising and instructing adults with firearms and no one thought (or at least no one commented to me) it was weird that 15/16 year old kids were doing this.

      There’s a discussion to be had, but a lot of the twitter debate seems to be centered around people that are shocked pikachu that rural Michigan is different from NY/LA/SF.

      The access is (especially given the kid’s struggles) is mindbogglingly stupid, currently MI does not have a Minor Access Prevention law. MI also has a history (Wayne Count (Detroit) of successfully prosecuting parent’s of kids that take guns and shoot people.

      Also, I have seen it locally reported that one of the notes literally included the phrase “the thoughts won’t stop. help me” and the school and the parents knew about this note. This seems particularly insane, in that I guess it’s not technically a cry for help because it was written down? There’s another discussion to have about why the “help me” part of the note is often truncated in national news coverage.

      The charges for the parents, and likely eventual charges for the school, I think will be prosecuted on a theory that is less about minor access/giving guns to kids/what happened days before and more about “so you knew the kid was issuing written pleas for help and having these thoughts, had 2 meetings in 2 days on the issue and still let him wander around unsupervised without even a private check (or for the school, an officer’s request to peek in the bag with parental permission for the search)?

  2. Dave says:

    Here’s an end-of-year question to ponder: has the virus news in 2021 been better or worse overall than it was reasonable to expect at the beginning of the year?

    I’d say worse for sure. If you had told me in January that my state (MI) would have 85% of over-65s vaccinated by now, and still hit a higher 7-day average death rate than the same week in 2020, I would have said you were nuts. But that is where we find ourselves, it seems.

    Paxlovid was unexpected good news, though. That puts something on the positive side of the scale, at least.

  3. Hey, some good news:

    Yesterday the FDA granted EUA to AstraZeneca’s evusheld, a long-acting antibody combination that confers resistance at 77% efficacy for at least 6 months.

    It’s intended for the immunocompromised who don’t respond to vaccination, or to those allergic to the vaccines (estimated 2 – 3% of the US population, or about 6.6 – 9.9 million). It is not intended for people who merely wish to evade vaccination, nor for those who already have COVID-19, nor for post-exposure prophylaxis (only for pre-exposure in at-risk populations who can’t be vaccinated safely).

    I had no idea, because it doesn’t appear on the calendar of either the VRBPAC or the AMDAC. It looks like one of those cases where the FDA didn’t ask for outside opinion, but just went ahead and made up its own mind.

  4. H. says:

    Just as long as the boys don’t make pretend guns out of a thumb & finger. Suspended immediately.

  5. Basil Marte says:

    Mental health article: actually, it’s terrible news? Pardon for the amount of quotes:
    > “isolation made it “harder to recognize signs of child abuse, mental health concerns, and other challenges,””
    > “a campus of high achievers that is, comparatively speaking, well-staffed for mental health support”
    > “an effort to launch a school mental health club, which works to help students understand when and where to seek help, and to destigmatize the experience”
    > “Murthy underscored the importance of friends, parents and teachers being attentive to changes in mood, behavior and interests. He noted that mental health symptoms in youths frequently become evident 10 years before they begin to be addressed.”
    > “School District has struggled to find available mental health professionals, falling about 500 social workers short”
    > “One good thing is that people are asking for help and trying to offer it to one another, even informally and without professional expertise,” Franklin said. “But we are also recognizing the deep need for professional expertise.”
    > “Historically, the problem has been the lack of money to hire counselors. For now, the money is there, but the professionals are not. The advisory recommends that government […] invest in a pipeline for counselors, nurses, social workers and school psychologists.”
    > “the advisory’s […] taking on problems that had been worsening long before the pandemic. […] requires a long-term investment from […] our entire society … for years and decades to come,” ”

    Compare, from https://srconstantin.wordpress.com/2016/12/12/sane-thinking-about-mental-problems/
    > “In college, I had a barrage of orientation sessions where we were told that if a classmate or friend was struggling with an emotional or psychological problem, that we should not attempt to handle the situation on our own, but should refer them to the school’s mental health facilities.
    Think, for a moment, about how wrong this is.
    They are teaching kids not to be kind to sad friends, but to report them to the authorities instead.”

    Oh wait, it gets even more so:
    > [The Surgeon General’s previous advisory] flagged the “urgent threat” of medical misinformation, calling on tech and social media companies to operate more responsibly.
    Murthy said there’s a connection between the two advisories because misinformation can amplify polarization, “and that actually creates a really stressful environment.”
    “I’ve learned from my own small children — they’re very sensitive to disagreement around them, whether their parents are arguing or other people are arguing.”
    Some of the recommendations seem aspirational, like asking technology companies to step up, said […] But aiming high is better than settling for the status quo, she said.”

  6. Yellowface Anon says:

    How likely will variant-specific boosters be mandated? I think EU COVID Pass (among others) are designed on the assumption that vaccine-acquired immunity wanes over time and forces you to re-vaccinate 270 days after your last vaccination/booster, which is why boosters in general are set to be a condition for revalidating vaccine passports (despite no evidence to see whether there will be life-long immunity after a specific number of shots/boosters either way). But if any government makes those boosters (instead of boosters in general) mandatory, we’re back to the time in limbo where vaccines were still being rolled out, worse if production is insufficient or there are *ahem* bottlenecks in distribution, and even worse when a lot of the vaccinated decides enough is enough and quits the system.

    Vaccine mandates themselves are enough to create the conditions that characterize post-Soviet states in the 1990s, and they can worsen it much further.

  7. potato says:

    This might be a dumb question, but I’ve had no luck finding an actual answer. If you’re under 50, are vaccinated, and test positive, is it worth attempting to treat in any way? Does the answer change when you develop symptoms?

    • TheZvi says:

      My understanding is that if you test positive with no symptoms you isolate to avoid infecting others but otherwise don’t do anything besides monitor for symptoms and take the low-hanging fruit (e.g. Vitamin D, Zinc, Fluvoxamine if it’s not that hard for you to get). If the symptoms happen then talk to your doctor etc, not medical advice, seek treatment. Watch especially for trouble breathing. But I try to stay away from telling people what treatments to get.

  8. Adam says:

    At my daughter’s (bay area) pre-school, they do a weekly covid test, supposedly to prevent spread within the school. This test has a turnaround time of 2.5 days (!). Given that, what time do they make them do the test? Answer: Wednesday morning, so the results come in just as they going home for the weekend. In other words they have chosen the *exact* hour of the week to take the test which results in it being of globally minimal value of stopping the in-school spread.

    Except sometimes there is no school on Friday, and on those weeks they move up the tests to Tuesday mornings.

    If the administrator is doing it as a low-bit-rate protest against the testing mandate, then bravo to them.

  9. Anders P says:

    That’s a seriously dumb argument by Taleb. Just because vaccine mandates and passports aren’t 100% about getting the ruling caste more power, I should welcome them because they’re only 98% about the ruling caste getting more power? Just because the government usually takes freedoms in nibbles, it means it’s completely unable to take them in gulps when given the opportunity? I expect better of him than to combine a straw man with a logic error. Sure, one can find people that will say “a vaccine passport system would not save any lives at all, even in the near term”, but that’s *not the argument* that the anti-mandate camp is making. I’ll give the pedants their due and say there may (debatably) be some public health benefit from a vaccine passport system, but given the extreme and likely second and third order costs of such a move, that a mandate can’t possibly be worth it, especially in the long term. For me, it’s hard to the see vaccine passport suggestion as anything other than a consequence of the elephant in the brain for people that find negative rights inconvenient for other reasons. They’re fooling themselves – they probably really do tell themselves they’re just interested in less COVID M&M – but some of us have dealt with people enough to know better. There are so many good options for mitigating COVID that could be implemented without resistance from the public, but none of these are being pushed with a fraction of the fervor that vaccines are, and the only thing all these underutilized measures have in common is that they don’t yield a gigantic and hard-to-reverse power dividend to the bureaucracy. How about we try some of those? They do realize that’s a tell, right?

    • Yellowface Anon says:

      The ship has sailed, and you probably won’t avoid post-Soviet level of dysfunction at this point, whatever that’s done.

      • Yellowface Anon says:

        I guess while it would be suitable to debate COVID mitigation measures in 2020, given how the measures have entrenched themselves, what most opponents of incipient medical authoritarianism should be thinking is the ways to exit the entire social and economic system – given their common beliefs that the “Old Normal” and “New Normal” is also corrupt in ways much further than having a particularly strict set of anti-COVID measures (like alienation, anti-humanism, statism, oligarchy, conspiracy, genocidial, etc.)

    • Unirt says:

      OK, but what then are the good mitigating options that are better than vaccine mandates, which can be done without resistance from public? Paxlovid? My country cannot implement Paxlovid before the European health bureaucracy has officially accepetd it; Europe is always several weeks behind the US in accepting things so we won’t probably have any Paxlovid before omicron wave is over. My country has only 2/3 vaccination prevalence and it’s not rising – everyone who wants has got their shots by now. So I’m feeling slightly more safe going to a restaurant where they check vaccination passports with ID documents – it maybe reduces my chances of getting Covid before I get my booster shot just a little bit. A little bit feels better than nothing to me. Any other mitigation option we could use?

      • Anders P says:

        I can think of at least 4 major categories of mitigation measures that are all low cost, safe, and have at least some evidence to support them: (1) improving baseline risk factors in at risk people through e.g. diagnosing and treating hypertension, by encouraging weight loss, by supplementing vitamin D when deficient; (2) encouraging testing, especially by individuals using at home kits in response to exposures; (3) early treatments (even if you’re skeptical of ivermectin, how about fluvoxamine and NAC? How about organizing medical personnel to do house calls with monoclonal antibodies for high risk people *before* they have pneumonia?); and (4) in-hospital treatments for severe cases. Re: (4), if there was a bake-off for “best reproducible hospital protocol for reducing complications and death from COVID pneumonia” with a $50M prize for a winner, every hospital in the developed world would start innovating, but we’ve seen nothing like that. Why? Is it because the world was just waiting for an internet rando like me to suggest it? Might it not instead have something to do with the downstream politics?

        All of these categories of things stack together and nearly anything within each of them would get less resistance, making them better options in practice. Nobody cares whether hospitals voluntarily adopt the Duke protocol or the UCLA protocol, as long as they’re doing what they do best.

        Also, did you know that vaccines neither stop infection nor prevent transmission? At this point, they are just for the person who has been vaccinated, so vaccine requirements are essentially seatbelt laws, except instead of fining a person we make it so they can’t work and can’t go out. If you proposed making people unemployable for seatbelt violations in 2019, everyone would have thought you were a misanthropic monster.

      • David W says:

        In order of easy to more difficult: Open a window. Strap a HEPA filter to a box fan and recirculate the air through the filter. Upgrade the HVAC to do more changes/hr through a better filter, or ideally through a UV-C system. Ventilation has been underemphasized throughout the pandemic, so it’s the lowest hanging fruit. It works for every variant, through a very clear mechanism.

        As a bonus, ventilation is something you can address for your personal benefit without needing cooperation from anyone but the landlord

    • TheZvi says:

      I believe it is important to point out that the governments are doing what the public wants. That doesn’t make it right or smart, but it does change the right way to view what is happening, and Taleb doubtless has a lot of people he interacts with who have a different model.

      I don’t view him in any way as saying this is OK or that he supports such rules, at least not here.

  10. Craken says:

    We may not have all the relevant info on the school shooting. But, the parents clearly made at least two mistakes: they bought a handgun for a 15 year old and they failed to check his bag when they were called to the school the day of the shooting. I know a number of gun owners and I’ve never heard of anyone buying a handgun for a teenager. I can’t imagine a good reason for doing so–it’s poor judgment. Knowing he had access to the gun, why did the parents not check for its presence on that day? Next, the school officials should have asked about whether he had access to a gun. It’s not clear they did ask, and I wouldn’t assume it. If they asked and the parents answered truthfully, then the school officials were also duty bound to check the bag. Yet, they didn’t. It’s almost as though every adult involved in this tragedy is dysfunctional.

    “Seems like our authorities don’t take this pandemic all that seriously as a physical thing in need of actual mitigation.” This is a fundamental problem in America. It extends far beyond mismanagement of the pandemic, which has served to pull back the curtain. The American ruling class is almost entirely composed of mere verbalists. These are people who cannot model physical reality, who have no capacity for, much less background in, science, math, engineering, mechanics, logistics. They are good at verbal and institutional manipulation–and that is all they are good at. The container ships keep accumulating in the Pacific, despite the efforts of people, like Peterson, who do understand physical reality (https://www.freightwaves.com/news/its-official-96-container-ships-waiting-to-dock-in-southern-california-ports). The power of the elite is derived from the Lippmann/Bernays school of political domination via thought control, now augmented by the surveillance state. McNeill famously labelled the ruling class “macroparasites.” But, some parasites are useful to the host, some are irrelevant to it, and some are harmful. Their position on this scale is a function of how capable they are of doing things and of how many resources they consume. Our elite consume huge resources directly and indirectly (cultural degradation, over-regulation, miseducation, etc), yet they are less and less able to do things. They possess form without substance, information without knowledge, and, worst of all, power without responsibility. They are decadent and degenerate.

    For your forthcoming Covid summary, gleichschaltung in action:
    https://www.tabletmag.com/sections/news/articles/lab-leak-fiasco
    This retelling is even worse than I remember it, and I have not had an iota of faith in the official press for 14 years. Imagine the Times and the Post randomly choosing the exact same day to launch an attack–heavily politicized, of course–on the lab leak theory! It’s almost as though they were waiting for a suitable scapegoat before coordinating for an ambush. The deliberate conflation of lab leak accident and bioweapons attack—is that worse than the implicit pretense that there could be no connection between the two, that the lab could not be dual use? The vast reach of Chinese financial tentacles, the media’s tension between functioning as corporate money maker and official (deep state) press, the placement of Daszak as primary source for the anti-lab leak narrative to the exclusion of other officially approved experts, the censorship and the atmosphere it created, the descent of even the once venerable “Nature” into this cesspool of lies…All this reminds me of a line from Henry James about “the black and merciless things behind the great possessions.”

  11. Jesse Kytaychuk says:

    The problem with rare, extreme events is that the signs are so unspecific. If you work with suicide, you would see this often.

    Yes, there are signs of suicide–but they are so common (in comparison to actual suicide). The false positive rate is too high to be effective.

    My fear is that we are going to start seeing aggressive paranoia and many atudents with typical depressive symptoms (hopelessness, depression, withdrawal, anger) are now potential school killers.

  12. Pingback: Omicron Post #6 | Don't Worry About the Vase

  13. On Paxlovid, update is that final Pfizer data is expected in a few days, a perfect timeline gets the whole thing done by end of month, the 24% at Polymarket for that is probably somewhat low. Nothing’s going wrong, except for the total lack of urgency.

    Just today (Tues 2021-Dec-14 @ 6:45am), Pfizer submitted the complete data package for paxlovid. This is, of course, just the press release; formal scientific publication for peer-reviewed journal is coming.

    This now means the clock is ticking for an FDA meeting to authorize it (probably EUA, not full authorization, given the speed at which things are moving). Too much to hope for a meeting this week, but next week is maybe not out of the question? There will be grumbling about holidays, but then there is also grumbling about the pandemic.

    Some highlights:

    (1) Unlike molnupiravir, the efficacy in the full set is still pretty good: 88% vs 89% in the partial dataset, so no change there and that’s good. 89% efficacy if given within 3 days of symptoms, 88% efficacy within 5 days, so that’s good too: a slighty wider timing window. Even better, risk reduction in those of 65 was 94%, so it seems to work even better in the higher risk elder population.

    (2) By day 28 after treatment: only 5/679 pts in the treatment arm were hospitalized, vs 44/682 in the placebo group. I haven’t run the numbers to get confidence limits there yet, but will do so soon. 0 deaths in the treatment arm vs 12 in the placebo arm. (So, yeah: 100% efficacy vs death again. I’ll be sure to calculate a confidence limit for that.)

    (3) Viral load reduction in treatment arm was 10-fold (0.93 log10 copies/ml relative to placebo) at day 5 of treatment. (Translation: “ginormous”.)

    (4) 2% of pts in treatment arm dropped out for side-effects, vs 4.2% in the placebo arm. So less side-effects than placebo, which is what one always loves to see.

    (5) In vaccinated subjects, it was less good at reducing symptoms, but still reduced hospitalization by 70%. There will be animated discussion on this, both by the FDA wondering for whom it should be described, as well as nimrods who think it means they can shirk vaccination.

    (6) In the trial it worked against several variants (quantitative data pending), and lab tests indicated efficacy against Omicron (inhibits the same viral protease essential to viral reproduction).

    (7) US government has bought 10 million courses of treatment for $5.3bln ($530/course of treatment). Pfizer claims 200,000 courses available this year, and 80 million next year. Given that there are only 17 days remaining in this year and it’s not yet approved, that’s impressive.

    (8) Dosing would be 2 pills of nirmatrelvir and 1 of ritonavir, twice a day.

    • TheZvi says:

      Presumably the issue with the vaccinated isn’t that 70% isn’t good enough, but that 70% of a smaller risk is a lot less than 88% of a bigger risk, but also it’s kind of crazy to give it to the unvaccinated first, so it’s not clear what to do while supply is the limiting factor? Once we have enough supply presumably we just give to everyone. But 200k doses is going to be one day’s cases by year’s end.

      • Presumably the issue with the vaccinated isn’t that 70% isn’t good enough, but that 70% of a smaller risk is a lot less than 88% of a bigger risk, but also it’s kind of crazy to give it to the unvaccinated first, so it’s not clear what to do while supply is the limiting factor?

        Dunno. 70% is plenty good enough, and if that had been the overall result I’d still be happy. (I guess I should be happy the higher-risk unvaccinated folk get a good result, but I’m really, really tired of cutting them any slack at all, at this point. Yes, I am a bad person for thinking that, but it’s been a whole year of foot-dragging on getting vaccinated.)

        At this point — only 8 hours after the press release dropped! — I’m working from a press release and the one or two newsies I trust (though they’re all working off the same press release I just read, so nothing new there). True to the strictures of the literary genre of press releases, the information is annoyingly sunny and maddeningly vague.

        In some ways, the only significant bit here is that the submission happened, there were no potholes encountered, and the FDA is now the rate-limiting step. I’d better be hearing complaints from FDA folk that they have to work over the weekend, because delaying this for any cause is gonna make people really mad. Also, dead.

        But 200k doses is going to be one day’s cases by year’s end.

        Well, if it gets approved on Dec 30, there’s only one day left, so that works out. Not in a good way, but it works out.

    • Here’s my summary of all I could find on the paxlovid submission in a few hours. Basically same as the above, with a few more journalist sources who checked the same things.

      Still looks like good news to come.

  14. Dave says:

    Criticisms of fluvoxamine: https://www.the-scientist.com/news-opinion/a-closer-look-at-the-new-fluvoxamine-trial-data-69369

    I don’t really put that much stock in these, but the one about the placebo group not being effectively blinded seems like maybe it should carry some weight.

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