Covid 1/13/22: Endgame

Important note, fleshed out a bit more in Omicron Post #14: From various sources, I have become convinced that rapid tests taken from nose swabs are likely to often be several days slower at detecting infections than rapid tests that use throat swabs.

So if you are testing with the goal of actually learning whether you have Covid or are infectious, that’s what you should do. Otherwise, you’re mostly testing in order to have conducted a test.

Your call.

We’re on the way down in the Northeast – we have the wastewater in Boston, which is already down 50%, we have a clear peak in New York City, and several states are clearly stabilized or better. Within a week, I expect the peak to be hit on average throughout the country.

That doesn’t mean things suddenly end, of course. Assuming no worries about hospitals, the highest value to vigilance actually comes right after the peak, if you think you’ve avoided infection until now. You’ve survived roughly half the risk at that point, making it more reasonable to try and avoid infection entirely, yet risk is still very close to its maximum on a per-day basis.

Yet it is time to start once again making plans for The After Times, which will be with us sooner than it might seem. Right now, the schools are a mess, everything is facing staff shortages and it all feels a little scary, but (death counts and a few hospital conditions aside) this is as bad as it’s going to get, and within a few weeks things will be improving on all fronts.

Executive Summary

  1. If you do a rapid test and want to know the real answer, you need to do a throat swab.
  2. Cases peaking in the Northeast now, rest of country within two weeks.
  3. Schools are a complete disaster, but that’s another entire post.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 6mm cases (+71%) and 9,700 deaths (+10%).

Results: 4.9mm cases (+37%) and 11,856 deaths (+34%).

Prediction for next week: 5.6mm cases (+13%) and 15,000 deaths (+30%).

That’s a clear miss on cases. My presumption is that we were missing more cases than I realized, and for that and/or other reasons we peaked earlier than I expected and a lot of the Northeast is on its way back down shortly. The rest of the country will follow within a few weeks. On net I still expect an increase because I don’t expect big drops in measured cases in the places that have peaked, not quite yet.

On deaths, the wonkiness continues. The West came back to its early-December rate, despite the Omicron wave having arrived late. Other areas also so increases that seem a little early slash a little big, I definitely expected things to go better on this front. I still don’t expect things to get that much worse, and presume that the declines the previous two weeks involved holiday wonkiness, and the number now is nowhere near as scary as it looks without that context.

I still do expect a rise next week, and it’s possible it could be substantially bigger than this – the ‘real’ bump should be bigger than the one I’m predicting, the uncertainty is both the real size and the measured size of the increase.

Deaths

Cases

Almost a full doubling out West, but not in other regions and the Northeast has likely stabilized. A lot of cases are being missed right now and that should continue for a bit.

Vaccinations 

Omicron version of the Pfizer vaccine will be ‘ready’ in March, but not sure if anyone will even want them.

Pfizer will produce the doses to be ready in case countries want the shots, but Bourla noted that it was unclear if a vaccine targeting variants was necessary or how exactly it would be used.

Moderna boosters now also down to five months from second dose. No confusion here.

Vaccine Effectiveness

Fourth doses, how would they even work?

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Moderna to report data on children ages 2-5 in March. I wonder if in expectation this would make us more or less crazy.

Not including the people you are most worried about in your clinical trials results in exactly what you would expect. Thanks, ‘bioethics.’

Vaccine Mandates

You need proof of vaccination to buy hard liquor in Quebec, which did result in a lot more vaccinations, because the people believe that they need hard liquor. You don’t need that proof to sell hard liquor, because working at the liquor store isn’t exactly an enticing reward and we want someone willing to do it.

By all accounts the Supreme Court did not cover itself in glory during its hearings about Biden’s vaccine mandate, with justices revealing deep misunderstandings about the facts on the ground. One could almost say there was dangerous misinformation involved. The ‘good news’ is that it was not at all obvious that the facts would have any material impact on the court’s decisions.

Isolation Guidelines

The UK says that 30% of people will be infectious on day 6. Scott Gottlieb tells us that yes, such people might be non-zero amounts of infectious, but the pandemic is mostly being spread by people who are positive and don’t know it. He notes that if the CDC had been more straightforward and open about the whole thing, and presented the actual logical situation, it would have been better. A good reminder.

Without that, we end up with this.

It all actually does make sense, it’s the difference between what you ‘can’ do versus ‘should’ do, and what you need to do to keep things running versus what you don’t have to do until next week, and what can and can’t adjust privately with grace. That doesn’t mean it sounds sensible to people who hear it.

Some new research is out on that question of how long people remain infectious, showing 3 out of 16 samples still infectious on days 7-9 after first positive, which is then cited as evidence that we are going to render our children unsafe. Infectiousness is not Boolean, so the effect size here is presumably small, with the first five days of isolation still (if we take this at pure face value) accounting for the vast majority of new infections.

I want to point out how completely incompetent we are as a civilization at running this experiment. That sample size was sixteen! And Michael Mina thinks this is important enough to take seriously. What the hell? The experiment only requires testing people, we do that all the time anyway, is running this with a few hundred samples this hard?

When I try to do simulations and look for estimates of generation times – the average time from when I get infected by you to the time at which I infect someone else – reasonable estimates go from 2.2 days in a South Korean study on the low end, to an upper range of 3 to 4 days. The data don’t make sense with anything longer.

So if the mean time between infections is about three days, and your first day is mostly safe since the virus has to multiply first, then how many cases can happen more than five days after your symptoms start, which is also at least one or two days after you get infected? Assuming any reasonable distribution, only a very small number.

Thus my guess is that the results here were a fluke due to small sample size, and the UK’s guess of more like 15% on Day 6 is about right.

Or, to respond to the link’s claim – if something does not ‘drive the pandemic’ it by definition is not ‘putting people at risk’ in the general sense, so we should only worry about vulnerable people in context, which sure isn’t students.

Tests

Thread introducing the concept of the Default Difficulty of Life.

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Can I afford it? Mu.

I can, of course, afford any given tiny little dystopian nightmare like filing for reimbursement on a diagnostic test, where the payment is capped at $12 and the market clearing price is twice that. I am capable of navigating quite a bit of difficulty, in a way that many others cannot. But those navigations are expensive in time and focus.

Remember, when things are Out to Get You, to take your Slack, their favorite line is that You Can Afford It, and if you allow the things you can afford, soon you will have no slack, and you can afford nothing.

And, indeed, increasingly it seems most people have gotten got, have no slack, and can barely afford to keep their heads above water, especially in the most important ‘raise a family’ sense.

I strongly agree this is an underappreciated concept, both regarding Covid and not regarding Covid. Also the Default Difficulty of Doing Thing, for any given thing, matters too. Every time you raise it, whether or not this involves monetary expense, less Doing of Thing will occur, both in particular and in general. Related to Beware Trivial Inconveniences. We need to lower the Default Difficulty, and look highly suspiciously on everything that raises it.

Not run the government by offering three easy payments and a mail-in rebate, knowing full well that almost no one gets the rebate.

Meanwhile, the strategy continues to be to buy doses rather than buy capacity, without long term commitments that can be relied upon to justify ramping up capacity, same as vaccines, which inevitably results in shortages because there’s less free supply, no ability to ration via price and no expansion of capacity.

And how are those coming along? The very definition of Real Soon Now, and a missed opportunity to use the Exact Words.

Meanwhile, they plan to make it an even billion tests in time for us not to need them.

NPIs Including Mask and Testing Mandates 

You want to know what being truly anti-mask looks like? It looks like Bryan Caplan staring death in the face, and saying ‘hey, I’m having trouble seeing your face, can you take off that mask?’

What if the choice was between masks and a 50% annual chance of death?  The reasonable reaction would probably be, “Fine, we’ll be severely dehumanized, but we’ll survive.  Just like war.  I guess I’ll take it until a better deal comes along.”  When the choice is between masks and a 0.5% annual chance of death, however, the reasonable reaction is rather, “I’ll take my chances and live like a human being.”  Indeed, once you’re old enough, even a 50% annual chance of death starts to look like a good deal.  My considered judgment: If another Covid strikes when I’m 80, I do not want my grandchildren to wear masks around me.  I want to enjoy their laughter while I still can.

The dehumanization thing is being undervalued, although I still think it’s something like the third or fourth most important problem in practice with masks. And for Bryan, that alone is overwhelmingly sufficient, given that the risk level here is way above the real one. An annual 0.5% chance of death is much worse than getting Covid-19 yearly, and masks prevent much less than one Covid-19 case per year. This is a very overdetermined opinion being offered here. I am impressed.

The alternative might be simple defeatism, like the administration not distributing N95-quality masks because they despair that anyone would use them. Which is wrong, trivial inconveniences are a big deal.

Thread of practical mask advice non-memes for pandemic adjacent teens.

Think of the Children

Don’t worry, we haven’t forgotten about them, I split this section off into another post this week.

In Other News

Confirmation that the FDA is advocating for and directly causing discrimination in the distribution of life saving medicine on the basis of race.

Djokovic update: He won his case, and he will play. What is the law? Depends who you ask. Got to hear both sides.

Here is a transcript of him talking to government agents about his situation when he was first detained.

Bari Weiss is done with Covid, whether or not Covid is done with her.

And why not? Walensky comments on Good Morning America, unabridged (part that was cut is in red).

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Latest Long Covid paper, showing vaccination reducing Long Covid symptoms 50%-80% as one might expect. Given no controls on what gets reported, it’s an interesting question what that translates to in terms of real symptom frequency – vaccinated people are more likely not to attribute things to Covid, and also some of the symptoms being reported aren’t from Covid, so could go either way. I didn’t see the kinds of controls here that would let me update much in other ways.

The latest Pirate Wires hits many of the familiar notes, while pointing out that the new tone from on high are the familiar notes that would have gotten one marked as a wisher of death upon (largely immune, not that this fact stopped anyone) children until quite recently. I mention it because of a particular turn of phrase (which I’ve bolded) I want to notice, rest is for context and a smile.

Three days after Christmas Biden revealed his new Covid brand direction, in what essentially amounted to the shrug emoji, rejecting the notion there was anything the federal government could or even should attempt to stop the pandemic. It was truly as if the White House’s prior message of doom was delivered only to ruin one, last family gathering before finally admitting the hysteria had gotten out of control, was best-case futile, and was in the case of our nation’s youth probably actually killing people. The partisan swarm activated.

That phrase, ‘could or even should,’ stood out to me as importantly insightful. You would think that could would proceed should, three times fast. We used to worry that those preoccupied with whether they could wouldn’t stop to think if they should. Instead, we have people so preoccupied with whether they should that they don’t stop to think if they could. For two years, we’re told what we should do, in some weird moral sense, by those who never much cared about whether we could do it, whether it would accomplish anything useful or the mission at hand, or whether doing so passed any sort of cost-benefit analysis.

Things we already mostly knew, many scientists chose not to talk about the lab leak hypothesis because they thought that it would harm science in China. This is not my prior on how science works, but it is exactly how Science(TM) works.

CNN suggests not intentionally catching Covid right now, offers Five Good Reasons. They are:

  1. It’s bad.
  2. Long Covid is bad.
  3. Think of the children.
  4. You’ll stress the health care system.
  5. ‘Don’t mess with mother nature.’

As evidence of the last one, they offer this, oh my is this classic Liberal Media, chef’s kiss.

“Oh, that was a bad idea too,” Offit said. He told a story about an educational film on vaccines he made years ago, and the cameraman revealed he had a sister who had taken her child to a chicken pox party. Tragically, the child died from the infection.

I give this Five Good Reasons a two out of five. Long Covid is a consideration (and there’s a non-zero chance you never need to get infected, and have gotten through something like 30%-60% of the risk depending on where you are, already), and the health care system is still under above average stress. I do think that’s enough that getting infected on purpose at this time is an error.

Robin Hanson, as one might predict, is not impressed, but respects the asking of the question and describes it the way I would, as ‘overstated.’

Not Covid

What they had actually discovered was boredom, or rather, the practical function of boredom. But can they program it to like herring sandwiches?

Living the dream, an NYC subway car of one’s own.

Living the dream is also having one of the good dishwashers, which luckily we already have, since they are once again being made illegal. We’ve been saved from the danger of properly washed dishes, good job everyone. If you haven’t yet, get a good one while you can.

Saying the quiet part you were saying out loud, except a lot louder.

They are who we thought they were. Will we let them off the hook?

From Marginal Revolution: What’s the best example of an experiment or trial that could be scientifically useful and informative but which can’t be done for legal, ethical or logistical reasons? Mostly uninspired answers, but good thought experiment.

The Bed of Procrustes

Taleb shared the new aphorisms in the latest addition. Regardless of the extent to which you agree with them, they’re good food for thought, and I figured it would be a fun exercise to divide them into a few categories. Would be interesting to flesh this out, but for now, quick takes sounds like fun. Note emphasis on quick – I might or might not give same evaluations on reflection.

  1. Full agreement – take this seriously and literally.
  2. Great aphorism – take this seriously but not literally.
  3. Good aphorism – take this more seriously on the margin than you’d expect.
  4. Disagreement – take this neither seriously or literally.
  5. Opposition – take the reverse of this more seriously than you take this.
  6. Abstain – take a pass, because of reasons

Full agreement: 4, 5, 7, 8, 9, 17, 18, 19, 20, 27, 28, 29, 32, 34, 36, 38, 39, 40, 41, 44, 46, 48, 52, 53, 54, 55, 56, 57, 61, 62, 63, 64, 65, 67, 68, 69, 72, 76, 77, 81, 83, 84, 85, 86

Great aphorism: 11, 23, 25, 33, 37, 50, 59, 66, 70, 73, 88

Good aphorism: 1, 2, 3, 14, 15, 43, 45, 47, 49, 51, 58, 60, 71, 74, 79

Disagreement: 6, 10, 12, 13, 26, 31, 35, 42, 75, 78, 80, 87

Opposition: 21, 22, 24, 82, 89, 90

Abstain: 16, 30

That’s a really good ratio there, these aren’t trivial statements or obvious truths. Full agreement with half the non-abstains, remarkably little disagreement and opposition. Most disagreement essentially comes from Taleb believing strongly that it’s important to have the right enemies. I am more inclined to suggest taking a card, writing on it “There Is No Enemy Anywhere” and putting it into one’s pocket. These days that’s the one most people need. Taleb likes enemies he can call idiots. Where there must be an enemy, I prefer a (ideally non-evil) Worthy Opponent.

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41 Responses to Covid 1/13/22: Endgame

  1. Yellowface Anon says:

    You are basically ignoring what you quote from Bourla in your Omicron post about “Chance we will be getting boosters modified for Omicron within 6 months of our previous booster shot”. Or you need to change that specific condition for that probability.

    Let me ask these since you mentioned the variant-specific boosters being ready sooner than I actually thought: What is the likelihood that a mandate for variant-specific boosters, starting with Omicron, will be imposed anywhere? I don’t think there will be a big demand since Omicron is so mild, so a captive market is likely to be created thru adding such a mandate onto vaccine passports, as I see it.
    How would it work out given there are people in various stages of being boosted and vaccinated? Are they trying to revoke vaccine passports of those who have been vaccinated but unboosted, like Israel? Even if they aren’t eligible for variant-specific boosters yet? It links back to that caste system nightmare scenario I mentioned in one of my previous comments.

    And then what about the likelihood of vaccine passports staying and the boosters programme being in place or even strengthened by mandates? In Conservative eyes vaccine passports are already significant enough to be considered Permanent Midnight – and their lifestyle have been modelled on an avoidance of vaccine passports, contact tracing, and the like.

    • TheZvi says:

      I would be very surprised to see Omicron boosters mandated specifically at any point, they might become mandated implicitly because they’re all that is available and your old one has expired.

      In any case, I understand your position in such matters, but I can’t be rehashing essentially the same thing every week with detailed probability estimates, beyond what I already put in the posts. I do not expect vaccine passports to survive the year with anything like their current enforcement levels unless a new variant shows up.

      • Ariel says:

        I would expect that in Israel, that conditioned on green passes existing (they didn’t exist when cases were very low) and Omicron being a majority of cases, 3 months after an Omicron booster is available you would lose your green pass unless you have an Omicron booster.

      • Yellowface Anon says:

        I am not unwilling to comply, but having vaccine passports themselves has already created political and economic rifts, and it should really worsen. But some people might run into administrative trouble over a continued boosters program that tiers the vaccinated, and this makes less sense day by day.

        I think a post after the end of the Omicron wave, if there isn’t another variant to fearmonger with, is good enough, and that can be an exposition on Permanent Midnight vs After Times depending the level of lingering restrictions. (And what to do if another pandemic sweep thru a large part of the World? More of the same from the NPI & vaccine mandate playbook?)

  2. matt says:

    Assuming no new variants (big assumption, I know), when do you expect the US to drop below 100,000 cases per day? 50,000? 10,000 (if at all in the foreseeable future)? I’d be interested in these predictions going forward, whether in the Omicron updates or the general updates.

    • TheZvi says:

      100k/day in measured cases? That’s a few months away. I’ll think about making a full prediction soon.

      • TheZvi says:

        (With wide error bars, of course. There are scenarios where it happens sooner. Hence the pause to do math / think / etc)

      • Jess says:

        I’m more curious about positivity rates, hospitalisations, & deaths. I wonder when we’ll be below 1% positivity rate and 100 deaths per day on the 7-day average. The US got down to about 250 deaths per day around late June/early July 2021, & 1.8% positivity rate in mid-June 2021. Assuming more vaccinations + boosters in play now vs the initial rollout last winter/spring, I’d hope to see lower figures this coming summer. My city, Philly, had a couple days just barely under 1% positivity in summer. Given my age of 36, I’m more concerned about probability of ‘Long COVID’ than probability I’ll die or be ICU’d from COVID given I am boosted.

  3. Anonymous says:

    Measurements have peaked in several California wastewater systems, too: https://soe-wbe-pilot.wl.r.appspot.com/charts

    • TheZvi says:

      Great find, thanks!

      Interesting stuff, a mix of peaks and pre-peaks.

      I gotta say, I misread “Sunnyvale” for a second.

      • Sunnyvale resident says:

        I assume you misread it as Sunnydale? The idea that Sunnyvale is the real-world location corresponding to Sunnydale does have some weak-ish grounding (https://buffy.fandom.com/wiki/Sunnydale#Connection_to_Sunnyvale ); we even used to have a haunted Toys’R’Us, built on an old cherry orchard where someone supposedly died an unlucky death and came back to spook the kids looking for toys.

        For Santa Clara County, the linked sewage graphs seem to be the same thing that’s on the county dashboard as well: https://covid19.sccgov.org/dashboard-wastewater . I don’t think it’s very surprising to see the Bay Area turning around faster than the inland areas; the pattern of more-urban areas getting hit first is common, and since the boosters seem to do a bit for reducing breakthroughs, there’s probably less dry kindling here: I barely know any unboosted adults, and most of my acquaintances’ kids are vaccinated. Clearly there’s bias in whom I know of course – even in Santa Clara County, while the “completed vaccination numbers” are very high, the official vax numbers certainly don’t reflect “everyone” being boosted. My read is that this most likely means that the unboosted social groups are going through Omicron infections pretty fast, and the mostly-boosted groups are getting moderate levels of spillover; when the virus is basically finished with the unboosted groups it seems very reasonable for the spread to slow down.

        Somewhat surprisingly to me, the local case rate still seems to be >4x higher for the unvaccinated than for the vaccinated, which seems like a much larger difference than what’s being seen in other places (https://covid19.sccgov.org/dashboard-case-rates-vaccination-status ) but maybe that’s caused partially by a comparative lot of boosters, partially that nearly all of us WFH tech employees are vaccinated (I expect WFH status reduces the spread speed by quite a lot) . That graph has a 7-day lag, but should still represent nearly all Omicron infections at the tail end. And not that the rate is low among the vaccinated either right now of course.

        We have twins in 5th grade; after the Christmas break, we’ve constantly been getting “non-close-contact” notifications from the school, i.e. cases in another class, and our kids’ best friend’s teacher tested positive yesterday so that class is now on close-contact notice, but AFAICT the school is holding up in a mostly-“normal” fashion, i.e. I haven’t heard of classes getting mashed together because of a lack of teachers yet. Also, the statements from the school indicate that they really haven’t seen any spread based on in-school contacts, with pretty much all the infections being traced outside of school. Local policy in practice amounts to testing the kids 5 days after a close-contact notification if they’re vaccinated, attending school in the meantime (which at least sounds a little less crazy than some of what I’ve been hearing about?); also, since this is elementary school, pretty much all the vaxxed kids had their vaccine series completed shortly before Christmas, so they’re probably pretty much maximally infection-protected right around now. Hopefully that’s enough to get through the next few weeks without too much nonsense.

  4. Zack says:

    Is there any reason to believe a fourth dose could have negative immune effects? I’ve seen some maybe-sketchy claims about it “wearing out your immune system”, but I’m not sure what these are based on or if I can safely dismiss them out of hand

  5. corey says:

    Hi, I wanted to get your take on this thread: https://twitter.com/IanRicksecker/status/1478611650760437765?s=20
    The author’s bio is “We must suppress and eliminate COVID. With its long-term complications and transmissibility, this is not a disease that we can accept as “endemic”.”, which seems quite different than your recent readings of the situation. Ian’s desire for suppression seems impossible at this point, but I don’t really know what to make about his claims of severity.
    As always, greatly appreciate your work.

    • TheZvi says:

      I mean, no, but even if true, what is his proposal for suppression? Eradicate half the animal species on the planet? Martial law across the world? It’s not a sane ask.

  6. Humphrey Appleby says:

    Out of curiosity…

    What is your probability estimate for the fraction of rapid tests that are done by people wanting to know the correct answer? (as opposed to, by people needing to satisfy a testing requirement, and desiring a negative result regardless of whether a throat swab would yield a positive).

    My estimate is 5%.

    • Humphrey Appleby says:

      by `needing to satisfy a testing requirement and just wanting a negative test’ I am referring to both formal testing requirements (e.g. test to stay in school), and informal requirements, either enforced via social pressure or individual guilt (wanting a negative test result so you can go about your life without feeling guilty).

      I think `testing for the sake of having done a test’ comprises the overwhelming majority of actual tests done.

      • Jess says:

        Satisfying a testing requirement also goes the other way too: There are probably a non-zero number of people who would be fine with not being sick at all yet wanting a positive result to get out of something, like a gathering or work or something else that will reject you on positive result.

    • Elena Yudovina says:

      Where does “testing to see if you can come out of quarantine” fall on this scale? If I’m synthesizing things correctly, this is a case of “testing to know the answer,” but where it doesn’t matter that the nose swab doesn’t start picking up the virus until later. Unless it also stops picking it up sooner, in which case I’m confused about when it’s supposed to pick it up at all?

      • Humphrey Appleby says:

        Depends whether you actually want to know whether you are still infectious, or just want a green light to resume your life. My estimate in this latter case is that it is 50/50.

  7. thechaostician says:

    I noticed that the dishwasher link refers to “Biden’s predecessor”. Using the name might cause an emotional response the article wants to avoid.

  8. Anonymous-backtick says:

    You and Yglesias seem to think you’ve caught the Texas GOP saying that spending time in line is the objective. Whereas they are obviously saying that (spending time in line is the cost of the old status quo, preferable to mail-in voting because of the security and not because of the inconvenience, and…) the “but you’ll get covid” objection to the status quo is not consistently applied to other things.

    They’re not “saying the quiet part out loud”. They’re saying the kinds of things they already said about in-person voting in a way that gives you no new information about whether they secretly prefer inconveniencing people.

  9. Bobbo says:

    So if mutations are a function of just how much virus is out there… and there’s more virus out there now than ever… doesn’t that mean that the risk of a new variant of concern is higher than ever?

  10. Yellowface Anon says:

    I should ask something for my personal reference: is there cases where spacing out 2 shots of COVID vaccines, like more than 3 months, leads to administrative trouble, like vaccine passports and employee mandates?

    • TheZvi says:

      I have not seen any examples of any trouble with postponed doses, so long as they eventually happen. I HAVE seen people paranoid enough to make this a consideration, but I think they’re wrong. And we spaced our kid’s doses out as much as we dared until Omicron was about to hit.

      • Yellowface Anon says:

        I actually mean things like getting vaccine passports that are either used domestically or for international travel.
        If that’s the case it makes good sense if the purpose of such a record being signaling instead of actual immunity.

        Even more toxic politicization: I think Boris Johnson’s scandal in the UK will permanently cripple trust in harsh NPIs and consequently all forms of lingering restrictions e.g. vaccine passports, analogous to how Conservatives are primed against even complying with mask mandate by seeing high-profile people going around maskless.

  11. Error says:

    “If you do a rapid test and want to know the real answer, you need to do a throat swab.”

    Is there any reliable information on whether nose-swab tests can be re-purposed as throat-swabs?

    Google suggests that the FDA recommends against it, but it’s unclear whether that’s because the tests don’t work that way, or because idiots might stab themselves in the throat, or just because ‘use only as directed’ is the default advice.

    (Being in IT, I do have some sympathy for the latter, notwithstanding Delenda Est. RTFM and all that.)

  12. Donald Fagen says:

    I think you should reconsider how your ‘more dakka’ principle applies to medicine.

    More directly, I think it just doesn’t. We take medications at specific doses to balance benefits and toxicities, which are always present. Insulin is good for a Type 1 Diabetic, but ‘more insulin’, will eventually kill them.

    There is no default assumption of benefit from an indefinite number of vaccine doses. RCTs must be done to establish a putative benefit.

  13. davidwwall says:

    If Omicron has taken over, any future variant will likely be a mutation of Omicron. Isn’t that a reason somebody might want an Omicron-specific vaccination? Or is the assumption that “everybody” will have *had* Omicron, so an Omicron-based vaccination would be moot? (My wife and I live in Palo Alto, which apparently peaked a week ago, and have apparently not had Covid at all.)

  14. Sebastian H says:

    Re the Djokavic situation, I think there is some reason to believe that he was trying to game the system such that we can’t be sure if he has actually had Covid recently. His latest positive test was timed *exactly* right to be just inside the allowable window for the Australian open without being too far away to force him to get vaccinated for the French Open (was within that window by just 3 weeks). That timing is fortuitous enough throat when combined with everything else it seems like he’s just skirting the rules through false tests. If you’re a very regular traveller I can see why the more paranoid countries might want to insist you get vaccinated (because it does limit the spread, even if imperfectly).

    • TheZvi says:

      Yeah, there’s no reason to assume good faith on his part here, but also if you’re calling BS on someone’s claims you should be explicit about that and justify it, rather than making an exception for no clear reason.

  15. Ninety-Three says:

    Both funny and illustrative, US travel advisory last updated Dec 20: “The Department of State continues to advise U.S. citizens not to travel to Ukraine due to COVID-19 and to reconsider travel due to increased threats from Russia.”

  16. Neon says:

    Zvi, assuming one gets infected, what is the probability of 1) an asymptomatic omicron infection, 2) a very mild, cold-like infection? I would like to calculate both for people in different age and sex groups, everybody took two shots of Pfizer in mid-2021.

  17. AnonCo says:

    I am confused by your throat swab messaging. If I want to actually learn if I am positive with a home rapid test should I:

    A. Only buy rapid tests that were designed as throat swabs? Which are these?

    B. Use a nose-swab-designed test but actually swab my throat?

    This is ambiguous in your announcements and I wouldn’t know who else to trust on this.

    Given that finding any rapid tests at all in my area this seems like an important distinction for people who are able to come up with one, but probably not get to choose a specific one.

    • TheZvi says:

      B should be sufficient.

      • AnonCo says:

        Thanks – That is what I assumed, because it “seems” like they should function the same and they are all sharing the same air and mucus and what not.

        But I don’t ACTUALLY know how these tests REALLY work, and I could spin myself some tale about tests being designed to work with cells from the nose and not the throat or something like that.

  18. DCM says:

    Zvi! Thanks as always. Primary question for me at this point (besides lingering long-covid uncertainty) is to what extent there is omicron to omicron reinfection risk. Don’t think I have seen you cover this yet, do you have a POV here?

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