Covid 1/20/22: Peak Omicron

The Omicron and Weekly posts are now combined, so this includes the last day’s Omicron developments, which will be how it works going forward. Next week’s will include the probability updates section as well. When there is urgent news, I’ll supplement as appropriate.

This week was the peak. From here, it would be highly surprising if Omicron cases didn’t start declining. The other news is mostly more of the same, with several developments worth analyzing: The Supreme Court throws out one of Biden’s mandates but upholds the other, Djokovic gets deported a second time, a great proposal to expand Manhattan (which got its own post), and other neat stuff like that.

Executive Summary

  1. If you live in USA and haven’t done so yet, order your free Covid-19 tests.
  2. We are at or past the peak in Omicron infections in the United States and UK, but that doesn’t mean it’s over yet, next few weeks still rough.
  3. England lifts all Covid-19 restrictions, midnight is perhaps temporary after all.

Let’s run the numbers.

The Numbers

Predictions

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

Results: 4.9mm cases (+0%) and 12,606 deaths (+7%).

Prediction for next week: 4.4mm cases (-10%) and 14,500 deaths (+15%).

The deaths number is confusingly low this week. Cases increased by a huge amount with the three week lag, yet the deaths number isn’t increasing much. There’s about to be a much bigger three-week-lagged increase in cases, but the pattern is clear so my estimated size increase needs to adjust. I am fully prepared to miss low reasonably often here, if I wasn’t the estimate would be wrong.

For cases, it seems clear that we are peaking, so we should expect things to begin to decline. The question is how fast, with some areas not yet peaked, and the Northeast already having a much smaller share of total cases. The decline could easily be much faster than this, but things could also stay mostly steady for one more week.

Deaths

Even with Omicron being milder, the lack of more deaths is very good news here. The next week is the time when deaths should by all rights go much higher, so if they stay under control this week, we’re fully in the clear.

Cases

The Northeast already peaked, as probably did a number of other large states like Illinois, Florida and California. The South might have one more week left in aggregate, it also might not.

Cases at Yale in similar freefall to rest of east coast.

Thread pointing out that cases are declining in many places.

Trevor Bedford thread on us having peaked nationally but often not locally, including good state-by-state graphs. Expects about a symmetrical march down to the path up.

Ashish Jha thinks we have peaked.

Vaccinations 

US announces (MR secondary source, StatNews article) that…

…if the Food and Drug Administration decides to update Covid-19 vaccines to take better aim at Omicron or other variants, it is unlikely to go it alone.

Instead, a senior FDA official told STAT, the agency expects to take part in an internationally coordinated program aimed at deciding if, when, and how to update Covid-19 vaccines. The approach would ensure decisions are not left solely to individual vaccine manufacturers.

“We can’t have our manufacturers going willy-nilly [saying], ‘Oh well, the EMA decided they wanted this composition, but FDA wanted that composition,’” the official said, referring to the European Medicines Agency. “So we are very much of the mind that we would like to be part of a more global process in helping to come to what vaccine composition there should be now.”

Tyler is kind:

Designed for flexbility and speedy response?  I guess we’ll see.  Here is the full StatNews article.  And obviously, the entire public health community is up in arms about this…

The entire public health community being up in arms about it is at least some good news, although I haven’t seen any other evidence of their arms being up in this, so perhaps arms are not so up as I would like to see. Any version of this that they weren’t up in arms about would almost be guaranteed to involve sufficient delays as to render any updates so slow as to be useless.

Then again, the system for determining flu vaccines that this is modeled on works reasonably well as far as I can tell, so perhaps it will be fine, and also the alternative was perhaps a true nightmare? If comparing to ‘the manufacturers do what they think is best and we agree to be OK with that’ this is obviously a painfully slow nightmare, but that does not seem to be the relevant counterfactual, except insofar as this is enshrining that we will never, ever do anything that sensible. To that extent, this is a loss. To the extent that we’d already accepted that we’ll never do anything sensible, this is probably an expected value win.

Vaccine Effectiveness

Vaccines do good work even shortly after being infected (paper).

Results Among Israeli residents identified PCR-positive for SARS-CoV-2, 11,690 were found positive on the day they received their first vaccine injection (BNT162b2) or on one of the 5 days thereafter. In patients over 65 years, 143 deaths occurred among 1413 recently injected (10.12%) compared to 280 deaths among the 1413 unvaccinated (19.82%), odd ratio (OR) 0.46 (95% confidence interval (CI), 0.36 to 0.57; P<0.001). The most significant reduction in the death toll was observed among the 55 to 64 age group, with 8 deaths occurring among the 1322 recently injected (0.61%) compared to 43 deaths among the 1322 unvaccinated control (3.25%), OR 0.18 (95% CI, 0.07 to 0.39; P<0.001).

It can still be too late to get vaccinated, of course, as the videos of intensive care patients can attest to, but it looks like the vaccine very much starts doing good work right away, and your risk of death is reduced even before the vaccine has time to do its work. This makes physical sense as does the effect size, so I’m inclined to believe it.

Vaccine Mandates

Mandates are popular, but this does change somewhat when the proposed details are completely insane. Somewhat.

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So yes, there are some limits. Almost half of Democratic voters want to fine or imprison those who publicly question vaccines, but that means that the other half don’t. And forty percent of Democrats don’t want to place the unvaccinated under semi-permanent house arrest.

You say sixty-percent empty, I say forty-percent full.

I’ve seen objections to this poll on the grounds that Rasmussen Reports is a right-wing polling organization. It’s definitely that, so you should take the information with that in mind. My understanding is that they will have a partisan lean in their horserace polls and might replicate such a lean in whatever direction is convenient in other polls, and they certainly chose to ask these questions because they think the questions are to their benefit, but I don’t believe that they are making things up. These numbers are at least approximately correct – maybe 52% instead of 59% of Democrats want to place the unvaccinated under house arrest, that’s different, but it’s not fundamentally different.

I also find that reaction interesting, because it implies that every agrees that this is a very bad take and it’s politically advantageous to Republicans if they can show that a lot of Democrats do in fact have this terrible take, so Democrats are accusing Republicans of making it up.

This implies that the people on the left applauding such tough measures are scoring in-group points but not helping their broader cause.

Also, mandates work.

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That sounds pretty great to me. A big music concert is a highly optional experience that provides a lot of value. Vaccine mandates make make the concert more desirable for a lot of people, so having one provides more value to customers and hence more concerts and music. Also you convince almost fifty thousand people to get vaccinated in order to attend Lollapalooza alone.

So of course this was the comment that came attached.

On the other hand, her other example seems different, with Brookline taking dining mandates to the next level. There continues to be precious little middle ground where physical circumstances and other details actually matter to what people support.

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She also shares some details about the protests going on in Boston, which I found fascinatingly local and quirky.

This thread by Andy Slavitt highlights the mindset. He refers to DeSantis and others as ‘paying people to not get vaccinated’ because they refuse to make exceptions and deny those people payments they would normally be entitled to, and consider vaccinating and boosting a personal choice. Letting those fired for not getting vaccinated get unemployment? Paying them. Hiring people from other states to come work in Florida and offering signing bonuses, because more officers are needed? Paying for not getting vaccinated. Asking Dr. Fauci questions that don’t genuflect? He has no idea what anyone could be asking of this ‘humble civil servant’ who keeps a portrait of himself in his office and may have been involved with gain of function research.

We see this a lot, including outside the context of Covid-19 or vaccination. Any refusal to cut ties and payments to those engaging in X is seen as paying for X, or as support for X, as opposed to thinking there is more to life than X.

Whereas here is a better take we can hopefully all agree upon: Using that amazing Telemundo enthusiasm to make clear that you think anti-vax people are morons, and letting the morons think to themselves ‘no, you’re a moron’ and then we all move on.

(An aside: For some reason, YouTubeTV decided that my Monday Night Football play-by-play for the wildcard game (but not the onscreen graphics or between-drives comments) were going to be handed over to the Spanish language announcers (but not the closed captions, which meant I couldn’t use this as a chance to learn some Spanish, although I did pick up a few words like ‘touchdown’ and ‘linebacker.’). I couldn’t understand most of what they were saying, but I am confident that if I could have understood them they would have made the game a lot more fun, because those people were so excited to be there and clearly loved their football the same way they love their futbol, you love to hear it.)

NPIs Including Mask and Testing Mandates 

Anarchy in the UK! Woo-hoo!

If you thought this would never happen and these restrictions were going to be permanent, you need to update. Or if you think this too shall reverse, you might not.

It is delivery, but it’s no DiGiorno.

Domino’s is not pizza. It is a substance almost, but not quite, entirely unlike pizza. At a minimum, within the confines of New York City it is definitely not pizza. This is how to tell your pizzas, which are things Domino’s does not produce. Here are some places in New York City that do produce pizzas, high quality ones at that.

The thing is, here, that’s an advantage. Domino’s is in the non-pizza delivery business. That’s exactly what we need, to deliver non-pizzas as quickly and efficiently as possible. Capitalism solves this. Speed premium, ahoy.

The good news is it turns out we did solve this one, at least on the ordering side. By all reports, the ordering and delivery service is giving us four free tests, with sub-minute ordering times and no hassles whatsoever. It even went live a day early. We finally got one right. Let’s stop to ask how we got this one right, so we can get future ones right as well. Then let’s check to see if the deliveries show up on time.

There’s also another delivery coming soon, they’re sending us N95 masks. That’s also a very good idea. It comes from the Strategic National Stockpile, which hopefully we will rapidly replenish. It seems like we frequently draw from some huge National Stockpile in time of need, but we never hear about the announcement of the expansion or creation of a National Stockpile.

As government interventions go, creating lots more and bigger Strategic National Stockpiles of goods that are highly valuable in a pinch seems like an excellent plan, and a 1-out-2-in general rule might even be justified. If we’d had enough masks in reserve in March 2020, things would have turned out very differently. The pandemic would have been better contained and institutional credibility wouldn’t have been incinerated lying about masks.

If left to its own devices Capitalism Solves This because private actors would invest in stockpiles to sell at a profit, but we have a variety of official and unofficial price controls that prevent this. Everyone is terrified to raise prices lest they piss people off, and when higher prices are most needed to ensure incentives and proper allocations, we start arresting the people who charge them. So, same as it ever was, once we ban the market from solving the problem we need to solve it collectively. There’s no reason we can’t have a reserve of billions of masks.

The question was asked, if masks are for one-day use, what’s the point of sending each person one mask? The response was that masks save lives, that’s the important thing, we want to give people the tools they need to protect themselves and their families. Which is both the right answer – some supply is better than no supply – and also completely ignoring the actual question.

A better answer (in addition to ‘this is what we can do right now and it’s a start’) would be that people can use the N95s in the situations where they matter most, since risks follow power laws, so they still do a lot of good, and also they send a strong message to switch over to N95s in general. An even better message would be to admit that almost no one treats N95s as the disposable items they’re supposed to be, and instead reuses the same N95 for quite a while, and mostly This Is Fine, it’s still way better than cloth masks (that you also probably reuse for weeks or months on end).

It also sheds light on the initial mask shortage back in March 2020.

I’m Sorry, Sir, This is The Centers for Disease Control and/or a Wendy’s

It should be the job of the Centers for Disease Control to control disease.

Or at least, that’s one theory, sure.

It turns out that controlling disease means doing things when they might matter.

That’s not to say that there is no useful meticulous science to be done, very slowly and carefully, around controlling disease. That, too, has its time and place. But if we hope to control disease in a crisis when it matters most, your OODA loop has to be measured in days or hours rather than months or years. I’ve still got further discussion of that thread on CDC publications on my stack, but I want to do it justice and it no longer seems time-sensitive.

Thinking probabilistically and making decisions quickly under uncertainty is their job. Even more than it is the job of most other people as well.

Thus, I was thrilled to see America’s Finest News Source report that they’re finally taking correct and bold action of exactly the right type.

ATLANTA—Stressing that the effort represented the best chance of ensuring American make responsible choices around the pandemic, the Centers for Disease Control and Prevention announced Thursday that it planned to send every U.S. household a pamphlet on probabilistic thinking and decision-making. “What we’re hoping to do is give every American a quick refresher on how to use statistical analysis to assess their priors and make Bayesian inferences, thereby ensuring they overcome their innate psychological biases—simple stuff, but important nonetheless,” said CDC director Rochelle Walensky, estimating that the pamphlets’ lessons on the baseline fallacy alone would save far more lives than mask-wearing, handwashing, and the Covid-19 vaccine combined. “Obviously, most everyone in the nation has already at least skimmed the seminal studies of psychologist Danny Kahneman on the fallibility of human thinking. So the pamphlet will skip over some of the basic stuff like the availability heuristic and head straight to prospect theory. Hopefully none of this feels too patronizing.” Walensky added that if Americans took away one easy lesson from the pamphlet, she hoped it would be P(H|E) = (P(E|H) *P(H))/P(E).

Definitely that, completely unironically.

Supreme Court

The Supreme Court upheld the federal vaccine mandate on health care workers, but rejected Biden’s attempt to use OHSA to impose a similar mandate on all large employers.

The mandate for federal workers was being imposed without the proper authority to do so, and while I am not a lawyer, I’m weird in that I still believe that should matter when things go before a court of law. The mandate on health care workers had explicit authorization in the statute, so it was justifiably upheld.

Scott Gottlieb pointed out that the administration was doing little to enforce the rule, thus the rule was symbolic and more about giving employers cover to impose mandates they wanted to impose anyway, and so the change makes little difference.

Left-wing voices generally seemed to be of the opinion that the Supreme Court has no business deciding what is and is not allowed under the law, and instead their Very Serious People should decide via Expert Opinion. Or on a more basic level, they cared about the practical effect of the restrictions the President wanted to impose, but didn’t seem to care at all about the rule of law or whether the President had the legal right to impose the restrictions in question.

This is the reasonable version, understanding there is a law but not caring for it.

Here’s the pure version, what is the law?

And here’s the opinion piece version (WaPo).

And in a development that was in some ways even more alarming, the court upheld a vaccine mandate that applied only to health-care workers in facilities that receive federal funds — but four of the justices voted against it.

But four justices — Clarence Thomas, Samuel A. Alito Jr., Neil M. Gorsuch and Amy Coney Barrett — said just that. Legislative language that authorizes the Department of Health and Human Services to regulate the “health and safety” of medical facilities, they said, isn’t enough, since there is no specific language authorizing precisely this kind of mandate.

“If Congress had wanted to grant [the government] authority to impose a nationwide vaccine mandate, and consequently alter the state-federal balance, it would have said so clearly,” Thomas wrote for the others. “It did not.”

The alarming philosophy in question, that a minority of justices endorsed here, is that if the Federal Government wants to impose a law, it must first pass one. Scary, I know.

I happen to disagree on the merits here, because I do think that Congress authorized this when it said it could require things that guard the health of Medicare and Medicaid recipients, so if you want to object you’d have to object to the whole broader structure, and they’re not doing that here.

There is one other note I am very sympathetic to here, which is that this rule of law kick only seems to properly and fully apply when a Democrat is occupying the White House. That does seem to be a thing, but the error should be fixed where there is an error.

The note I am mostly not sympathetic to is that laws shouldn’t have to be passed because the other side is refusing to pass any laws. If that’s so terrible, as one could reasonably argue, shouldn’t you go and win elections by pointing this out? It’s not like this no-laws policy is new or surprising.

The liberal justices did not appear to be in as good standing as members of the reality-based community as one might have hoped. They said some things that are not.

For example, this very much is not.

Sotomayor, who did not join her eight colleagues on the bench for the arguments, but opted to take part remotely, was the worst offender. At one point, the Bronx-born jurist claimed that implementing the requirement for businesses was necessary because “Omicron is as deadly as Delta … we have hospitals that are almost at full capacity with people severely ill on ventilators.”

“We have over 100,000 children, which we’ve never had before, in serious condition,” Sotomayor added, “and many on ventilators.”

Not only did Sotomayor’s statement contradict experts who say Omicron is less severe than Delta, but it defied data from the Department of Health and Human Services showing a total of 3,342 confirmed pediatric hospitalizations with COVID-19 across the US as of Friday — making the justice’s math off by a factor of nearly 30.

Here’s Breyer, also saying that which is not.

When Breyer waded into the fray, he suggested the OSHA rule was needed because “hospitals are full almost to the point of maximum” and that “750 million new cases” had been reported in the US yesterday — despite the fact that the population of America is around 330 million.

More disturbingly, no, seriously, what is the law?

Perhaps more disturbingly, Sotomayor said at another point in the argument that “I’m not sure I understand the distinction why the states would have the power” to institute a rule like the one being pursued by the Biden administration, “but the federal government wouldn’t.”

And there’s this Zen koan, how is a human not like a workplace machine, to be modified to the specifications required for safe operation in the factory? And what does blood have to do with this given that Covid isn’t even blood-borne? Why does everything have to be so creepy?

JUSTICE SOTOMAYOR: So what’s the difference between this and telling employers, where sparks are flying in the workplace, your workers have to be — wear a mask?

MR. KELLER: When sparks are flying in the workplace, that’s presumably because there’s a machine that’s unique to that workplace. That is the —

JUSTICE SOTOMAYOR: Why is the human being not like a machine if it’s spewing a virus, blood-borne viruses?

And of course there was the whole ‘well more people might quit if we don’t force them to get vaccinated so coercion is fine’ argument, from Breyer.

And they said, in our view, hmm, yeah, that’s right, some people may quit, maybe 3 percent. But more may quit when they discover they have to work together with unvaccinated others because that means they may get the disease.

Here is the actual decision.

The Secretary of Labor, acting through the Occupational Safety and Health Administration, recently enacted a vaccine mandate for much of the Nation’s work force. The mandate, which employers must enforce, applies to roughly 84 million workers, covering virtually all employers with at least 100 employees. It requires that covered workers receive a COVID–19 vaccine, and it pre-empts contrary state laws. The only exception is for workers who obtain a medical test each week at their own expense and on their own time, and also wear a mask each workday. OSHA has never before imposed such a mandate. Nor has Congress. Indeed, although Congress has enacted significant legislation addressing the COVID–19 pandemic, it has declined to enact any measure similar to what OSHA has promulgated here. Many States, businesses, and nonprofit organizations challenged OSHA’s rule in Courts of Appeals across the country. The Fifth Circuit initially entered a stay. But when the cases were consolidated before the Sixth Circuit, that court lifted the stay and allowed OSHA’s rule to take effect. Applicants now seek emergency relief from this Court, arguing that OSHA’s mandate exceeds its statutory authority and is otherwise unlawful. Agreeing that applicants are likely to prevail, we grant their applications and stay the rule.

The counterargument seems to be that OSHA is tasked with safety, this is safety, therefore OSHA is tasked with it:

In a dissent, Justices Stephen Breyer, Sonia Sotomayor, and Elena Kagan argued that OSHA was acting within its broadly defined limits. “The administrative agency charged with ensuring health and safety in workplaces did what Congress commanded it to: It took action to address COVID–19’s continuing threat in those spaces.”

There was no specific command from Congress for OHSA to address Covid-19, so the implication is that anything that impacts health is fair game in the workplace and can be regulated without further authority from Congress. I am not a lawyer, but as I read this, since almost everything impacts safety, this effectively means we would no longer have law with respect to large businesses, only regulations that the President can change at will.

Here is a legal argument that the OSHA rules do in fact apply to any ‘grave danger’ and that the court was wrong to draw a distinction between workplace and non-workplace harms, but that the decision was still correct because Covid-19 does not impose a ‘grave danger.’ Without one, Congress needed to delegate the necessary authority to do this because it is a major question, and they did not do so. Post agrees with my instinct that a decision the other way would have given OSHA control over essentially all workplace conditions.

The interesting question is, how different would physical conditions need to be, in order to change the answer under the law and justify such rules? What if Covid-19 was a lot deadlier, and vaccines protected against transmitting to others but didn’t protect you yourself? I’d certainly then want to impose the mandate, and I’d hope Congress would be willing to pass a law to do that, but if they refused then ‘do it anyway’ isn’t obviously how the law works.

The concrete issue is moot at this point in any case. The corporations that want to impose a mandate already did. The ones that don’t want to aren’t going to start now either way. It’s done. What matters is potential future regulatory overreach, on which the difference has been split.

There was also a to-do about whether justices asked each other to wear masks. There was a report they were in conflict over this, then it turned out they weren’t. No idea what happened beyond a clear underlying demand to find a controversy that wasn’t there.

Hospitals

The ‘circuit breaker’ dashboard continues.

Here we are in micro.

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As a reminder, here’s a translation guide:

  1. ‘Has capacity’ means there’s no doubt everything is fine and will stay fine.
  2. ‘Continued risk’ means there is some way to doubt everything will stay fine.
  3. ‘Unsustainable’ means things are getting worse so might not stay fine.
  4. ‘Forecasted to exceed capacity’ means there’s actual math saying things are going to not be fine.
  5. ‘At or over capacity’ means things are, to some extent, not fine.

We are overall at the peak, but that doesn’t mean any given area is at the peak, so things that are currently fine could easily end up not fine, but I’d mostly treat anything in categories 1 and 2 as fully fine, and anything in category 3 as likely to be sustained and highly unlikely to be serious levels of not fine. The counterargument to that is that they’re continuing to move things from category 3 to category 4, but I still think that the marginal moves are likely to only go marginally over capacity at this point.

That does still leave a bunch of scary areas, although their combined populations aren’t as high as they look due to the rural-urban divide.

Here’s the update by state.

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Notice that Ohio, despite being mostly red in the first picture, is only in yellow here, which illustrates the population densities, and also that local conditions look worse than average conditions and there’s some amount of transfer capacity. Where things are over capacity, they’re not wildly over, and our worst fears are not going to come to pass.

I don’t say this to make light of the situation. As per reports like this, conditions in many hospitals are terrible and overwhelming. There’s still a world of difference between this and the types of conditions that were feared as recently as a few weeks ago.

Some Kind of Djokovic

The saga of Djokovic at the Australian Open, which will presumably be the first episode of Netflix’s new tennis documentary, yes I can tell you they definitely got that, did not exactly increase the extent to which people’s outer coverings contained glory.

First, there’s Djokovic himself. As I understand it, he did the following.

  1. Was already a player nobody liked.
  2. Got Covid-19 early in the pandemic.
  3. Refused to get vaccinated on grounds he’d already had Covid-19.
  4. Refused to get vaccinated even though this was clearly going to cause endless trouble due to his need for constant international travel.
  5. Took a generally strong anti-vaccine stance.
  6. Reported he’d tested positive for Covid-19 again at exactly the time necessary to allow him to compete in both the Australian Open and the French Open, uh huh, yeah.
  7. Was seen maskless shortly after the test among fans.
  8. Made a mistake on his visa application and failed to coordinate the paperwork properly.
  9. Got refused entry to Australia.
  10. Had his family issue threats of at least symbolic physical violence.
  11. Won a court case letting him enter Australia.
  12. Also, oh yeah, he lied about his travels on his visa application.
  13. Got deported from Australia.
  14. Missed the Australian Open and his chance to set historical records.

So, yeah, whatever else is going on, let’s be clear, f*** that guy. He played with fire while also pissing off the fire department, and then his house burned down.

That doesn’t mean that it’s fine for the government to go burn down his house. If it does head over with a casket of lighter fluid and burn the place down, we can notice that this is not an acceptable process, while still acknowledging that the fire-playing also was not cool and we’re not that unhappy about the particular result.

How much will this matter? That depends how this happened, but more than that it depends on how people think that it happened. Which narrative will take hold?

My good friend Seth Burn thinks this is simple enough (and yes, it stands).

There certainly exist worlds where it is that simple, in which case banning him seems totally fine. But do we live in such a world (WaPo)? It’s complicated.

After a weekend of hurried court hearings, a panel of three Australian federal justices unanimously upheld the immigration minister’s decision to cancel Djokovic’s visa on the grounds that his presence in the country might incite anti-vaccine sentiment and “civil unrest.” The decision cleared the way for the government to deport him, ending his hope of competing in the Australian Open.

Although it would have been possible for Djokovic to appeal the ruling to Australia’s High Court, the timing of Sunday’s decision — roughly 24 hours before Djokovic was due to take to the tennis court — made another challenge unfeasible.

The timing is suggestive, but the correct focus here is on the grounds used: That his presence in the country might ‘incite anti-vaccine sentiment and “civil unrest.”’

That is very different from saying that Djokovic lied on his application, or that he might get infected and spread the virus. The danger they’re pointing to is his symbolic meaning.

Australian Prime Minister Scott Morrison praised the decision. “Australians have made many sacrifices during this pandemic,” he said in a statement, “and they rightly expect the result of those sacrifices to be protected.”

As usual, politicians praise courts when they get the results they like, and don’t care about the rule of law or the principles involved. Ignoring the sunk cost fallacy issue, in what way is Djokovic’s exile ‘protecting those sacrifices?’

First off, I’m going to leave this graph here for no particular reason.

Whatever they were protecting, it wasn’t the Australian people being protected from Covid infections. All that hard work over two years didn’t fully go to waste, but Omicron is very much out of the box.

What they are protecting Australians from is something else.

Adding to the drama was Hawke’s decision to put the unvaccinated player’spersonal beliefs on trial, arguing that his past anti-vaccine statements, behavior and huge platform as one of the world’s biggest sports stars meant his continued presence in the country could incite anti-vaccine sentiment and “civil unrest.”

That claim immediately came under criticism from Djokovic’s attorneys on Sunday, who said the minister had unreasonably failed to consider what deporting the tennis star would do for civil unrest.

“It was just quite obvious that that in itself might be apt to generate anti-vax sentiment,” Nick Wood said.

So at this point, the government is arguing that letting the world’s best tennis player into the country to play tennis would incite anti-vaccine sentiment because they wouldn’t punishing everyone equally for their failure to comply. The response that seemed best to Djokovic’s lawyer was not to point out that this was absurd or a violation or rights, but rather to question which decision would have the better symbolic meaning.

Meanwhile, what is Djokovic doing that is so provocative or likely to incite sentiment? Seems mostly like it’s ‘not getting vaccinated.’

Wood also argued that the government had relied on old and selectively used quotes from Djokovic to describe his position on vaccines. Djokovic had been playing tennis around the world — including in Australia — for the past year of the pandemic without inciting unrest, he said. And the only evidence of a connection between Djokovic and anti-vaccine protests was the reaction to the government’s own decision to deport him.

Stephen Lloyd, arguing for the immigration minister, said that Djokovic had done nothing to retract or change his stance, including in an Instagram statement last week, and that the fact he remained unvaccinated spoke volumes.

Indeed, it seems like there is very strong evidence that ‘letting tennis player play some tennis’ doesn’t have the impact they are claiming, at least not of much magnitude, unless you decide to make a big deal out of it.

The judges clearly showed what matters in this Australian court, and it wasn’t the rights of individuals or the rule of law.

Two of the three justices appeared concerned with whether the minister had fully weighed the potential outcome.

“One could see a situation where it was plain to anyone with common sense that canceling the visa would cause overwhelming public discord and risks of transmission through very large public gatherings,” Allsop said.

Then there’s this obvious nonsense.

“Given Mr. Djokovic’s high profile status and position as a role model in the sporting or broader community, his ongoing presence in Australia may foster similar disregard for the precautionary requirements following receipt of a positive covid-19 test,” he wrote.

So basically, failures to obey authority are likely to lead to arbitrary other failures to obey authority, so authority must always be obeyed no matter whether the rules in question make any sense, since some of the rules make sense.

Australia could have made a principled decision that Djokovic lied on his visa application, and those who lie on their application get deported. They could have made a principled decision that there is no exemption for recently having Covid-19, or that they didn’t believe his claim that he’d had it. Or they could claim that they admit people into the country as inherently political decisions at their sole discretion, and been straight about it.

They didn’t do those things. Instead, they made absurd consequentialist claims that entail the right to enforce arbitrary punishments for failures to kowtow to authority, as the guiding principle of the state, as a matter of principle. They want this to be common knowledge.

What we do about it is up to us.

On the bright side, there’s at least two things we can all agree on.

And this bit of trivia.

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Think of the Children

So, I can confirm that this happened this week.

  1. 75% of the staff of a school calls in sick due to Covid-19 (including quarantines).
  2. This happens in the morning, so the school says it is technically open since some kids have already left and have nowhere to go, but there’s no actual school happening, tells everyone to please stay home.
  3. 15% of parents actively ask in the morning about whether, if their kid doesn’t show up, they will be marked as absent.
  4. Because, you see, absences might go on your permanent record, and also make it more difficult to get reimbursed when the time comes to sue the city to reclaim the massive tuition bill you spent on the assumption you’d mostly be able to recover it, but which the city forces you to sue over in the hopes they might not have to pay or you’ll give up and send your kid to a normal public school instead.
  5. This raises the question of whether they would send their kids to this non-school in order to avoid being marked as absent, if it came to that.

As a reminder, this is a big deal, if you don’t have an official ‘remote option’ or other way to avoid these ‘unexcused absences’ then the system is effectively threatening to derail a student’s life if they don’t show up for class, in addition to any financial issues. Report to serve your time, at the time we say, or else, Covid exposures be damned.

The good news is that Tuesday was the first week that those ‘learning from home’ could be marked as attending without a positive Covid test in the NYC school system. Which led to a recent high of almost 82% attendance thanks to the changing definition. That still seems quite low.

What is school about, again?

Freddie deBoer tells it like it is, while explaining one of the core problems with closing schools.

Here’s a basic point I’ve been making for at least a dozen years, including in my book, and will now do again: the educational function of public schools, while certainly of prime importance, is the secondary function of public schools. The first function is giving children warm, safe places where they can be stimulated and looked after, and where they can access cheap or free meals if they need them. The humanitarian good of this function dwarfs that of the education function.

I would also challenge exactly what the ‘educational function’ is teaching children, but either way it is good to remember what is going on here, and that this is a place we require children to be or else at some times, then closed down at others.

And I’d challenge the ‘fine, then keep your kids home, then, if you want’ attitude because the school system very much does not generally offer any kind of flexibility to children. You show up, where you are told to show up, and you are here delivering all the proper passwords to the proper authorities, or else. Even when the ‘or else’ is a subtle one, it’s very much there, and carries many days.

No, professor, your students are not primarily there to be ‘vectors of disease,’ (WaPo). Hell of a story.

Nor is it about obsessing over Covid-19 case rates in the places most protected against Covid, but those places don’t seem to agree, yet they often don’t share their case data, which is probably good since the value of information is strongly negative.

In other news, we learned via MR that children as young as nine are launching DDoS attacks on their schools, with rates doubling from 2019 to 2020. They blame games where ‘disrupting opponents is viewed as just another way to win’ and worry about this leading to a life of crime. I would instead be happy the kids are practicing useful skills, and notice that if they’re turning their attention to messing up the school’s internet connection more often, maybe there are a large number of obvious reasons why they might want to do that.

Permanent Midnight

A theory of permanent masking.

One can interpret this in a number of ways. In the sensible metaphor, you keep masks in your house and take them out when you are sick or when there is another pandemic. That makes perfect sense, and I support this idea, so we won’t have a mask shortage if and when this happens again. I do think from the details here that this is the intention.

One can also interpret this type of thing as a request to always carry a face mask, forever, and use them in some places like transport, forever. That makes a lot less sense.

It’s interesting how well metaphors like this reveal thinking. Does being outside without an umbrella as rain clouds gather reflect poorly on you? Absolutely not, and unless it’s going to be major storm, anyone going only a short distance is probably making the right decision.

I’d also note that has anyone tried carrying around an umbrella all the time? Or actually thought about the decision on whether to carry one on a given day? It’s highly annoying. Unless you’re already using a backpack or other convenient carrying device and have one that folds up nicely, it means one of your hands is busy and you have another thing to remember all the time. It’s a non-trivial cost, which is why people often get caught without an umbrella. A universal mandatory-umbrella-carrying social norm would be rather expensive and stupid.

Also, as my father often said, do you know what happens when you get wet? You dry off.

And that’s why we mostly don’t mock people who get caught without an umbrella. And why those who do mock such people are what we like to call assholes.

Long Covid

Some of these deserve more detailed treatment, I intend to address that in another post when I have time. Hopefully next week.

A request for anyone who had Long Covid then got monoclonal antibodies, your experiences could help justify a new clinical trial. If this is you, please do help.

A new paper explores potential mechanisms for neurological Long Covid symptoms.

Long Covid patients lack native T and B cells according to a new study, suggesting a mechanism.

Report from Israel that breakthrough cases of Covid-19 after double vaccinations are not more likely to lead to Long Covid symptoms than not having been infected at all. So weird to say ‘we know it can happen after mild infection’ when there’s a ‘baseline rate’ of it happening without an infection at all, even in the worlds where it is mostly the result of Covid-19.

Katja Grace, whose thinking I generally respect, has a post making the case for taking Long Covid more seriously. You have to consider the post’s arguments in light of it being a steelman case for taking Long Covid seriously, from a reference class of thinkers I’ve observed to be likely to be inclined to take such things seriously. One does still have to also update on her decision to write the post.

In Other News

Scott Gottlieb suggests an obvious improvement, to combine the FDA and CDC advisory panels. There’s no reason to have two such veto points. At most we want one.

He also reports that people are getting rid of their pet hamsters after Hong Kong ordered its hamsters killed. Please don’t do this, especially if you have kids. The Covid-19 risk here is at most minimal.

And he is doubtful that China suspending almost all international travel can be sustained for that long. I’m in the ‘they can sustain this for a while’ camp for this particular intervention, to me the question is whether it will be enough, and also whether they’re willing to make that permanent.

Various views of DeStantis’s Covid-19 record in Florida, it’s not clear who is trying to claim they did what and why but it’s going to be fun watching them claim all of it.

Via MR, an archived (now deleted) Twitter thread with claims about the combination of remote work, complete lack of social connections outside of work, over the top pandemic fear and a highly pro-woke corporate culture resulting in deeply dysfunctional and unhappy employees at a major tech company. Source has obvious agenda but no reason I can see to be faking the reports of general Covid-19 paranoia and resulting deep unhappiness.

This madness must end. Life must resume, and soon. As much as I’m sympathetic to ‘this is not the week to do that’ one must reply with some version of ‘if not now, when?’ and have a concrete answer. Next week or two weeks from now is totally acceptable as an answer to when, if you mean it. Under a hundred thousand cases a day is too conservative but understandable. Real Soon Now is not.

We also need to stop the madness of not letting people see their dying loved ones. I do not know how common this is, but it is mind-boggling that even now this is not a decision you are allowed to make for yourself. Damn right I’d demand to see my parents if they were dying of Covid-19. If I get it, I get it.

Report from a nursing home where testing was reportedly actively sabotaged to prevent positives and keep staff coming in. If true, someone please nail these bastards.

BBC overview of what happened with Ivermectin.

A hospital reported to have used a rather more aggressive approach to race-based care allocation than the current system where you need any excuse at all and the right racial identification counts but so do lots of other things. In this case, you needed a total of 20 points, which was a real bar to clear, and racial identification could net you 7, whereas most conditions max out at 6. They caved under legal pressure.

Thread on ethics of sharing anecdata. Doctor who has concerns contrary to party line (and contrary to my math calculations) points out that sharing anecdotal information that supports party line (‘Omicron isn’t mild’) is widely praised, whereas information opposed to party line (‘boosters can have rare side effects’) is widely condemned.

This is because what people care about is the Simulacra-Level-2 results of information sharing combined with the associated Level-3 affiliations. If you are shown Scary Medial Picture, that’s presumably because You Should Be Scared Of This Thing, and that’s the message a lot of people get, full stop. There’s also a Level-1 concern about people’s resulting models becoming inaccurate. Sharing rare things can effectively be misleading to humans who use the availability heuristic and can’t handle base rates, whereas sharing examples of common things is helpful.

These are all valid things to be concerned about. We also need to be concerned about using such concerns to entirely suppress information that goes against the desired narrative, especially if rare concerns are impactful enough that they may dominate the calculus. By default these concerns get weaponized in exactly this way, forcing all information sharing to serve authority.

In this particular case, I basically classify frequently sharing and harping on the particular information in question as Not Helping. I understand the source ‘means well’ but source is doing what I can only call harping on concerns where the math very much does not justify the observed level of harp, either in general or especially by this source. I sympathize with the condemnations. I view the effort as persuasion via ‘getting around’ the math rather than providing information that lets us do math better. Of course, my preferred intervention, should this get sufficiently out of hand, is fully covered by the unfollow button.

Not Covid

Bryan Caplan does not place enough bets, and bets too small.

New paper shows that EBV (the virus that causes “mono”) is the leading cause of multiple sclerosis (paper, gated). I haven’t read the paper but everyone seems to think it is the real deal, and the basic case seems ironclad. This is huge. A million Americans have MS, and this suggests such mechanisms are common elsewhere too. We should update our priors about how bad it is to catch viruses in general, and of course EBV in particular, and also have new hope we may be able to prevent or cure MS down the line. If nothing else, a vaccine for EBV would also prevent MS, and hey look, we have this new nifty mRNA tool for making vaccines.

The latest Very Serious Person message in its correct form.

FedEx asks permission to add anti-missile lasers to their planes. Our cyberpunk future is that much closer, but if it were here FedEx wouldn’t ask for permission.

Music consumption is focusing more on older music. This is good in the sense that music that is older tends to be better because age filters the good from the bad, and also because the exhaustion of the search space combined with various forms of over-optimization and over-commercialization means that new music tends to start out worse as well. It is bad to the extent that it means we are under-investing in new music. Since artists gather only a small portion of gains from new music, we should be suspicious we are under-investing, but also artists vastly over-invest in new music creation compared to their potential profits due to intrinsic motivations, social payoffs and delusional aspirations, so this could go either way. Mostly, it seems like the amount of new music isn’t down much whereas older music consumption is up a lot, and in the long run the potential for long-run profits should provide more incentive to create new music, so it all seems fine. My bigger concern is that it seems as if the range of old music is narrowing, but perhaps this is indeed welfare-maximizing.

Eye emoji.

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74 Responses to Covid 1/20/22: Peak Omicron

  1. J says:

    Important typo: “giving us four free masks” should be “giving us four free tests”

  2. LB says:

    EBV is a very unusual virus: it infects long-living B cells, and causes permanent infection in most (all?) people. When the virus is not actively replicating, you still have a latent infection of immune cells. That a permanent infection of the immune system can cause immune dysregulation does not provide much information about more typical viral infections.

    • lunashields says:

      All herpes-like viruses are permanent, and that’s just the most common ones that come to mind. So not that unusual I would say.

      • LB says:

        I generally agree with your comment. I was trying to suggest that worrying about viral infections in general is not the correct level of abstraction. EBV causing MS provides information about the effects of persistent viral infection.

        An argument against this is that even temporary infections can trigger long-term autoimmune disorders, for example reactive arthritis. Nonetheless, I think EBV is a different beast. Persistent infection with EBV, and not the initial encounter, is probably what causes MS. Despite decades of efforts, no autoantigen has been found for MS. MS definitely involves the immune system, but this is evidence against it being an autoimmune disease. The most effective therapies for MS are those that wipe out the reservoir for EBV, B cells.

        • lunashields says:

          It seems that chances of triggering MS are hugely higher if you get it as an adult, so looks like initial infection does play a big role though.

        • LB says:

          I think the timing of infection being important is independent of whether the initial infection is the trigger. The initial infection being the trigger (and later persistent infection not being necessary) probably means that MS is an autoimmune disease (maybe there’s some other mechanism for this, but I haven’t seen one proposed). Late infection in this case makes it more likely for the immune system to generalize incorrectly, and identify some self protein as an antigen.

          Persistent EBV infection causing MS is also consistent with an effect of late infection. Late infection causes mononucleosis more often than early infection. Mononucleosis leads to proliferation of EBV infected B cells. Having more persistently infected B cells makes it more likely that some subset will be dysfunctional. Prior mononucleosis is associated with greater MS risk, though I’m not sure whether the effect is independent of infection age.

  3. Matty Wacksen says:

    >The Supreme Court upheld the federal vaccine mandate on health care workers, but rejected Biden’s attempt to use OHSA to impose a similar mandate on all large employers.

    Minor point, but I thought the US Supreme Court only upheld the stay, and did not rule on the merits of the case conclusively?

  4. lordfrezon says:

    Came down to NYC this last weekend specifically to eat pizza and used your articles as a guide. Can confirm that they are informative and lead to good decision making. Also can confirm that NYC pizza is very good. I brought a pie home on the train (Amtrak is wonderful) and it was rated highly by my household even warmed up the day after.

    • Dave says:

      I operate a relatively new pizza business (far away from New York) and can confirm that Restaurant Guide 2: Pizza was key to figuring out what we wanted our pizza to be and not be.

      • TheZvi says:

        Cool! Care to share which one it is? I keep neat places outside the city starred on Google Maps in case I’m ever in the area.

        • Dave says:

          Hildegard’s Bakery in Winnipeg, Canada. You are unlikely to wind up in the exact centre of the continent by accident, but here we are! The style we settled on after much playing around is sort of a wood-fired sourdough NY-coal-fired-Neapolitan-Apizza hybrid.

  5. Andrew D says:

    Your comment on the “UK lifting all restrictions” seems to imply that this the first time the UK is at this stage, which it is not, they merely changed the rules back to how they were between mid July and late November last year.
    (And it’s also technically incorrect in two minor points: 1) It’s not the UK, it’s just England (Scotland, Wales and Northern Ireland set their own rules and still have more restrictions. 2) It’s not ‘all’ restrictions, there is still the legal obligation to quarantine after a positive positive test, as well as border restrictions (quarantine for unvaccinated travellers and testing after arrival for vaccinated travellers). There is also still a variety of guidance that de facto serves as restrictions, as it would be difficult or impossible to not follow it for certain settings (eg workplaces or care homes).

  6. Dave says:

    From the Katja Grace long covid piece:
    “If everyone believed that covid was bad enough to get, it would die out in a month (possibly with terrible economic downsides for a month). It probably isn’t that bad, but if it really is quite bad to get, and ways to avoid it exist, people will probably realize that eventually, and adjust.”

    This is not true at all. Animal reservoirs (infected pets, farm animals, deer, etc) would make this impossible, even if it were sociologically realistic to imagine everyone realizing that covid is so bad that they will work even harder to avoid it than people did in March/April ’20.

    I have a high opinion of Grace overall, so I’m surprised to see her making uninformed statements of this sort.

  7. Matty Wacksen says:

    >That is very different from saying that Djokovic lied on his application

    Yeah so “lied” is a bit of a weasel-word here unless we’re talking about the allegations he faked a test. I think he made an incorrect statement about prior travel, something I don’t see as being particularly important to the visa process and more of an indication of the fact that border-police like collecting information.

    • TheZvi says:

      I think in the context of Covid risk travel is relevant and not just random info, and also Djokovic can afford to make sure he gets this right, he isn’t some random traveler. It’s kind of weird to just forget about this kind of thing.

      • Matty Wacksen says:

        “What places have you traveled to recently” is a standard question on visa forms even pre-covid. I’m not sure why this should be covid-relevant information on an object level unless there is some variant contained in Spain and he traveled out of it.

      • ThirteenthLetter says:

        Maybe we should back up and ask ourselves if it makes sense to go to ridiculous extremes to screen passengers flying _into_ countries where Covid is already spreading widely and uncontrollably. What possible difference could it make to Australia if Djokovic was allowed in or not?

  8. Lambert says:

    I wonder how much the news about No. 10 breaking lockdown rules last winter is contributing to the swift relaxation of restrictions.

    Also I thought we were going to cure MS using stents but that didn’t pan out. Should we be taking the outside view here?

    • Metacelsus did a thorough writeup on EBV back in September as part of their series on herpesviruses. They also touched on it again in their last post of the series discussing herpesvirus treatments and prevention.

      They seemed to feel that developing an effective vaccine would likely be very difficult, but that it was still worth attempting given the potential upside.

      https://denovo.substack.com/p/epstein-barr-virus-more-maladies

      https://denovo.substack.com/p/herpesvirus-treatment-and-prevention

      Key quote from the second link:
      ————–
      “In general, developing an EBV vaccine faces many challenges. As mentioned in my original EBV post, even the strong anti-EBV immune response in EBV-infected individuals is inadequate at preventing superinfection by a new strain. Furthermore, since the severity of primary EBV infection increases with age, an EBV vaccine that provides imperfect or short-lived protection may do more harm than good, by delaying infection to an age where it is more severe.”
      ————–

  9. cakridge2 says:

    What’s up with the 21% of Republicans who support permanent house arrest for the unvaccinated? That number’s so high that I have trouble believing it.

    • Dave says:

      It’s not quite the Lizardman Constant, but isn’t there some other law about how some kinds of survey questions get 20-30% support as a baseline for each option no matter what the options are? Maybe something on ACX? It seems like the relative differences between groups may be informative, but the absolute “20% of Xs support P” is just a noise floor.

    • scmccarthy says:

      I don’t know how the poll was worded but you could easily imagine a person who wants the government to do more to stop covid to pattern match that to whatever the most doing-things available answer is.

    • crh says:

      Bear in mind that number includes Republicans who vaguely support vaccine mandates in general and (don’t care about/didn’t listen to/are incapable of interpreting literally) the exact question that was asked.

    • cakridge2 says:

      All good points, thanks, everyone.

    • MoveMyCat says:

      Did it say “permanently” anywhere in the question? Confine non vaccinated people to their homes was, after all, government policy for at least several months in most European countries and several States before there were any vaccinated people. The number in favour of such policies is still too high, but I wonder how much of this is a difference between people hearing the question thinking it means reserving the power to do so for short periods, and the people reporting the poll presenting it to the media as being permanently.

      Looking up the question, it is “Would you favor… a proposal to limit the spread of the Coronavirus by having federal or state governments require that citizens remain confined to their homes… if they refuse to get a covid-19 vaccine?”

      The fact that multiple jurisdictions have made (and enacted) such proposals and none of them have done so permanently does seem relevant.

      • cakridge2 says:

        You’re right that it said nothing about a permanent house arrest, I should have read more closely. I maintain that it would be de facto permanent since the unvaccinated are very stubborn about not wanting to be vaccinated.

  10. jimancona says:

    With respect to nursing homes not testing staff, it’s been happening the entire time. My mother-in-law was in a nursing home in Massachusetts with Alzheimer’s at the start of the pandemic. When my wife asked the head nurse if they were testing staff, she said, “Oh, no! Who would work if they tested positive?” Shortly thereafter my mother-in-law got Covid and died in May 2020, without my wife or her siblings being able to visit. According to CMS data, that place lost 30% of their patients in the first three months of the pandemic.

  11. Henry says:

    Updates from New Zealand:

    – The government (which still requires all international arrivals to go into hotel quarantine) recently suspended its next room release for quarantine (https://www.rnz.co.nz/news/national/459786/government-postpones-next-miq-lottery-due-to-spike-of-omicron-cases-at-border), citing a large number of Omicron cases at the border increasing the risk of a leak and a need to free up more space in quarantine. Only… most of these spaces are for March and April, so I’m not sure what their expectations are? Do they think Omicron border cases are still going to be just as high then? Do they expect we’ll still be keeping out Omicron? One plausible reason they didn’t actually give was more room to allow people to isolate away from their household, as is currently allowed.

    – There remains no confirmed community spread of Omicron, although there’s been several cases active in the community but linked directly to the border, so it seems highly unlikely our luck can last for long. The government has signalled its intention to move to the “red” level of restrictions at the first hint of Omicron community transmission (vaccination certificates required almost everywhere, social distancing, masks, limits of 100 people). (https://www.stuff.co.nz/national/health/coronavirus/300500308/covid19-what-life-will-look-like-under-red-traffic-light-setting-after-omicron-gets-in)

    – I gave my Covid-19 talk to the EANZ retreat to a positive reception. My main takeaways were that Omicron was coming, it’s somewhat socially valuable (I estimated NZ$200) to avoid getting infected at the peak, and you don’t get much bang for your buck from “wear your mask every time you go outside” levels of precaution. One interesting audience question was whether it was worth deliberately getting infected and immediately isolating, to avoid infecting his parents that he lived with. It’s an idea that people like Robin Hanson like and public health people hate, but I’m not sure. It seems on the face of it to be a decent idea for less vulnerable/high exposure people living with more vulnerable/low exposure people. But it also seems like it might a too-clever-by-half spicy idea.

  12. J says:

    I’m interested in thoughts on future variants. Seems like there’s plenty of evolutionary room for them, and we’ve already had 2 that outcompeted the others while being significantly worse on at least one axis each. I really want to believe we can just start ignoring covid after this wave, but seems like that must rest on assumptions about cross-variant immunity at the very least. What else am I not considering? Seems like a variant as transmissible as Omicron yet more severe than Delta, plus immune evasion vs other variants is a real possibility.

    • Graham Blake says:

      Even in a scenario with frequent immunity dodging mutations we probably still arrive at something akin to seasonal influenza. Immunity often resides along a spectrum, it’s rarely binary – perfect immunity or no immunity. Some cross-variant immunity preservation is probably safe to expect, or what we’d be talking about is something akin to a brand new pandemic – i.e. something akin to a novel influenza pandemic.

      I don’t know if anyone has nailed down a perfect estimate of prior infection effectiveness against reinfection with Omicron, but I think the general sense is that it’s about twice as effective as two-dose vaccine. It seems plausible this cross-variant immunity would work in the other direction as well, from Omicron to variants descended from previous lineages.

      It also seems plausible we will soon have something akin to multivalent influenza vaccines for COVID where we get a dash of Delta and a sprinkle of Omicron on top of ancestral lineage in future boosters, providing broader spectrum protection to vaccine recipients. Not to mention, a sizable percentage of vaccinated individuals are currently getting a “booster” of sorts from Omicron itself. All of this should add up to fairly broad population level immunity that provides some protection against future variants – assuming future variants are not so different they practically qualify as a novel virus as far as our immune systems are concerned.

      We are tantalizingly close to this population level immunity now. Omicron was almost worst-case, at least in terms of immunity escape and simultaneous infections, and it seems like we are going to get away with bending but not breaking. I think this strongly hints that the next wave should bend us even less. Even now it seems like the most at risk are the few who remain unvaccinated without any history of prior infection, and the immunocompromised. There should be fewer of the former going forward now, and I am fairly optimistic that we can pivot to primarily making accommodations for the immunocompromised our primary COVID response.

  13. jimancona says:

    Just to show that the craziness continues: My grandson, a first grader, now not only has to wear a mask outdoors for recess, but also while chewing food at lunch. That is, he may pull down the mask to take a bite or drink, but must then cover up again to chew and swallow. This is in a suburb of Portland, Maine with a 99% vaccination rate.

  14. lunashields says:

    The thing about EBV and MS is fairly interesting. It’s a childhood disease. And it causes any complications (including MS) pretty much never, if you get it then. Now, due to general improvement in cleanliness/staying home while sick/etc now a lot of people don’t get it during childhood, get it when they are adult, and then it’s much worse. One could argue that a non-universal vaccine could exacerbate the problem.

  15. Yellowface Anon says:

    I’m planning to move to England right now, and it isn’t about COVID.

    The thinking about Permanent Midnight is basically asking, “should we apply pandemic standards to diseases that are becoming endemic? Should we do everything again when a new pathogen shows up? Or say, repurposing some of those measures for some other agenda, like climate change or terrorism or economic policies or police state? And will pondering all these be politically advantageous to us? Sending good signals?”

  16. Baxter Moss says:

    Can you please link to where Novak “lied” on his application? Thanks.

  17. Yellowface Anon says:

    OOT but about preparedness of future crises. One of the Conservative memes running wild is extrapolating the results of Cyber Polygon hosted by the WEF into a potential wide-ranging sabotage thru cyberattack false flag, that leads to massive infrastructural and economic failures for another pretext to impose authoritarian responses, solely based on the analogy to the previous Event 201 and COVID that came after it. It compounds with the impression of general economic failure caused by the usual financial culprits they like to devilize. The fear itself sounds a lot like a AGI catastrophic scenario, but replacing AGIs with (well) cyber warfare. Might also be using their priors to interpret the cybersecurity dilemma in a pessimistic or malicious way.

    Have you done posts related to cyberattacks, and how worried should we be on this possibility? Is it in line with the risk from AGI, or something else. I’m also interested in how rationalists think of the risk of cyberattacks outside what the WEF itself has researched on the issue. A lot on the far right are taking this impression seriously and becoming preppers and/or farmers.

    • TheZvi says:

      I haven’t covered cyberattacks – I have nothing approaching the resource/time level to handle most threats/questions/etc. It’s not on the level of AGI, but it’s certainly a worry that’s being under-respected.

      As for these kinds of ‘conservative memes,’ maybe someone has to but also someone else is going to have to because I don’t have that kind of time (unless some kind soul wants to pay my hourly, but there are better ways to do that kind of thing, so don’t do that).

  18. Zvicontent Aficionado says:

    Zvi, do you have any information (or guesses) about the relationship between the physical activity level and SpO2 levels while wearing nothing vs. surgical vs. N95 vs. P100 masks?

    I’m asking because I’m getting conflicting information about breathing resistance, comfort, and safety. On one hand, a trusted doctor told me that P100s are more effective and convenient in daily use than N95s. On the other hand, I heard that they’re harder to breathe through than N95s, plus that the “N95 respirator use by those with heart and respiratory diseases can be dangerous, and should only be done under a doctor’s supervision.” (The Sacramento County Public Health Officer during 2018 fires). What’s the truth?

    • lunashields says:

      As someone who used N100’s in the beginning of the pandemic(disposable ones by 3m with the exhaust valve), they are really easy to breath through, and much more comfortable than a typical n95.
      Also, wearing breathing restricting bane-style masks was already very popular before the pandemic, to increase the efficiency of exercise. With a bunch of confirming research. So I wouldn’t worry much about it.

      • lunashields says:

        Oh, and N100 is better. P100 is oil resistant, so you’d want to use them if you’re in a paint shop or some such, no reason otherwise. That oil resistance makes them harder to breath through due to a different material.

    • TheZvi says:

      Can confirm that 100s are generally better for this, but the biggest thing is that experiences vary. They aren’t that expensive, so this is a place where you should f*** around and find out.

  19. ConnGator says:

    Perhaps your death estimates are consistently too high because you are not taking into account the mildness of Omicron enough.

  20. FXBDM says:

    Some on the anti-vaxx side are discussing a Danish Study (https://www.medrxiv.org/content/10.1101/2021.12.20.21267966v3.full) that would show negative efficacy against the Omicron variant after 90 days.
    The provincial dashboard where I am (Quebec) also showed some form of negative efficacy against infection. I am wondering whether there is something there, or if this can be explained by some form of sampling bias?
    The Danish study says “The negative estimates in the final period arguably suggest different behaviour and/or exposure patterns in the vaccinated and unvaccinated cohorts causing underestimation of the VE”.

    • David W says:

      I don’t see anything about prior infection in that paper. The more people in the ‘unvaccinated’ group who have prior infection, the less effective the vaccine will be in comparison, when looking at a limited window to measure infections like they do. But they only controlled for “age, sex and geographical region”.

  21. JiSK says:

    > Via MR, an archived (now deleted) Twitter thread with claims about the combination of remote work

    Thread is no longer accessible at that link, any alternative?

  22. Randy Lowery says:

    What’s going on in Denmark? Cases seemed to be leveling off a couple of weeks ago but are now spiking – doubling over the last 10-12 days. Positive test rate increasing. Number hospitalized moderately higher than in December but ICU and ventilated down sharply.

    https://www.sst.dk/en/english/corona-eng/status-of-the-epidemic/covid-19-updates-statistics-and-charts

  23. Craken says:

    In general, Grace’s blog post concentrates too much on what has happened to the unvaccinated, then assumes the most pessimistic perspective on that applies to the vaccinated today, which exceeds the steelman’s remit.

    The Nature paper in point “F” of Grace’s write-up claims a 60% excess mortality for non-hospitalized Covid patients between 30 days and 6 months after diagnosis. Can this be made to match the known numbers for Covid deaths within 30 days (ie, official Covid deaths) on the one hand and the known excess mortality over the relevant period on the other? By the time that paper was published, in April 2021, America had about 500,000 official Covid deaths. This implies about 60 million infections to that date. The population death rate in America under normal conditions is 0.9%. So a 60% increase in mortality for 18% of the population during a half year period ought to increase mortality for the total population by about 0.054%/year or 180,000 excess deaths beyond official Covid deaths. The Economist gives American excess deaths as 250,000 above official Covid deaths for the full period of the pandemic up to last month. The 180,000 in the Nature paper is therefore too high. Even if the vaccinated suffer none of this type of excess death, just adding the infections of the unvaccinated in the April 2021- Dec 2021 period to the 180,000 would exceed the 250,000 for total excess deaths. But, this one source of excess deaths cannot be the only source. Other sources: The main analysis in the paper excluded late deaths among the hospitalized, though the paper does show (in Fig. 3) such deaths are significantly higher among this group. Reluctance to seek needed medical care must be another factor. Subpar care for non-Covid patients by overstretched medical personnel is probably still another contributor.

    How could they have chanced upon this misleading estimate? Their study only counts people with a Covid diagnosis, thus missing the mildest cases and asymptomatics–who presumably have lower late death rates. And the undiagnosed are the majority of infections, have been the majority throughout the pandemic. When accounting for this, late mortality may be closer to 20% over the 6 month follow up. And 20% of 50% (half a year) of 0.9% is a very small number: absolute risk of death is very small here. And when the absolute risk is this small, the risk of confounders is more of a concern. On the other side, she’s not entirely wrong to worry that even a very small tip of death may signal a much larger bulk of various illnesses.

    Her explanation at “K” sounds like a just-so story. I could see 2-5% being real long Covid (not the 10% she fears), but that number being concealed in the French and German studies by uninfected people with psychosomatic issues. A study was linked (https://wwwnc.cdc.gov/eid/article/27/9/21-1042_article) in the Less Wrong comments which showed lack of seroconversion for a third of infectees. This occurred disproportionately in young people, who were also more likely to have low viral loads–too low to produce a systemic antibody response. The commenter then argued that this controverted the French/German studies on Long Covid prevalence. But, it seems to me that it’s more likely to reinforce their conclusion, since it is more likely that older people with strong antibody responses will develop Long Covid–and these are the people who test positive at very high rates on antibody tests. The particular pattern of inaccuracy attributed to the antibody tests ought to result in an overestimate of Long Covid.

    Some viruses do have unexpected long term effects, as the the EBV-MS paper reminded us. Certain Papillomaviruses can cause cancer, with a considerable delay. There may be types of Covid pathologies delayed by decades. We don’t know what causes the onset of Alzheimers, for example. Or it might cause a new disease.

  24. Yellowface Anon says:

    Update from HK: 125 local cases, experts expect situation under control (read: near-zero COVID) in 2-3 months (I suppose 8 weeks), catering industry association states likely wave of insolvencies in March under current restrictions. Full lockdown is possible but not likely from my view.

    Also supervaccines are closer than we thought: https://www.cnet.com/health/the-armys-universal-vaccine-aims-to-end-all-covid-pandemics/

    Not sure if you knew this but Bourla concurs with you in the After Times (of course, conditional on mass vaccination): https://www.healthleadersmedia.com/covid-19/covid-19-pfizer-head-sees-return-normal-life-spring

  25. Yellowface Anon says:

    https://www.euronews.com/2022/01/22/covid-19-vaccine-passport-protests-in-europe-draw-thousands-of-people

    I can find FB live footage of anti-vaccine passport riots right in the middle of Brussels right now. As I said violent people move faster than than reasoned discussions on whether vaccine passports are worthwhile.

    • Yellowface Anon says:

      (I might have mis-entered my email)
      As I said, they aren’t as much on vaccine mandates as the memes and conspiracy theories about the WEF (The Great Reset in particular).
      I read a lot of their rhetoric early on in the pandemic and it looks like they are here to say until EU politicians are tarred and feathered, because they think on a politicized mindset and are extensions of say, Yellow Vests. The antivaxx Red tribes are made of the same material but with local state, party and militia structures.

  26. High-Priority Questions says:

    Dear Zvi,

    1. How effective are FFP3 masks (such as 3M Aura 9332+) compared to poorly sealed N95s (1/3rd of risk), well-sealed N95s (1/8th of risk), and P100s (1/20th of risk)?

    2. What could be the risk of catching omicron through the vents connected with a common gravitational ventilation duct in a small block (concerning ~20 people)? They are not supposed to mix the air between different apartments, but sometimes it may happen.

    I’m in a high isolation mode for the next weeks, as I do want to avoid the infection during this wave. I have sealed all 4 vents in my apartment, and I have two windows minimally opened for the entire time. There is no gas installation or sources of an open fire, so I’m not concerned about the carbon monoxide, but I worry a bit about the potentially decreased O2 and/or increased CO2 concentrations.

    I have asked online. Some people claim that I’m going to die, or at least get very sick due to constantly low O2/high CO2. Some say it’s nearly impossible to catch omicron through the vents due to the distance, location of the vents (near the ceilings), and the low viral load. Others claim that there is a non-negligible infection risk, and sealing vents is basically a good idea. What’s your risk estimate and a suggested strategy?

    • TheZvi says:

      1. I don’t know that mask, sorry.
      2. Having no air circulation for a month seems like a very bad idea. At a minimum, you need to buy a CO2 monitor, make sure the levels aren’t rising too high, and if they are change your strategy. If it’s too cold to use windows on their own you’ll need to try the ducts. It’s not zero risk, but it’s better than O2 depravation for sure. If they did mix it’s still not that big an exposure.

      • High-Priority Questions says:

        1. FFP3s have a minimum 99% filtration efficiency, so they’re supposed to be an equivalent of (K)N99s. Does this information help in the effectiveness estimation?

        2. Thank you. Could you please give even a very tentative risk estimate for the indoor infection via the ducts (8 weeks, 4 people in one small apartment, open ducts, country with a 30:70 omicron-to-delta ratio as of today)? I also have two air purifiers at home, working 24/7 at the minimum rate.

        (Sorry for bothering with details, but these two estimates would be very important for me)

        • TheZvi says:

          1. A 99% mask doesn’t obviously have a % reduction in infections vs. a 95%, but it does 5x+ the threshold dose from there. My guess is this is a huge additional bonus if it works right, and things like vents probably stop mattering, because they’re under the threshold.

          2. What matters is the 20 people who might be a potential infection source during those 8 weeks, probably with ~10 infections (since some already had it, and a few randomly dodge). The 4 of you don’t matter that much because the risks there are so correlated already (assuming none of you are taking additional risk). So the question is, how many of them are going to have enough circulating air that connects with you to be a threat? My guess is that this is… a few percent by default and then you do all the crazy stuff on top?

          I mean, yes, a KN99 plus some open windows plus air purifiers and ducts that aren’t even supposed to circulate should be 99%+ protection taken together in this spot, I’d think, but I’d hesitate to speculate more.

    • ThirteenthLetter says:

      Have you considered that you should be speaking to a psychiatrist if you’re so terrified of this that you’re hermetically sealing yourself in your apartment?

      Please, I am _begging_ you, get a grip. If you’re vaccinated it’s no worse than any other respiratory virus. You don’t have to live your entire life in terror! You genuinely don’t! You will be fine!

  27. J says:

    My test supplier is claiming the feds are seizing most shipments of tests for their 4-free-tests program.

    And here’s the Utah governor asking people not to test: https://www.deseret.com/utah/2022/1/14/22883724/utah-gov-spencer-cox-says-dont-get-tested-for-covid-if-you-have-symptoms-omicron-test-shortage

  28. High-Priority Questions says:

    Thank you Zvi, you’re great. We won’t wear KN99s inside the apartment, but we’ll make some vents slightly permeable (e.g. paper towels stopping bigger droplets). Unsealed windows and air purifiers will hopefully do their work in case of improper circulation – this may probably offer 95%+ protection plus near-zero risks associated with low O2/high CO2, which I guess sounds fine.

  29. Meghan Zvi Stallion says:

    Zvi, what do you think about the BA.1 vs BA.2 omicron variant? Is BA.2 likely more infectious and less lethal, and thus indicative of the virus’ evolution towards extremely contagious but less dangerous strains?

  30. Zvi Mask-owitz says:

    Hey Zvi, what do you think about the “wearable purifier” types of mask, such as LG PuriCare? If the nasty coronavirus(es) with likely re-infection capabilities and unknown long-term effects are here to stay with us for years, it would be wise to have a mask that 1) offers >99% level of filtration, 2) has no breathing resistance.

    • TheZvi says:

      I mean, yes, if you are sufficiently worried about Long Covid issues that you want to not get it indefinitely, you’ll want to find the right kind of super-mask. Whether that particular approach is the right one I don’t know. Wish I could be more help.

    • ThirteenthLetter says:

      The science is settled: there are no long-term effects we know of that are worse than happen with any other respiratory virus. If you believe in science, you will happily stop wasting your money on fancy masks and go back to normal life.

      • TheZvi says:

        I am confused why you think you can say ‘the science is settled’ here.

        (And while I strongly agree that sealing oneself in a room is massive overkill, once you’re already wearing a mask I don’t think it’s unreasonable to instead wear one that actually fully works, even if the long-term effects are as you believe.)

  31. Mark says:

    Would be curious to know your thoughts on the “vaccine failure” data coming out of Scotland.

  32. There’s some very exciting work happening now on pan-coronavirus vaccines, capable of vaccinating against a large number of variants at once, and the discovery in some COVID-19 patients of some broadly neutralizing antibodies (bnAbs).

    The pan-coronavirus vaccines have read out from Phase 1, which is being analyzed now. The bnAbs, if manufacturable at scale, could really step up the game in antibody infusion.

  33. Pingback: Covid 1/27/22: Let My People Go | Don't Worry About the Vase

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