Covid 3/10/22: We Have a Plan

Covid situation continues to improve, although Covid remains a thing. There’s a new executive plan that I did my best to read with incomplete success, that checks off lots of boxes and doesn’t have anything horribly wrong with it.

What’s less great is that Congress passed an omnibus bill that cut out all pandemic funding and most already allocated funds have been spent, so we are failing to pay for our Paxlovid purchases and threaten to run into a wide range of other problems as well if this isn’t addressed, such as us no longer paying for the uninsured to get treatment and running out of monoclonal antibodies. It would be quite the disaster, although scaled to the extent of cases at the time.

In the meantime, slowly but surely less and less masking is required and vaccine cards are checked less, and people start to see each other more often the way people used to. We presume that like most such things the snafus with pandemic funding will get sufficiently worked out that it won’t actually cause us to lose access to treatments, although I wouldn’t fully count on it. Life returns, and we can shift our doom scrolling to the invasion of Ukraine.

On that front, writing continues to be difficult. I’ve written a post focused on what options are available, both on an individual and collective level, on the continued theory of ‘this is the piece of the puzzle I know how to write right now’ and writing each piece even out of order makes other pieces easier.

Meanwhile, back to the Covid show.

Executive Summary

  1. Conditions are safe and one can return to living life.
  2. Congress withholds pandemic funding, endangering treatment if not fixed.
  3. New executive plan for Covid seems fine, so long as they get their funding.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 247k cases (-25%) and 9.200 deaths (-19%).

Results: 226k cases (-32%) and 9,138 deaths (-20%).

Prediction for next week: 170k cases (-25%) and 7,050 deaths (-22%).

The decline in deaths finally picked up a bit, which I expect to accelerate a bit more. Cases pleasantly surprised, as it seems behavioral changes haven’t slowed the decline much yet, although I will continue to predict that those changes will soon have some impact. I definitely see substantial changes taking place around me.

Deaths

I found the log scale button, so here’s the new deaths graph.

Some excellent data journalism indeed, relative death rates over time edition:

Image

Cases

Now in log scale.

The decline in cases continues to be steady in log/percentage terms. I do expect that to slow somewhat soon as behavior adjusts, but no sign of it so far.

I Read The Plan So You Don’t Have To

You’re welcome.

Well, all right, by read the plan I mean ‘read the executive summary carefully then skim the rest to see if any of it isn’t content-free’ since that already took hours and most of the sentences are content-free, but hey, you still don’t have to and that’s what counts.

First I accidentally started reading the January 2021 version of the plan by accident, and you know what? Once I realized it was from January 2021, it was pretty good. It had way too many different priorities and way too much bluster and made some major conceptual errors, and everything useful was kind of obvious, sure, but other than that it seemed like it was mostly was a good plan.

How’s the new plan?

I nitpick a bunch throughout here, but mostly I was actually pretty impressed. There’s a lot of thought to logistics and thinking ahead in ways that could physically matter. Yes, there’s also a lot of bragging, both justified and otherwise, and all that, and a lot of stuff that’s content-free especially when it’s talking about equity, but there was no avoiding that. I’m not quite as high on it as Scott Gottlieb, but I’m still high.

So we’re going to live with Covid, then. Good.

It’s weird to me that protect against and treat are on the same line here, but these are good goals to have at this point. The ‘continue’ here is generous, but that’s fine.

#1: Protect Against and Treat Covid-19

Next up they brag about Paxlovid, which is indeed brag-worthy if we actually get to buy it. I do expect that, but see the next section. Yet they’re saying they already have enough for everyone, which, again, news to me.

They have a very long list of checked off things, many of which one could reasonably dispute are ready to be checked off. They are even claiming to have achieved ‘equity’ in various different ways that seem rather implausible.

I noticed this which was also excellent, if a bit on the small side.

A billion a year is good, but I don’t want to wait a year and no one else does either, and the world has seven billion people, so would be good to step this up a bit, but I can’t complain too much.

There’s a bunch of good stuff next around Test and Treat and having enough treatments (again, see next section), as well as updating preventative measures to reflect the current state of the disease.

They claim in some places to have created a ‘one stop shop’ for resources and data, which would be news to me, in others they say they will launch in the future.

The approach to the immunocompromised is to prioritize them for treatment and testing and vaccination, but doesn’t act like this is a good reason to shut things down. Again, good.

There’s a nod to Long Covid but it has no substance beyond things like ‘pioneer a research program.’

There’s quite a lot of mentions of equity, which also mostly has no substance, except a grab bag of various interest groups and feel-good initiatives that likely do nothing at all getting name-checked. They talk about training a ‘representative work force’ of nurses, for example, while not talking about expanding the supply of nurses or doctors or other health care workers. I’m all for training more representative workers, but mostly I care that it means we’re also training more workers. Enough with the artificial supply shortages.

They also notice the pan-coronavirus vaccine efforts, which would be a huge win, but again don’t say much else.

There’s an explicit ‘we should stop using stupid rules for when to mask and start using reasonable ones.’

Mostly the section is ‘let’s do a lot of the things we should obviously be doing’ which is great since they correctly identify many such things and most importantly avoid any glaring false positives, along with a side of ‘look at all the things that happened while Biden was president, isn’t he great.’ The bad news is that they also avoid almost all specifics, so this ‘plan’ isn’t much of a plan in the sense that it would actually tell you what is going to happen, even before we get punched in the mouth.

Section on misinformation does not mention censorship, which is good.

There’s a lot of ‘make everything free’ which is probably good in context so long as the price incentives for manufacturers stay intact and we have enough for everyone. When things get backed up it turns ugly.

The only glaring omission is that there’s no mention of air ventilation here, although they do clearly intend to do a lot about it in the context of schools. In other contexts, they don’t plan to do anything or provide resources, but if you improve it, they will highlight it for you. I’m not sure why school ventilation is where it’s at and other ventilation is unexciting. There’s also no mention of ultra-violent light or Vitamin D or helping people be generally healthy, but I had all of those very close to 0% anyway.

#2: Prepare For New Variants

I hope this one is true, especially the sequencing and the wastewater.

If we can get systematic wastewater data from across the country that’s a really big game. What does it mean to have 700 systems? I don’t know, but it’s more.

Better to do this than not do it, but this being described this way means we have not yet done it, and also ‘while maintaining strict and longstanding practices’ means they do not mean it. They will make it as fast as does not require any compromises or tradeoffs, which is still way way faster than normal for some reason, but no faster. That won’t be good enough when and if we need it most.

Silly question. Why is this specifically for Covid? Why isn’t this going to help with the next other pandemic?

There’s a lot of ‘look how much more testing and surveillance we do in various ways, and then we’ll do even more,’ and yeah, agreed, that sounds great.

There’s also a lot of talking logistics in the sense of saying ‘logistics good, we’re doing and thinking about logistics.’ Which is the right level for this kind of document, and very welcome.

#3: Prevent Economic and Educational Shutdowns

This section starts with bragging that things used to be bad and now they’re less bad.

Then… nothing, really, other than paid sick leave. A lot of ‘giving people resources they need’ while also dictating what resources are ‘needed.’

#4: Continue to Lead Vaccination Efforts

Again, a lot of bragging about how much they’re doing and expecting to be graded on the ‘check out the last guy’ curve, while not aiming for all that we could (realistically and rather cheaply) do.

Paxlovid Remains Unpurchased

Paxlovid access likely matters more than all other questions combined at this point.

If you can get access to Paxlovid in time, there is a huge (perhaps 90%+) decline in the downsides of getting Covid-19, thus consigning the whole thing to not be a big deal even with another surge.

Biden announced exactly the right approach at the State of the Union with the test and treat program. You take a test, if you’re positive you get treatment on the spot. The only catch is making sure we have treatment to give you.

Yet somehow this case of #YouHadOneJob is not working out.

Direct link to post.

Image

This is even worse in the medium-long term if it isn’t fixed.

What are we doing here? Playing politics with ‘transparency’ and holding up all ability to spend anything on anything.

Amid heated negotiations over a government funding bill, three dozen Republican senators including Senate Minority Leader Mitch McConnell (R-Ky.) are refusing to consider more Covid-19 relief funding unless the federal government provides a full accounting of how funds have been spent. The White House disputes the accusations that there has been a lack of transparency, and an administration official said the White House briefs Congress on a regular and bipartisan basis about details of the status of relief funding.

If lawmakers aren’t able to reach a deal for more Covid-19 funding, that’s a big problem for the Biden administration. The White House on Thursday acknowledged its Covid-19 response money has nearly run out and it needs $22.5 billion more, or it won’t be able to secure treatments, vaccines and tests for the future.

I have no idea whether this ‘transparency’ is indeed a problem, but holding up the funds to pay for Paxlovid, when the total amount asked for is about 0.5% of the money that’s already been spent, is a rather crazy way to make this point.

Congress actively cut all pandemic funding out of the bipartisan omnibus bill, I have no idea why both sides agreed to this but it seems like this was the change that made Republicans in the house sign on to the bill. Of all the things they could have asked for, they selected ‘don’t provide any money for medical treatments or vaccines.’

Also foolish is not keeping a reserve of authorized funds for such an occasion, given current political conditions, if they need bipartisan consent to get more funds, but all that does is buy more time.

This threatens to go well beyond Paxlovid, a few months of this and we’ll run out of money to pay to treat the uninsured and then for monoclonal antibodies. Statement from the White House:

What’s even more painful is that they’re offering us an additional ‘four free Covid-19 tests,’ which mostly screws up the supply allocation and makes people feel slightly better, but didn’t save any money for the treatment that is the whole reason to test in the first place.

If someone spends all their money on such ineffective things, then comes back and says they urgently need money for effective things, there is a problem.

Physical World Modeling

Mina warns us that Omicron spread with a backdrop of a lot of pre-existing immunity, and we should not be too confident even now that we know exactly how deadly it is relative to past strains, especially in light of the disaster that is Hong Kong (Bloomberg). Things are very much quite bad in Hong Kong right now, due to a combination of using Sinovac as their vaccine and having previously suppressed the virus, leaving the population vulnerable.

Things in Hong Kong are more than twice as bad as they’ve ever been in the United States, although there may have been individual cities the size of Hong Kong where it’s been this bad for brief periods.

If you protect the population for a while but then fail in the wake of a variant that’s harder to contain, you’re going to get hit that much harder all at once.

China continues to face this issue. If they let up, they risk being slammed the way Hong Kong is now slammed. Thus, they do not let up. So far, they’ve managed to hold things together outside of Hong Kong, and the longer they do that the more it provides evidence of their ability to do that. But they are sitting on a time bomb and there is no clear path to its diffusion. It would not look this bad because China is not a single city, but it would be quite bad.

Prevention and Prevention Prevention Prevention

Austria suspends its mandatory vaccination law.

Experts write a more than hundred page paper on ‘charting a path back to normal.

Its publication comes at a critical time, when the combination of declining case counts, deep-seated Covid fatigue, and a dangerous and unprovoked war instigated by a nuclear power threaten to push control of the virus and planning for future pandemics to the far back burner.

The non-dangerous time? That’s the most dangerous time of all. Except for the tine when it’s dangerous for other reasons and people might want to pay attention to stopping a potential world war or something harmless like that.

“I do think it’s a worry,” Ezekiel Emanuel, vice provost of global initiatives at the University of Pennsylvania and another of the authors, said of the risk that Russia’s attack on Ukraine will drain attention and funding from the Covid response. “And part of the reason to lay this out is to emphasize that that would be a huge mistake, and a really, really serious flaw.”

Tradeoffs? Don’t talk to me about tradeoffs. Tradeoffs.

“We’re not going to normal 2019,” he noted. “There are things that are going to be better. Our surveillance system better be better. Our indoor air quality system better be better. Our willingness to put up with [for] short periods of time — and around certain vulnerable populations — having special public health precautions. All of that should make a big difference in the mortality.”

That is actually all perfectly reasonable when they put it like that, but it hardly needs over a hundred pages to say ‘do the things we should have been doing in 2019 anyway.’

I do wish they’d use that language to talk about proposals. Be clear that you’re pitching something that was long overdue before Covid-19 showed up, and we can talk about it. Yes to better indoor air quality. Yes to masks and taking time off when you are sick, or in special situations. When I visited the hospital I wore a mask in the common areas and yes of course that makes sense. I only wish I’d also worn longer sleeves to ward off the insect bites.

Last week I didn’t get to the whole circus around DeSantis telling a student they should remove their mask during an outdoor event because it was stupid, but that they could do whatever they want, which they did. Here’s a mom of one of the students and some other people expressing outrage about it. This was then widely called ‘bullying’ so I wonder what one calls it when people are told they must put on masks by force of law.

Think of the Children

Walensky expresses some regret over being over-optimistic about vaccines, in particular in not warning people that effectiveness might wane over time. Yet if it happened again, even if they knew what they know now, would they act differently? I doubt it. There were a lot of people who would not have gotten vaccinated if they had thought they would have needed a booster, or would have opposed vaccine mandates. Reassuring everyone that they would not need a booster was part of the sales pitch, and vital to the sales pitch going as well as it did.

This did later hurt booster adaptation, but I doubt it hurt it all that much. The damage was more of a general-loss-of-credibility type, and that’s the road that’s been chosen in general.

Thus, were authorities ‘too optimistic?’ Only compared to a world in which their goal was to communicate what they knew, rather than find a not-outright-lying-too-obviously way to communicate the message that would get the reaction they wanted.

Back when the vaccines first arrived, I remember speculation on whether immunity would wane over time. It was certainly possible this would happen, but at the time I saw no reason to expect it as a default, and I would have bet on there being less waning than there turned out to be. Also even with the unexpected waning and without a booster it’s still a pretty good vaccine.

There’s a better version of our authorities that carefully warns us that immunity might wane, and if executed systematically I believe it would lead to better outcomes, but it would only make sense here in the context of an extreme shift towards that world.

Thread on vaccines in children, yes they work, you should space the doses more.

Then there’s this thing that seems to have happened.

The sign and policy I’m sure do exactly that, and also at minimum involve a lot of unnecessary lab work and bother and also probably some kids skipping sports.

The whole myocarditis scare thing has done orders of magnitude more damage than myocarditis, while also increasing children’s net risk of myocarditis.

Then again, Florida disagrees, and recommends that healthy children not get vaccinated. This does not appear to have any legal consequences, but it will no doubt decrease uptake there and likely elsewhere. It also gives us a fully clean and legitimate anti-Florida talking point, as opposed to most anti-Florida talking points that seem to mostly be Florida Derangement Syndrome of some kind.

In NYC schools, children under 5 must continue to mask while older children can get on with life. This is of course exactly backwards since younger children are at less risk and pay a higher price for needing to have masks, but the word ‘vaccine’ is magic. Also, there’s this rule that you don’t have to mask if your child care facility includes an elementary school, which is conclusive proof that this has little or nothing to do with physical reality.

In Other News

From America’s finest news source, FDA being unusually helpful.

Article at Medium argues against very idea of focused protection in the Great Barrington Declaration by assuming its conclusion, and dismissing all targeted proposals as either part of the implemented Narrative for everyone and thus irrelevant, or as not part of the implemented Narrative and thus impractical and impossible. This is the standard level of such discourse.

New Russian conspiracy theory is that USA was developing Covid-19 variants in biowarfare labs in Ukraine. So, Yahtzee?

In response, USA claims to not have biological or chemical weapons. Did this raise or lower your probability that the USA has biological or chemical weapons?

(My answer to that question: No.)

Vaccine shipment from Lithuania to Bangladesh cancelled due to lack of support for UN resolution condemning Russia. This is very much Not Helping and Not the Way, and hopefully will remain an outlier.

Recent rise in UK cases seems to be driven by incidental testing, which doesn’t mean it isn’t a real (although small) rise. It does mean there is little worth worrying about unless the trend continues quite a lot in ways I do not expect.

Hopson over at NHS is now writing blog posts on how to be an anti-racist organization, which seems like the very definition of everything going back to normal.

When I went to buy croissants at the wonderful La Maison de Macaron this morning (hint: get there at 8am as they open if you can, so the croissants will be maximally fresh), I asked them about reopening their lovely dining area. They responded that after a week of having it closed, they realized that even before Covid having it open was costing them money because they weren’t a full restaurant, so they’re keeping it closed. This makes me sad, it was my favorite place to take people to meet. I wish there was a way to support it, but Americans so despise table fees that I fear any attempt to charge what it costs would backfire.

Not Covid

Heckler speaks truth to power.

Walking more (taking more steps) associated with reduced all-cause mortality and some of this might be real but I’m going to assume this is largely correlation that isn’t causation.

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21 Responses to Covid 3/10/22: We Have a Plan

  1. Minor nit: “ultra-violent light”.

    Personally, I’d leave it that way and put in a pic from your favorite shounen anime. But that’s just me.

  2. If you can get access to Paxlovid in time, there is a huge (perhaps 90%+) decline in the downsides of getting Covid-19, thus consigning the whole thing to not be a big deal even with another surge.

    True for many, but not for all.

    My sibling got COVID-19 a few weeks ago. Even though I found him paxlovid nearby, his physician (sensibly) would not prescribe it due to interactions with other essential medications that were in play. So… antibody infusion.

    He got sotrovimab, back when that still worked. Sotrovimab no longer works vs Omicron/BA.2. Yes, there’s bebtelovimab, or will be, once we gear up to make it (and buy it).

    The point I drew from this is that while paxlovid is wonderful, it’s not for everyone. We need to keep up the pressure to make mab infusions available (“available” as in: manufactured, stockpiled, paid for, logistically positioned near patients, HCPs educated about writing scrips for it, clinical resources to do the actual infusions), and to keep making new versions to keep up with the virus.

    But yeah, for the majority of people paxlovid is absolutely great. Probably pan-coronavirus effective too, based on orthologous proteases in other coronaviruses, and that’s good news we haven’t really understood yet.

    • TheZvi says:

      Yeah, I do get that you don’t get to full 90% because you can’t give to 100% of the people due to time, supply and interactions and all that. And if you know you’ll be in that category, and also there’s a huge surge, and you’re in a high-risk group, maybe you should start to care somewhat when that happens. But I think you need ALL of those to hold.

  3. thechaostician says:

    There are two things which I found surprising about the situation in Hong Kong, as told by Bloomberg:
    (1) It sounds like they are having problems with transmission within nursing homes. I thought that this was mostly a solved problem, especially if you’re willing to impose draconian restrictions.
    (2) The elderly in Hong Kong have lower vaccination rates than middle aged people. This is confirmed here: https://www.covidvaccine.gov.hk/en/dashboard/ . Over 90% of the people of each decade from 20-59 are vaccinated (one dose), including over 99% of the people aged 40-49. Above that, the vaccination rate falls and only 54% of the people over the age of 80 are vaccinated. Do you know why this would be?

    • TheZvi says:

      (1) I think it’s a solved problem for original strain but with Omicron and ineffective vaccines the level of draconian restrictions necessary once things are bad in general seems super tough to overcome. These people need direct physical attention, that’s why they’re there.

      (2) I don’t know why that is the case – presumably it’s a cultural difference based on historical paths through time? As in, they remember e.g. Mao, and want no part of a Chinese vaccine? Pure speculation.

    • Yuring says:

      Once there’s astrazeneca, which killed elders. Then there’s vaccine hesitation.

  4. Bob says:

    “as high on it as Scott Gottlieb” link is broken.

  5. A1987dM says:

    > ultra-violent light
    Best. Typo. Ever.

  6. Cumulo Nimbus says:

    A question for fellow readers – the US still requires a negative PCR, irrespective of vaxx status, taken 24 hours before boarding your aircraft, for arrivals from overseas. Meanwhile country after country after country is dropping this condition of entry.

    What prospect is there of this dropping soon? I travel to Chicago April 10th and the last thing that can fuck me up for a trip that I really, really, really cannot miss is testing positive before I fly…

    • TheZvi says:

      Not zero, these things happen suddenly, but for April 10 I would assume this is still going to be in place. If it was May 10 I’d think you’d have a decent chance.

    • Dave Kasten says:

      US still generally requires a negative _test_, but note that it does not need to be PCR. Can be what in some countries is called a “proctored ART” — i.e. an rapid antigen or similar test done by a medical professional rather by yourself, with results reported in a way that meets government requirements. (This is probably easier to find, cheaper, avoids risk of lab delays, etc., and was what I did when I recently returned from overseas to US).

      You can also travel with documentation that you’ve _fully recovered_ from COVID in the past 90 days.

      See https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-international-air-travelers.html

      I have no insight into odds of the current rule changing by your desired timeframe.

  7. Rotten Bananas says:

    Update from HK: One type of compulsory testing (that involves queuing at testing stations) replaced by rapid testing self-reporting reported cases dropped back to 20-30k level from the change; compulsory universal testing plans (the type China does) indefinitely suspended; closures extended to 4/20 at least (!) but barbers are reopened with vaccine passports.

  8. sorendunn1@gmail.com says:

    I am confused – people are dropping restrictions because COVID cases and deaths are dramatically down from where they were a month ago, but assuming cases drop down to the level of the CDC ensemble’s weekly increase in death predictions for 4 weeks from now (4408) and remain there that still leads to COVID being the 4th or 5th leading cause of death for the US. Are we just accepting this level of cases as inevitable or are we projecting cases will continue to drop significantly even more than four weeks in the future? Any clarification on this would be much appreciated!

  9. Matty Wacksen says:

    >Hong Kong graph

    The variable that matters is the area under the graph; right now this is still much smaller than the one under the US graph.

    >The whole myocarditis scare thing has done orders of magnitude more damage than myocarditis, while also increasing children’s net risk of myocarditis.

    Source? I was under the impression that for children the risk of myocarditis from the vaccine was far higher than the risk of myocarditis from covid.

  10. cph says:

    Hong Kong is a preview of what could happen on a much larger scale throughout the rest of China very soon. The thought of that is both terrifying and heartbreaking. Yesterday’s 7d avg death rate in HK was 33.74. That death rate in China would mean almost 50,000 deaths in a single day—a full order of magnitude more than the worst day in the US. A humanitarian disaster caused by political hubris and nationalism. (Though that’s usually the cause, isn’t it?)

    I don’t expect it to get there—not all of China is a dense city—but it’s terrifying to even consider it. However I think it’s within reason that China’s death rate gets to at least double the US’s worst, which was a little over 10.

  11. Bean says:

    China does have a clear path towards diffusion. It’s the same as everywhere else: using vaccines to lower the risk of transmission until it’s negligible. The zero covid strategy is supposed to buy time for vaccine development while keeping deaths at a minimum and healthcare resources freed up in the meantime.

    I’m not sure why you refer to zero covid as a time bomb. Would you say that the planet is sitting on a smallpox time bomb? Should we have accepted smallpox as an endemic disease rather than pursue a zero smallpox strategy?

    Also, what do you mean by “let up?” They’re reopened several times. That’s why we occasionally see headlines about lockdowns.

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