Coronavirus: Links, Discussion, Open Thread
Will things get worse before they get better?
Feb 16 | 148 | 664 |
So far there have been three waves of coronavirus cases in the US. The first wave was the beginning, when it caught us unprepared. The second wave was in July, when we got sloppy and lifted lockdowns too soon. The third wave was November through January, because the coronavirus is seasonal and winter is its season (also probably the holidays). From Johns Hopkins CRC:
A fourth wave may hit in March, when the more contagious B117 strain from the UK takes over. Expect more shelter-in-place orders, school shutdowns, and a spike in cases at least the size of July's, maybe December's. That will last until May-ish, when the usual control system (more virus -> stricter lockdowns -> less virus -> looser lockdowns -> more virus) moves back into the "less virus" stage. Also coronavirus is seasonal and summer isn't its season. Also by that time a decent chunk of the population will be vaccinated. The worst consequences of the UK strain should burn themselves out by late spring.
Prediction: 75% chance that there will be a new wave peaking in March or April, with a peak at least half again as high as the preceding trough.
[EDIT: some people link new studies saying the B117 strain is less virulent than previously believed, and the US has been getting much better at vaccination since I checked, probably my prediction above is too high and we should worry less about this]
We should also be concerned about a fifth wave (possibly overlapping with the fourth wave; they may not have obviously separate peaks). Virologists have identified two new strains, one in South Africa, one in Brazil, which probably have "immune escape" - the ability to infect people who have already gotten, recovered from, and developed antibodies to the original strain (or been vaccinated against it). Both strains already have a few cases in the US. It will take them a few months to spread to the point where they're relevant, but they should eventually be the majority of new cases.
Prediction: 66% chance that sometime this year, the South African and Brazilian strains - or other new strains with similar dynamics - will be a majority of coronavirus cases in the US.
Some sources describe these strains as "vaccine resistant". This is a matter of degree. The UK strain is probably very slightly vaccine-resistant (most sources are describing it as not vaccine resistant, but if you look closely this is another "well we can't prove it is" situation, and the best point estimates suggest some tiny amount of extra resistance which probably doesn't make a big difference.). The South African strain is significantly vaccine resistant. The Brazilian strain is too new to know much about, but seems to be very similar to the South African strain and I would be surprised if its numbers differed very much.
In terms of preventing sympomatic infections, the best current data suggests that the Novavax vaccine is 96% effective against Coronavirus Classic, 86% effective against UK, and 60% effective against South Africa. AstraZeneca is something like 80% effective against Classic, 65% effective against UK, and the South African study was kind of bungled but our best guess is "seems pretty bad". Johnson and Johnson is 66-72%+ effective against Classic and 57% effective against South Africa. Pfizer/Moderna hasn't been tested against South Africa in real life yet, but lab studies suggest slightly decreased efficacy.
The good news is that vaccines which protect inconsistently against infection are probably still good at protecting against severe disease and death. For example, although the J&J vaccine is only 66-72% effective at preventing people from getting symptomatic disease, it's 85% effective at preventing severe disease, and (at least so far in studies) 100% effective at preventing deaths. In fact, most vaccine studies have shown 100% efficacy at preventing deaths. Probably some of this is that the trials are underpowered to detect rare outcomes, but the vaccines really do seem good at this, even with strains that have some level of vaccine resistance. Also, although I don't know of any studies investigating this, it makes sense to think that vaccinated people would also be less likely to transmit the virus to others if they do get it.
Prediction: 55% chance that later, when we have great evidence on this, we’ll find that P/M, Novavax, AZ, and J&J all cut deaths from all extant strains by at least four-fifths.
When the fifth wave strikes in late spring/early summer, some of the population (~50%?) will be vaccinated, another part of the population (~25%?) will have had the disease already, and the rest (~25%?) will be completely vulnerable. The new strains will probably cause a limited number of mild cases among the vaccinated/resistant, and a larger number of more severe cases among the vulnerable. Either way, the presence of the larger vaccinated/resistant contingent could potentially make this less severe than previous waves. Also, we may have learned more about treating severe COVID (with eg ivermectin, fluvoxamine), which might further decrease deaths.
R in most US states right now is closely clustered around 1. Mutant strains are more contagious, enough to bring the R0 up to 1.5 or so. But having a lot of the population vaccinated will bring it back down again. Also, I'm acting like there's some complex-yet-illuminating calculation we can do here, but realistically none of this matters. It's not a coincidence that all US states are closely clustered around 1. It's the control system again - whenever things look good, we relax restrictions (both legally and in terms of personal behavior) until they look bad again, then backpedal and tighten restrictions. So we oscillate between like 0.8 and 1.2 (I made those numbers up, I don't know the real ones). If vaccines made R0 go to 0.5 or whatever, we would loosen some restrictions until it was back at 1 again. So unless we overwhelm the control system, R0 will hover around 1 in the summer too, and the only question is how strict our lockdowns will be.
In autumn, if we haven’t already vaccinated everyone there’s a risk things will get worse again because of the seasonal effect. Also, for all we know maybe the virus will have mutated even further and become even more vaccine resistant. Now what?
Vaccine companies say it should be pretty easy to create a vaccine targeted to the South African strain. Remember, it only took them two days to invent the original coronavirus vaccine. This one should be even easier, since we already know the principles involved. The vaccine is basically taking a part of the coronavirus' chemical code which functions as a "password" and telling it to the immune system so it can break its password and defeat it. The mutant coronaviruses haven't done anything fancy, they've just changed their password. The vaccine companies can plug in the new password to the vaccines they already have, and they'll work against the mutant strains.
But even if they have it tomorrow, that's...what? Another four months for studies, one month before the FDA is able to meet to discuss an approval (you can't rush meetings!), two months to ramp up production, and five months of Distribution Hell while we argue about who should be first in line and prosecute people for distributing vaccines too quickly. So maybe by this time next year you get a vaccine against the South African strain. And by that point the virus will have just changed its password again and we'll be right back where we started.
The problem is, all the virus has to do is change its chemical "password" - a simple one-step process. The people fighting the virus have to go through the entire FDA approval, production, and distribution pipeline each time - a seven million step process. This puts us at a bit of a handicap.
Best-case scenario, here's how we respond:
The FDA declares that all vaccine approvals it's already granted are extended to include minor updates to respond to new mutations, indefinitely. They agree that the general method is safe and effective, and so whenever the virus changes its password, the vaccine companies can create updated versions of the vaccines which include the virus' new password. Maybe they retest for safety (easy) but not efficacy (hard). Maybe this works for some of the vaccines involved but not others, I'm not sure.
Then they act as if they want vaccines to be produced. They subsidize all the existing companies and factories. They allow anybody to manufacture vaccines and charge market price for them, subject only to usual safety restrictions. If Amazon wants to get into the vaccine distribution business, for God's sake, let them. If that means some poor people can't afford vaccines, the government throws money at them until they can.
I don't think any aspect of coronavirus response so far could fairly be described as "best-case scenario". But if we manage to pull it together this time, I think we could bring the time from "discover new strain" to "vaccine for that strain is in your arm" from the current ~12 months down to ~2. Even granting it will take a few months to ramp up to this much better regulatory regime, that would be enough to give us a vaccine with full efficacy against the South African strain before it completely sweeps through the the US.
At that point - about six months from now - the real endgame starts.
Some number of people will have gotten vaccinated against coronavirus. Polls are kind of inconsistent about how many people plan to do this, but it looks like 66% is a good guess. Some additional number will have already had coronavirus. So at some point we get herd immunity to Classic, and at some slightly later point we get herd immunity to South Africa, even though it can potentially infect vaccinated people a little.
Then the virus mutates again. Mutation rate is a function of number of cases, so as number of cases goes down mutation rate should also go down, but number of cases probably isn't going down to zero in the US for a long time if ever, and parts of the Third World are going to take forever to be vaccinated, either for logistical or political reasons. We're not going to literally eradicate the coronavirus this year, and probably not this decade. So it will always have a chance to mutate and become more vaccine-resistant, and the new vaccine-resistant strains will give it more chance to transmit and therefore more chance to mutate, and so on.
Each new mutation is another 2-12 months of vaccine scramble. Also, although 66% of people are willing to get one vaccine, I think a lot fewer peopple are going to be willing to get a new vaccine every 2-12 months, especially if there's no guarantee it will end anything, and especially especially if lockdown is over and coronavirus has left the news cycle.
The most likely way this ends is that the coronavirus becomes another seasonal flu. Every year, the flu mutates a bit. Every year, we tell people to go in for their flu shots which make them immune to (our best guesses about) this year's flu. Every year, in the winter, flu sweeps across the world, a little slower in highly-vaccinated countries and a little faster in unvaccinated ones, and kills a six-digit number of people. Every year, this sucks, but at least in First World countries most of the elderly have been vaccinated and so it's less bad than it could be.
This is how I picture the coronavirus situation ending too. Enough people get vaccinated that it's no longer an abnormally dangerous pandemic. Each year, it mutates a little bit, and we change our vaccines a little bit. Unusually at-risk people and unusually-conscientious people get the vaccine; everyone else ignores it. Then we let it happen, mourn the dead, and go on.
Prediction: 60% chance that in 2022, public health officials recommend that you get “your yearly COVID shot”, even if you have previously been vaccinated against COVID
(I want to make it clear I'm not saying COVID is currently "just the flu". It is currently much worse than the flu. Once everyone is vaccinated against several strains of it, the additional burden of a new strain might be no worse than the flu. Or it might be several times worse than the flu, but still on the same order of magnitude, to the point where it’s worth deploying the same intuitions to think about it. I doubt very much it will be as bad as it is now.)
[EDIT: Tomas Pueyo thinks this might not happen because the mutation rate is pretty low. But Trevor Bedford thinks the mutation rate might actually be pretty fast. Right now we’re not sure whether COVID is just picking the low-hanging fruit for good mutations or actually really good at mutating; depending on which of these is true we might or might not see the flu-like pattern.]
I don't usually think about this, but a biologist friend confirms: the number of diseases is increasing over time. More and more pathogens evolve to take advantage of human dominance of the planet. Cows and monkeys are out; humans are the Next Big Thing in the infection industry. Health care improves faster than diseases evolve, so on net fewer people die from infectious disease each year. But just because we're winning the race in general doesn't mean we win every leg. New diseases just occasionally get added to the world and stick around permanently. Fifty years ago nobody had to worry about AIDS; now lots of people do. The coronavirus will become a part of daily life, and it's going to suck.
I expect people to worry about this about as much as they worry about the flu now, ie not much. But I'm not sure exactly how it plays out. There will have to be some moment at which shelter-in-place restrictions loosen up and stay loose. I hope this will be as an adjustment to gradually increasing vaccination rates and gradually decreasing case numbers, and not as an unconditional surrender because we can't get our act together and the stress of new vaccine-resistant strains becomes too much.
On the opposite hand, some of my patients are anxious that lockdown will never end. Often these people are a bit paranoid or have a political axe to grind. But are they 100% definitely wrong? Some changes probably won't revert: at least some businesses have expressed some level of plan to go permanently work-from-home. I bet we'll pick up the Asian custom of wearing masks in crowded areas if we feel sick. Doordash-style food delivery companies were always going to grab market share; COVID just sped up the process - but it sped it up a lot, and it wouldn't surprise me if a lot of restaurants never re-opened, or only re-opened "in the cloud". I'm rooting for a permanent suspension of restrictions on telemedicine; now that everyone has seen it can be safe and effective, it would be perverse for the government to reinstitute all the roadblocks after things clear up.
Beyond that, we move into the really paranoid stuff. What if we never have rock concerts or music festivals again? What if places want you to wear masks forever, because there will always be a little bit of coronavirus or flu or common cold floating around? I think the chance of this is really low, less than 1%. But I hate to say 0%. Grade-school kids used to wander around town on their own or in bands of friends, playing games and exploring. Then there were various panics about child kidnappings and people insisted kids stay within their parents' sight at all times. Now crime is way down, people have stopped panicking about kidnapping, but they'll still call the police if they see an unattended kid because that just isn't done. There are whole countries whose cuisines are still built around weird decisions they made as part of World War II rationing. I really don't want this to happen, but I also didn't want normalized perma-surveillance after 9/11, which cured me of thinking anyone cared very much what I wanted about this kind of thing.
Prediction: 90% chance that on an average day in mid-2022, on an average street in the SF Bay Area, fewer than a tenth of people will be wearing face masks.
I think we're far enough along now that the possible endings are scattered across a narrower region of probability space. Right now the best things governments can do is approve existing vaccines, work very quickly on a regulatory framework for constantly-changing vaccines, and start a flu-style program for ensuring a yearly coronavirus vaccine featuring up-and-coming mutant strains arrives at doctors' offices in time for the start of winter disease season. I’ve heard rumors that some officials are already thinking along these lines, which is heartening.
Prediction: 50% chance that sometime in 2021, the FDA grants a pharmaceutical company general approval for coronavirus vaccines which can adapt to changing virus strains without going through the entire FDA approval process again, and that whatever fast-track lane they get takes less than three months between creating the vaccine and it being approved for general use.
This is the revival of the old Coronalinks / Open Thread, so feel free to use the comments for any coronavirus-related discussions you want to have.
Oh, and in case you’re one of the new readers I picked up this weekend and you don’t know how it works: I record all these predictions and grade how I did at the end of the year. You can see my past record here and by following the links at that post. If you disagree with me, consider telling me what confidence level you would assign to the statements I made, or making predictions of your own.
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It's a little far out to be speculating about this but I wonder what the unintended consequences of fast-tracking regulatory approval for more modular vaccine platforms will be. It's something we obviously ought to be doing, but I wonder what the world of vaccine, or even drug development, looks like when modular platforms are orders of magnitude faster to get to market.
I've heard that if the process for such a modular vaccine platform is straightforward enough, it could have huge implications for other viral disease. No one has vaccinated against "common cold" because there are several hundred different viruses, and no one wants to go to the trouble of getting a shot to prevent half a percent of all common colds. But if you can just upload a spike protein (or whatever) from each of those several hundred viruses into a single platform, and get a single shot that protects against all of them, then people would be willing to get that shot. And if it takes only a couple months from sequencing to injections of vaccines in arms, then flu vaccines will be able to keep up with the current season, instead of being based on the strains predicted last year.
Yeah, isn't this sort of regulatory model what led to the Boeing 737-8? Fast tracked re-approval for "small incremental change" in what was previously approved - abused by those who benefit from shorter approval timelines.
Except that the risk to going slowly for Boeing was losing market share. The risks of going too slowly for vaccine approval are that a big, known number of people die, and as long as that’s appreciably bigger than the risks of vaccinating it makes sense to do it. If we needed the 737 max to airlift people off an island where a predictable number of them would certainly die, we might say the risks were worth it.
A good place to start answering that question would be to look at the thalidomid-scandal (nightmare fuel), research what went wrong there process-wise, and whether subsequent regulation was overkill. Or if the mistakes that were made would be likely to happen without any government regulation at all. [or if you want to get fancy, if existing drug regulation already prevented much greater harm.... like 50k crippled babies instead of only 20k crippled babies]
Then look at the outbreak of AIDS and look for takes on how many lives the delay in approval for medicine against it took. And then look for more examples for either side.
And then try to look for radically innovative drugs and if they could have plausibly happened sooner.
Also whether experts think if revolutionary drugs are likely to still be discovered, at all. [which would support deregulation to find them faster]
I'm not sure AIDS is a good example here. Lots of unanswered questions in my mind, e.g. why the rush to proclaim it was caused by a virus (HIV)? why is there no vaccine for HIV? what is the evidence that HIV virus causes AIDS? to name a few. This is based on reading I did last year that surfaces as I was diving into COVID-19 science - as a hobby, not as a virologist. If I am out in left field or out of the ballpark entirely, I am more than ready to be corrected.
Wait, are you actually questioning whether HIV causes AIDS? Or are you, like, taking the perspective of scientists in the 80s?
The former. It's a tangent in this thread but I can look up and pass on my sources if there is interest.
Well, that's the go-to anti-FDA story in libertarian circles.
And I am in no rush to doubt the three facts about AIDS, I remember from high school. So I do think, that you are out of the ballpark entirely.
But this is not my ballpark. Nor do I really want to play ball there.
Assuming I could perfectly trust your reasoning for this extraordinary claim (which I'll stay agnostic about), I still would not want to invest the time to understand it.
Sorry, that's rude, but AIDS is a happily irrelevant topic in my life :)
Like @David Gretzschel said, I think a thalidomide-scale scandal is inevitable under this policy... the question is, would it still be worth it, in terms of lives saved ?
Hmm.... I didn't say that. But I just laid out that this would be where I'd start researching. [if I really wanted to know, which I don't, cause that sounds like work]
My prior is, that the precautionary principle is entirely useless butt-covering and that companies/researchers would know not to create Contergan-babies (or similar disasters), whether bureaucrats set up hoops for them to jump through or not.
All I could really do is just argue the "rah rah government bad rah rah free markets good"-perspective, which at this point would bore everyone here (including myself) to tears.
Of course the main regulatory barrier is proving efficacy, which is unrelated to the thalidomide situation, which was a safety issue (and of course proving safety was required even at that time). The issue with thalidomide was the failure of science: "During this period, the use of medications during pregnancy was not strictly controlled, and drugs were not thoroughly tested for potential harm to the fetus... [because] At the time of the drug's development, scientists did not believe any drug taken by a pregnant woman could pass across the placental barrier and harm the developing fetus"
Ok, I should amend my statement to say that a thalidomide-style scandal is inevitable in general; but it is much more likely under a policy that allows untested drugs to be released into general use.
Obviously no corporation *wants* to have a thalidomide event, but there's never any way to financially justify any kind of extensive testing, especially if such testing causes you to delay deployment. It's always going to be significantly cheaper to just bet on everything going ok, and then dealing with the eventual fallout.
Well you have to balance the "thalidomide scandals" with the "UnknownX" scandals of all the drugs that we couldn't get that cost thousands of lives- the coronavirus vaccines being one obvious example. Thalidomide killed 2,000 babies and disabled thousands more, but the lack of a free market in coronavirus vaccines plausibly cost hundreds of thousands or millions of lives. Which maybe was your point.
There's a similar rule for medical devices. I think it's generally fine, but it's occasionally led to problems like a small substitution in the material used in a hip replacement device causing friction and corrosion which let to heavy metal toxicity and tissue death around the implant. Still, I think reasonable standards could be set and we could learn from whatever mistakes come up.
Great article! Regarding COVID becoming a new flu-like situation, I read this insightful take on it that bets that it won’t: https://twitter.com/tomaspueyo/status/1359170996008325123
"Eradicate" is a really high bar. I believe that measles and polio meet all the criteria he mentions, but we haven't managed to eradicate either of them (though polio might be eradicated any year now). There are currently far more covid cases than polio, so I don't think it'll be easier to eradicate than that.
Although I don't think that COVID will be eradicated, through the combination of vaccines + drugs + cornering it into lower risk populations its damage will be greatly diminished. More details about that here: https://cosmicmiskatonic.substack.com/p/clubhouse-russia-and-the-end-of-the
I mean, if covid is just as frequent as measles, then we can likely give it substantially less thought than we currently give the flu - we give measles less thought than the flu, and I believe that measles is far scarier than covid.
Yeah, I think that will be the gist of it. COVID is so dangerous now because nobody has immunity to it. Once big swaths of the population do, and that immunity is updated for at risk people through vaccines as variants arise, its danger will diminish greatly.
The next big question to answer will be when will countries with a zero tolerance policy (China, Australia, NZ, Singapore) will relax it to restart global travel.
This is simply untrue. Lots of people have immunity to it, whether via related coronaviruses, having gotten sick and recovered, and people who have gotten vaccinated. Then there are those of us who pay attention to the world around us, and have been "overdosing" on Vitamin D since the beginning of this vast kerfluffle.
But there's a huge range in between "flu-like situation" and "eradicated", and ISTM measles and especially polio are much closer to the latter than to the former. If we brought COVID down to the level of polio, we would go fully back to life as we knew it in 2019, except for stuff which in retrospect we should already have been doing back then (e.g. not going to the office in person when you have a cold, or at least wearing a surgical mask if you *really* need to).
My guess for the prevalence of COVID in OECD countries in 2023 would be
~20% chance COVID > flu,
~45% chance measles < COVID < flu,
~30% chance polio < COVID < measles,
~5% chance COVID < polio.
Yeah, after reading this post I was wondering if COVID was really mutating fast enough to pull off a second round of vaccine-resistance (presumably each mutation is less likely than the last, assuming an equal number of opportunities?) let alone N rounds of it. Thanks for linking that thread, which gives a pretty persuasive No to my question. Having seen it, I'd peg Scott's "yearly COVID shot" scenario at more like 30% probability.
I've heard a lot about Vitamin D's efficacy (or lack thereof) in treating COVID. Right now, my overall takeaway is something like "Being deficient has very bad correlations with outcomes, mediocre studies tentatively suggest that supplementing vitamin D could have very good causal effects on outcomes, for some reason we have yet to do non-mediocre studies on this yet." I've been taking 6000 IU per day, since I'm not exactly basking in sunlight these days so it'll improve my bone health if nothing else and even a 10% chance of it being protective against COVID has massive ROI. What evidence have other folks seen? Opinions by knowledgeable medical professionals / replication-crisis-y folks especially welcome.
To start things off, some links I've seen:
Big list of studies: https://vitamin-d-covid.shotwell.ca/
Twitter thread on why a recent pro-supplementation study is very poorly done and misleading: https://twitter.com/fperrywilson/status/1360944814271979523
Zvi on Vitamin D, from a while ago: https://thezvi.wordpress.com/2020/09/10/covid-9-10-vitamin-d/
Scott on why you should never believe anything about Vitamin D: https://slatestarcodex.com/2014/01/25/beware-mass-produced-medical-recommendations/
Right now, I put around 40% chance that supplementation is Seriously Good, 20% chance it’s mildly good, and 40% chance it’s only as good as it is in a normal winter (i.e. worth doing but not worth stressing about much more than flossing). Hoping the other replies in this thread will let me update those odds to be more confident one way or another.
Funny, I made my comment before reading the Scott's post on vitamin D. This section from that post may very well describe the situation: "every couple of months someone breathlessly announces that their correlational study has found vitamin D protects against Disease X, when what they actually mean is that Disease X (like practically every other disease) decreases serum vitamin D levels and so the disease state is associated with low Vitamin D levels."
I've generally been skeptical of the claims that a given supplement helps various diseases and for that reason this is the first time I've mentioned it publicly. I feel a little embarrassed about bringing it up now and I probably won't again.
Drake, Do you have go to Twitter follows for Covid related stuff?
Yeah, Vitamin D seems like a real missed opportunity for public health. Especially here in Canada, where sunlight is a distant memory this time of year.
Movie director Tyler Perry has advised black people to get some sun during winter or take Vitamin D supplements. It seems like that advice falls in the Can't-Hurt-Might-Help category of good things to do.
Yeah, this is one of the few health issues where I can imagine race per se mattering, and not just poverty/culture that's correlated to race for whatever reason. My pasty white skin is an adaptation to northern latitudes, where sunburn was less of a risk than vitamin D deficiency. If vitamin D matters significantly, then we'd expect some seasonality/latitude/skin colour correlations with medical outcomes.
(God, does it ever feel gross agreeing with Steve Sailer on anything even vaguely related to race. But I suppose that someone who thinks everything is about race can be right once in a while if we live in a world where anything is about race.)
Skin color is connected to race, but not exactly the same thing, if that helps.
Hence "even vaguely related". But yeah, the key point on these issues is not to treat people differently because of things that don't matter on an individual level, and this one actually does matter on an individual level (if my knowledge of biology is accurate, at least - I won't swear to that, but it does seem to make sense).
As I understand it, vitamin D is one of the few cases where there are different medical standards based on race. Black people have significantly lower serum vitamin D than white people in the US, but seem to have adapted to that lower vitamin D level somehow. So the 'normal range' of serum vitamin D is a function of race; the same serum level that will show up as an issue for a white person's panel will be categorized as normal for a black person.
I'm completely ignorant of the research on the topic, so I have no idea how correct they are to do this (or how they handle mixed-ancestry people; presumably they might have dark skin without the low vitamin D adaptation or vice-versa?)
Black people used to all live in places close to the equator, where the greater exposure to sunlight surely meant that they had far more vitamin D in their bodies than when living in far more northern places (especially when compounded with office-dwelling, rather than an outdoors lifestyle). So surely they are way below their normal range?
Black people seem to not have the kind of bone density problems due to vitamin D deficiency that white people have, but the vitamin has many other effects.
Most of us are clearly getting a lot less sunlight than our non-office dwelling ancestors (or even our pre-computer ancestors), so I would recommend compensating for that, as we are surely adapted for far higher levels of vitamin D. So taking modest amounts of very cheap supplements that bring us up to the levels of our ancestors seems wise. I don't see any downsides here, especially since toxicity is very low.
This also resolves the mixed race issue. IMO, people can scale their intake based on the season, how outdoorsy they are, the food they eat (fatty fish in particular) and their skin tone, but I see no reason to do so based on (racial) genes.
I forgot age.
I think the evidence is it's not protective, but I agree that given the low risks taking it anyway is reasonable. I'll post about this later.
Not protective against what - the virus or severe symptoms?
Vitamin D should be combined with vitamin K, to prevent kidney stones.
It's really hard getting some decent recommendations. Drake is talking about 6000iu a day of (presumably) D3. In the UK the recommended daily allowance is 400iu a day. Zoe looked at a 400iu kind of dose and came to the conclusion that it might have a slightly protective effect in some women. I suspect most research that hasn't shown much in the way of effects hasn't gone near 6000 iu, and I'd be willing to guess that 400iu won't cut it.
While a decent study with a decent amount of D3 is not around yet, I'm taking 2000iu a day.
6000iu sounds a bit high, tbh.
6000IU is on the high end, yeah. I did look into this beforehand, and my impression is that tolerable upper intake levels under 5000 IU/day are quite conservative. See e.g. https://www.ncbi.nlm.nih.gov/books/NBK56058/, which from a quick read doesn't seem to find any evidence of toxicity in adults at levels under 10,000 IU/day and suggests a sustained intake of 25,000 IU/day is where one should start worrying. Plenty of sources seem to be of the opinion that existing recommendations are lowballing it, e.g. https://pubmed.ncbi.nlm.nih.gov/16549491/, which points out that just being outside all day can give you the equivalent of 10,000 IU (other sources quote something like 4000-25000 IU from sub-sunburn doses of sunlight). Given that I weigh more than the median human in these studies, barely go outside, and am closer to the poles than the equator, I'm inclined to aim a bit higher.
The RDA's across countries are _bananas_ – sometimes orders of magnitude apart. The science is pretty bad overall in this whole area.
I'm a firm believer in the efficacy of Vitamin D in both preventing and treaing covid. Here are some of my notes:
December 2020 -- relationship between Vitamin D deficiency and COVID-19 is strong.
January 2021 -- https://www.youtube.com/watch?v=bQyhjQUjHjU David Davis MP and Vitamin D. Promoter of Vitamin D as an immunomoderator.
Vit D initially thought be important for bones and muscles. Then promoted for immune system.
Nordic countries == fewer COVID fatalities and food fortified with Vitamin D
Feb 13, 2021: Spain, convincing therapeutic evidence -- Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study -- https://youtu.be/oYK9-zvJF_k
Your Feb 13 link refers to the study I mentioned above; it has serious flaws. In particular, their randomization was not on a per-patient basis, but on a per-ward basis, and of course different wards could have radically different populations of higher- or lower-risk patients. See this twitter thread for an explanation of some of the issues: https://twitter.com/fperrywilson/status/1360944814271979523
As I was shoveling snow I was thinking with regard to Vitamin D / covid trials, the attitude people (including me) take with regard to the trial quality corresponds highly with their preconceived notions as to the effectiveness of Vitamin D.
Anyway, thanks for sharing your perspective and supporting facts.
It is frequently recommended for menopausal women and I've been taking it for a few years now. My depression went away shortly afterward. It doesn't prove causation but it is definitely suggestive since there is a correlation between depression and vitamin D levels. As one ages, one's skin becomes less efficient at synthesizing vitamin D. I can't see where a deficiency in any vitamin would be helpful, so I'm continuing to take a small daily supplement. I admit that I have hopes that it is of some small advantage regarding coronavirus although I haven't seen any good studies (or more accurately reports of good studies) either.
The toxicity level is high, but still people should be aware that it is possible to take too much.
> Prediction: 50% chance that sometime in 2021, the FDA grants a pharmaceutical company general approval for coronavirus vaccines which can adapt to changing virus strains without going through the entire FDA approval process again, and that whatever fast-track lane they get takes less than three months between creating the vaccine and it being approved for general use.
I think this prediction is far too low: the initial emergency use authorization for the Moderna vaccine took ~5 months from completion of the first trials, and that was for a new technique. Now that it's a proven technique, I'd expect that it'd take far less time the second time around.
Modeling the FDA as making decisions on the basis of reasonable common-sense ideas about what it should take to approve things doesn't seem to have a great track record, though. Also, general approval for all future changes of a given type != quicker approval for a single new minor change.
There's also a major difference between an emergency authorization for a specific product when there's nothing else available, and blanket authorization for unspecified variations for the indefinite future.
What is your definition of "proven technique"?
Solid set of predictions and reasoning.
I want to give feedback that the big grey boxes with blocky text look fairly ugly to me. At first I thought they were straight-up bugs, or inserted screenshots from elsewhere. I think I’d strongly prefer the reading experience of blocks-of-italics. (But not sure!)
Woah - I cannot edit my comments after-the-fact on Substack. Hmm, much more hesitant to hit post.
Strongly seconded; especially with chronological sorting, this biases the first comments people see towards errors and typos. Edit functionality for comments (even for just a 5m window after posting) is probably my biggest Substack feature request.
I like the gray boxes when I read the article in my email inbox, but after reading your comment and then rereading in website I agree. It looks like there's a slight size difference and that's exacerbated by the blocky font. Maybe gray box with a slightly different font? I'm not a fan of reading long blocks of italics.
I would like to suggest Slanted Roman as an alternative to italics. https://tex.stackexchange.com/questions/68931
Unfortunately I'm not sure HTML+CSS lets you choose between the two, within a given typeface, and I imagine Substack gives you even less control.
Fact: Monospace font makes technical and analytical text up to 50% more official and authoritative.
However, I would suggest taking a window-shop at the available of lovely monospace fonts out there: https://www.youtube.com/watch?v=nv40SUNH8Iw
The current choice looks (if I'm not mistaken) to be Ubuntu Mono, which is an excellent choice. Although I wonder if that's just my computer's settings being applied to this site somehow.
It's not Ubuntu mono for me, despite that that *is* my configuration that I do see on other sites.
Ubuntu mono would be an excellent choice though.
This is what I see: https://i.imgur.com/6IK9Dpn.png
Not Ubuntu mono (look at the bottom right of a lowercase a - ubuntu mono doesn't have a sticky-outy bit there.)
That's in Chrome - I do see Ubuntu mono in FireFox. Firefox is more respecting of fontconfig settings than Chrome, generally.
Ah that's interesting. Here's what I see (pretty sure Ubuntu Mono):
https://imgur.com/a/uE5w2da
This is in Qutebrowser, which is distantly related to Chrome.
Nope, that's not Ubuntu mono, this is Ubuntu mono: https://i.imgur.com/8kjacMg.png (compare the lowercase a).
Yours is different again to what I have in Chrome though, and I can see why you'd mistake it for Ubuntu mono based on e.g. the lowercase L.
Ah yep, you're right, and it was the lowercase L that messed me up. Now I don't know what's going on.
Honestly, I kind of liked them. They punch up the text a bit, but not garishly.
I've seen a lot of reports of brutal side effects, particularly from shot #2, of the mrna vaccines. It's possible, I suppose, that this would go down with more careful dosing...but as is, I think this alone nukes any possibility that everyone takes a Moderna/Pzifer shot yearly. (And once everyone isn't going to be doing that, game theory says you shouldn't.) Not least because the accumulated total risk to serious reactions goes up, as far as I can tell, and both autoimmune/allergic things seem (to my non-expert view) to only get worse for most people. I think it's highly unlikely we all get our yearly covid shots.
That is to say: either we crush it right now with the first round of vaccines or *the game is over* and we should give up. And we've missed the chance.
Why does game theory say you shouldn’t? Expected return on vaccine is far above expected cost either way.
I'm 33 and in good health. My chance of a serious coronavirus infection round to zero. ("What about long covid????" What about it? I'm not convinced it's real; I saw some interesting data that it's really just something Scott talked about many years ago during med school: if I trip and fall into a hospital inpatient bed, they're gonna immediately discover all the things that were already wrong with me.).
I want a vaccine now because it'll protect /let me see my parents and let us re-open society. When we've given up on either half of that, what's the expected QALY return I see from a vaccine? I doubt it's significant, and in particular quite possibly lower than my chance of a serious vaccine reaction, which only gets worse. (Not least because I have a history of anaphylaxis.)
I think you've got the game theory backwards on this.
If everyone else is going to get vaccinated, then herd immunity kicks in and your chance of getting infected is drastically lower, so the risk of side effects of the vaccine is larger relative to the risk of covid.
If no one gets vaccinated and new strains are an accepted fact of life, the risk of side effects is now relatively lower to the risk of covid.
I strongly disagree with "And once everyone isn't going to be doing that, game theory says you shouldn't" since I think game theory points in the exact opposite direction.
Your personal expectation about the risk of a side effect for you / risk of infection for you is a different matter than the theoretical game theory question.
I'd encourage you to make an attempt to compare the risk of side effects with the risk of covid, since it sounds like you so far haven't actually crunched numbers on that. Both of the risks are pretty low, but I think you'll find the risk of side effects to be low enough too that you may end up with a different conclusion.
You are right that the more people are vaccinated, the more I can free-ride on them. Sorry, that was a bad way to phrase my actual belief, which is that most people are not going to co-operate with defectbots. It's a bad idea to take a vaccine to save the rest of society at some cost to yourself if society is predictably going to stab you in the face for that.
Didn't he just say he did that analysis? Risk of COVID ~= zero for people his age. Risk of side effects ~= very high. Also, risk of unknown side effects = unknown. There are serious scientists discussing the possible risks for long term autoimmune disease if mRNA vaccines crossing the blood-brain barrier out there, which has supposedly happened in mice, but it takes at least 6 months for the first signs of such damage to become visible.
Also, there seems to be a lot of talk about vaccines not actually stopping you from getting infected or transmitting onwards, in which case it's not actually a vaccine at all but a therapy. If you aren't sick why would you take a therapy?
This logic is why governments will end up forcing people to take the vaccine, or at least stand by whilst they let other people force people to take the vaccine. It's not a reasonable thing for the vast majority to take. "Herd immunity" remember, is the very concept epidemiologists spent most of 2020 collectively dumping on, so good luck convincing everyone they have to take vaccines that bypassed the approval processes on a regular, recurring basis, when they won't get seriously sick anyway and herd immunity supposedly isn't a real thing.
Sorry, re-reading my post I should clarify that what happened in mice is the mRNA vaccine particles crossing the BBB, not auto-immune disease, at least as far as I know. My sentence could be parsed multiple ways and I don't want to create unnecessary panic (only the right amount of panic ;)).
If it takes 6 months for damage to become visible, we'd know about it by now, since Moderna completed its phase II trials in mid-July (and it started the trials earlier than that).
That's good to know.
Even conjecturing if damage is evident after 6 months, we wouldn't actually know until the longitudinal studies are completed in 2, 5, 10, etc years. It's a huge population with an established frequency of naturally occurring illnesses, and possibly a small subset of legitimately vaccine-injured. It is extremely difficult to prove that this latter subset actually exists, even as it approaches being obvious. Especially as the control group is shrinking. This is a point I'm particularly concerned about. I personally think it was a mistake for the FDA to ever approve a first-in-human treatment for this in the first place, but can't really do anything about it now.
That's not true. The 2009 Swine flu vaccine, Pandemrix, used in Europe, caused hundreds of cases of narcolepsy. People's lives were destroyed. The extent of side effects of mRNA vaccines is incomplete particularly the long term ones, people need to take their own risk assessments. If I was young and at low/no risk, it would be foolhardy to take it.
It depends on whether you think people have any motivation to take the vaccine for social reasons. People with anaphylaxis might avoid the vaccines, but plenty of others would be happy to do it as a way of volunteering to help society.
I agree with Mek: I can't speak to your personal anaphylaxis risk of course, but for most, even younger people, the risk of vaccine is effectively 0 (unless you put high weight on unknown long-term risk), and risk of getting seriously sick with Covid is not. Not talking long covid or near-death, just getting seriously ill. It was not just old and sick people filling the hospitals in LA county last month.
I shouldn't say the risk is 0 of the vaccine: I should say the risk of side-effects is much lower than the risk of getting moderately to pretty sick from covid.
Though I wouldn't characterize it as "brutal side effects" as GP did, I've been hearing the vaccine makes some people sick enough that they need to take a day or two off work. Unusually annoying for a vaccine, but much better than actually catching covid.
Anecdotally, this is exactly right. Spouse and I, as well as another family member -- all in essential worker categories -- recently had the second shot, and all three of us had pretty bad cases of flu-like symptoms (specifically: fever, chills, sweats, muscle fatigue, headache) lasting ~16 hours and costing a night's sleep. Miserable! I would not look forward to making an annual ritual of it.
Which vaccine did you get, if I may ask? I've been wondering if the different vaccines have different rates of these flu-like side effects but I haven't found anything on that. I'm definitely a little worried, because my reaction to flu vaccine has been so bad I had to stop getting it.
Excellent username, btw :)
Pfizer.
I, too, have had similar (but lesser) reactions to flu shots, which I used to think was all in my head. But even those reactions were enough to trigger some motivated reasoning where I would talk myself out of trying too hard to get my flu shot.
Thanks for the data point! For a couple years I thought it might be a coincidence or psychosomatic but then one year I couldn't raise my arm for several days and my knee got swollen and I had difficulty walking for a week-ish. I have autoimmune issues and my rheumatologist ended up saying it was reasonable for me to not want to take it anymore. I want to be vaccinated for Covid and I may not even have a choice which one but I find myself trying to form.a preference anyway.
Is that last sentence definitely correct? A lot of people supposedly get the virus without any symptoms at all. Of those who do get it, or at least report they had it, a few days off feeling rubbish seems to be the usual course of the disease unless they're in the small minority that needs to be hospitalised.
It would make a kind of logical sense for the side effects of the vaccine to be similar to the side effects of actually getting the disease. The mRNA vaccines make cells look like they're infected and then the body goes and destroys them. The difference is the lack of self-replication, but if you read the reverse engineerings of the mRNA code itself it's clearly been heavily optimised to produce as much spike protein as possible. It's not totally clear to me that the number of cells your body will end up killing due to the vaccine is guaranteed to be lower than any possible SARS-CoV-2 infection. A small infection could presumably be killed off by your body before it reaches the level of cell takeover the vaccine is able to achieve.
Well, and a lot of people get the vaccines without any side-effects at all
Anecdotally, an individual of my acquaintance, not known for taking time off work, wound up taking about 2 weeks off immediately after receiving his first covid vaccine - the one where the next shot is supposed to be 4 weeks later (not sure which of the 2 that is, and he didn't recall which one he'd been given) - and blamed his inability to work on the vaccine.
My suspicion is that the vaccine was not the cause of his illness - it was just very bad timing. But I don't know that for sure. And I spoke to him briefly by phone during this period; he was pretty clearly not his normal energetic self.
What's your best estimate for the expected QALY of a covid infection for someone in good health and under 40?
And if you're trying to convince *me* to take a vaccine, I mean, I want one badly now. My point is that this idea that we're going to first convince the FDA to allow, then convince the population to *take*, a new covid vaccine every year is highly unrealistic. There simply will not be buyin, because you're offering them a sucker's bet.
I don't have an estimate for you my friend. I probably should find one. I am not trying to convince you personally to take a vaccine: I don't know your health history and I am not a medical doctor.
I'm not certain we will do an annual coronavirus vax, but even if we did, I don't see why it's so unrealistic. We do it with the flu. The flu sucks to get. The coronavirus often sucks to get. We can do flu and COVID at the same time. Not everyone will take it, just like not everyone takes the flu vaccine. But we can try to encourage it for people who can.
I just don't understand the sucker's bet portion of your statement: I know a lot of people who have gotten sick from covid, and a lot who have gotten the vaccine. Everyone would take the vaccine in a heartbeat. Bad side effects from the vaccines are extremely rare.
CDC suggest (very roughly) half of adults get flu shots: https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm
That will, it seems, do stone nothing to stop covid.
Right now we're pulling out every stop (poorly, because our government and society has lost the mandate of heaven^W^W^Wstate capacity) to convince *everyone* to get their vaccine. Suppose you're a normal person who doesn't think about this much pre-covid. But you hear your Congresscritter, your local mayor, and your favorite celebrity beg you to get your vaccine, and promise that if we all do, we can take off those masks, send your kids to school, and go back to work. You take the vaccine (and are sick as a dog for two days.)
Then you hear the paper tell you "Yeah, that didn't work, because of <boring explanation about mutations you don't care about.> So we're still locked down, but you should get the *next* vaccine. We swear we'll open up after that."
You are not getting 80%+ compliance with that second vaccine, even if we could produce it. The median person is going to tell you "fool me once!" and refuse.
Why would half of people getting vaccinated every year do "stone nothing" to covid? My understanding is that if 100% vaccination reduces R0 by a factor of 0.6, then 50% vaccination should reduce R0 by a factor of 0.3, which would still have been enough to stop this third wave, even if it wouldn't have stopped the first or second.
You think it will do nothing? I disagree... look at current slope of cases and hospitalizations.
Half of adults get flu shots, and that's without having experienced a massive flu epidemic that killed their neighbors, shut down society for a year, and led to the closure of their favorite restaurants. I think people will be more sympathetic, especially as they know more and more people who get vaccines and are fine.
I take myself for example: I was a little nervous, until a bunch of people I know have gotten the vaccine recently with 0 side-effects.
I agree that some people will feel quite sick for a day after a vaccine dose, and will be hesitant to do it again. Vast majority do not.
Which vaccine did your friends get? The side effects seem to vary quite a lot. mRNA vaccines are reported to often have quite strong side effects, but e.g. the Oxford/AstraZeneca vaccine (classical technology) doesn't seem to in quite the same way.
The Oxford/AZ vaccine is an mRNA vaccine, just using a different vector (chimpanzee adenovirus not lipid nanoparticles).
The only ''classical" Covid vaccines currently in use AFAIK are Novavax (recombinant viral protein from insect cell culture) and Sinovac (killed virus).
I don't think you can generalize the flu vaccination rate to covid, though. I have been really inconsistent about flu vaccines (maybe 1 in 5 years average), but I'd jump on an opportunity for a covid vaccine. I imagine a lot of people think like I do, and we'll see a much higher rate for covid vaccinations than for seasonal flu.
Flu seems rare enough among my contacts, and not severe enough, that it's just not much a concern (e.g. I don't think I've ever had flu in my adult life). Covid, on the other hand, is so contagious it seems like the smart choice to me, not only for my own health, but for people around me who might be more vulnerable.
I've been trying to figure out whether or not I've had flu! I've never really known what the difference is between "flu" and "cold", and I suspect that most people are similar. A significant amount of flu is likely either asymptomatic or only minorly symptomatic, and so my guess is that a lot of things I thought were "colds" were actually "flu". (At least, given the number of annual flu infections the CDC has said there are, it would seem quite surprising that I haven't had it.)
I'm guessing that I (and many others) will also be more serious about getting flu vaccines after this year.
The best data of COVID outcomes on a large-ish sample of young healthy adults (ages 20-35) that I am aware of is this paper :
https://www.nejm.org/doi/full/10.1056/NEJMoa2019375
which indicates a hospitalization risk of ~1%.
Long COVID is probably real but rare.
What we know comes from a mixture of prior studies about SARS/MERS infections, anecdotal evidence, and population surveys of recovered COVID-19 patients:
- We have evidence that medium-term symptoms exist, lasting up to three months, in about 10% of confirmed COVID patients
- however, we also know that we are only capturing 10-20% of actual COVID infected, meaning that this is likely an overestimate
- we also don't know how many of these symptoms were happening before infection, as you noted
- We have no evidence that symptoms last over three months, though they likely do. It is more likely that they fade over time, though.
- We have evidence that women are more likely than men to develop medium-term symptoms
- As might be expected, medium-term symptoms are more prevalent in older age groups (https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1792/6012625)
Based on what we know now, which isn't much, I would put the probability that a young, healthy, COVID-recovered male has significant medium-term symptoms so as to affect daily life to be less than 1%. That's also the same number that Derek Thompson comes to in his Atlantic article: https://www.theatlantic.com/ideas/archive/2020/09/what-young-healthy-people-have-fear-covid-19/616087. For me, not worth worrying about, but I don't begrudge anyone for taking their own personal precautions.
Yeah, this seems roughly right to me.
(I will also say that the described symptom bubble in Thompson's article really does ping a lot of the "this sounds like mass hysteria!" signals in my brain. I feel like that can't be the explanation, there's too much real stuff, but doesn't it feel like the story you'd get from a large societal delusion?)
s/bubble/bundle/
Reports of long covid are often reminiscent of reports of some other semi-existent causes of malaise like fibromyalgia and chronic fatigue syndrome. (This doesn't mean the people who claim to have them don't have medical problems.)
But, long covid could be real.
It reminds me a bit of the cases of chronic Lyme disease (/post-treatment Lyme disease syndrome). A lot of post-Lyme patients have reported that one of the biggest struggles was in even getting people to believe that what they were experiencing was real. I wonder if we're missing any long covid reports due to a similar effect, and if so, how many (obviously this problem shouldn't apply to population surveys of recovered covid patients).
This sounds right. But the fraction of infected 30-somethings that spend a week too tired to get out of bed is high enough that that alone seems worth worrying about. (Maybe not taking all these precautions with my life if I weren't also protecting other people from more serious things, but enough to motivate a good amount of care.)
Maybe you don't need a second dose?
In terms of side effects from the vaccines, in 3-6 months I believe we're probably going to "discover" that you don't actually need the second dose of some of the vaccines, or that it can be a half/quarter dose.
The British adventure in forgoing the second dose for most people will be very revealing, and even the existing data from the clinical trials suggests that the first dose provides very substantial protection from the virus.
If I'm right about this, then the risk of any vaccine side effects at all plummets substantially, which makes the math on getting an annual shot much easier for people to swallow.
Agreed, but now we're asking for the parlay of the FDA allowing rapid vaccine recodings and allowing a new dosing structure. I find either of these highly unlikely.
Can anybody explain why each dose of Moderna's mRNA vaccine is 3.3 times the volume on each dose of Pfizer's mRNA vaccine? Are there more filler ingredients in Moderna or did Moderna decide to just go with a bigger dose, or both?
My impression from reading the FDA write-ups of clinical trials back in December was that the second dose of Moderna packs a bigger wallop of side-effects than the second dose of Pfizer, but I didn't do a systematic analysis.
There are trials testing half a dose of Moderna, and preliminary data says it provides an immunity just as strong than a dose. Each company went with a "guessed" dose for their trials, because there was no time to test different dosages... so your hunch is probably right, and Moderna's dose is too big.
Thanks. How about the tested gaps between first and second doses: Pfizer tested 3 weeks and Moderna 4 weeks? How much were those decisions to have fairly short gaps between shots due to beliefs about what would be best for patients in the long term vs. what would be quickest to get the clinical trials over and one with?
I don't think that second part is completely accurate. Along with NIAID, Moderna did conduct a Phase 1 trial with two cohorts given different doses, 25 or 100 micro-grams, to assess safety and efficacy, as is usual in a P1 trial. The results were announced in May of 2020.
I double-checked my source, and you're right. He said that they didn't test many different dosages as usual, not that they tested just one. Now they're testing 50mg, I think?
The UK isn't forgoing second doses though, just delaying them in favour of more first doses more quickly.
Thanks, I should've been more clear with how I phrased that.
The effect is theoretically going to be the same though, until they pivot to giving second doses (in a few months). The incidence of coronavirus infections (severe or otherwise) will drop hugely among people who get the first shot, which will demonstrate that the second shot isn't extremely necessary.
Well, yes.
The justification given for giving the second dose after 12 weeks (instead of 3) is that the second dose only gives a marginal increase in protection ( https://www.bbc.co.uk/news/uk-55503739 ). It is thought, however, that the second dose might be important for longer-term sustained protection.
It's a bit involved, though, because the data from trials only tests the regimen used, and so some of the calculations are based on assumptions, interpolation, etc.
However, IIRC the Oxford/AstraZeneca trials found that a smaller _initial_ dose gave better protection.
Of course, in the case where we're getting periodic vaccine updates to account for new strains, the longer-term sustained protection angle might matter less. If I'm going to need to go back in a year or two to get vaccinated against new strains anyway I'm not concerned much about missing a second dose this year.
I think you're modeling other people as being overly similar to you, both in beliefs and approach to thinking through things. I also think you should rephrase "it's highly unlikely we all get our yearly covid shots" as a quantitative prediction.
The [law of truly large numbers](
https://en.wikipedia.org/wiki/Law_of_truly_large_numbers), plus high globel awareness, plus global info distribution at nearly c, plus media optimizing for engagement/fear/rage: Huge overrepresentation (in quantity and severity) of rare observations.
For sanity, what is a good Fermi estimate for
[number of really brutal side effects worldwide] / [number of shots administered worldwide]
?
Also, side effects of shot #2 means that the first shot did it's job very well, unless the side effects are of autoimmune nature, but very likely that would have been the biggest issue in every reported case.
"I've seen a lot of reports of brutal side effects, particularly from shot #2, of the mrna vaccines"
You might be exposed to a particular bubble, e.g. communities with a financial and moral interest to amplify "bad" side effects of vaccines. All studies and reviews we have so far show a very minimal amount of serious side effects, and relatively common minor side effects for most people (some fever, some pain at the site on injection, general flu-like symptoms for a couple of days).
Trial data, Israel data, UK data all agree on this.
Anecdotal but my wife is a nurse and her and all of her friends and co-workers have had pretty minor side-effects from the second dose (mostly fallen in the bucket of flu-like symptoms for a couple days). I think the characterization is where the disagreement lies though. To an individual, having flu-like symptoms for a couple days is pretty bad but from a medical perspective it is a "minor side-effect" because there is nothing medically significant about it that would require medical attention.
I'm sorry, I really disagree on "flu-like symptoms for a couple days" being pretty bad in any reasonable risk-reward evaluation, especially when actual Covid19 is more likely to give the same symptoms, for longer, with a small chance of worse ones, and with the added benefit of possibly infecting and killing your neighbours
A better form of evaluation is to see what those symptoms prevent you from doing. I had some minor arm pain the following day. I describe it as "helped a friend move a couch" pain. It didn't prevent me from doing anything, though the pain was greater if I lifted my arm above my head. So I decided to skip doing home repair work that day because I'm a wuss, but otherwise was able to work, etc. Ultimately, I wasn't prevented from doing anything.
If flu-like-symptoms prevent people from going to work or caring for their family, they should not be disregarded, even if they are considered "minor". Cost/benefit analysis requires summing across all costs, even when they are small.
In this scenario, those at greatest risk from COVID will tend to opt into getting vaccinated, while those with the least risk will tend to weigh "high chance of getting 1-3 days of the 'flu'" verses "very low chance of something worse" and skip the vaccine. Not everyone will get infected with COVID, and of those it's about 40-50% that have no symptoms, maybe more. Of those that get symptoms, the vast majority, especially of people without serious underlying conditions and below age 65, have relatively mild symptoms.
My bet is on very few people taking a vaccine that had a high chance of getting you sick to the point of missing work/family time. Based on current understanding of the side effects, I would predict 20% take a yearly vaccine. Most of them will be older and/or have ongoing medical conditions that make them particularly susceptible to COVID.
If what you are saying ends up being accurate, then it means that we might need mandatory vaccines at some point, or similar policies ("vaccine passports" to travel or stuff like that), or maybe to pay people like $200 to get vaccinated. That's if vaccines block transmission, of course.
So a couple things to clarify:
1. Symptoms were "flu-like" (body aches, fatigue, headache) but were probably quite a bit less severe than the actual flu. Some has it worse than others but for the most part it was "I feel crappy but if I HAD to do something important then I could"
2. Basically everyone I know who has had both doses had basically zero side-effects (aside from a sore arm at the injection site) from the first dose.
I still think there is no reasonable cost/benefit tradeoff that would tell you not to get the vaccine because of the tail risks of getting COVID (even if you're young and healthy), but if for some very particular reason you couldn't risk 1-3 days of flu-like symptoms then you should still get the first shot.
Private practice healthcare worker here who also has older patients so I've had conversations with several dozen people who have been vaccinated with Moderna or Pfizer vaccines. Sore arms for a day after first shot and then some hours (under 24 in every case) of low-grade fever, tired, or achy in a mild flu-like way after second shot for most people. No one had to miss work. No one had over 24 hours of feeling bad. Some people had no symptoms other than feeling a bit tired or noticed no symptoms at all. I think the image of 1-3 days of flu and missing work is very much not the standard response.
Right, sorry I didn't mean to suggest that the side effects my and her friends experienced somehow outweigh the reward of being vaccinated. My only point is that the severity of side-effects is subjective and most people would likely not characterize them as minor in the worst case (and the people in question described them as serious side-effects in colloquial sense even though none of them ever considered NOT taking the vaccine).
"with the added benefit of possibly infecting and killing your neighbours"
🤣
Do you not consider a minimized risk of infecting others to be worthy of consideration in your calculus?
I do. Most people won't. Relying on the kindness of strangers is a bad strategy.
It seems to me there are two overwhelmingly important variables for determining how "normal" things get in 2021. The first, which you mention but I think still underplay, is the extent to which vaccinated people are protected against severe disease and death even if/when the virus mutates to possibly be more (re)infectious.
The second, which it doesn't look like you mention, is the extent to which treatment protocols continue to improve, particularly treatments which can keep people out of hospitals rather than just saving their lives once they get sick enough to be hospitalized. The Treat Early folks are quite bullish on fluvoxamine and ivermectin, for example, and have a longer (and regularly updated) discussion here:
https://www.quora.com/What-is-the-current-treatment-for-Covid-19/answer/Steve-Kirsch
I think you'd perform a public service by taking a look at their evidence and saying whether/how much you think that bullishness is justified.
Thanks, I've added in a sentence on treatments.
Nitpick: you say "severe COVID" in that sentence and I don't think that's right: the idea IIUC is to find effective ways to treat *before* it becomes severe, unlike existing treatments like dexamethasone. This matters because if the earlier treatment works it reduces hospitalizations much more than later stage treatments, thus reduces risk that high levels of infection overwhelm hospitals, thus reduces justification for social restrictions to prevent high levels of infection.
Brazil is big on ivermectin for early treatment of COVID since July and it still one of the countries with the worse mortality/population around, so yeah, idk if that bullishness is justified.
Also COVID being a "winter" disease is kind of sketchy since Manaus, one of the cities worst hit by COVID in the world and the origin of the Brazilian strain, has only one season: Eternal Summer. Also, Brazil's "second" wave is hitting hard right now and it is summer here.
Also, it is summer right now in South Africa. Michael Mina talks somewhere about temporal clusters but the winter - summer bit may be a coincidence.
Yeah I wonder if the winter thing is just that we spend more time indoors in the winter and it seems to transmit more indoors. Are there any numbers on outdoor vs indoor spread of the virus?
Is there data on what % of newly-infecteds in Brazil actually got administered ivermectin and what their subsequent probability of hospitalization was?
But yeah, ivermectin evidence looks iffy to me too. Personally crossing fingers for a favorable result from the large fluvoxamine RCT being run out of the WUSTL, stopcovidtrial.wustl.edu, and hoping more trials like that will be run asap.
I've seen a number of people much better informed than me speculate that if you were exposed to one of the current 4 common cold coronaviruses for the first time in your 60s it might go as badly for you as a SARS-CoV-2 infection does.
It's possible/plausible. There are hypothesis that the 1889-1890 Russian flu wasn't in fact an influenza but instead the common cold coronavirus varient OC43 making the jump to humans from cows (the last common ancestor between the human strain the bovine strain being dated to right around then).
"There are whole countries whose cuisines are still built around weird decisions they made as part of World War II rationing."
You can't just throw this out there without a link! Total nerdbait. Simple searches just tell me how tough it was in a 1930s car with less gas available - I have to know!
My parents bought margarine rather than butter when I was a kid, which I think was related to it becoming standard due to WWII rationing. But also, The Establishment had managed to convince Americans that margarine was better than butter, so it just tasted right to them.
Here's a graph showing how butter consumption per capita plummeted during WWII:
https://www.unz.com/isteve/why-did-we-ever-eat-margarine-instead-of-butter/
But margarine consumption per capita kept growing into the 1970s.
There really was a sense in that era that new artificial products were better than old natural ones because they were more futuristic. For example, when making up shopping lists for Boy Scout backpacking trips in 1970, the first items on my list were Tang and Space Food Sticks.
Futuristic was better was indeed true for, say, laundry detergents.
But opinions have shifted when it comes to food.
Pad Thai
Wikipedia isn't sure about pad thai specifically, but it's confident that Thai cuisine moved away from rice and toward noodles as a direct result of WW2, which makes this probably the strongest example so far of what Scott mentioned.
https://en.wikipedia.org/wiki/Pad_thai
I can't pretend to know anything about this at all, but you're telling me (ie, Wikipedia is telling me) that due to a shortage of rice, Thais were encouraged to eat *rice noodles* instead of *rice*? Exactly how much less rice is in rice noodles than pure rice, per calorie consumed?
Hmm, good point. The wikipedia footnote points to https://web.archive.org/web/20191115203628/https://www.nationthailand.com/tasty/30345187 which claims the change was due to "the high cost of rice production". I also found https://gastronomica.org/2009/02/10/finding-pad-thai/ saying that noodles were promoted to address disease concerns. So, it's not a nutrition thing but maybe something about how one goes from crop to food-- noodles are easier to mass produce, store dried, and/or keep sanitary? I'm just guessing at this point, and it looks increasingly like WW2 wasn't the main factor after all anyway.
Thailand was neutral in WWII, but leaning Japanese, right? Did they export a lot of rice to Japan, or what?
Thailand was a part of WW2 as a military ally of Japan, they were strongarmed a bit into that though, and their main contribution was allowing Japanese troops to cross Thailand and invade Burma and Malaya.
Rice can be eaten cold a while after cooking, noodles are usually served after cooking, ie freshly sterilized.
* soon after cooking
Rice noodles can be made out of broken rice grains.
Not quite a result of rationing, but Okinawa has a big thing going for Spam, the canned meat as a result of US service people using tins of Spam as an exchange currency.
I don't know about whole cuisines, but three smaller examples:
* Carrot cake got popular during WW2 due to sugar rationing. People kept eating it.
* Carbonara pasta is (I'm told) due to to tons of eggs and bacon being provided by American soldiers in Italy. (I'm not sure I fully buy this? It's not like Italy didn't have a long cured pork tradition or lacked dairy.)
* Budae-jjigae is a Korean stew with spam and other meats highly available on American army bases. (Some Korean places will do a ramen version; strong recommend.)
My parents gave me a huge number of carrots when I was a child, which I very much liked. They told me carrots would improve my eyesight.
I only recently learned that the claim that carrots-improve-eyesight was RAF propaganda during the successful Battle of Britain in 1940 to offer a cover story for why British fighter pilots were so successful at spotting German bombers in order to keep secret the invention of radar.
True in vitamin A deficiency. No idea if that was a thing in WWII Britain.
Maybe propaganda used on a grain of truth to anchor an exaggeration for other purposes (hide radar from Germans, save sugar, what else?)
Carbonara pasta existed before WW2. The story I've heard is that it was associated with charcoal-burners (hence the name), who were out in the middle of nowhere for long periods of time and needed a dish they could make without fresh veggies.
On the other hand, Wikipedia mostly backs up the story you heard-- WW2 made carbonara what it is today: https://en.wikipedia.org/wiki/Carbonara
Fanta was invented in Nazi Germany as a Coca Cola substitute due to the US embargo, though it has changed considerably since then.
"The name 'Fanta' came during an employee contest to name the new beverage. Keith told them to let their Fantasie (German for imagination) run wild. On hearing that, salesman Joe Knipp thought of the name Fanta."
It... was a difficult time for imagination.
Mit Fantasie...... schmeckt das.
Polynesians love Spam, which I believe they were introduced to during the War in the Pacific.
Best example might be fish & chips in the UK (wikipedia says it was never subject to rationing). A smaller example is whale meat in Japan: https://www.wired.com/2015/12/japanese-barely-eat-whale-whaling-big-deal/
It's part of why UK cuisine is like that. (the other reason is that we urbanised before refrigerated transport and all the other technologies that let you form the complex supply chains needed to feed the cities without resorting to jellied eel and Fray Bentos pies)
"Why UK cuisine is like that"
I think you mean "Why UK cuisine up to the 1980s was like that".
UK cuisine nowadays (aside from Fish & Chips) is very much non-stereotypical and is probably (though I don't have data here) one of the more cosmopolitan/globalised palates globally?
British cheese is the big one I can think of. During the war, only certain kinds of cheese were allowed to be produced. This is a big part of why cheddar- and cheddar that only faintly resembles the cheese made around the town of Cheddar in Somerset- dominates the British cheese market. Most non-cheddar cheese production had to be revived by post-war enthusiasts.
Of course, it is also the case that non-industrial cheese production was in decline *before* the war, but rationing is what seriously affected the variety available.
https://www.thecourtyarddairy.co.uk/blog/history-british-cheese-20th-century-eradication-farmhouse-production/
Somewhat similarly to various wartime foods, the long reign of Bob Hope and Bing Crosby on postwar television was due in part to their being the kings of the hill during WWII. They had been brilliant technical innovators in the early 1930s who figured out the best way to incorporate the microphone into stand-up comedy and singing, respectively. So by the Forties they were the top of the pop culture heap. Then they remained huge figures into the 1970s with people who had emotionally bonded with them during the War.
Hope, in particular, built his shtick around being a coward--which seemed really funny and relevant during wartime, although it could be baffling to young generations. (Woody Allen borrowed Hope's persona of the nervous coward and updated it for a later generation.)
British beer was pretty strongly impacted. Mild ale - the most popular style as of the late 19th century - became a much weaker product largely to comply with WWI restrictions, and crashed in popularity in the mid 20th century, possibly in part because as the country recovered from WWII people got tired of drinking a beer that had been redesigned for no-longer-extant conditions of scarcity.
South Korea and an entire sub-cuisine built around Spam would be a good example.
Not directly because of rationing exactly, but related to WW2 era shortages.
Both Finland and Sweden celebrate a particular Lent-associated festival day by eating filled, sweet cinnamon buns: https://en.wikipedia.org/wiki/Semla
(It is very good and very easy dessert to make, recommended.)
The Swedish version is very traditional and has a long and proud history of pastrymaking evolution that goes back centuries and involves one dead king. Long story shortly told, the Swedish version is always filled with whipped cream and almond paste, sometimes served with hot milk.
In Finland, there is an alternative version which is also very common, with sweet jam (strawberry or raspberry) instead of almond paste; this is due to almond paste being rare, expensive and difficult to acquire product in Finland post-WW2, causing introduction of innovative jam version which became widespread. Nowadays, the difference in pricing is negligible, but the jam version was popular enough to become established product. However, some purists persist in their claim that the original almond-paste version is the only true orthodox pastry, sparking recurring and predictable mild debate and point of contention every year.
my main question is how long until I'm allowed to make new friends again? right now some people are doing online dating, but seemingly nobody (in Blue Tribe circles anyway) is making new non-romantic friends. And due to moving right before COVID started, I'm no longer geographically near all my old groups of friends.
It's painful to imagine that even if restrictions on public gatherings eventually ease, I might still have to basically live a totally solitary life for many more years, as nobody who would be in my social circles will be willing to interact with a new person. I really hope you are overestimating the effect the new strains of the virus are going to have.
If this is true I might have to consider either trying to move to a country like Taiwan or New Zealand where they can manage it more successfully, or else moving to a red state where people just don't care.
I'm planning on leaving the Bay Area in a few months if things don't significantly ease here. States like Florida and Iowa have made the (in my opinion, rash) decision to remove restrictions against the realizations we'll just have to live with the virus and return to our daily lives.
However, when most of our high risk populations have been vaccinated and deaths and hospitalizations have been reduced to an insignificant number, this decision won't look so rash anymore... but my guess is that the Bay Area and its citizens still won't update. The government here is content to continue imposing irrational restrictions and residents are content to continue practicing irrational overreaction against the virus.
Be aware there's probably significant populations near you that are doing less, they're just not telling you about it.
I live in NYC. No one I know is willing to so much as spend an afternoon inside a friend's apartment. Turns out outside of the nerd subculture...huge fractions of the city have resumed normal life and just kept silent about it. An ex of mine who is much closer to the club/fashion scene has been going to parties and dinners frequently; they're not public, but they're happening.
Oh yeah, for sure. I biked every street in Oakland over the summer and got to see pretty much every subculture over here. Normie populations are taking 1/2 to 1/5th the precautions that nerd/Blue Tribe populations are.
I'm much more of a normie than a nerd and have no problem making normie friends, but the problem in the Bay is that these secret normie parties are pretty much exclusively happening within already existing social circles. Thus, it seems to make more sense to go to a place where there's simply less stigma against restriction defection and try to build a social circle from scratch.
I agree but that's hard even in normal conditions. I was starting to think pre-covid I needed more normie friends and wasn't sure how to find it. Now when they're not even allowed to announce their presence?
Do something kinda social. I like (liked) rock climbing (in gyms). It's much more easy to strike up a conversation with a stranger when you're in a context _demonstrating_ that you both share similar interests.
"Rash" are we? DeSantis ordered the over 65 to receive the virus first along with "front liners". Those in those groups who want to take it are nearly all have done so. Life here in central coastal Florida is already back to normal other than masks in supermarkets for those who want it, though individuals and businesses are free to set their own policies in this regard.
>> Those in those groups who want to take it are nearly all have done so.
This isn't true. Florida's 65+ population is 4.7 million. Only 1.76 million 65+ers have received at least one dose of the vaccine as of yesterday.
https://www.floridadisaster.org/globalassets/covid19/vaccine-info/2021feb/vaccine_report_20210214.pdf
Many don't want to take it, as I said, but it seems I may have jumped the gun a bit, assuming that number is accurate. They will have it soon enough. The main point stands; that we are being "rash" is a mischaracterization borne of prejudice.
But your evidence for it being ok to reopen was wrong? That would seem to say that at least the reasons you were ok with reopening were also wrong right?
See responses below. Is it only FL who's bucking the CDC garbage about protecting the vulnerable first? The point is that he is getting it done in Fl.
If only 1/3 of 65+ people have gotten the first dose (out of two), "rash" seems like exactly the right word to use. Why not wait a bit longer?
Ivor Cummings a good follow on YouTube for Covid sanity. Here's a debate from past October discussing the lockdown issue. https://www.youtube.com/watch?v=Qgn4B2Iq2cg
Ivor Cummins (no "g") said in September that "around 80% are already de facto immune through cross-immunity, T-cells, prior coronaviruses" (source: https://www.youtube.com/watch?v=8UvFhIFzaac)
80% immunity would mean we pretty much had herd immunity already. This is obviously false given the larger waves which have happened since he made his prediction.
https://www.covidfaq.co/Ivor-Cummins-20d36373da834c8f884486a3302ac58e has more on failed predictions from the man. He's a diet guru with a Patreon, not an epidemiologist or virologist.
Nonsense logic, though he may have been wrong on that point. Who is correct 100% of the time? Use of the word Guru here is inappropriate and indicates intent to slander. He backs up what he says with plenty of "data" which seems to be the obsession on this forum. The WHO and CDC have been all over the place with their 'science.' Are you willing to discount everything they propose as well?
Why do you say "may"? He *is* wrong on that point, has not retracted, and continues to make incorrect statements, and conspiracist ones too (like governments timing lockdowns for when the virus was going to decline anyway to give the "illusion" that they work, or the PCR false positives stuff).
Use of the word "guru" here is entirely appropriate: he has a bunch of followers who think he's the bees knees, and a Patreon. I appreciate you may be feeling some sort of sunk cost/post-purchase rationalisation having donated to him, but it is not rational to do so. Slander is only slander if it is false, after all.
I don't really follow the WHO or CDC, as I'm in the UK, so I haven't really formed an opinion of them.
Interestingly, CovidFAQ says they will correct any noted errors promptly, however I contacted them to correct a factual error with their page on kids (they said 8x more transmissible in a study, I read the study, it said 2x) and they totally ignored me and did not fix it.
They don't say 8x anywhere, but they've got the numbers swapped in point 2 of https://www.covidfaq.co/Claim-Children-don-t-spread-the-virus-5eb4d5fac8ad4236b197fac77eb021d8: it's 7x more likely to bring in and 2x more likely to transmit, and that should be for 12 - 16 year olds according to figure 3 and following in https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948617/s0998-tfc-update-to-4-november-2020-paper-on-children-schools-transmission.pdf. They're on Twitter, may be try them there?
Here's an article listing doctors and researchers who find that masks simply are not effective. https://www.rcreader.com/commentary/masks-dont-work-covid-a-review-of-science-relevant-to-covide-19-social-policy
The short answer is because there's scanty to no evidence that shutting down the economy is helpful. Looks like DeSantis follows Drs and Scientists like the ones listed below, not just pronouncements from Fauci and Biden.
Here are bunch of simple charts mapping mask implementation and infection rates. https://thefederalist.com/2020/10/29/these-12-graphs-show-mask-mandates-do-nothing-to-stop-covid/
Alex Berenson is a good follow on Twitter for keeping track of covid related statistics. Here's some recent evidence that the vaccine isn't working in Israel, which moved aggressively to vaccinate Israelis: https://twitter.com/AlexBerenson/status/1361539340304801792
It is working; compare cases by age group.
The best case I've read is that it's made a marginal difference. So basically at this point like all the other measures tried in the west the result no significant reduction in cases (other than redefining what. that is the day after Biden was inaugurated) or deaths.
Troll
In January, WHO proclaimed that PCR tests are inaccurate with a high rate of false positives, then changed definition of a Covid case to require 2 PCR tests and a doctor's diagnosis. Just a coincidence, no doubt.
That was Jan. 23. Oh, and different countries have different requirements as to what constitutes a covid death, making any data set that doesn't tease this out somewhat suspect.
I also live in California, in a deep blue region of a deep blue city. When I walk down the downtown area, it seems just as packed as it was before the pandemic, and that's the way it's been since May.
What is your point? And please name names.
Suggestions as someone who just went through the same thing: connecting with those geographically distant friends through online board games and video games (Stadia is a great low cost way to start) has helped me. I was finding one of the things I missed most was doing activities with friends - and so just calling to chat wasn't cutting it. That said, it's still not as good as it was before (but it's nice to have not lost touch). Good luck!
How much were the three waves in the US over the last 11 months separate waves hitting the same people three times versus how much were they waves hitting separate people once? I really don't know the answer to that question.
The first wave hit some big cities, especially New York, and was very bad for blacks and Hispanics (especially, I'm guessing, Caribbean Latinos).
The second wave was worst in the Sunbelt air-conditioning belt of Arizona, Texas, and Florida, and hit Hispanics (especially Mexican Latinos) hardest.
The big third wave started in the Upper Great Plains and moved south with the cold weather. It hit non-urban whites hard for the first time, along with Hispanics for the third time. Blacks were not hit as hard in the third wave. For awhile, whites had a higher rate of excess deaths during the third wave than blacks did, although last I looked blacks had pulled even.
My guess is that a combination of being closer to herd immunity and "once-bitten, twice-shy" learning from experience makes places and groups that were previously highly vulnerable more hardened targets for the next wave.
By now, covid has has hit almost all of the country hard except, perhaps the northwest coast from the Bay Area to Seattle and upper New England.
Louisiana was hit in all three waves. Los Angeles, Texas, Arizona were hit in both the second and third. Michigan was hit in the first and third. Nearly everywhere got some hit from the third - even the Northwest and upper New England (though those regions still haven't been hit as hard as even many of the second waves).
But how much were the same places within states hit twice? E.g., Detroit got hammered in the first wave. Did the third wave hit Detroit again or mostly just the places in Michigan that weren't Detroit?
I believe El Paso was bad in both the second and third waves. I think New Orleans was at least two of the waves. Los Angeles was definitely bad in both the second and third wave. I don't know about Detroit.
I'm also pretty sure that Paris and Brussels were both hit bad in the March-May wave and also in the November-January wave.
Was any community hit by all three waves? Perhaps the big Navajo reservation?
The graph of new cases here in the Seattle area ( https://imgur.com/a/6W5bF3r ) shows the same waves as in the graphic at the top of Scott's article.
I think most regions had waves that approximately lined up with these national ones. But Seattle's high point on that graph appears to be about 30 cases per 100,000 per day, which is below the level that some places had in their *trough* between the second and third peaks. Which makes it hard to say whether Seattle really ever got any of the waves.
We were less hard-hit overall, to be sure, though they were still waves from the local perspective.
For comparison, OP suggests NY and AZ as places that may not have been hit by some waves.
https://imgur.com/a/CtH79Ri
AZ's first-wave bump doesn't look that far from trend and NY indeed seems to have missed the second wave altogether.
I've been obsessively following case rates in the Bay Area, and we had the same three waves as well. With some differences in magnitude from the national average, and the first wave is a bit fuzzier because testing was nearly nonexistent then compared to what it was in the 2nd and 3rd waves, but still three distinct peaks.
The "three different waves to three different groups of people" idea may have some truth in terms of what areas were hardest hit, but I think you can make out three peaks everywhere.
This discussion needs some absolute as well as relative criteria for what constitutes a wave. My impression is that in terms of excess deaths the Seattle and to a lesser extent San Francisco have never had a wave of the magnitude of New York City in the spring or the Dakota in the fall.
Here's Navajo County in Arizona: https://www.nytimes.com/interactive/2021/us/navajo-arizona-covid-cases.html
It seems to have been hit hard by the second and third waves, but not the first.
Here's Orleans Parish in Louisiana: https://www.nytimes.com/interactive/2021/us/orleans-parish-louisiana-covid-cases.html
It seems to have been hit hard in the first and third waves, though not quite as hard in the second. (Still, it did get hit by all three.)
New Orleans is a tourist town with a motto of "Laissez les bon temps rouler" and little tradition of following anti-fun rules like social distancing. So, it would be near the top of the list of predictable cities most likely to get hit hard by all three waves.
Hey Scott, Sorry if someone has already suggested it, but have you considered putting (/ having an intern put) the old layout back on the blog archive? It's a bit easier to read, and also has some nostalgia value.
I'll probably get around to it sometime, thanks for the reminder.
Hi - new member here, still learning the ropes. 1) the efficacy rate for flu vaccine is between 30% and 50%, which doesn't matter a great deal as the disease for many sufferers is not severe. It would suck if the rate for Covid vaccine stabilises around this number. 2) There was something last week (sorry, I wasn't tracking sources last week) about the vector used to propagate the Astra Zeneca vaccine. It is a chimpanzee vector. The story was, the human body when vaccinated learns how to prompt Covid19 anti-bodies the "chimp way" and that learning sticks - and when a new human-derived mutation arrives, the human body doesn't respond effectively.
Hard to know what you're referring to for sure without the source, but it sounds like you're talking about a common problem with adenovirus vaccines (like the AZ one) if you need to rely on multiple vaccines. Basically the adenovirus is like a 'package' that pass in whatever code you want to become immune to, in this case some covid identifier proteins. The problem is that your immune system also learns to tear up the adenovirus itself, basically ripping up the package before it has a chance to deliver the important bit. So if you've already gotten an adenovirus vaccine, you might not be able to get another one that uses the same base virus.Thats why the AZ vaccine is using a chimp adenovirus, because humans haven't been exposed to it before, but we don't really know for sure if you'll be able to make a small tweak for new variant and have it work the same way. It might be a one time use option (but we really don't know). Here's a link with everything you could want to know in much better detail https://blogs.sciencemag.org/pipeline/archives/2021/02/08/how-you-make-an-adenovirus-vaccine
Thanks Endmash - diligent searching failed to locate the source - my bad entirely. Although I did come across this tidbit from a news report https://www.sunstar.com.ph/article/1883079/Davao/Local-News/AllYouNeedToKnow-AstraZenecas-Covid-19-vaccine : "Based on the interim analysis by Oxford University, which has been peer-reviewed and published in The Lancet on December 8, 2020, Covid-19 Vaccine AstraZeneca "has an acceptable safety profile and has been found to be efficacious against symptomatic Covid-19 in this interim analysis of ongoing clinical trials." Trials were conducted in Brazil, South Africa and the UK." The takeaway is that the AZ trials were conducted in the 3 countries that now have the identified Covid19 variants.
The better news is that COVID-19 prompted the real and serious development and rollout of the mRNA vaccine platform and proved the safety and efficacy of a vaccine developed in literally 48 hours. That gives us an incredible technological platform to be able to use an mRNA influenza vaccine and potentially slash mortality and morbidity because we won't have to "guess" what the dominant strains will be months in advance, we'll be able to literally roll the active strains in…live. As it's happening. This is a huge deal for influenza and it will be a huge deal for other pathogens as well.
I'm not sure the flu vaccine does *anything*. If you graph the year-by-year deaths from the flu, and then try to guess which years they messed up production (wrong strains, production failures), you couldn't pick them out.
I still got my flu shot because it probably doesn't hurt, and we really do not want the flu and covid doing any gene transfer this winter.
Perhaps a prepper-like splinter culture of "CoViD recluses" will develop: people who either move to remote rural locations, or to "filtered communities" with elaborate protection including domes, UV lamps, air filtration, and so on.
Ethnic minorities will be stereotyped as infectious ... wait, that happened before.
I'd love to see more discussion of three issues:
*It seems that restrictions (lockdowns, dining bans, etc) are ultimately driven by a need to prevent hospitals from being overwhelmed. If that's true, is the policy of vaccinating high risk people going to lead to a de facto herd immunity strategy in the general population?
*Do we need to implement draconian border controls in the near term to prevent even more dangerous new variants from spreading? So far the new variants look the vaccines should be of some benefit. But there's no guarantee that will continue to be the case. And we seem to have a really pitiful ability to catch new variants in time.
*There's been some suggestion that the new strains are more virulent in children. The loss of life in QALY terms has been better than it could have been in part because Covid seems to mostly kill the very old or infirm. Given the vaccine dynamics, it certainly seems that it would be fitness boosting for that to be the case. How much of a concern should that be. And what can we do about it, if anything?
How incredibly weak are our current border control methods that the new variants seem to come into our country just fine, presumably by airport? I haven't flown but thought that there was at least testing going on.
NZ isn't letting anyone in without current NZ citizenship. And even then they have to sit in a quarantene hotel for 14 days — or longer if they develop symptoms. Travelers have to pay for this out of their own pockets.
I'm sure out hospitality industry can use a boost to their bottom line right now, though! I'm all for it. Seriously! But I don't think any politician on either side of the aisle would have the guts to implement a full lockdown of legal travelers to the US. Illegal border crossings are another problem all together. Trump's wall isn't working as well as expected in the areas that it's been built...
The virus isn't sneaking in through Mexico, is it? At least, the original version came in on airplanes into New York City.
There is a lot of policy space between "almost no one can come, and even then they have to quarantine for two weeks" and "ehhhhh, whatever, fill out this form saying you aren't sick right now."
First cases in the West Coast came in from China. First cases in NYC came in from Iran.
During the first wave the US infected Mexico. I think there were some infections from cruise ships along the Pacific coast, and there was some evidence that outbreaks around Guadalajara came in with the US retirees who winter down there. Mexico City's first outbreak was traced to China if I recall.
It looks like we will have between 125 million and 150 million vaccinated after Biden's first 100 days. Beyond that somewhere between 60 and 100 million already have the antibodies. At the low end 185 million are resistant. At the high end, 250 million. So, there are fewer and fewer people who can spread a March bump.
"It looks like we will have between 125 million and 150 million vaccinated after Biden's first 100 days. Beyond that somewhere between 60 and 100 million already have the antibodies."
Unfortunately, there may be a fair amount of overlap between those two groups.
Where are you getting that from? Metaculus says 150 million vaccinated by July 1.
I'm not sure what Metaculus is pricing in a la vaccine skepticism, but we're doing 1.7 million doses a day right now with ~55 million people already vaccinated, so ~300 million doses around ~July 10th. And I think it's a safe bet that the # of vaccines per day will continue to trend up.
55 million doses already given* not people vaccinated
Even one dose of Pfizer, Moderna can provide significant protection from COVID-19. It's been shown that single dose can prevent hospitalization if people are infected after that 1st dose.
Also some percentage of people infected don't develop full immunity. They're susceptible to a second infection, but so far it looks like second infections are less severe, too.
Does anyone around here (or maybe on Metaculus) have predictions for whether or not there will ever be challenge trials (in the US or elsewhere)? Besides the obvious effect challenge trials should have on all other related predictions, this also potentially impacts my personal decision of whether or not to get a vaccine when it becomes available to me (as I would like to volunteer for a challenge trial).
What would challenge trials be used for? At this point, any testing for future additions to these vaccines will just be for safety, not efficacy.
I'm confused: wouldn't vaccines need to be proved effective against new strains? Or is that part of what fast-tracking means?
We need to prove the first vaccine effective in order to start using it, because we wouldn't want to tell millions of people they are vaccinated if they aren't. But if all we've done is add another strand of protection, then the efficacy test can just be vaccination of the general population - if the new batches start arriving in late March, then everyone vaccinated after that has a possible additional protection, and hopefully a few months later we would have data showing that they do.
The entire point of a challenge trial is to reduce that "a few months later" to a matter of weeks instead.
Also, you're assuming the new vaccines are just the old vaccines + a little bit extra, whereas I was assuming they were their own thing (albeit based on similar technology, so some of the steps could be skipped). I think both options are possible but still personally place a higher probability on my assumption. (I acknowledge that I'm not being very precise here; I haven't been following this whole thing very closely.)
The way the mRNA vaccines work is that they just sequence the RNA of the virus, figure out which part codes for the spike, and then they synthesize that same RNA in their factory and get it into the lipids and then the vials and then people's arms. They're really fast to design and get out there. We wouldn't need to wait until the new bit is proven effective, if it's been proven safe, since it would just go in along with an existing injection that has already been proven effective at what it's doing.
I would imagine you could recruit young military volunteers for human challenge tests of variant vaccines.
A problem with new clinical trials for vaccines is that the really require a major wave to get over and done with in a reasonable number of months. If there is no 4th or 5th wave for six months, we could be twiddling our thumbs for six months waiting for a large enough sample size.
This is especially true with highly efficacious vaccines like mRNA. One reason the Pfizer/Moderna dragged on a long time was because the vaccines were so effective that there were few cases in the vaccine arms, so they had to wait longer to get their agreed-upon sample size almost completely out of the placebo arm. (Of course, another reason was that Pfizer stopped processing samples in late October until the day after the election, blowing past its 32 and 62 checkpoints, in order to not announce results before the election.)
"(Of course, another reason was that Pfizer stopped processing samples in late October until the day after the election, blowing past its 32 and 62 checkpoints, in order to not announce results before the election.)"
Do you have a source for this? Why would Pfizer risk winning the vaccine race (and billions in profits) by waiting until after the election?
I got it from Matthew Herper's interview with Pfizer executive William Gruber in StatNews on November 9, 2020
https://www.statnews.com/2020/11/09/covid-19-vaccine-from-pfizer-and-biontech-is-strongly-effective-early-data-from-large-trial-indicate/comment-page-7/#comment-3047884
“Gruber said that Pfizer and BioNTech had decided in late October that they wanted to drop the 32-case interim analysis. At that time, the companies decided to stop having their lab confirm cases of Covid-19 in the study, instead leaving samples in storage. The FDA was aware of this decision. Discussions between the agency and the companies concluded, and testing began this past Wednesday. When the samples were tested, there were 94 cases of Covid in the trial. The DSMB met on Sunday.
“This means that the statistical strength of the result is likely far stronger than was initially expected. It also means that if Pfizer had held to the original plan, the data would likely have been available in October, as its CEO, Albert Bourla, had initially predicted.”
So, if Pfizer had stuck to its publicly announced plan for when to unblind its results, with a first unblinding after 32 cases and then another after 62 cases, they would likely have announced the vaccine’s success before the election (probably on Monday, November 2nd, one week before the actual public announcement), and Trump might have won. But, instead, they stopped processing samples until the day after the election, by which point they had almost triple the number of cases needed to make a determination.
That's one of the more remarkable news stories of 2020, but virtually nobody has heard it.
"Why would Pfizer risk winning the vaccine race (and billions in profits) by waiting until after the election?"
Probably because Pfizer feared being seen as helping Trump. Recall this gloating article in the New York Times on November 1:
"Welcome to November. For Trump, the October Surprise Never Came.
"Trump’s hope that an economic recovery, a Covid vaccine or a Biden scandal could shake up the race faded with the last light of October."
https://www.nytimes.com/2020/11/01/us/politics/trump-october.html
I sure can't say that Pfizer made the wrong business decision. After all, only about 0.001% of the populace even know that Pfizer shut down their lab's processing of clinical trial results until after the election. They stopped the count. But hardly anybody knows that. It's not like it's easy to learn how clinical trials work and see what Pfizer did.
I laid out the evidence here:
https://www.takimag.com/article/the-new-normal-by-any-means-necessary/
Science Magazine did a detailed fact check of this claim and found it to be completely without evidence.
Company representatives explained that the decision was made to drop the 32-case unblinding because it had to meet a higher efficacy threshold than the 62-case unblinding, and because given the rate of spread at the time they expected it would be days - not weeks or months, as they'd thought when they designed the protocols - between hitting 32 cases and hitting 62.
So the decision was: delay by about a week, and in return get a much higher chance of being approved.
https://www.sciencemag.org/news/2020/11/fact-check-no-evidence-supports-trump-s-claim-covid-19-vaccine-result-was-suppressed
"Ugur Sahin, scientist, CEO, and co-founder of BioNTech, says the initial plan to look at 32 cases stemmed from a conservative assumption about the rate of spread of COVID-19 and the sense of urgency about the need for a vaccine. If the vaccine looked terrific at 32 cases and it was going to take months to get to 62 cases, then waiting seemed like a mistake, he says. “To me, every day counts.” And he had little patience for the debates over when to look at the data. “These protocol discussions are endless, and I’m often leaving the room,” Sahin says.
In mid-October, the companies had yet to confirm 32 cases. But with the epidemic exploding at many of the trial’s locations—which were mainly in the United States—they had second thoughts about FDA’s request that their first interim analysis should have more to support an EUA request. FDA “had strongly recommended to us that we change that, and the pandemic just was spiraling out of control in the United States and elsewhere, and we realized that we probably could get cases much faster than what we had anticipated,” Jansen says.
The math was simple: COVID-19 cases among participants were jumping from one or two per day to up to 10 or more. It became clear that the trial would accrue 62 cases shortly after hitting the 32 mark, and the higher number meant greater statistical power—and fewer debates about the meaning of the data. This 62 cutoff both lowered the efficacy bar the vaccine had to clear, and was also something of an insurance policy: If the vaccine triggered mediocre immune responses and it teetered around 50% efficacy in the trial, it could more easily have been deemed futile at 32 cases because of bad luck."
i'm very curious what people here think about repurposing of already-approved pharmaceuticals for early treatment and pre-/post-exposure prophylaxis. To start the discussion off, i know there's some data for TMPRSS inhibitors: ambroxol/bromhexine and also pretty much like, every antiandrogen since AR affects TMPRSS2 expression. TMPRSS inhibition has direct antiviral activity. Also people have been looking at drugs with immunomodulatory effects such as fluvoxamine and ivermectin. The immunomodulatory part is important because AFAICT the actual damage caused by the disease seems mostly to come from severe immune system dysregulation and its consequences (immunothrombosis, hyperinflammation) so tweaking the immune system's operation so it doesn't fall down that path is very much desired. Doubly so if the immunomodulatory drug in question doesn't affect viral clearance. There's some trials for ivermectin showing faster viral clearance and quicker cessation of anosmia and also an RCT for fluvoxamine with really quite good results. There's also a certain endosomal entry inhibitor that became a culture-war subject but honestly my understanding is that without blocking the TMPRSSes or at least TMPRSS2, blocking endosomal entry is pretty much worthless.
It seems to me that fear is causing us to massively over correct to try to prevent unlikely and unrealistic failure cases. For example:
People are afraid that unsafe vaccines will get approved because the procedure is getting rushed. Instead of trying to maintain the most critical parts of the testing process, and skip the rest, we are scheduling one month of thumb twiddling between when we get the data and when we meet to discuss it.
People are afraid of line cutting so we are prosecuting doctors who distribute vaccine doses out of order instead of letting them get thrown out.
People are afraid of price gouging, so we all decided not to do it, which removed the incentives to scale out production as quickly as possible.
Zvi has been saying this stuff for months now: https://thezvi.wordpress.com/
> we are scheduling one month of thumb twiddling between when we get the data and when we meet to discuss it.
It's not "thumb twiddling", though, as per one of the links in the post: https://www.biospace.com/article/why-is-the-fda-taking-so-long-to-review-a-covid-19-vaccine-/
"""
According to the FDA, “This amount of time will allow the FDA to thoroughly evaluate the data and information submitted in the EUA request before the meeting and to be prepared for a robust public discussion with the advisory committee members.”
"""
What do you expect them to say? That the month is full of thumb-twiddling? Numerous commenters have states the data could be analyzed in a few days at most. The CDC was taking holidays through that period.
The only criticism I read was an article by an academic with no firsthand experience with the FDA's processes saying he could do it in a couple days. Are there more credible sources?
I'm not happy about them taking holidays if that's true. My prior, though, is there's some probability they would have done work off-the-clock, given the incredible importance of expedience here.
Based on my own experience with 'process', the fact that the FDA/CDC/whomever scheduled meetings more than _one_ day in the future is extremely strong evidence of them "thumb-twiddling". What else can they be doing? Literally – what else is more important than them having those meetings ASAP, e.g. flying everyone in on a jet immediately from wherever they are? In fact, why shouldn't those officials be under guard at their offices (or wherever they can most effectively make the relevant decisions as quickly as possibly)?
You could only do the meeting on 1 day notice if there's almost no preparation required, and my prior on that is very tiny. I'm assuming this is the type of meeting where a bunch of department heads get together and say "hey I checked this stuff and the only problems we found are insignificant". I would guess there are hundreds of pages of reports to be filed and a book-sized checklist that people need to go through. The amount of CYA involved in regulatory processes is quite extraordinary and I wouldn't find it surprising if there's multiple weeks of full-time work to do before the meeting.
> The amount of CYA involved in regulatory processes is quite extraordinary and I wouldn't find it surprising if there's multiple weeks of full-time work to do before the meeting.
That reads exactly like "thumb twiddling".
Not being able to ignore the existing "book-sized checklist" – and adjust, as seems warranted, to an emergency of this scale, seems pretty difficult to justify.
I can think of several changes that they could have made to their process, just off the top of my head:
1. Defer 'filing' the reports! Surely that can be delayed while the important work of determining the safety and efficacy of the vaccines is prioritized.
2. Embed FDA/CDC employees in the labs/teams evaluating/testing the vaccines and have them analyze the data as fast as they can, without requiring that anyone 'file an official report'. In machine learning, some models/algorithms work 'online', i.e. as new data comes in. Surely _some_ evaluation of the, e.g. trial data, can be performed near the start of the whole 'project' and updated periodically (or even in something close or closer to 'real time').
3. Do away with 'official meetings' and, like in [2], do as much work as possible ASAP and update the overall evaluation as new evidence is received, i.e. 'learn online'. The final approval should involve a minimal amount of extra work – not "multiple weeks of full-time work".
Practically – 'pragmatically' – you're right that, given the prior status quo, it's not true that, for those meetings, given their role in the current 'process', there's "almost no preparation required". I'm not mad or angry at any individual employee at the FDA (or CDC or whatever), or even any specific bureaucrat higher-up in the hierarchy. Almost all of their incentives align with 'following process'. I'm just frustrated that even a disaster of this scale wasn't enough to push them to _even more_ radically streamline the whole ordeal.
Pretty surprised at the confidence of B117 resulting in a 4th wave so soon. That seems to under emphasize seasonality/immunity and over emphasize behavior to my mind. >10% of the us is currently had at least one shot and a partially overlapping ~10-20% (depending on how much under testing you think there has been) have been infected and gained some level of immunity. If you ballpark guess that in march something like 20% have some degree of protection does that not compensate for the variant being more infectious, or are my estimates way out of line?
Zvi wrote some more details on the model for this here https://thezvi.wordpress.com/2021/01/06/fourth-wave-covid-toy-modeling/
He's since walked some of his pessimism about a fourth wave back though, amid news that B117 might actually be less than 50% infectious: https://thezvi.wordpress.com/2021/02/11/covid-2-11-as-expected/
At this point, Scott is more pessimistic than Zvi, which seems surprising.
The idea that the new variant is more infectious came from the same epidemiologists that have a consistent track record of total failure on pretty much everything (at ICL), not to mention publishing practically fraudulent papers (see Flaxman et al). As with everything else they "know" about COVID it was simply based on looking at case curves and making assumptions.
Additionally the data the ONS released to support this claim actually showed the supposedly super-infectious new variant declining before mid November. The explanation for this was literally, "before mid November this PCR signal we're using meant something different so don't look there" with no explanation of how it was different or what changed. The graphs presented to the public were then truncated to try and hide what had been done.
tl;dr - don't believe anything epidemiologists say about anything. The field is just terrible. Worse than social psychology.
Me too. Cases are dropping in the US at -3% per day for seemingly no reason (I don't buy that this is a seasonal shift yet), implying to me that the population has some partial herd immunity (14% had antibodies last November, it's surely much higher now - even 30% would take a big chunk out of R_eff).
I would expect that there is at least partial immunity to variants, such that population immunity levels, existing restrictions, and favourable seasonality in the coming months will result in the B117 epidemic not blowing up.
Evidence that would convince me otherwise would be a measurement of the current exponential growth rate of the B117 variant in the US. If it's positive (compared to to the regular variant having negative growth), that's evidence that the status quo is not enough to prevent it growing.
But the US is currently averaging R_eff = 0.85 or so. a 30% bump on that due to a variant and cases will be growing at +2% per day. But there'll be more people vaccinated and better seasonal conditions by then so...
80% prediction of no blowup due to B117.
Check Yougang Gu's COVID projections. ~30% have been infected in the U.S. and over 10% have had their first vaccine dose (with substantial overlap), so we are close to 40% with considerable immunity already. There were also studies suggesting 10-15% had substantial resistance due to previous infection with other coronaviruses
We are approaching spring with a virus that is estimated to be 30-70% more infectious than "original" Covid19. There is some level of immunity, but vaccines still haven't got to the people that contribute to spreading the virus more (i.e. young people).
Further, even if this theoretical argument doesn't convince you, if you separate the components as if old Covid and B117 were two different diseases, you see that while the former is declining as expected, the latter is rising exponentially everywhere (Denmark, Italy, France, Germany).
I think that the "fourth wave" is a given. The only thing that might change in this one is that the vaccines will have a strong effect on deaths, since most old people will have had at least one shot of Pfizer/Moderna by the time the wave peaks. This could be, however, counterbalanced by the fact that there might be less restrictions, leading to more people getting in contact with the virus, leading to roughly the same amount of deaths.... especially since many states use hospital occupancies as metric to ease/harden restrictions. Of course this is dumb and we should strongly push for restrictions to stay in place even with less hospitalizations/deaths, but one year of pushing for this has produced absolutely nothing so it's a fool's hope that this time they will listen.
I'm sure there will be a '4th wave' of some kind, but the timing and intensity is what I'm doubtful of. Estimating exponentials is really hard, especially when there are multiple competing drivers (vaccines, behavior, prior exposure, r0) which are also hard to estimate. But it takes time even for exponentials to grow, and there is a huge difference between 30% and 70% more infectious. I think your confidence interval should at least include 'small rise in cases that is brought under control because of increasing vaccination'
There's really no chance that people are going to tolerate more restrictions if there are fewer deaths/hospitalizations. But that is fine? We can pay a high economic/social premium to avoid deaths, but not obviously worth it to pay that to avoid cases. The issue is if you get this runaway exponential growth and hospitalization data are lagging by two weeks, then you can still end up with steeply rising hospitalizations of course and be too late to avert a crisis. However for this to happen you would really need some extreme exponential growth in cases coupled with everyone just ignoring this for weeks, which still seems unlikely to me.
Well, that's only if letting cases spread freely doesn't lead to new strains which put us back on square two (meaning we have vaccines but we need to jab everyone and lockdown again while we do that).
Also, if the virus spreads freely some young (<50) people still die (not enough to overwhelm hospitals, but the number is in the thousands/tens of thousands).
> Further, even if this theoretical argument doesn't convince you, if you separate the components as if old Covid and B117 were two different diseases, you see that while the former is declining as expected, the latter is rising exponentially everywhere (Denmark, Italy, France, Germany).
This is greatly misleading. B117 is rising exponentially *in comparison to vanilla covid*, not in absolute numbers (which are stagnant in France and Italy, have kept falling sharply since late December in Denmark, are slowly but surely falling in Germany).
Huh, no, it's not, it's rising also in absolute numbers! Cases due to B117 are rising exponentially.
Do you have the numbers? I was hasty to declare it couldn't grow exponentially when the overall sum was flat or falling, but it might be indeed possible if the other strain has been going done faster than expected and the starting point was low. I'm still not exactly convinced by the data I can easily find (e.g. https://en.wikipedia.org/wiki/Variant_of_Concern_202012/01#Development_of_the_B.1.1.7_lineage ); the Denmark numbers show a large relative growth but the overall sum is declining sharply, whereas the other countries haven't been measuring much to begin with).
> the other countries haven't been measuring much to begin with.
They did study it in Germany (I only have access to this output sadly, not to the raw data), and this projection was the result: https://pbs.twimg.com/media/Etx5CLyXYAACw3h?format=jpg&name=medium
And at the beginning of December in London it was exponential under restrictions that would (and had!) normally neutralised OGCovid's exponential growth bursts.
As everything with this pandemic, I admit it's not 100% confirmed yet, but the few data points we have now agree with this theoretical argument: a virus with 50% more transmissibility which has shown it can bypass "Tier 3" restrictions in the UK (that's, in a way, how it was discovered) should rightfully have R>1 in every country whose measures are currently "Tier 3"-like (Italy, Germany, France,...).
The good news is that actual lockdown works (see London cases graph, and also cases everywhere else in the UK that never lifted off exponentially due to early introduction of the lockdown when B117 was still low)
The projection you are linking (Der Spiegel?) isn't convincing -- you can extrapolate small numbers to anything. The Danish data ( https://files.ssi.dk/covid19/virusvarianter/status/status-virusvarianter-16022021-ccxh ) is more worrying, but the highest increases in the # of confirmed B.1.1.7 cases has been concomitant with the highest drops in total COVID incidence. Multiplying new variant percentages by total incidence results in a 2.3x increase over 5 weeks, almost all of it however supported by 1 week. My takeaway for now is "we need better numbers".
We DEFINITELY need better numbers, yes. But if I had to make a prediction, B117 is definitely spreading exponentially anywhere without lockdowns in place
See also this, in the US: https://twitter.com/DrEricDing/status/1359871587126763521
> the Denmark numbers show a large relative growth but the overall sum is declining sharply
No. You can see the data here (goes up to 10th of february)
https://www.covid19genomics.dk/statistics
Second graph
Number of B1.1.7 cases rising (Colored red) while overall cases dropping
The second-to-last prediction would be more interesting to me if it gave a probability for people wearing masks indoors (say, a grocery store). Outdoors, people are much more cavalier about masks already, and are already drifting down towards mostly-not-wearing (plus generous distancing) in my Silicon Valley neighborhood. Indoors, they're still at nearly 100%. And this fits with what I've heard about transmission-- that indoors is by far the greater risk.
90% confidence in "not much outdoor masking" seems to imply a 10% probability that our mid-2022 masking norms aren't just paranoid and security-theater-y, but actively irrational. One would hope there's a somewhat higher risk that we'd still be wearing masks in grocery stores.
Would it be bad if lots of people kept wearing masks indoors, even if feeling okay? And not out of any requirement of the store.
So some people don't wear them, some people do, and the former doesn't give any shit to the latter.
I think this is too pessimistic. The math on vaccination and herd immunity suggests that once you get to over 50% immune... The r value drops and keeps dropping in an additive manner.
Doesn’t account for a immune escaping variants.
Immune escaping variants are a very definite risk that we should all worry about and strongly try to mitigate, but right now they are not a concern (meaning that the best vaccines are still very effective against all dominant strains) so I wouldn't account for these when thinking about a short-term scenario.
I think this is fairly plausible, and here’s a question not discussed there: Where in this multi-year to permanent cycle do schools again educate all of the kids they were, in the buildings they were, where having 25-35 in a classroom, very often closer than 6 feet apart, was the norm?
The UK is aiming for 'in a few weeks'. Not sure about universities.
"all the kids they were" - probably never. At least some families have found that online school programs, unschooling, or homeschooling suits them better than whatever schools they were in before. I've heard from homeschooling friends that their communities have been growing. Early polling seems to suggest that almost half of parents are at least considering moving to homeschooling or some other non-traditional option even after lockdowns. Even if only a tenth of those go through with it, that would more than double the number of homeschooled kids in the US (which, before the pandemic, was 3-4%).
https://www.federationforchildren.org/national-poll-40-of-families-more-likely-to-homeschool-after-lockdowns-end/
I'm a teacher, in a potentially high-risk group, and I'd be willing to jump back to normal as soon as I can get a vaccine and a two-week period for it to kick in. I'm not even picky - I'd take Sputnik or Sinovac. As a parent, though, it's tricky - I'd want to see good community spread metrics and maybe even vaccines for kids once we get the data in on those, and if my son's school stopped offering online schooling right now and told me to send him back I'd have a *very* tough decision and possibly move him to some kind of homeschooling program. Perhaps it's weird to be a teacher and be so on-the-fence about the benefits of traditional education... or perhaps not. Anyway I think a lot of people will be rethinking schools after this.
One big question is when high risk activities, such as major concerts, sporting events, and conventions happen at 100% capacity. Whole industries, businesses, and urban developments are built around these kind of events happening on a regular basis, and they can't be put on pause forever. At some point things need to resume or people need to figure out what to do with all those useless arenas, stadiums, and hotels.
But I also wouldn't be surprised if future stadiums and arenas are designed with better ventilation, so that a few decades from now, the 20th century ones all feel cramped and unhealthy to people.
People tend not to notice ventilation. I doubt most people could tell the difference between a room with 2 ACH and 6 ACH just by observing it or being in it for a while (assuming nothing obvious like an open window or a breeze).
ACH = air changes per hour
I'd wager it depends on what the person making the air changes had for lunch.
I've read that they're saying the vaccine might not stop the spread: vaccinated individuals could become asymptomatic carriers. To what extent is this a real possibility, versus an abundance of caution?
Like, I understand they haven't run specific trials on that for these specific vaccines, but for all the vaccines we've had in the past, how effective have they been in preventing transmission?
It sounds like asymptomatic people are something like 40% less transmissive than symptomatic people. Since the vaccines turn at least 95% of cases into asymptomatic cases, it seems like they should cut transmission by a significant amount. And if a good number of those aren't just asymptomatic, but actually eliminated, then that's significantly more.
https://www.nature.com/articles/d41586-020-03141-3
The "but we just don't KNOW if the vaccines provide sterilizing immunity" talking point constantly spouted by experts and repeated by the media needs to move beyond a black or white scenario.
It is guaranteed (I would bet on this with 1000 to 1 odds) that being vaccinated provides some sterilizing immunity. If being vaccinated reduces symptoms, and we know that asymptomatic spread is much less prevalent than symptomatic spread (https://www.nature.com/articles/d41586-020-03141-3), this would be logical.
It is all but guaranteed (I would bet on this with 10 to 1 odds) that being vaccinated provides a majority of sterilizing immunity — though it was a small sample size, Moderna's data indicated a 66% reduction in nasal viral load only 21 days after just one dose, and we would expect this to grow in strength with more time and after a second dose (https://imgur.com/tdom2E7).
If I were vaccinated today, in 10 days I would reduce my overall caution by half, and in a month I would reduce it by 80%.
Further discussion: https://old.reddit.com/r/medicine/comments/l6bq5a/is_it_really_likely_that_the_covid_vaccine_doesnt/
By the way, is there an alternative to the term "sterilizing immunity"?
My impression is that a lot of people who are leery of vaccines get freaked out when they encounter the term, thinking it is talking about vaccines sterilizing human reproductive systems.
Has anybody yet seen an authoritative estimate for Quality-Adjusted-Life-Years Lost due to covid? We have them for most other diseases.
How much worse is it for places to want everyone to wear masks than for places to want men to wear underwear and pants nowadays, or for places to want everyone to wear hats or ties at some other points in time? It'll at least be a weird fashion restriction that serves some function in lowering the overall burden of respiratory diseases.
Carjacking came roaring back in 2020, probably partly due to society telling people to mask up like bandits in old Western movies.
Citation?
Why carjackings have skyrocketed in parts of the country during the pandemic
Carjackings have shot up 537% in Minneapolis this year.
By Andy Fies
December 12, 2020, 9:40 AM
https://abcnews.go.com/US/carjackings-skyrocketed-parts-country-pandemic/story?id=74674597&cid=social_twitter_abcn
... The assault on Williams, captured on surveillance video recently released by the Chicago police in an effort to identify and catch his killers, focused attention on a dramatic spike in carjackings there. In all of 2019, there were 501 incidents of that crime. So far that number has more than doubled to 1,125 this year, according to the latest Chicago police statistics.
But Chicago is neither the only nor the worst example of this disturbing crime trend. Minneapolis police report that carjackings there have shot up 537% this year. Carjacking calls to 911 in New Orleans are up 126%. Oakland police cite an increase of 38%. And while many police departments do not keep carjacking-specific numbers, instead classifying them as auto theft or armed robbery, crime experts like Chris Herrmann, a professor at John Jay College of Criminal Justice, say anecdotal reports of a carjacking surge are coming in from metropolitan areas around the country including Milwaukee, Louisville, Nashville and Kansas City.
And he explains that the pandemic, which has normalized mask-wearing, makes these thefts easier.
"If we weren't in a pandemic and you saw a guy coming up to your car with a mask on, you probably would freak out and hit the gas pedal," he explained. "But nowadays, everyone's wearing masks. So there's this anonymity part of the pandemic that I think a lot of criminals are taking advantage of."
Mask-wearing anonymity may be only one way criminals are taking advantage of the pandemic as carjackings, along with other violent crimes, have risen sharply. According to a recent analysis by the Police Executive Forum (PERF): "Preliminary data from 223 police agencies across the United States reveal steep increases this year in homicides and aggravated assaults."
While masks probably contribute to general lawlessness, I think that a bigger factor worth considering is the change in policing tactics in response to the summer protests.
https://reason.com/volokh/2021/02/01/explaining-the-great-2020-homicide-spike/
This article makes this case and backs it up with data. I'm not quite sure how to feel about unconstitutional/hostile policing being effective at suppressing violent crime.
Thanks, good article.
Same thing happened after 2014, when murders in the US went up 22.9% in two years. When the authorities and media decide that every cop is a criminal and all the sinners saints, the police retreat to the donut shop.
But, in an era of video cameras, the aid to lawbreakers provided by not only allowing but encouraging masks can't be negligible. Decades ago, many states passed anti-mask laws to fight the KKK. They seem to work.
Minneapolis resident here. Been in favor of defunding the police for 20 years as a loony libertarian. This is 100% a big deal and has soured most normies on any kind of police reform.
Streets became unsafe for pedestrians within hours of the burning started, because people started driving 60 miles an hour in residential neighborhoods (personal observation and discussion with other parents w/ kids in the age range that can run out into the street). Shootings are way, way, way up (check the www.bringmethenews.com search box). Unreported crime is way, way, way up based on my direct observations and conversations with a friend of mine that owns a private security firm.
Masks are definitely more inconvenient than hats or pants for any situation where people want to eat or drink. I suspect they also add friction to face-to-face socialization due to it being harder to read expressions.
From personal experience: Masks are a substantial hindrance in education, as it's much harder for teachers to convey nuance and also harder for them to "read the room". Granted, the lip-reading deaf teacher down the hall has it much worse than I do...
Also much worse for folks who wear glasses or have hearing problem. Plus they block off a lot of communication that happens through facial expressions which is a big hinderance in social situations.
I volunteer with kids with autism. Opaque masks are a very significant problem for them.
It makes life a lot harder for glasses wearers. A properly secured medical mask of course won’t cause fogging, but a cotton mask (or even a KN95 mask, applied as best I could) results in my glasses fogging up to the point that I can’t see out of them. It’s fine with contacts though, which is my solution, but I don’t think that all glasses wearers will switch to contacts.
Right. A reasonably effective mask like a KN95 fogs up glasses.
washing your glasses with a wet cloth and drop of dish liquid will stop that from happening for the better part of a day
Unfortunately, dish soaps can mess with the glasses, especially if you have anti-glare coating. Can't say for sure whether you're safe with regular, bottom-shelf, no-magical-additives no-name dish soap, or if it's more endemic to the anti-glare coating itself.
I switched to a half-face respirator on the ambulance for exactly this reason. I can walk around a grocery store with lightly-fogged glasses. Driving or caring for another person requires more.
I wear a mask brace on top of my KN95, and it greatly reduces fogging. They're a structure of several stretchy loops, 2 that lay near the edges of the mask and 2 that goes around your head to hold it in place. They pull the mask edges tight against your face. Got mine from fixthemask.com, best 15 bux I've spent in a while.
Is the San Francisco / mask one supposed to be "greater" instead of "fewer"?
"Sorry, things may get worse before they get better."
Depends on how you define "things". I believe the only metrics we should really be looking at are hospitalizations and deaths (yes, Long COVID is a problem, but a lesser one).
34% of America's 65+ population has already been vaccinated. This number is rising quickly (I'm tracking it on a vaccination spreadsheet here and will start tracking longitudinal data as of tomorrow's update: https://docs.google.com/spreadsheets/d/1Kti2ccedNp05K_jlda-jozj55WUIv5VmNMjTDnnS6R4/edit#gid=0).
Cases will quickly start to decouple from deaths and hospitalizations. So a spike in cases is not as big of a deal, and really shouldn't result in many additional restrictions, at least not ones similar to the winter spike.
We are soon entering a period where not getting infected will become a matter of personal preference, rather than an altruistic endeavor to avoid killing someone or causing them serious illness.
This may be true, but it’s a hypothesis not a fact. Beware cargo cult science thinking.
What is the "this" you're referring to?
There is enough evidence and definitely enough theoretical arguments to say that allowing the virus to spread "freely" due to older people being vaccinated can lead to mutations able to escape vaccine immunity.
Even more worrisome is the fact that in a vaccinated population there might be strong evolutional pressure for the virus to evolve in this way.
Now, this might be true, or it might not be true, it is too early to say. But we know enough to say that this is definitely part of the Reasonable Worst Case scenario, which is the one we should be planning policies for.
I'd predict that the cultural effects will be influenced by economics, culture-war factors, or a desire for signaling. Profitable gatherings will continue to be encouraged by advertising; more spontaneous or altruistic ones will stay online. Public group activities will be tilted towards the political factions that are now more likely to engage in them. I'd give a 70% chance that at least one NFL stadium reaches 90% capacity during the 2021 season, a 90% chance that food service workers in Democrat-governed cities will remain obligated to wear masks through the end of 2021 (and beyond), and a 75% percent chance that mass transit ridership stays below 2019 levels for a decade (unfortunately for the climate).
What I have wondered about for a while, is whether a system would arise (or be proposed) for allowing people entry to mass gatherings *only if they provide proof of vaccination*. The Super Bowl this year was eager to announce that it had allowed a few thousand vaccinated health care workers to attend in person. It hasn't come up yet because vaccination rates are still low, but once they are generally available and rates get around 50%, there will be eagerness to push those rates higher, impatience to drop restrictions, and concern about the portion of the population that refuses and the resulting persistence of the virus. Someone will get the bright idea to offer incentives, and someone else will get the bright idea to claim it's the Mark of the Beast; it would be challenging to avoid economic or racial disparities in such a system as well.
One of the first times I ate at a restaurant in the fall (outdoors), I began to suspect that face coverings on waitstaff will be here to stay, at least in certain fancy restaurants. At the sort of place where waitstaff wear a uniform, a facemask will just become part of the uniform, and convey the social separation and subservience of the waitstaff to the guests.
Only if we abolish tipping in the United States. Tipping is driven social signalling, and facial expressions are critical to human social signalling. Waitstaff who can e.g. smile and be seen to smile will have an advantage over those who can't.
If everyone in a given restaurant wears the facemask (as management will insist) then it at least won't affect the relative tips of the different waitstaff. (This might be a secondary benefit of masking, eliminating one of the irrelevant factors in waitstaff compensation.)
Maybe. This was the year I upped my tipping from fifteen to twenty, and I give it to pretty much everyone. My old standard was fifteen or so, up to twenty for good service. As long as covid is still in the air and the staff is still masking, I'll probably keep it at that level.
Back in March or April, I counted the "it's an annual disease like the flu" as the awful-tier outcome. I stand by that, but it's looking even more likely now than it was then, and I have less hope that I was wrong in my estimates.
I think there's an interesting question of whether we've managed to turn the flu into something much more manageable though. We will see if any habits we picked up this year help protect us against the next flue season too.
That would be nice!
New reader here. Excellent article, thanks Scott. Very curious about your predictions on the long term impacts on young children. Like your WW2 analogy, will there will be a whole generation of kids who are fearful of any human contact even after things return to normal(ish)? Or will the extreme social distancing learned behavior fade as we become more integrated into the world again?
People in the older generations who saw polio cases sometimes associate water fountains and even swimming pools/water parks with polio and avoid them - I get the impression that was emphasized when they were children. So maybe.
This reads like a very Bay Area view of Covid and response - or a very myopic view of a particular part of the culture.
I've flown at least 12 times since the pandemic started. We've hosted many visitors from out of state, we go to restaurants multiple times a week - they are fairly full - and most of our friends do the same. We gather indoors and out for various occasions. Family is the same.
We're fragmenting into two covid subcultures, as others have noted. But the simple fact is that the data does not justify anyone who is under 70 and healthy changing the way they live now vs. how they lived in 2019 and prior.
I learned recently that for some destinations, vacation travel actually went *up* this year. The fact that aviation as a whole can be down 80-90%, while vacation travel is steady or rising, indicates just how little aviation was driven by vacation, and how it was mostly business travel.
https://www.youtube.com/watch?v=v_rXhuaI0W8
Vacation travel being up for some destinations doesn’t mean it’s up overall right?
Look up Russell’s Chicken.
This is like saying “I bang a bunch of chicks bareback and haven’t gotten AIDS yet. All you people worried about AIDS are crazy.”
I agree that nobody under 70 should change their lifestyle for selfish reasons. I'm not sure about the altruistic effects - if I catch COVID (and pass it on to a few people before realizing it) am I contributing to someone over 70 dying?
That only seems like a concern for people who have routine close contact with elderly/high risk. If my only unmasked contacts are young people, then it’s extremely unlikely that my infecting them would lead to severe illness or death. It’s possible that one of my low risk contacts would then go on to infect a high risk person, but at that point the chain of causation is interrupted and it wouldn’t be my moral responsibility.
It's not, as some people can't help having close contact with high risk people, so the chain of causation is not interrupted if it wasn't their choice. Doctors, nurses, policemen, firefighters, cleaners in care homes, plumbers, electricians, ...
The "hospitals being overwhelmed" thing still matters, even if the disease doesn't progress to the "severe" stage. The total amount of hospital resources available are more-or-less fixed. A small change in the absolute percentage of the population requiring hospitalization will drastically change the relative utilization of hospital resources. We haven't actually exceeded capacity anywhere yet (NYC hit the brink last year), but people in healthcare are still really worried about that possibility.
"I agree that nobody under 70 should change their lifestyle for selfish reasons."
Why? COVID is pretty bad for those well under 70, as well: https://twitter.com/lymanstoneky/status/1352011344497795073/photo/1
Really? This is pretty surprising for me to hear you say. What about the frequency of long-term effects? That alone makes me pretty reluctant, just on a selfish level, to go back out to bars and the like. Why do you think differently?
From what I have read, the rate of long term effects seems no different than other viral infections
Speaking of which, masks and distancing also reduce the rates of other viral infections. I remember apocalyptic warnings about this being a joint covid/flu season, but instead the flu season apparently didn't happen at all. Whatever measures we took to suppress covid absolutely crushed the flu.
I don't know how much the average person's behavior will change as a result, but I have certainly at least considered switching from teaching to an entirely-online job in order to reduce my exposure to *all* pathogens, pollution, and stressful interactions with other people (while still maintaining my social life at pre-pandemic levels). That idea seemed absolutely crazy before I spent a year doing it. It helps that I have friends who are digital nomads and work abroad from home.
I could imagine a trial lockdown could move the needle, at least a little, on how many people choose to work remotely, is what I'm saying, and not just because of the danger of covid exposure.
A) The "not social distancing" subculture definitely contributes to the spread, and significantly. It might not have got into you specifically, but there are countless examples in the literature of gatherings that lead to superinfection events that lead to tens of deaths. So, if you are at all concerned about not contributing to the killing of elderly/fragile people, you should change the way you're living
B) The more the virus spreads, the more it can mutate. We know this now: this virus is capable of evolving fast. So you could be initiating a worse pandemic by not applying social distancing (it happened in the UK, in South Africa, and god knows where else)
C) An uncontrolled spread of the virus (the one you'd have if everyone under 70 acted as you suggest) would lead to overwhelmed hospitals, which would lead to healthcare being substantially broken for months, possibly years. At all ages, people need healthcare: they break bones, they get cut, they get various treatable diseases, they have car accidents, fall down the stairs, their appendix gets inflamed and needs to be removed.
All this to say: the data definitely justifies changing your life. Acting as you are right now is a sort of prisoner's dilemma scenario, in which you are freeloading on other people's sacrifices. This is morally wrong, but I can see how it could be the best personal choice for selfish reason... but it's definitely not the best societal choice, and the data definitely doesn't support any of it.
And let me add a cynical remark: do you really think that our current selfish cynical society would choose to deal such a blow to the economy if the only benefit in doing so was saving lives of people over 70?
More cynicism: do you think we'd see this much obsession over Covid if it wouldn't have made Trump look bad?
Covid is terrible. But the terribleness seems to be askew to how it's presented.
"More cynicism: do you think we'd see this much obsession over Covid if it wouldn't have made Trump look bad?"
In America? Only from Republicans.
I am from the UK. The rest of the world couldn't care less about Trump, and we are just as "obsessed" with Covid19, which is killing hundreds of thousands of people.
Devil's advocate: The UK media is very closely tied to American media via language, and of course the UK have Boris Johnson to make look bad, who is usually lumped in with Trump/Modi/Erdogan.
Has the media/the "covid-obsessed" crowd suddenly reversed course, as a result of Biden's victory or inauguration? The sources I pay attention to (WaPo, The Atlantic, Zvi) seem to have maintained the same general tenor of presentation, but I don't live in America so maybe there's something I'm missing. But that suggests to me that the presentation isn't caused by "TDS" or anything like that.
I’ve also noticed that LessWrong/SSC types tend to overestimate 1) the extent to which California’s super strict restrictions are typical of US as a whole and 2) the extent to which people conform to those restrictions.
Even if you think people in your area all wear masks and avoid socializing, drive an hour or two and the situation will be different. Or get to know people and you’ll see they make exceptions. The Deborah Birx case is an example: no one, to a first approximation, follows all public health advice, even the people who make it.
The post handwaves that R stays at about 1.0 by stating that people and governments adjust their behavior around surges and lulls. But you should be able to check this with mobility data, or opentable.org, or something. As far as I know, we never observed any consistent correlations with this.
Anecdotally, people in my large liberal city have no idea what local or state R is at. How many cases/deaths there are, or what hospital capacity is. And any discussion of COVID going up is accompanied with derision for hypothesized anti-maskers driving spread, and any discussion about it going down is self-congratulatory with comments about how we need to keep doing locking down hard.
In other words, no one wants R to be 1.0. Pro-lockdowners want it to be 0.0 and anti-lockdowners don't care. People and local governments just have no concept of R, or trends, or absolute vs. relative levels, or anything numerate. So I don't see any way they'd be adjusting their behavior to maintain R at 1.0 when they don't even know what local levels are. They also wouldn't care if the trend was flat even if they knew what it was, since a flat trend is no one's goal. COVID levels could be 10x higher or 10x lower in my area and everything would be the same.
"the data does not justify anyone who is under 70 and healthy changing the way they live now vs. how they lived in 2019 and prior."
WRONG. In percentage terms, deaths rose most for the 45-64 age range: https://twitter.com/lymanstoneky/status/1352011344497795073
I would really like to know about the likelihood of long-term effects from mild covid cases in people who have been vaccinated. I am okay with taking the reduced risk of catching mild covid post-vaccination if we're just talking about the ~two weeks of acute symptoms, but if "long covid" is still occurring frequently (I recall seeing estimates of 10-50% in current inoculated cases) then I'm back to dreading the virus, even post-vaccine.