Droplets sink to the ground and get away from our air intake holes. Coalescing with other droplets that makes them larger and eliminate them from the air would happen in fog, or maybe very humid air. (Example situation: crowded bus in winter with fogged windows, bad air circulation and closed windows)
In dry air their water evaporates faster, the droplets become fine aerosol that sinks *much* slower, it basically stays in the air and thus remains at nose height. (Example situation: winter indoors with few people in large room, the air from outside comes with little humidity and when warmed its relative humidity is very low.)
But there are also water molecules in/about the virus particle that can evaporate and thereby inactivate the virus.* So a very dry air may still float particles, but they would be harmless after a while.
*This is accelerated if the virus is on a surface that takes up water, hence the faster inactivation on cardboard than on, eg, steel.
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'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.
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.
"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.
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).
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.
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.
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.)
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.
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 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.
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.
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!)
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.
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.
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.
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).
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.
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.
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.
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.
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
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.
(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?)
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.)
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.)
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?
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.
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.
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.
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).
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:
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.
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.
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.
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.
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 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.
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.
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.
"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'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)
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.
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.
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.
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?
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.
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
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.
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.
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.
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.
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.
It is more complicated than that.
Droplets sink to the ground and get away from our air intake holes. Coalescing with other droplets that makes them larger and eliminate them from the air would happen in fog, or maybe very humid air. (Example situation: crowded bus in winter with fogged windows, bad air circulation and closed windows)
In dry air their water evaporates faster, the droplets become fine aerosol that sinks *much* slower, it basically stays in the air and thus remains at nose height. (Example situation: winter indoors with few people in large room, the air from outside comes with little humidity and when warmed its relative humidity is very low.)
But there are also water molecules in/about the virus particle that can evaporate and thereby inactivate the virus.* So a very dry air may still float particles, but they would be harmless after a while.
*This is accelerated if the virus is on a surface that takes up water, hence the faster inactivation on cardboard than on, eg, steel.
...are *caused by* coronaviruses
Forever is a long time. At some point I have to imagine we'll have nanites or something that can just eat all the coronaviruses. Or something.
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'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.
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 :)
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.
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
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.
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.
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.
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.