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.
Hi - new member here, still learning the ropes. 1) the efficacy rate for flu vaccine is between 30% and 50%, which doesn't matter a great deal as the disease for many sufferers is not severe. It would suck if the rate for Covid vaccine stabilises around this number. 2) There was something last week (sorry, I wasn't tracking sources last week) about the vector used to propagate the Astra Zeneca vaccine. It is a chimpanzee vector. The story was, the human body when vaccinated learns how to prompt Covid19 anti-bodies the "chimp way" and that learning sticks - and when a new human-derived mutation arrives, the human body doesn't respond effectively.
Hard to know what you're referring to for sure without the source, but it sounds like you're talking about a common problem with adenovirus vaccines (like the AZ one) if you need to rely on multiple vaccines. Basically the adenovirus is like a 'package' that pass in whatever code you want to become immune to, in this case some covid identifier proteins. The problem is that your immune system also learns to tear up the adenovirus itself, basically ripping up the package before it has a chance to deliver the important bit. So if you've already gotten an adenovirus vaccine, you might not be able to get another one that uses the same base virus.Thats why the AZ vaccine is using a chimp adenovirus, because humans haven't been exposed to it before, but we don't really know for sure if you'll be able to make a small tweak for new variant and have it work the same way. It might be a one time use option (but we really don't know). Here's a link with everything you could want to know in much better detail https://blogs.sciencemag.org/pipeline/archives/2021/02/08/how-you-make-an-adenovirus-vaccine
Thanks Endmash - diligent searching failed to locate the source - my bad entirely. Although I did come across this tidbit from a news report https://www.sunstar.com.ph/article/1883079/Davao/Local-News/AllYouNeedToKnow-AstraZenecas-Covid-19-vaccine : "Based on the interim analysis by Oxford University, which has been peer-reviewed and published in The Lancet on December 8, 2020, Covid-19 Vaccine AstraZeneca "has an acceptable safety profile and has been found to be efficacious against symptomatic Covid-19 in this interim analysis of ongoing clinical trials." Trials were conducted in Brazil, South Africa and the UK." The takeaway is that the AZ trials were conducted in the 3 countries that now have the identified Covid19 variants.
The better news is that COVID-19 prompted the real and serious development and rollout of the mRNA vaccine platform and proved the safety and efficacy of a vaccine developed in literally 48 hours. That gives us an incredible technological platform to be able to use an mRNA influenza vaccine and potentially slash mortality and morbidity because we won't have to "guess" what the dominant strains will be months in advance, we'll be able to literally roll the active strains in…live. As it's happening. This is a huge deal for influenza and it will be a huge deal for other pathogens as well.
I'm not sure the flu vaccine does *anything*. If you graph the year-by-year deaths from the flu, and then try to guess which years they messed up production (wrong strains, production failures), you couldn't pick them out.
I still got my flu shot because it probably doesn't hurt, and we really do not want the flu and covid doing any gene transfer this winter.
Perhaps a prepper-like splinter culture of "CoViD recluses" will develop: people who either move to remote rural locations, or to "filtered communities" with elaborate protection including domes, UV lamps, air filtration, and so on.
Ethnic minorities will be stereotyped as infectious ... wait, that happened before.
It looks like we will have between 125 million and 150 million vaccinated after Biden's first 100 days. Beyond that somewhere between 60 and 100 million already have the antibodies. At the low end 185 million are resistant. At the high end, 250 million. So, there are fewer and fewer people who can spread a March bump.
"It looks like we will have between 125 million and 150 million vaccinated after Biden's first 100 days. Beyond that somewhere between 60 and 100 million already have the antibodies."
Unfortunately, there may be a fair amount of overlap between those two groups.
I'm not sure what Metaculus is pricing in a la vaccine skepticism, but we're doing 1.7 million doses a day right now with ~55 million people already vaccinated, so ~300 million doses around ~July 10th. And I think it's a safe bet that the # of vaccines per day will continue to trend up.
Even one dose of Pfizer, Moderna can provide significant protection from COVID-19. It's been shown that single dose can prevent hospitalization if people are infected after that 1st dose.
Also some percentage of people infected don't develop full immunity. They're susceptible to a second infection, but so far it looks like second infections are less severe, too.
Does anyone around here (or maybe on Metaculus) have predictions for whether or not there will ever be challenge trials (in the US or elsewhere)? Besides the obvious effect challenge trials should have on all other related predictions, this also potentially impacts my personal decision of whether or not to get a vaccine when it becomes available to me (as I would like to volunteer for a challenge trial).
We need to prove the first vaccine effective in order to start using it, because we wouldn't want to tell millions of people they are vaccinated if they aren't. But if all we've done is add another strand of protection, then the efficacy test can just be vaccination of the general population - if the new batches start arriving in late March, then everyone vaccinated after that has a possible additional protection, and hopefully a few months later we would have data showing that they do.
The entire point of a challenge trial is to reduce that "a few months later" to a matter of weeks instead.
Also, you're assuming the new vaccines are just the old vaccines + a little bit extra, whereas I was assuming they were their own thing (albeit based on similar technology, so some of the steps could be skipped). I think both options are possible but still personally place a higher probability on my assumption. (I acknowledge that I'm not being very precise here; I haven't been following this whole thing very closely.)
The way the mRNA vaccines work is that they just sequence the RNA of the virus, figure out which part codes for the spike, and then they synthesize that same RNA in their factory and get it into the lipids and then the vials and then people's arms. They're really fast to design and get out there. We wouldn't need to wait until the new bit is proven effective, if it's been proven safe, since it would just go in along with an existing injection that has already been proven effective at what it's doing.
I would imagine you could recruit young military volunteers for human challenge tests of variant vaccines.
A problem with new clinical trials for vaccines is that the really require a major wave to get over and done with in a reasonable number of months. If there is no 4th or 5th wave for six months, we could be twiddling our thumbs for six months waiting for a large enough sample size.
This is especially true with highly efficacious vaccines like mRNA. One reason the Pfizer/Moderna dragged on a long time was because the vaccines were so effective that there were few cases in the vaccine arms, so they had to wait longer to get their agreed-upon sample size almost completely out of the placebo arm. (Of course, another reason was that Pfizer stopped processing samples in late October until the day after the election, blowing past its 32 and 62 checkpoints, in order to not announce results before the election.)
"(Of course, another reason was that Pfizer stopped processing samples in late October until the day after the election, blowing past its 32 and 62 checkpoints, in order to not announce results before the election.)"
Do you have a source for this? Why would Pfizer risk winning the vaccine race (and billions in profits) by waiting until after the election?
“Gruber said that Pfizer and BioNTech had decided in late October that they wanted to drop the 32-case interim analysis. At that time, the companies decided to stop having their lab confirm cases of Covid-19 in the study, instead leaving samples in storage. The FDA was aware of this decision. Discussions between the agency and the companies concluded, and testing began this past Wednesday. When the samples were tested, there were 94 cases of Covid in the trial. The DSMB met on Sunday.
“This means that the statistical strength of the result is likely far stronger than was initially expected. It also means that if Pfizer had held to the original plan, the data would likely have been available in October, as its CEO, Albert Bourla, had initially predicted.”
So, if Pfizer had stuck to its publicly announced plan for when to unblind its results, with a first unblinding after 32 cases and then another after 62 cases, they would likely have announced the vaccine’s success before the election (probably on Monday, November 2nd, one week before the actual public announcement), and Trump might have won. But, instead, they stopped processing samples until the day after the election, by which point they had almost triple the number of cases needed to make a determination.
That's one of the more remarkable news stories of 2020, but virtually nobody has heard it.
I sure can't say that Pfizer made the wrong business decision. After all, only about 0.001% of the populace even know that Pfizer shut down their lab's processing of clinical trial results until after the election. They stopped the count. But hardly anybody knows that. It's not like it's easy to learn how clinical trials work and see what Pfizer did.
Science Magazine did a detailed fact check of this claim and found it to be completely without evidence.
Company representatives explained that the decision was made to drop the 32-case unblinding because it had to meet a higher efficacy threshold than the 62-case unblinding, and because given the rate of spread at the time they expected it would be days - not weeks or months, as they'd thought when they designed the protocols - between hitting 32 cases and hitting 62.
So the decision was: delay by about a week, and in return get a much higher chance of being approved.
"Ugur Sahin, scientist, CEO, and co-founder of BioNTech, says the initial plan to look at 32 cases stemmed from a conservative assumption about the rate of spread of COVID-19 and the sense of urgency about the need for a vaccine. If the vaccine looked terrific at 32 cases and it was going to take months to get to 62 cases, then waiting seemed like a mistake, he says. “To me, every day counts.” And he had little patience for the debates over when to look at the data. “These protocol discussions are endless, and I’m often leaving the room,” Sahin says.
In mid-October, the companies had yet to confirm 32 cases. But with the epidemic exploding at many of the trial’s locations—which were mainly in the United States—they had second thoughts about FDA’s request that their first interim analysis should have more to support an EUA request. FDA “had strongly recommended to us that we change that, and the pandemic just was spiraling out of control in the United States and elsewhere, and we realized that we probably could get cases much faster than what we had anticipated,” Jansen says.
The math was simple: COVID-19 cases among participants were jumping from one or two per day to up to 10 or more. It became clear that the trial would accrue 62 cases shortly after hitting the 32 mark, and the higher number meant greater statistical power—and fewer debates about the meaning of the data. This 62 cutoff both lowered the efficacy bar the vaccine had to clear, and was also something of an insurance policy: If the vaccine triggered mediocre immune responses and it teetered around 50% efficacy in the trial, it could more easily have been deemed futile at 32 cases because of bad luck."
i'm very curious what people here think about repurposing of already-approved pharmaceuticals for early treatment and pre-/post-exposure prophylaxis. To start the discussion off, i know there's some data for TMPRSS inhibitors: ambroxol/bromhexine and also pretty much like, every antiandrogen since AR affects TMPRSS2 expression. TMPRSS inhibition has direct antiviral activity. Also people have been looking at drugs with immunomodulatory effects such as fluvoxamine and ivermectin. The immunomodulatory part is important because AFAICT the actual damage caused by the disease seems mostly to come from severe immune system dysregulation and its consequences (immunothrombosis, hyperinflammation) so tweaking the immune system's operation so it doesn't fall down that path is very much desired. Doubly so if the immunomodulatory drug in question doesn't affect viral clearance. There's some trials for ivermectin showing faster viral clearance and quicker cessation of anosmia and also an RCT for fluvoxamine with really quite good results. There's also a certain endosomal entry inhibitor that became a culture-war subject but honestly my understanding is that without blocking the TMPRSSes or at least TMPRSS2, blocking endosomal entry is pretty much worthless.
It seems to me that fear is causing us to massively over correct to try to prevent unlikely and unrealistic failure cases. For example:
People are afraid that unsafe vaccines will get approved because the procedure is getting rushed. Instead of trying to maintain the most critical parts of the testing process, and skip the rest, we are scheduling one month of thumb twiddling between when we get the data and when we meet to discuss it.
People are afraid of line cutting so we are prosecuting doctors who distribute vaccine doses out of order instead of letting them get thrown out.
People are afraid of price gouging, so we all decided not to do it, which removed the incentives to scale out production as quickly as possible.
According to the FDA, “This amount of time will allow the FDA to thoroughly evaluate the data and information submitted in the EUA request before the meeting and to be prepared for a robust public discussion with the advisory committee members.”
What do you expect them to say? That the month is full of thumb-twiddling? Numerous commenters have states the data could be analyzed in a few days at most. The CDC was taking holidays through that period.
The only criticism I read was an article by an academic with no firsthand experience with the FDA's processes saying he could do it in a couple days. Are there more credible sources?
I'm not happy about them taking holidays if that's true. My prior, though, is there's some probability they would have done work off-the-clock, given the incredible importance of expedience here.
Based on my own experience with 'process', the fact that the FDA/CDC/whomever scheduled meetings more than _one_ day in the future is extremely strong evidence of them "thumb-twiddling". What else can they be doing? Literally – what else is more important than them having those meetings ASAP, e.g. flying everyone in on a jet immediately from wherever they are? In fact, why shouldn't those officials be under guard at their offices (or wherever they can most effectively make the relevant decisions as quickly as possibly)?
You could only do the meeting on 1 day notice if there's almost no preparation required, and my prior on that is very tiny. I'm assuming this is the type of meeting where a bunch of department heads get together and say "hey I checked this stuff and the only problems we found are insignificant". I would guess there are hundreds of pages of reports to be filed and a book-sized checklist that people need to go through. The amount of CYA involved in regulatory processes is quite extraordinary and I wouldn't find it surprising if there's multiple weeks of full-time work to do before the meeting.
> The amount of CYA involved in regulatory processes is quite extraordinary and I wouldn't find it surprising if there's multiple weeks of full-time work to do before the meeting.
That reads exactly like "thumb twiddling".
Not being able to ignore the existing "book-sized checklist" – and adjust, as seems warranted, to an emergency of this scale, seems pretty difficult to justify.
I can think of several changes that they could have made to their process, just off the top of my head:
1. Defer 'filing' the reports! Surely that can be delayed while the important work of determining the safety and efficacy of the vaccines is prioritized.
2. Embed FDA/CDC employees in the labs/teams evaluating/testing the vaccines and have them analyze the data as fast as they can, without requiring that anyone 'file an official report'. In machine learning, some models/algorithms work 'online', i.e. as new data comes in. Surely _some_ evaluation of the, e.g. trial data, can be performed near the start of the whole 'project' and updated periodically (or even in something close or closer to 'real time').
3. Do away with 'official meetings' and, like in [2], do as much work as possible ASAP and update the overall evaluation as new evidence is received, i.e. 'learn online'. The final approval should involve a minimal amount of extra work – not "multiple weeks of full-time work".
Practically – 'pragmatically' – you're right that, given the prior status quo, it's not true that, for those meetings, given their role in the current 'process', there's "almost no preparation required". I'm not mad or angry at any individual employee at the FDA (or CDC or whatever), or even any specific bureaucrat higher-up in the hierarchy. Almost all of their incentives align with 'following process'. I'm just frustrated that even a disaster of this scale wasn't enough to push them to _even more_ radically streamline the whole ordeal.
Pretty surprised at the confidence of B117 resulting in a 4th wave so soon. That seems to under emphasize seasonality/immunity and over emphasize behavior to my mind. >10% of the us is currently had at least one shot and a partially overlapping ~10-20% (depending on how much under testing you think there has been) have been infected and gained some level of immunity. If you ballpark guess that in march something like 20% have some degree of protection does that not compensate for the variant being more infectious, or are my estimates way out of line?
The idea that the new variant is more infectious came from the same epidemiologists that have a consistent track record of total failure on pretty much everything (at ICL), not to mention publishing practically fraudulent papers (see Flaxman et al). As with everything else they "know" about COVID it was simply based on looking at case curves and making assumptions.
Additionally the data the ONS released to support this claim actually showed the supposedly super-infectious new variant declining before mid November. The explanation for this was literally, "before mid November this PCR signal we're using meant something different so don't look there" with no explanation of how it was different or what changed. The graphs presented to the public were then truncated to try and hide what had been done.
tl;dr - don't believe anything epidemiologists say about anything. The field is just terrible. Worse than social psychology.
Me too. Cases are dropping in the US at -3% per day for seemingly no reason (I don't buy that this is a seasonal shift yet), implying to me that the population has some partial herd immunity (14% had antibodies last November, it's surely much higher now - even 30% would take a big chunk out of R_eff).
I would expect that there is at least partial immunity to variants, such that population immunity levels, existing restrictions, and favourable seasonality in the coming months will result in the B117 epidemic not blowing up.
Evidence that would convince me otherwise would be a measurement of the current exponential growth rate of the B117 variant in the US. If it's positive (compared to to the regular variant having negative growth), that's evidence that the status quo is not enough to prevent it growing.
But the US is currently averaging R_eff = 0.85 or so. a 30% bump on that due to a variant and cases will be growing at +2% per day. But there'll be more people vaccinated and better seasonal conditions by then so...
Check Yougang Gu's COVID projections. ~30% have been infected in the U.S. and over 10% have had their first vaccine dose (with substantial overlap), so we are close to 40% with considerable immunity already. There were also studies suggesting 10-15% had substantial resistance due to previous infection with other coronaviruses
We are approaching spring with a virus that is estimated to be 30-70% more infectious than "original" Covid19. There is some level of immunity, but vaccines still haven't got to the people that contribute to spreading the virus more (i.e. young people).
Further, even if this theoretical argument doesn't convince you, if you separate the components as if old Covid and B117 were two different diseases, you see that while the former is declining as expected, the latter is rising exponentially everywhere (Denmark, Italy, France, Germany).
I think that the "fourth wave" is a given. The only thing that might change in this one is that the vaccines will have a strong effect on deaths, since most old people will have had at least one shot of Pfizer/Moderna by the time the wave peaks. This could be, however, counterbalanced by the fact that there might be less restrictions, leading to more people getting in contact with the virus, leading to roughly the same amount of deaths.... especially since many states use hospital occupancies as metric to ease/harden restrictions. Of course this is dumb and we should strongly push for restrictions to stay in place even with less hospitalizations/deaths, but one year of pushing for this has produced absolutely nothing so it's a fool's hope that this time they will listen.
I'm sure there will be a '4th wave' of some kind, but the timing and intensity is what I'm doubtful of. Estimating exponentials is really hard, especially when there are multiple competing drivers (vaccines, behavior, prior exposure, r0) which are also hard to estimate. But it takes time even for exponentials to grow, and there is a huge difference between 30% and 70% more infectious. I think your confidence interval should at least include 'small rise in cases that is brought under control because of increasing vaccination'
There's really no chance that people are going to tolerate more restrictions if there are fewer deaths/hospitalizations. But that is fine? We can pay a high economic/social premium to avoid deaths, but not obviously worth it to pay that to avoid cases. The issue is if you get this runaway exponential growth and hospitalization data are lagging by two weeks, then you can still end up with steeply rising hospitalizations of course and be too late to avert a crisis. However for this to happen you would really need some extreme exponential growth in cases coupled with everyone just ignoring this for weeks, which still seems unlikely to me.
Well, that's only if letting cases spread freely doesn't lead to new strains which put us back on square two (meaning we have vaccines but we need to jab everyone and lockdown again while we do that).
Also, if the virus spreads freely some young (<50) people still die (not enough to overwhelm hospitals, but the number is in the thousands/tens of thousands).
> Further, even if this theoretical argument doesn't convince you, if you separate the components as if old Covid and B117 were two different diseases, you see that while the former is declining as expected, the latter is rising exponentially everywhere (Denmark, Italy, France, Germany).
This is greatly misleading. B117 is rising exponentially *in comparison to vanilla covid*, not in absolute numbers (which are stagnant in France and Italy, have kept falling sharply since late December in Denmark, are slowly but surely falling in Germany).
Do you have the numbers? I was hasty to declare it couldn't grow exponentially when the overall sum was flat or falling, but it might be indeed possible if the other strain has been going done faster than expected and the starting point was low. I'm still not exactly convinced by the data I can easily find (e.g. https://en.wikipedia.org/wiki/Variant_of_Concern_202012/01#Development_of_the_B.1.1.7_lineage ); the Denmark numbers show a large relative growth but the overall sum is declining sharply, whereas the other countries haven't been measuring much to begin with).
And at the beginning of December in London it was exponential under restrictions that would (and had!) normally neutralised OGCovid's exponential growth bursts.
As everything with this pandemic, I admit it's not 100% confirmed yet, but the few data points we have now agree with this theoretical argument: a virus with 50% more transmissibility which has shown it can bypass "Tier 3" restrictions in the UK (that's, in a way, how it was discovered) should rightfully have R>1 in every country whose measures are currently "Tier 3"-like (Italy, Germany, France,...).
The good news is that actual lockdown works (see London cases graph, and also cases everywhere else in the UK that never lifted off exponentially due to early introduction of the lockdown when B117 was still low)
The projection you are linking (Der Spiegel?) isn't convincing -- you can extrapolate small numbers to anything. The Danish data ( https://files.ssi.dk/covid19/virusvarianter/status/status-virusvarianter-16022021-ccxh ) is more worrying, but the highest increases in the # of confirmed B.1.1.7 cases has been concomitant with the highest drops in total COVID incidence. Multiplying new variant percentages by total incidence results in a 2.3x increase over 5 weeks, almost all of it however supported by 1 week. My takeaway for now is "we need better numbers".
The second-to-last prediction would be more interesting to me if it gave a probability for people wearing masks indoors (say, a grocery store). Outdoors, people are much more cavalier about masks already, and are already drifting down towards mostly-not-wearing (plus generous distancing) in my Silicon Valley neighborhood. Indoors, they're still at nearly 100%. And this fits with what I've heard about transmission-- that indoors is by far the greater risk.
90% confidence in "not much outdoor masking" seems to imply a 10% probability that our mid-2022 masking norms aren't just paranoid and security-theater-y, but actively irrational. One would hope there's a somewhat higher risk that we'd still be wearing masks in grocery stores.
I think this is too pessimistic. The math on vaccination and herd immunity suggests that once you get to over 50% immune... The r value drops and keeps dropping in an additive manner.
Immune escaping variants are a very definite risk that we should all worry about and strongly try to mitigate, but right now they are not a concern (meaning that the best vaccines are still very effective against all dominant strains) so I wouldn't account for these when thinking about a short-term scenario.
I think this is fairly plausible, and here’s a question not discussed there: Where in this multi-year to permanent cycle do schools again educate all of the kids they were, in the buildings they were, where having 25-35 in a classroom, very often closer than 6 feet apart, was the norm?
"all the kids they were" - probably never. At least some families have found that online school programs, unschooling, or homeschooling suits them better than whatever schools they were in before. I've heard from homeschooling friends that their communities have been growing. Early polling seems to suggest that almost half of parents are at least considering moving to homeschooling or some other non-traditional option even after lockdowns. Even if only a tenth of those go through with it, that would more than double the number of homeschooled kids in the US (which, before the pandemic, was 3-4%).
I'm a teacher, in a potentially high-risk group, and I'd be willing to jump back to normal as soon as I can get a vaccine and a two-week period for it to kick in. I'm not even picky - I'd take Sputnik or Sinovac. As a parent, though, it's tricky - I'd want to see good community spread metrics and maybe even vaccines for kids once we get the data in on those, and if my son's school stopped offering online schooling right now and told me to send him back I'd have a *very* tough decision and possibly move him to some kind of homeschooling program. Perhaps it's weird to be a teacher and be so on-the-fence about the benefits of traditional education... or perhaps not. Anyway I think a lot of people will be rethinking schools after this.
One big question is when high risk activities, such as major concerts, sporting events, and conventions happen at 100% capacity. Whole industries, businesses, and urban developments are built around these kind of events happening on a regular basis, and they can't be put on pause forever. At some point things need to resume or people need to figure out what to do with all those useless arenas, stadiums, and hotels.
But I also wouldn't be surprised if future stadiums and arenas are designed with better ventilation, so that a few decades from now, the 20th century ones all feel cramped and unhealthy to people.
People tend not to notice ventilation. I doubt most people could tell the difference between a room with 2 ACH and 6 ACH just by observing it or being in it for a while (assuming nothing obvious like an open window or a breeze).
I've read that they're saying the vaccine might not stop the spread: vaccinated individuals could become asymptomatic carriers. To what extent is this a real possibility, versus an abundance of caution?
Like, I understand they haven't run specific trials on that for these specific vaccines, but for all the vaccines we've had in the past, how effective have they been in preventing transmission?
It sounds like asymptomatic people are something like 40% less transmissive than symptomatic people. Since the vaccines turn at least 95% of cases into asymptomatic cases, it seems like they should cut transmission by a significant amount. And if a good number of those aren't just asymptomatic, but actually eliminated, then that's significantly more.
The "but we just don't KNOW if the vaccines provide sterilizing immunity" talking point constantly spouted by experts and repeated by the media needs to move beyond a black or white scenario.
It is guaranteed (I would bet on this with 1000 to 1 odds) that being vaccinated provides some sterilizing immunity. If being vaccinated reduces symptoms, and we know that asymptomatic spread is much less prevalent than symptomatic spread (https://www.nature.com/articles/d41586-020-03141-3), this would be logical.
It is all but guaranteed (I would bet on this with 10 to 1 odds) that being vaccinated provides a majority of sterilizing immunity — though it was a small sample size, Moderna's data indicated a 66% reduction in nasal viral load only 21 days after just one dose, and we would expect this to grow in strength with more time and after a second dose (https://imgur.com/tdom2E7).
If I were vaccinated today, in 10 days I would reduce my overall caution by half, and in a month I would reduce it by 80%.
By the way, is there an alternative to the term "sterilizing immunity"?
My impression is that a lot of people who are leery of vaccines get freaked out when they encounter the term, thinking it is talking about vaccines sterilizing human reproductive systems.
How much worse is it for places to want everyone to wear masks than for places to want men to wear underwear and pants nowadays, or for places to want everyone to wear hats or ties at some other points in time? It'll at least be a weird fashion restriction that serves some function in lowering the overall burden of respiratory diseases.
... The assault on Williams, captured on surveillance video recently released by the Chicago police in an effort to identify and catch his killers, focused attention on a dramatic spike in carjackings there. In all of 2019, there were 501 incidents of that crime. So far that number has more than doubled to 1,125 this year, according to the latest Chicago police statistics.
But Chicago is neither the only nor the worst example of this disturbing crime trend. Minneapolis police report that carjackings there have shot up 537% this year. Carjacking calls to 911 in New Orleans are up 126%. Oakland police cite an increase of 38%. And while many police departments do not keep carjacking-specific numbers, instead classifying them as auto theft or armed robbery, crime experts like Chris Herrmann, a professor at John Jay College of Criminal Justice, say anecdotal reports of a carjacking surge are coming in from metropolitan areas around the country including Milwaukee, Louisville, Nashville and Kansas City.
And he explains that the pandemic, which has normalized mask-wearing, makes these thefts easier.
"If we weren't in a pandemic and you saw a guy coming up to your car with a mask on, you probably would freak out and hit the gas pedal," he explained. "But nowadays, everyone's wearing masks. So there's this anonymity part of the pandemic that I think a lot of criminals are taking advantage of."
Mask-wearing anonymity may be only one way criminals are taking advantage of the pandemic as carjackings, along with other violent crimes, have risen sharply. According to a recent analysis by the Police Executive Forum (PERF): "Preliminary data from 223 police agencies across the United States reveal steep increases this year in homicides and aggravated assaults."
While masks probably contribute to general lawlessness, I think that a bigger factor worth considering is the change in policing tactics in response to the summer protests.
This article makes this case and backs it up with data. I'm not quite sure how to feel about unconstitutional/hostile policing being effective at suppressing violent crime.
Same thing happened after 2014, when murders in the US went up 22.9% in two years. When the authorities and media decide that every cop is a criminal and all the sinners saints, the police retreat to the donut shop.
But, in an era of video cameras, the aid to lawbreakers provided by not only allowing but encouraging masks can't be negligible. Decades ago, many states passed anti-mask laws to fight the KKK. They seem to work.
Minneapolis resident here. Been in favor of defunding the police for 20 years as a loony libertarian. This is 100% a big deal and has soured most normies on any kind of police reform.
Streets became unsafe for pedestrians within hours of the burning started, because people started driving 60 miles an hour in residential neighborhoods (personal observation and discussion with other parents w/ kids in the age range that can run out into the street). Shootings are way, way, way up (check the www.bringmethenews.com search box). Unreported crime is way, way, way up based on my direct observations and conversations with a friend of mine that owns a private security firm.
Masks are definitely more inconvenient than hats or pants for any situation where people want to eat or drink. I suspect they also add friction to face-to-face socialization due to it being harder to read expressions.
From personal experience: Masks are a substantial hindrance in education, as it's much harder for teachers to convey nuance and also harder for them to "read the room". Granted, the lip-reading deaf teacher down the hall has it much worse than I do...
Also much worse for folks who wear glasses or have hearing problem. Plus they block off a lot of communication that happens through facial expressions which is a big hinderance in social situations.
It makes life a lot harder for glasses wearers. A properly secured medical mask of course won’t cause fogging, but a cotton mask (or even a KN95 mask, applied as best I could) results in my glasses fogging up to the point that I can’t see out of them. It’s fine with contacts though, which is my solution, but I don’t think that all glasses wearers will switch to contacts.
Unfortunately, dish soaps can mess with the glasses, especially if you have anti-glare coating. Can't say for sure whether you're safe with regular, bottom-shelf, no-magical-additives no-name dish soap, or if it's more endemic to the anti-glare coating itself.
I switched to a half-face respirator on the ambulance for exactly this reason. I can walk around a grocery store with lightly-fogged glasses. Driving or caring for another person requires more.
I wear a mask brace on top of my KN95, and it greatly reduces fogging. They're a structure of several stretchy loops, 2 that lay near the edges of the mask and 2 that goes around your head to hold it in place. They pull the mask edges tight against your face. Got mine from fixthemask.com, best 15 bux I've spent in a while.
"Sorry, things may get worse before they get better."
Depends on how you define "things". I believe the only metrics we should really be looking at are hospitalizations and deaths (yes, Long COVID is a problem, but a lesser one).
Cases will quickly start to decouple from deaths and hospitalizations. So a spike in cases is not as big of a deal, and really shouldn't result in many additional restrictions, at least not ones similar to the winter spike.
We are soon entering a period where not getting infected will become a matter of personal preference, rather than an altruistic endeavor to avoid killing someone or causing them serious illness.
There is enough evidence and definitely enough theoretical arguments to say that allowing the virus to spread "freely" due to older people being vaccinated can lead to mutations able to escape vaccine immunity.
Even more worrisome is the fact that in a vaccinated population there might be strong evolutional pressure for the virus to evolve in this way.
Now, this might be true, or it might not be true, it is too early to say. But we know enough to say that this is definitely part of the Reasonable Worst Case scenario, which is the one we should be planning policies for.
I'd predict that the cultural effects will be influenced by economics, culture-war factors, or a desire for signaling. Profitable gatherings will continue to be encouraged by advertising; more spontaneous or altruistic ones will stay online. Public group activities will be tilted towards the political factions that are now more likely to engage in them. I'd give a 70% chance that at least one NFL stadium reaches 90% capacity during the 2021 season, a 90% chance that food service workers in Democrat-governed cities will remain obligated to wear masks through the end of 2021 (and beyond), and a 75% percent chance that mass transit ridership stays below 2019 levels for a decade (unfortunately for the climate).
What I have wondered about for a while, is whether a system would arise (or be proposed) for allowing people entry to mass gatherings *only if they provide proof of vaccination*. The Super Bowl this year was eager to announce that it had allowed a few thousand vaccinated health care workers to attend in person. It hasn't come up yet because vaccination rates are still low, but once they are generally available and rates get around 50%, there will be eagerness to push those rates higher, impatience to drop restrictions, and concern about the portion of the population that refuses and the resulting persistence of the virus. Someone will get the bright idea to offer incentives, and someone else will get the bright idea to claim it's the Mark of the Beast; it would be challenging to avoid economic or racial disparities in such a system as well.
One of the first times I ate at a restaurant in the fall (outdoors), I began to suspect that face coverings on waitstaff will be here to stay, at least in certain fancy restaurants. At the sort of place where waitstaff wear a uniform, a facemask will just become part of the uniform, and convey the social separation and subservience of the waitstaff to the guests.
Only if we abolish tipping in the United States. Tipping is driven social signalling, and facial expressions are critical to human social signalling. Waitstaff who can e.g. smile and be seen to smile will have an advantage over those who can't.
If everyone in a given restaurant wears the facemask (as management will insist) then it at least won't affect the relative tips of the different waitstaff. (This might be a secondary benefit of masking, eliminating one of the irrelevant factors in waitstaff compensation.)
Maybe. This was the year I upped my tipping from fifteen to twenty, and I give it to pretty much everyone. My old standard was fifteen or so, up to twenty for good service. As long as covid is still in the air and the staff is still masking, I'll probably keep it at that level.
Back in March or April, I counted the "it's an annual disease like the flu" as the awful-tier outcome. I stand by that, but it's looking even more likely now than it was then, and I have less hope that I was wrong in my estimates.
I think there's an interesting question of whether we've managed to turn the flu into something much more manageable though. We will see if any habits we picked up this year help protect us against the next flue season too.
New reader here. Excellent article, thanks Scott. Very curious about your predictions on the long term impacts on young children. Like your WW2 analogy, will there will be a whole generation of kids who are fearful of any human contact even after things return to normal(ish)? Or will the extreme social distancing learned behavior fade as we become more integrated into the world again?
People in the older generations who saw polio cases sometimes associate water fountains and even swimming pools/water parks with polio and avoid them - I get the impression that was emphasized when they were children. So maybe.
This reads like a very Bay Area view of Covid and response - or a very myopic view of a particular part of the culture.
I've flown at least 12 times since the pandemic started. We've hosted many visitors from out of state, we go to restaurants multiple times a week - they are fairly full - and most of our friends do the same. We gather indoors and out for various occasions. Family is the same.
We're fragmenting into two covid subcultures, as others have noted. But the simple fact is that the data does not justify anyone who is under 70 and healthy changing the way they live now vs. how they lived in 2019 and prior.
I learned recently that for some destinations, vacation travel actually went *up* this year. The fact that aviation as a whole can be down 80-90%, while vacation travel is steady or rising, indicates just how little aviation was driven by vacation, and how it was mostly business travel.
I agree that nobody under 70 should change their lifestyle for selfish reasons. I'm not sure about the altruistic effects - if I catch COVID (and pass it on to a few people before realizing it) am I contributing to someone over 70 dying?
That only seems like a concern for people who have routine close contact with elderly/high risk. If my only unmasked contacts are young people, then it’s extremely unlikely that my infecting them would lead to severe illness or death. It’s possible that one of my low risk contacts would then go on to infect a high risk person, but at that point the chain of causation is interrupted and it wouldn’t be my moral responsibility.
It's not, as some people can't help having close contact with high risk people, so the chain of causation is not interrupted if it wasn't their choice. Doctors, nurses, policemen, firefighters, cleaners in care homes, plumbers, electricians, ...
The "hospitals being overwhelmed" thing still matters, even if the disease doesn't progress to the "severe" stage. The total amount of hospital resources available are more-or-less fixed. A small change in the absolute percentage of the population requiring hospitalization will drastically change the relative utilization of hospital resources. We haven't actually exceeded capacity anywhere yet (NYC hit the brink last year), but people in healthcare are still really worried about that possibility.
Really? This is pretty surprising for me to hear you say. What about the frequency of long-term effects? That alone makes me pretty reluctant, just on a selfish level, to go back out to bars and the like. Why do you think differently?
Speaking of which, masks and distancing also reduce the rates of other viral infections. I remember apocalyptic warnings about this being a joint covid/flu season, but instead the flu season apparently didn't happen at all. Whatever measures we took to suppress covid absolutely crushed the flu.
I don't know how much the average person's behavior will change as a result, but I have certainly at least considered switching from teaching to an entirely-online job in order to reduce my exposure to *all* pathogens, pollution, and stressful interactions with other people (while still maintaining my social life at pre-pandemic levels). That idea seemed absolutely crazy before I spent a year doing it. It helps that I have friends who are digital nomads and work abroad from home.
I could imagine a trial lockdown could move the needle, at least a little, on how many people choose to work remotely, is what I'm saying, and not just because of the danger of covid exposure.
A) The "not social distancing" subculture definitely contributes to the spread, and significantly. It might not have got into you specifically, but there are countless examples in the literature of gatherings that lead to superinfection events that lead to tens of deaths. So, if you are at all concerned about not contributing to the killing of elderly/fragile people, you should change the way you're living
B) The more the virus spreads, the more it can mutate. We know this now: this virus is capable of evolving fast. So you could be initiating a worse pandemic by not applying social distancing (it happened in the UK, in South Africa, and god knows where else)
C) An uncontrolled spread of the virus (the one you'd have if everyone under 70 acted as you suggest) would lead to overwhelmed hospitals, which would lead to healthcare being substantially broken for months, possibly years. At all ages, people need healthcare: they break bones, they get cut, they get various treatable diseases, they have car accidents, fall down the stairs, their appendix gets inflamed and needs to be removed.
All this to say: the data definitely justifies changing your life. Acting as you are right now is a sort of prisoner's dilemma scenario, in which you are freeloading on other people's sacrifices. This is morally wrong, but I can see how it could be the best personal choice for selfish reason... but it's definitely not the best societal choice, and the data definitely doesn't support any of it.
And let me add a cynical remark: do you really think that our current selfish cynical society would choose to deal such a blow to the economy if the only benefit in doing so was saving lives of people over 70?
I am from the UK. The rest of the world couldn't care less about Trump, and we are just as "obsessed" with Covid19, which is killing hundreds of thousands of people.
Devil's advocate: The UK media is very closely tied to American media via language, and of course the UK have Boris Johnson to make look bad, who is usually lumped in with Trump/Modi/Erdogan.
Has the media/the "covid-obsessed" crowd suddenly reversed course, as a result of Biden's victory or inauguration? The sources I pay attention to (WaPo, The Atlantic, Zvi) seem to have maintained the same general tenor of presentation, but I don't live in America so maybe there's something I'm missing. But that suggests to me that the presentation isn't caused by "TDS" or anything like that.
I’ve also noticed that LessWrong/SSC types tend to overestimate 1) the extent to which California’s super strict restrictions are typical of US as a whole and 2) the extent to which people conform to those restrictions.
Even if you think people in your area all wear masks and avoid socializing, drive an hour or two and the situation will be different. Or get to know people and you’ll see they make exceptions. The Deborah Birx case is an example: no one, to a first approximation, follows all public health advice, even the people who make it.
The post handwaves that R stays at about 1.0 by stating that people and governments adjust their behavior around surges and lulls. But you should be able to check this with mobility data, or opentable.org, or something. As far as I know, we never observed any consistent correlations with this.
Anecdotally, people in my large liberal city have no idea what local or state R is at. How many cases/deaths there are, or what hospital capacity is. And any discussion of COVID going up is accompanied with derision for hypothesized anti-maskers driving spread, and any discussion about it going down is self-congratulatory with comments about how we need to keep doing locking down hard.
In other words, no one wants R to be 1.0. Pro-lockdowners want it to be 0.0 and anti-lockdowners don't care. People and local governments just have no concept of R, or trends, or absolute vs. relative levels, or anything numerate. So I don't see any way they'd be adjusting their behavior to maintain R at 1.0 when they don't even know what local levels are. They also wouldn't care if the trend was flat even if they knew what it was, since a flat trend is no one's goal. COVID levels could be 10x higher or 10x lower in my area and everything would be the same.
I would really like to know about the likelihood of long-term effects from mild covid cases in people who have been vaccinated. I am okay with taking the reduced risk of catching mild covid post-vaccination if we're just talking about the ~two weeks of acute symptoms, but if "long covid" is still occurring frequently (I recall seeing estimates of 10-50% in current inoculated cases) then I'm back to dreading the virus, even post-vaccine.
One interesting thing I've been seeing discussed is the question of how much this "long covid" syndrome is common for other viruses. It nearly matches the description I remember hearing when I was in college of mononucleosis, and of chronic fatigue syndrome, which has sometimes been described as post-viral fatigue syndrome. Are there some viruses that cause it more, while others don't cause it at all, or can it happen from any virus? Are there other viruses circulating that we don't even notice, because this is their only symptom?
Read somewhere respectable recently (sorry, can't remember where) that loss or distortion of smell and taste is common in "long covid." Prevalence of this symptom in long covid group seems important. For one thing, pretty much nixes any idea that these folks aren't really a distinct group at all, just a bunch of people suffering from 2 or 3 of the 10 or so most common ways people feel chronically crummy for miscellaneous reasons (fatigue, headaches, low mood, headaches, mental fog . . .). But also the persisting loss of smell and taste suggests that if long covid is a post-viral syndrome, it is a distinctive one.
Definitely possible. But it's also possible that covid damages smell/taste long term as a *separate* symptom from the "post-viral syndrome" that is also caused by covid as well as other viruses. This article was pretty interesting:
In the SUPER long-term, does COVID seem like something we could completely eradicate, like we did with smallpox? Or is it more similar to the seasonal flu?
And why? Why is that smallpox never mutated beyond control? Why is COVID more or less prone to mutation?
I reckon it is because smallpox was so deadly and scarring. If the outcome of being infected was death or permanent disfigurement people would be a lot more careful.
Secondary to that, smallpox was with humanity for a much longer period of time, so likely it was much closer to optimal virulence. Thus any new randomly mutated strains were self extinguishing relative to the dominant strain.
There are a lot of differences that made smallpox easier to eradicate.
The big ones (as well as what Fallacious Thoughtcrime said) are that smallpox had neither animal reservoirs nor asymptomatic transmission. Covid has both.
Short answer: no we won't be able to eradicate COVID.
Long answer: Coronaviruses hop between species. There are large "reservoirs" of the virus in bats, pangolins, and some other species. Mutations will develop in species populations which don’t have immunity. So future crossover of new strains will be possible, and even probable. In this respect, Coronaviruses are similar to the Influenza viruses, which, are harbored by pigs and ducks in southern China—among other species and places—but southern China is where many of the new flu strains originate.
Smallpox (Variola) does mutate, but Variola is a double-stranded DNA virus, and it mutates at a much slower rate than single-stranded DNA and RNA viruses. And, AFAIK, Variola has no animal reservoirs. At some point a new vaccine may be required—if it hasn't been completely wiped out like the WHO says—or it escapes or is released from a lab. The last known natural case was in Somalia in 1977.
The good news is COVID-19 is longest of the single-stranded RNA viruses. And depending on which research you trust, it mutates between 1/10th as fast or 1/2 as fast as influenza viruses do.
"Short answer: no we won't be able to eradicate COVID."
It's all a matter of will. China, the world's first (or second) most populated country eradicated COVID within its territory, as did Vietnam. Eradicating COVID is straightforward, but most countries don't have the will to do it. Perhaps China could institute economic sanctions against countries that threaten its economy with COVID imports.
No, China hasn't eradicated COVID-19. They're playing whack-a-mole with continual new outbreaks in cities all over China. The Chinese have been very efficient at whacking the COVID moles has their heads pop up, though. They've got an excellent testing program, and they're immediately locking down whole neighborhoods whenever a new infection shows up, but despite their excellent public health response new outbreaks keep happening — and many of them haven't been explained via contact tracing. Which is very disturbing to my mind. I'm starting to think there are SARS-CoV-2 reservoirs which are reinfecting human populations. The government is quite eager to SinoVac rolled out, because there have been unconfirmed reports about unrest and pushback at the sudden lockdowns.
Another big mystery about SARS-CoV-2 is why some countries have been hit much harder than others. A recent study of frequency of HLA protein types and COVID-19 deaths. There are hundreds of different HLAs and they provide natural immunity against various diseases. HLAs are inherited from our parents, and the frequency of different types vary widely across different human populations. This study found a correlation between the ratio of the S to N type HLAs, and the severity of COVID-19 infections.
Correlation is not causation, and I'm not fully convinced by this study. But it's interesting that it pegs countries like Malaysia, Thailand, and China have very high frequencies the N HLA and very low frequencies of the S HLA. And the mortality rate has been lower and rate of severe infections has been lower in those countries. The frequencies are reversed in countries like the US, GB, Sweden, Italy and Brazil, and the mortality rates and severe infection rates have been much higher. Of course, there's a theory the Coronaviruses have been infecting humans for untold millennia, hoping off from animal reservoirs into humans. From an evolutionary perspective, I don't think it's a coincidence that Pangolins and a particular species of bat are native to China and SE Asia — and SARS-CoV-2 seems to have hopped to us from those species. The populations in these countries have developed a natural immunity to the worst that Coronavirus can hand out through their HLAs...
Note that the annual flu vaccine update does not go through the entire FDA approval process that a brand-new vaccine does. I'm not sure what happens, I'd think there is some FDA involvement, but we manage to get out an updated vaccine for new flu strains every year without the FDA getting in the way of that. So I'm relatively confident we can do the same for coronavirus. (Also, my understanding is that coronaviruses don't mutate as fast as influenza.)
I hear the flu vaccine update thing was grandfathered in from when FDA restrictions were much looser. Might not be as easy to create a new carve-out for covid vaccines
A very California-centric post, short on data and attitudes from other states much less other countries. There are already indications that severe lockdowns cause more harm than good. The fact that vaccinations are touted as no guarantee of anything or a return to maskless lifestyle, the 99.5+ survival rate even without the vaccines, the politicalization and incompetence of the vaccine rollout schemes mean even the most brain-dead CNN watcher will stop listening sooner rather than later. It may be worse than the Flu, but that's not saying much.
In the Novavax trial in South Africa, the risk for people with previous infection to be reinfected was equal to the one for people with no previous infections.
Variants exist, arguing as if they don't is foolish at this point.
I'm not arguing that. My position is that corona is now little worse than the a bad season of flu. Particularly now that people like Cuomo aren't sending infected people into susceptible populations on purpose. Or do you deny that happened?
Corona is several orders of magnitude worse than a bad season of flu. And Corona with lockdowns, social distancing, mandated masks, working from home orders, travel industry paralysis, substantial reduction in public events etc.... is still a little worse than a bad season of flu.
Severe lockdowns (the ones in spring 2020) do cause more harm than "balanced" lockdowns (the ones in winter 2020), but both cause a net gain on deaths in the population because they stop an exponential spread much, much sooner than it would stop logistically.
This is now known by so many data points that it's essentially beyond any reasonable doubt.
I wouldn't argue against severe lockdowns in spring 2020 either: we didn't know exactly where the balance was, and we chose to be cautious. That's a rational choice.
A personal note: talking about "brain-dead CNN watchers" really doesn't help us give any more weight to your arguments (and in fact...)
About effectiveness of lockdowns? Everywhere, really. You always see an exponential trend abruptely stop way before logistic curve arguments would kick in.
"Public health experts say there are key lessons for FDA in the global, long-held approach to influenza. Shots made yearly to battle the flu rely on a foundational vaccine that is then altered to fight the particular variants that pop up each season. Drawing from flu vaccine practices would mean that manufacturers could skip monthslong trials that enroll thousands of people and instead prove safety and effectiveness in smaller studies that track a few hundred volunteers for weeks.
"Peter Marks, FDA’s top vaccine official, signaled Friday that the agency is leaning toward this approach. [...]"
Good article (I often find Politico is much more informative about governmental goings-on than the major newspapers). Another promising excerpt:
Adapting the flu strategy is an approach championed by scientists. It’s not practical to run full-fledged late-stage trials for Covid-19 booster shots or revised vaccines, said Paul Offit, a vaccine expert at the University of Pennsylvania who sits on FDA’s vaccine advisory board.
“The flu model is the only thing that makes sense,” Offit said, and not just because the limited trials could be carried out swiftly. “Thirty million people have already gotten vaccines, 20 percent of people are already immune. You would have trouble doing an efficacy trial” enrolling thousands for one strain of the virus.
I just don't understand how, even after a year-long major life disruption keeping this issue constantly on everyone's mind, the number of people willing to accept a free vaccine against a deadly global plague is STILL only two-thirds.
I have some patients who aren't interested. They say they're young and healthy, their chance of dying is basically nil, and they either are concerned about side effects or want to "leave it for someone who needs it more"
"Leaving it for someone who needs it more" makes it sound like they'd be happy to take it once supply is no longer constrained. Are the polls counting that as "does not want it?" I mean, I'm happy to let higher-risk people go before me, but I still want a vaccine as soon as I'm the best marginal use for one.
For the patients who say they're young and healthy, are they socially distancing anyway? Is there an argument for social distancing that doesn't also argue for getting the vaccine? (I guess someone could have a considered preference for social distancing over the risk of side effects, but given how unpopular social distancing is, that seems unlikely to be common.)
I'm wondering how many of those surveys are lacking a "already got the virus, go jab someone more needing" option. (Particularly the ones that report scary numbers of health workers declining vaccination.)
I like the idea of having the FDA give categorical approvals for modular vaccines. What can we do as citizens to make that happen: write to Joe Biden? call our members of Congress? something else?
I feel like people aren't talking enough about rapid testing. It seems like some California schools have managed to open using testing, which seems promising:
I was able to secure, through a friend of a friend, 15-minute nasal swab antigen rapid tests by way of Germany by way of China for $10 a pop. They're 99.4% effective and pretty easy to use. We have them at our house to use for future group social events - because who wouldn't pay $10 each to have a safe cabin weekend away with 10 friends?
The fact that these aren't being widely touted as the way out of this is maddening.
Wow! That' still a far sight better than I thought--my cached belief were current rapid tests being ~80% sensitivity. I wonder if I can talk my friends into using these.
The problem is getting them into the US. They aren't FDA approved and according to the friend of a friend the only way they were able to get them was due to science connections. But I'll be looking for ways to bulk buy a bunch if our supply runs low...
Michael Mina (https://twitter.com/michaelmina_lab) has been flogging rapid tests (https://www.rapidtests.org/) for a year and I am among those baffled by the lack of take-up. I assume it should work against any variant, and by driving the incidence of cases to near zero, vastly reduce the opportunities for variants to emerge in the first place. And then, why not use it for the flu, cold, norovirus (cruise ships ahoy). Use it on pigs, use it on cows, use it on chickens, use it on anything that moves. A virtual population immune system.
Not an expert myself, but after observing Mina shout into the void on this for like 8 months now, I have to assume that any effort to deploy rapid tests is just being blocked.
A cynical take is that the PCR testing companies are making a boatload of money and don't want that gravy-train disrupted.
An even more cynical take is that those companies are funding disinformation about rapid tests. Since the tests don't return the same results as PCR, the companies can exploit that to sow doubts about them.
This is a really helpful piece, but are we *sure* that this approach to vaccines is a good idea? Simply "changing the password" as often as possible and speeding it past normal processes? We don't know how reinfection affects people yet, and immune systems are complicated. It seems *possible* this could increase vaccine-resistant mutations or just somehow become a problem. We're moving really fast without a lot of information, and there isn't precedent for this. There's also the issue that, if we're going to make it like the flu shot, why don't we just do that now, and let those willing to take the risk interact normally, while giving vaccines to those who want them as quickly as possible, and helping them isolate? As you say, only a minority is likely to keep up with yearly injections. It scares me that our public decision-making basically operates, on the surface, according to a zero-risk logic. This is why I'm paranoid as you describe--if we continue validating this logic, it's not that hard to imagine things not going back to normal for decades, especially given the damage to the economy and social trust. I agree that, if I was thinking of it from a purely rational perspective, this would be like the flu in a few years. That's what I thought we'd decide back in March. But we didn't. And maybe that was reasonable given the unknowns early on, but it doesn't seem reasonable to me now. We're not operating like treating it as we do the flu is a comprehensible option, so my purely rational assessment is obviously false. This could change, but it worries me. From my perspective, the practical limitations on our ability to control this long-term, and the extraordinary accumulating costs that would come with trying, were very obvious from the beginning, and definitely not worth it. (Other than sensible, targeted mitigation measures, of course--I'm not saying do nothing, but anything close to eradication is not going to happen.) In the short-term, they seem worth it, but when you think about what would have to happen to keep it going long-term, the game is just unwinnable, and trying to win it just eats up the resiliency and ability to plan we could have used to cope with it and make necessary transitions. Society is a complicated system to be messing with---we don't know what we're disrupting in the long run. That's when you end up with no concerts forever---people may adjust to the risk and treat it like a flu, but there's no money left to sustain the concert industry, and a lot of people have grown to see it as an unnecessarily risk indulgence. If you don't come to a relatively clear-eyed acceptance of the situation, you can just get stuck drifting along as though it is a permanent emergency, even if most people want to live normally. They won't speak up against the others if we're operating under a logic that ignores the question of what the endgame is, and whether any of this is worth it long-term. I'm very uncomfortable with how this has proceeded and is proceeding. I appreciate that covid poses a real danger to some people, but I can't imagine any situation in which I would advise the response we've chosen. If I was high risk, I would want to shelter and be given the resources to do so, but I'd be terrified to have all of society "hibernate" like this. I would not see that as likely to protect my future, but likely to jeopardize it, by disrupting the available resources, conveniences, and stable society that make sheltering possible.
Re: "yearly COVID shot". I just got my second shot out of the two-component vaccine. That means me potentially being immune to two different vaccine vectors, hopefully for less than how long the COVID immunity lasts, but possibly longer. Is there a technology that would help us avoid running out of vectors for the foreseeable future?
It’s good to hear you say that. But if it’s a matter of not wanting to cause your audience to despair vs. writing your sincere thoughts on what direction this is heading..: I would rather hear what you’re really thinking.
Seconding this article causing me to adjust toward more pessimism and not enjoying that, but also appreciating your work specifically because you're so good at accurately capturing the world.
We need to consider just how different humanity is now compared to when Spanish flu arrived. It was allowed to take its natural course because we didn’t know any different. Today if we were told that allowing a virus to run its natural course would likely result in less deaths than fighting it (allowing for more mutations to proliferate), we couldn’t make the call. International travel, coupled with the fact that we are so easily triggered in today’s online world, the ‘panic and fear’ factor could make things worse.
Based on tele-work, tele-medicine and tele-everything else: the current nerdopolis that is the Silicon Valley will start losing its dominance, steadily and surely. Not sure how to quantify it, though.
I think this is long-term true but that COVID won't make much of a difference in itself. Housing prices have barely budged (rent has gotten better, but not buying, which suggests the market expects long-term stability).
You've described what will happen in the US which seems plausible. Here's what would happen in developing countries: people collectively decide to ignore COVID as-is, it kills off 0.3-1% of the population (depending on the median age) allowing the rest to reach herd immunity. New mutations kick in but they're not perfect at beating natural immunity and in any case the most vulnerable people have already been killed at that point, so the IFR consistently hovers around 0.1% which is low enough to let people ignore COVID. So no vaccinations, no "adjusting the vaccines each year", no masks, no social distancing, nothing. Society moves on as it did with every pathogen in human history after suffering some casualties. India is already there: their case counts have been falling for 6 months now despite having very few restrictions in place, all thanks to herd immunity.
India is not at herd immunity but the seroprevalence number is higher and some cities may be quite close to herd immunity which is a big deal given the sparser connectivity of the rest of the country.
"The latest sero survey - studies that pick up antibodies - suggests 21% of adults and 25% of children have been already infected with the virus.
It also found that 31% of people living in slums, 26% of non-slum urban populations and 19% living in rural areas have been exposed to the virus. That's far below 50% - a figure reported by some of the bigger cities, such as Pune and Delhi. Here, there is evidence of much higher levels of exposure to the virus, hinting that these places are likely closer to herd immunity."
I am affraid you are far too optimistic about going roughly back to normal. Especially in Europe where lockdowns have been stronger and more general than in the state, with much less political opposition. With the economic crisis looming, governments will not revert back to full democracies naturally, there will need to be popular pressure. At this point, there is a risk to fall to real dictatures, as the power in place feels the risk about having to render counts for last year decision threaten so many political, police and media heads.
The counter power at this time is mostly judiciary, parliament is absent / aligned with executive, and only having the judiciary guard against dictature seems small...
This worry me much more than the covid itself, delation, police violence, scapegoating of tourists / lockdown parties, arbitrary fines linked to ever changing illogical regulations... All of this is up regardless of the epidemy evolution (it keep increasing even when vaccination started and the epidemy stagnate).
Prediction about the future are notoriously hard, but there are more signs about the west transitioning from democracies to fear - powered autocracies than signs that the plagues are back.
Perfect for keeping police pressure on the general population, it's a compliance sign, easily allowing to sort good citizen (following government orders) from trouble makers.
Why do you think there is so much opposition on mask wearing while it is certainly not the major annoyance? Same reason, identity marker.
There are also some similarities with the typical identity control in Europe, which is a convenient tool for initiating a authority/compliance interaction between police and citizens. Many incidents start with those, it's one of the main issues raised by "problematic" youth about police behavior but statistics shows those types of checks catch very little criminals...Still, it's maintained....because it allows police to exert authority as it see fit, and demand compliance.
That's my feeling, but there are facts that back up this interpretation: mandating masks outside, even in non-crowded situations, is common in many places in Europe. People walking alone have been fined for not wearing (correcly) their mask. There is no possible medical reason for it (even allowing for the most fringe medical studies), and indeed no medical justification was attempted: it was for "educational purposes", to keep people used to masks.
Only trouble with masks is that it also makes identification more difficult. I expect this will be the main reason we will be back to usual mask restrictions (i.e. forbidden in public places, instead of mandated), especially as soon as another compliance marker can be used (police checking of vaccinal passport would do, but that's a hard pill to swallow....still, I would not be surprised)
As I wrote in my other comment, I feel that masks are somewhat of a red herring. Worse ideas are rearing their heads in the public sphere. I don't necessarily expect stay-at-home regimes to last beyond this summer, but I am almost sure that any political demonstration in the next 2 years will be a target of massive public shaming by the press and the government (and possibly also punitive police action) if it rubs the elites the wrong way.
How is that different from before? In NYC, cops have been beating on demonstrators my whole life. We had protests of cyclists tired of having their friends killed by careless drivers and all they were protesting for was bike lanes, and the cops showed up and beat the crap out of them. Like... cycling isn't even in the culture wars. They weren't protesting police brutality or the Iraq war. They just wanted bike lanes.
First of all, police wilding wasn't a widespread thing in large parts of (Western) Europe. Nor is it now; what I mean is, you aren't comparing apples to apples.
Second, both in Europe and the US, the media has generally been on the side of protesters, or at least not actively demonizing them, until the 2020 anti-lockdown protests. Even the Catalan independence movement, with all the headaches it has caused to the elite (and with real evidence of Russian meddling), has been generally getting the "legitimate grievance, maybe some excesses" treatments from the press.
I don't know - I attempted to test this by Google, using France since it's clearly in Western Europe, and since media coverage there might not have come to my attention because I do not read French news. Google "france protests media coverage" and you get the Yellow Vest protests; here's one of many stories I found alleging that they've received unfair treatment from the media. https://www.france24.com/en/20191116-a-year-of-insurgency-how-yellow-vests-left-indelible-mark-on-french-politics
My recollection of prior US protests is that the media tends to react to them in a partisan way - so the left media actively demonized e.g. the Tea Party protests and many of the various other right-wing protests, while the right media actively demonized the Iraq War protests and OWS (and of course BLM, even before the pandemic).
Conversely, the left media tended towards apologia for BLM protests even during the pandemic (a justified defense, in my opinion, since they were outdoors and the protesters were masked) and, while I sort of stopped paying much attention to right-wing media, I assume they did the same sorts of apologia for anti-mask/anti-lockdown protests.
But I don't think you could really say that "the media" has been on the side of protesters in general, or that the anti-lockdown protests were some kind of outlier. And again - the anti-lockdown protestors stormed a state capitol with guns and didn't get the business from the cops; whereas I've seen video of cops just brutally dismantling protests including, as I said, protests about seemingly non-partisan issues like traffic safety.
Humans don't dominate the planet. Plant life does, and it's not even close in terms of cell count. We should expect more viruses to be selected for infecting the social plants, assuming the virus's "goal" is only to increase its copy count.
All the really bad plant pandemics (Blight, Dutch Elm Disease, Panama Disease) seem to be fungal rather than viral. But viral infections are a problem, especially for nightshades like tomatoes, potatoes and tobacco. And there are fewer ethical quandries associated with torching a field of infected crops than a retirement home with a covid outbreak.
Certain plant viruses are not pathogenic. In these cases the infected host is asymptomatic while the virus co-opts the cellular machinery to replicate itself. Some viruses can even coexist with the host symbiotically. This set me to thinking about viruses in terms of the modern synthesis: If the "goal" of viruses was only to increase copy count, then we should expect that selection by now would have preferred benign plant viruses, not only because they are benign, but also because of the huge opportunity space - LOTS more plant cells to probe compared to other eukaryotic cells.
Early victims included a couple of Broadway figures in their middle-aged primes, gifted songwriter Adam Schlesinger of Fountains of Wayne and "Crazy Ex-Girlfriend" (who had just signed a big contract to compose a Broadway show with his creative partner Rachel Bloom) and Tony-nominated actor Nick Cordero. So, eleven months ago I figured covid was going to be pretty bad for our human capital.
But, since then, most of the fatalities among semi-famous people have been concentrated in either the elderly or the long-term sickly. I periodically look at the Americans who have died in the Wikipedia list and I don't see much evidence that our culture will deprived of too many great works going forward.
That sounds brusque, but when we are making trillion dollar decisions, we really ought to look at all the evidence, even impolite evidence.
Your impressions may differ, so I encourage you to look at the Wikipedia list or the New York Times' list of people who have died.
It takes exceptional humans some amount of time to become notable enough to have a Wikipedia article, so this method has a selection bias for older people.
When making trillion dollar decisions, we really ought to search out all the fairly easily available evidence.
The best evidence I can find is that covid is the opposite of the 1918 Spanish Flu, which mostly killed 20-40 year olds, thus imposing a huge human capital cost on society.
The advantage of looking at victims with Wikipedia pages is that you can usually see how long ago they did whatever it was that got them a Wikipedia page and estimate whether they'd have been likely to do much else of note if they hadn't died of covid.
Yeah, I know, it is cold-blooded to think this way, but when we are making trillion dollar decisions, we really shouldn't exclude relevant data for reasons of sentimentality.
The rich and powerful probably have access to drugs like casirivimab and imdevimab (what Trump got) which explains why their deaths from corona stopped a while ago.
Maybe, but if you look at the actual list of who has died, many are rich and have connections to the powerful, so they probably have access to any wonder drugs. But they were just, personally, over the hill.
I realize this is a methodology for getting a sense of how bad covid is that seems alien and hard to understand for most people. I've been trying to call attention to it since the late spring with little success.
But this pandemic's social effects seems to be the opposite of the Spanish Flu of 1918, which left a lot of young children orphaned and the like.
Is it safe for people to get additional vaccinations in rapid succession to beat virus variants? I realize that there isn't enough vaccine for that to happen much now, but I wouldn't be surprised if the vaccine process gets sped up.
One more area to hope for progress is for more genome-checking to keep track of mutations.
I am skeptical about the fast track. Any time you change the antigen in the vaccine, it could, by coincidence, resemble some normal body protein and trigger autoimmunity. Or do something else unintended. Not that it is super probable.
I will be glad to be corrected, I am not super sure about this.
As an Israeli who has been vaccinated, I can confirm that they plan to vaccinate every 6 months. When you get vaccinated, they make it clear that you will have to do it again soon.
Another point: Many many health giants around the world have spent billions on new Coronavirus vaccines. They will want to put them to use. I expect that by 2022 there will be an oversupply of such vaccines covering every extant strain.
What about Covid treatments? So far we had a few proposals but the results were a bit underwhelming (chloroquine, remesdivir, favipinavir, etc), but dexomethason seems to work at least for some severe cases. Now we have the monoclonal antibodies and nano antibodies - so far the results are are still a bit disappointing but in theory antibodies should work and at some point we should be able to produce them in mass quantities cheaply.
And by the way - what do you think about amantadine? I have already asked that question here: https://astralcodexten.substack.com/p/hidden-open-thread-1595#comment-1236759 - but with no replies. I think it is an interesting case of auto-immunology disease in science - that is I think the allergic reaction of the scientific establishment to dr Bodnar is overblown.
A minor terminological point on "If vaccines made R0 go to 0.5 or whatever, we would loosen some restrictions until it was back at 1 again." R0 is defined as the reproduction number in a completely susceptible population; the reproduction number when some people are immune (through having had the infection or vaccination) is called R or Rt (see e.g. https://www.nature.com/articles/d41586-020-02009-w).
All I have to say is I have zero regrets for every midnight movie I've ever seen. You don't know how much I miss them, and I treasure every hour I've spent in a theater after midnight. I'm devastated that they may never come back.
YOU'RE TEARING ME APART 'RONA!!!!1111
I also miss my family too. But can quarantine for a few days and see them.
Maybe I really am that paranoid type. I promise I don't have a political axe to grind. But I am just really curious why you would put the chance of rock concerts not happening again or mask wearing staying majority social pressure at "less than 1%" chance? I think it's literally a 50/50 chance.
You even compared it to child kidnapping panics which I agree with. I personally like to compare mask wearing to no smoking in airplanes. No one can smoke in airplanes anymore. It's never coming back. Same thing with going to a rock concert without a face mask. It's never coming back (except in very exceptional one-off cases). I could be wrong obviously, but I would certainly bet money against anyone putting it at "less than 1%" odds.
Restrictions have gradually gone down every time a COVID wave decreases, then only started going back up again once a new wave starts. This makes me think that restriction level is pretty sensitive to COVID prevalence.
True. And I'd agree with that. But what if it has a higher baseline now? We haven't gone back to the previous normal baseline which was the pre-pandemic. There's no compelling evidence to suggest that normalcy is very similar/identical to the pre-pandemic normal rather than a "new normal." In fact, there's a compelling argument to be made that since COVID will be a fact of life like an additional seasonal flu which didn't exist before (similar to how AIDS is a fact of life), then there is a higher baseline of restrictions for the normal state of society that did not exist prior to COVID's existence. Some examples I would personally bet on:
1.) Most places will have the legal right to enforce their own mask policies at all times forever. Restaurants, entertainment places etc can include "no mask no service" purely at their own discretion and a fair number of conscientious businesses will permanently enforce them as a socio-political stance to signal commitment to public health etc. I would bet that anywhere between 10-30% of people you see in businesses will be required by the business to be masked up.
2.) Big, closed, indoor events/things will have new rules forever unless you live in some rural not-so-dense-population-area where the political stance of freedom over safety trumps health considerations.
3.) Schools, colleges, teacher unions etc that are the exact opposite of #2 (aka their consideration for safety trumps personal freedom rights) will have much more sensitive responses to tiny COVID occurrences (ie: 1 student tests positive for COVID and entire 2nd grade class goes remote for a semester).
These are just my guesses. Admittedly, I'm not as good as you on getting things right so far, Scott. But I feel pretty confident about these.
We didn't see this happen after the 1918 pandemic, why would we see it now?
You have every right to be pessimistic considering our government/societal response here, but I don't think you're correct about this. In a year or two things will basically look like they did in 2019.
People are more risk-averse now than in 1918, both in general, and specifically wrt children. Pinker talks about this in one of his lectures (I think it was a TED talk) - our definition of harm has expanded and our tolerance of harm has decreased. Pinker thinks this (is part of what) creates the illusion that things are bad and getting worse when in fact (at least as of 2012 or whenever) things were objectively getting consistently better. I think Pinker thinks that this is just because people acclimate to whatever the general overall level of harm is in a society and then use that as a baseline from which to demand improvements, and so as the overall harm levels go down, so too does the overall tolerance of harm. I think there's perhaps something a bit deeper going on.
One of the ways that people adjust to a society with less absolute risk is to have fewer children. According to folks like Hans Rosling, when child mortality is high, people have 5 or 6 children, hoping at least 2 will survive. When mortality decreases people have 2 children, feeling reasonably confident that they'll both survive. But that also means that we in some sense are adjusting our per-child risk tolerance down, since it's a lot more catastrophic (at least, from the perspective of gene propagation) when 1/2 of your children die than when 1/6 of your children die.
So if the question is "how much risk will we (adults in society in general, or parents in particular) accept on behalf of our kids?" then there's good reason to believe that answer will be lower now than in 1918. In 1918 the US was right in the midst of the demographic transition from high birth rate, high infant/child mortality to low birth rate, low child mortality; mortality had dropped a lot from 1900-1918 but society hadn't fully caught up yet, and wouldn't until about 1940 (and then it boomed again during the... you know, baby boom... before dropping back down again by around the 1980s). I think this is part of the underlying cause fueling what Scott noticed about unattended kids in playgrounds - to me that looks like a post-baby boom downward adjustment in per-child risk tolerance.
I do think there will be some kind of new baseline after lockdowns. I think at the very least that baseline will include a Korea-post-SARS-like social norm of wearing masks when sick, and possibly more vulnerable people wearing masks during every cold/flu season (that was already the norm here in Georgia-the-country where I live - some of the older teachers at my school wore masks during flu season even before corona). I think it will include more hygiene and safety in school and a greater awareness of ventilation (I have friends who taught in Ukraine who said their school aired every classroom before and after every class, even before pandemic, even during winter, so again, this at least has precedent in at least one place). I think it will include a slight uptick in homeschooling and non-traditional schooling even after the pandemic threat is mostly or entirely over. And I think all of those things are part of broader overall trends that have been accelerated but maybe not created by this particular pandemic.
There is a big financial incentive for rock concerts and fans at basketball games to be a thing again. They're not gone forever, that's a good 99% bet.
I think you're discounting what I mean by "not a thing." I was mainly implying they won't look like anything similar to as we knew them before. If you look at my above reply giving 3 example scenarios you can see that I still believe the financial structures will be intact but that things will look fundamentally different and never change from this new structure post-pandemic. For example, I think that basketball games will be a thing yes, but I don't believe they will allow people to sit tightly close together anymore. During flu/COVID seasons, they'll require masks in all games. New financial innovations will happen to accommodate for this new reality.
Yes, this is what I fear. And I think it will have the effect of making them financially nonviable and less fun, while doing very little to control covid. There are ways this could be rearranged to something close to normal, but I don't see much of a desire to do so. I live in Boston, and no one here is begging for live sports to come back, so that's a bad sign. Maybe it's just me in my bubble, but I know few who would go. If they marketed cheaper tickets at younger people, it might be salvageable, but I feel like there will be too much pressure against allowing that. This really upsets me, because I thought when we got through several concert terror incidents without canceling concerts, that nothing could hold back the desire of people to see live music. But apparently not. I'm very depressed about this. Not just the concerts, but what they represent---a culture that considers basic human fun and interaction to be a privilege or luxury. That's not a world I want to live in. Hope I'm wrong.
Nope, it's not clear that they're not gone for long (forever is a very long time, let's focus on 20y ;-) )...and that's (for me) the biggest lesson of COVID: we have seen the limit of big financial incentive (i.e. economical power) v.s. political power. We knew it was the latter in past regime and current dictatures, but since the 70's I have believed it was the first that controlled western world. Apparently no, classic state power never went away, it was more a parenthesis and it can be back in the front seat once conditions are ripe. Now I am awaiting to see if it will "naturally" take the back seat again, or will find the front seat very comfortable stay there. I think it will stay there, as power usually do: it's rare for people exerting it to let it slip without a fight, if they have a chance to keep it. The Chinese model with a fear-from-crisis (epidemic, climate change, terrorism,...) justification seems to have seduced the western governments.
I also researched this claim. The WebMD article was atrociously written and argued primarily with tone, rather than evidence.
The claim about Pfizer Covid vaccinations and sterility pings back to an original claim that the vaccine produces a protein that causes the placenta to detach. But this is false. Although there is a small bit of nucleic acid that the vaccine and the syncytin-1 protein share, they are not similar at all. Furthermore, if it was the case that the vaccine caused miscarriage, then the virus itself would also cause miscarriage. The virus does not cause miscarriages, thus it is unlikely that the vaccine causes miscarriages either.
I am not an expert in any way. The best source I found for this information was this:
The power of suggestion brought the concern to people's minds, but the suggestion comes from a misinformed place about the relationship between the vaccine and this other protein.
Agree with the above. I'm worried that this rumor will has enough pseudo-scientific resonance with the minimally health literate to discourage vaccination in childbearing women. Or just that because it's centered on something like fertility, which is already somewhat mysterious and not well understood by the medical community, that it will cause anyone worried about their fertility to be fearful of vaccination. Not sure if this would be helpful, but if a professional society rather than the lay media would be more persuasive, this is from the American Society for Reproductive Medicine: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/covid-19/covidtaskforceupdate12.pdf I am in healthcare and was recently vaccinated; at least at my institution, they were collecting data on whether or not an individual was pregnant and/or lactating at the time of vaccination. I thought this was strange because these physiologic states are not contraindications to vaccination according to all the relevant professional societies' recommendations and the common sense of the mechanism of the vaccines. However, when I asked the nurse vaccinating me whether answering yes to these questions would lead to those folks not getting the vaccine, he said he didn't know. So that was strange. My hope is that this information is going to some centralized database and that they will be able to do some post-vaccination analysis of the vaccine's effect on pregnant and lactating individuals. Or that formal studies will be done soon so there is more hard evidence on the safety of the vaccine in this population.
I have the feeling that a lot of peaople assume that new virus-strains generally should be less lethal than old strains, not due to previous infection but because viruses will tend to mutate towards an equilibrium were it does not kill the host (because there will be a selection-pressure to let the host live and further spread that virus-strain). Is this a valid assumtion? Couldn't it be that "equilibrium-viruses" is selected for over (long) evolutionary time, and that they also depend on the virus in question acting as a selection-pressure on the host? So that, any given mutation is random and might as well be much more (or less, or equally) lethal compared to Corona Classic. Only in the long run will this pan out to be a more flu-like situation. (Confidence in this speculatory line of thought is low.)
I find it strange that people have stopped questioning our response to COVID19 and whether or not it's been a) justified, b) effective and c) cost effective. Now that the vaccines are here, those questions have been sidelined and stigmatized. I think we should continue to interrogate every aspect of our response to the pandemic.
How should we view clearly costly policies that are not supported by the overwhelming body of empirical evidence? I can see a case being made for lockdowns being so intuitively effective and studying them so fraught that we should proceed regardless of the evidence. But I think this case needs to be made explicit so it can be interrogated. Currently that's not what's happening.
In Georgia-the-country, all-cause mortality was actually down (from the previous five-year average) for the first six months of the pandemic, during which time we had three months of lockdowns which were so effective that we received international press coverage for it, and 37 cases per 100,000 for the whole country for the whole six months. In fact by day 180 (with day 1 being the first detected case in country) we had 17 covid deaths in a country of almost 4 million. In contrast, in our second wave, the government didn't do a lockdown until our hospitals overflowed, and our all-cause mortality shot up to about 1500 excess deaths per month before the government did a second wave of lockdowns to control the pandemic again. Once those lockdowns were in place, cases very predictably began dropping within 14 days. Now, the lockdown has been partially phased out and the infection rate is increasing again. On February 1st the first set of restrictions was removed; by February 9th my calculation of R jumped from .72 to .89 and is currently still hovering up around there.
That seems like pretty clear-cut evidence, to me, that a) lockdowns can prevent covid mortality, b) despite claims to the contrary, lockdowns don't (necessarily) cause an increase in non-covid mortality (e.g. through suicides, missed cancer diagnoses, or whatever else) - at least, not one that can be detected in the medium-term of six months, c) lockdowns can decrease case numbers and mortality rates when put into effect even if they're applied late, and d) effective lockdowns are clearly detectable in infection rates after a delay of 8-14 days.
The UK would seem to be a difficult case study because policy has been so scattershot and the government has veered from lockdown to handing out lunch vouchers for restaurants as a stimulus, so it may be hard to tease out confounding factors or localize public policy measures to infection rates. The US is probably worse, because of the politicization on top of the atomization and incompetent, incoherent policymaking and policy enforcement. But I believe if you look at countries with someone more coherent governance you'll see a clearer effect of lockdowns.
I've also seen studies suggesting that lockdowns have decreased all-cause mortality in other countries as well, due to a drop in pollution, injuries, and traffic-related fatalities. None of these have been particularly high-quality but it's something to consider in the face of people talking only about the costs of lockdowns - they may also have benefits outside of just slowing down covid.
Presumably the virus is going to become and remain endemic, and we'll see perpetual annual or semi-annual vaccination for the most likely variants, just like (and along with) flu vaccines.
Question about different vaccines: To what extent do they "stack" and to what extent do they make each other less effective?
E.g., if I get two shots of AZ but J&J turns out to be more effective, is it possible the antibodies in my body will render an additional J&J shot ineffective?
If so, is it clear whether this cannot happen with mRNA vaccines?
The OG strain is being referred to around my parts as the "Wuhan strain", so at least we're equal opportunity here. Others are pushing to call the UK strain by its designation "B117".
I can't imagine many Brits will have a problem with this, though I can only speak for myself. "China virus" was at best geopolitically motivated, and at worst intentionally xenophobic.
As a UK citizen I don't feel that I'm likely to be given a hard time because B117 was first identified here. The worst stereotypes I have to deal with are bad teeth and bad food - there's no history of stigmatising us as dirty, unhygienic or sneaky. Sadly the same can't be said by Chinese people.
Oh absolutely, couldn't care less about the feelings of the CCP. The Chinese diaspora is made up of individuals with feelings, though.
As for dumping on my own country, insofar as it makes sense to be proud of your country, I am. We've made our share of mistakes in recent years, and I'm certainly not defending our colonial history - but I'm glad to live in a country where self-deprecation is an art, and punching down is seen as bad form.
I think the first prediction is not well defined. What is a "wave", i.e. what is the y-axis? Case numbers (as everyone knows well) are dependent on testing which changes over time. A more reliable metric (although it changes over time as well) is hospitalisation rates. I would predict that we will not see another wave of hospitalisation in the US similar to the previous 3: the majority of older people will have been vaccinated and the protection against severe illness is very high
For now I'm not sure what to think about all those "mutants". Because it seems researchers "threw" something in petri dishes and made some conclusions with that. But I don't really see any "real world" implications with that... Great-Britain - you know, this country, that "named" one of those highly-infections mutants - got their daily infections down from 60k/day to now around 10/k day in just a month! You could theorize if it was the "old virus" that their lockdown did that even faster. But that is basically impossible to prove in either way! So ... *meh* you mutants, I don't care!
My thinking is more along the lines of this diagram in the German wikipedia about the spanish-flu:
We are currently in this second, really big and deadly "wave". We will have a third one, that is smaller, but I don't think it will be the "same" months as in this diagram. Because at least here in Germany nothing happened last years summer and we basically opened up "everything": bars, restaurants, cinemas, even concerts happened (but with fixed seating). And "our" second wave started in october/november; so it seems very seasonal! And sorry, for now I don't think these mutations change anything about that! Maybe time will prove me wrong.
But important about this diagram: it ends after the third wave! And I think that is something we do too with Covid19!
I was hoping to see a discussion of the so-called "Long Covid", since as far as I can tell from picking through various studies over the past 6 months, still has limited evidence that it actually exists as a unique effect of the coronavirus.
Studies all seem to fall into two camps: either a very small study of like 50 patients who were hospitalized, are elderly & obese, and demonstrate lung damage in scans taken 1 or 2months after being discharged. Or a survey of people from the "Long-Covid Support Group" on Facebook, who self-report suffering varied symptoms several months on, such as Fatigue, Tiredness, and feeling worn out.
Neither of these are remotely what we are interested in though. There have been enough studies, even without large samples or controls, that suggest lung damage in survivors that I expect there is a real effect, but if it mostly appears in hospitalized patients, who have pre-existing conditions, are elderly, etc. then chances are it's very rare overall. And that's assuming it's actually long term and doesn't go away after 6months.
The surveys get towards what we're interested in: what are the chances that an average person who gets infected with coronavirus has to suffer long term issues, even if the disease itself isn't a danger. But self reports of very vague terms like fatigue are just way too unreliable, and again we want to know if these are long term, not just for one or two months. One particular survey did ask for effects at 12 weeks and found sufferers fell away to almost nothing. At that point you have to ask whether this isn't just standard post-viral syndrome?
Ultimately I can't spend much time tracking down medical papers so perhaps there has been more definite evidence emerging recently as to the prevalence of long term sequelae and the possible effects.
Standard post viral syndrome is probably likelier in a depressing lockdown world bereft of fun and gyms. Disrupted exercise and socializing routines makes many people more vulnerable than they otherwise would be. And prone to sitting around all the time. If we were chickens, we'd call this "species inappropriate living conditions".
Would we notice if the flu (or some other viral infection) causes post viral more often these days, if it did? Not sure if good data is available.
> At that point you have to ask whether this isn't just standard post-viral syndrome?
I agree with you on the facts, but possibly not the interpretation: if the population of people with post-viral syndrome goes up by 10x, 100x, 1000x, or whatever - isn't that really bad?
Years ago I had "long norovirus" - no acute symptoms after about a day, but I felt run down and uncomfortable for several weeks after. I wouldn't want that again!
Oh for sure it's a bad outcome if thousands of people suffer illness for several months, but it's not the kind of bad outcome that actually warrants taking action. Much of the debate around long covid is how it demonstrates the need for control of the virus, even if people aren't dying from it.
Well unless being cooped up in lockdown is a strong contributing factor to developing post viral syndrome, in which case it also demonstrates the need to stop controlling the virus.
A thing I recently wondered about: Why are there no illnesses that do GOOD things to you?
Like a flu that makes you feel awesome and full of energy.
There are literally hundreds of disease strains that kill you, which is, we should not forget, a bad ending for the disease, in the coffin, it will not spread. If a disease made you feel great, you'd go out and meet people, which is great for as disease, and we would not spent billions to develop vaccinations and social distancing and such against it. From an evolutionary perspective, there should be massive advantages for a disease that makes you feel good vs. ones that make you feel bad. Yet I know of not a single one.
Now, there are a few obvious counterpoints.
1) Most of the symptoms we have when we are sick are not the disease, but the body fighting the disease. A body would fight a foreign substance no matter whether we like ot or not. But there are a lot of diseases that the body cannot successfully fight, from HIV to Herpes, that if you have them you are stuck with them. Why only those that will eventually kill you? And not all illnesses are so noticable as the flu, the body fights other sicknesses with us barely noticing. So a sickness where the signs of the body fighting it are low and the effect of the sickness making you feel great is at least thinkable.
2) If it was good, it would be a symbiote, and the body would just incorporate it, like the colon bacteria. True, but only over millions of years. Bacteria and viruses evolve much faster, so one evolving into a feelgood plague could happen spontaneously without cumbersome human evolution having had the time to give it an estabished niche.
Also, circumstances change. An illness that makes you feel awesome would have led our anchestors to be eaten by tigers or starving in winter, because they didn't build up stores in time. In our modern time, the same illness would just improve how you feel living your life.
Personally, I feel the reason for this is to show us that there are no loving gods, that, if something can be created to be good or bad, it most often is created to be as bad as possible (I kid, partially). But I really wonder. There are diseases that can manipulate an ants' brain to make the ant walk up a leaf of grasss and bite down at the end and wait for a cow to eat it. Some are that sophisticated. But none has the effect of releasing whatever hormone or neurotoxin would make you feel better, despite the huge evolutionary advantages that would have for it? It is easier for a disease to jump from bat to human than to be nice for humans?
Nothing is wrong here. You can't improve a complex, well-tuned, functional system with any simplistic outside intervention. And viruses are extremely simple in comparison to us.
Creating hormones or neurotoxins (other as a sideffect of disrupting the preexisting system) is far beyond what a virus can do.
That is generally true, however, some diseases seem to have very fine-tuned effects. If the ant is too simple for your tastes, I read that Toxoplasmose makes mice find cat urine attractive instead of repellent. Now, mice are higher developed mammals, and the degree of fine control needed to change the emotional reaction to one specific smell tells me that it is at least not theoretically impossible for a simplistic outside intervention to change how the brain reacts to things.
Toxoplasma gondii is a single-celled eukaryote and much more complex than any virus. And it also affects humans in the same dimension. Men find cat urine more pleasant, women less.
But this is not a positive change for people nor is it even useful for the parasite itself (I don't think the effect is strong enough, that some men would get eaten by a lion, because of this). That's just us being similar enough to mice, that it works on us to a lesser degree.
Also, it's easier for an organism to finetune a mice manipulation, given that they have a generation time of 10 weeks as opposed to our 25 years [plus/minus 10].
The most plausible vector to achieve any such "positive change" would be the brain.
The brain does not need a random outside intervention to regulate itself.
We have the blood-brain barrier to prevent most vectors of attack so that this system stays largely uncompromised from external influence.
We even have trouble getting meds to cross this barrier oureselves, it's that good at it.
It's there for a reason, any kind of infection in the brain is usually burnt out soon or a death sentence.
Sure, maybe we had parasites that could make us feel happier/more confident or make us more energetic without killing us, but if feeling that happy/that confident or that muscular would be universally good for us, we would already have evolved to be that happy/confident/energetic in the first place.
[not clear what's in it for the parasite or if effects like that are plausibly achievable]
This would come out the same as randomly dosing people with antidepressants, stimulants or anabolic steroids. [think of the side-effects of all that!]
Actually, there are fairly simple drugs like amphetamines which do make people feel better and more energetic, even if it's at a cost to the person-- and not always at a cost. Careful doses can be good for people.
For that matter, a disease that produced the effect of alcohol would be helping itself spread.
So I don't think there's a general argument against diseases with pleasant symptoms. Perhaps we don't notice them and/or blame their ill effects on diseases that do have painful symptoms.
[epistemic status: sloppy but mostly right I think. Sloppy must suffice, because I don't want to look up the role and structure of ribosomes (eukaryote protein factories), neurotransmitters and hormones and compare the complexity of DNA vs RNA, bits of info between human DNA vs virus RNA..... cell biology is too long ago for me to get the details right and it would be an infinite rabbit hole, since too many things are plausibly relevant to the question; a cell biologist could explain this better]
Yes, simple molecules can have strong effects.
But hormones, neurotransmitters or amphetamines are not replicators.
They are less alive than even a virus. Products, not producers.
Human cells specialize and create specialized environments.
And we already do produce hormones and neurotransmitters ourselves thru specialized cells in protected environments (ribosomes in organs, various glands and all that). Multi-celled eukaryotes like us can do that, because it's coordinated by the same DNA.
Specialized cells don't have to worry about being hunted by the immune system. [unless you have an autoimmune disease]
Or about plundering access to energy, that's also a given.
They don't have to compete with anything else either.<br>A foreign organism is in a hostile environment, because it's not part of the larger multi-cell system. All the resources it takes, detract from what's available for native cells. It won't be protected, it will be hunted down.
HIV manages to not get hunted down, but it does so by attacking the T-Cells of our immune system, which fatally compromises it.
Let's assume that creating a specific (undiscovered) aphetamine saves your life from AIDS and makes you immortal as well. [like.... such a molecule just exists, is fairly simple and it works reliably on most people it infects, so that HIV could be symbiotic]
And that the HIV virus could mutate into that miracle-amphetamine factory.
What's in it for HIV? An immortal host would be neat.
But HIV has a generation time of 14 hours. In order to evolve into producing those miracle-amphetamines, a lot of mutations would have to occur in-between, since evolution happens only in minimal incremental steps.
But each incremental step to building a factory would have to be competetive. And there's no reason why having a quarter, half or 90% of the parts of a factory would be a competetive advantage against non-mutated HIV-virusses.
But in that time, there is no incentive for HIV viruses to evolve to produce amphetamine for you.
In a very very naive and simplicistic way, the virus wants to use some of your energy to replicate itself. You want to use your energy to survive. So your body will always be trying to kill the virus (a defense system that assumes that every virus is bad will fare better than a system that tries to differentiate good and bad virus, in the long term).
I would not expect the body to stop fighting an infection just because the human thinks its nice. However, having the conscious mind not trying to fight the disease, so not holing up in bed, taking medicine, avoiding contact, all that should be an evolutionary advantage for a disease, while killing their host should be a severe evolutionary disadvantage. The body may fight the disease, but that can be helped or hindered by the conscious acts.
Yet we have hundreds of cases where the evolution of the disease goes towards "kill the host" and none where it goes towards "make him feel good". That is surprising to me.
(I remember reading in a book by neurologist Oliver Sacks that syphilis can have such an effect, that he had a patient who suddenly felt more positive and energetic and deduced that that must be "amor's arrow", a resurgence of syphilis she had in her youth. So the mechanism even seems to work in practice, only it plays out like this only in a tiny number of cases, and usually syphilis tortures and kills you.)
If the virus manages to spread before killing the host, that's enough. It's like the reason why diseases that affect just the elderly don't quite disappear with evolution: you've already had kids.
We're going in an area that's not my expertise, so take my words with a pinch of salt but: I'd argue that most of the "fighting" the disease is our body trying to stop its cells being repurposed as viral factories. It's not that the virus desires us to feel bad/hole up in bed etc, it's more that our body forces us to do it in order to save energy and be in the optimal condition to win the fight.
There are plenty of viruses (perhaps including Coronavirus?) that your immune system is capable of ignoring rather than fighting. Hepatitis is like that - in which case the virus will live inside you permanently with no detectable symptoms until it eventually kills you via liver cirrhosis ~50 years later (unless something else kills you first). There's a higher short term cost for the body to pitch a fight against the virus, but in the case of hepatitis it's probably preferable.
Well the immune system certainly doesn't ignore Covid19, but yes I agree on your broad point. I think it's a fool's errand to try and simplify virology to first principles to be fair.
If there was such a 'pathogen', how would you tell? Maybe there's a whole bunch of them, but nobody goes to the doctor because they feel great. In fact, given the shenanigans the gut-brain axis is capable of, there's almost certainly a whole bunch of them.
So, an extraversion/hypomania virus? Cf. toxoplasma getting mice all excited about cats, except it turns out modern cats are pretty chill and give you well-paid murine jobs and hot mice of your preferred gender.
We would have noticed it under a microscope and asked ourselves "what the hell is that". And then we would know about it, after studying the unknown pathogen.
There's a disturbing amount of new things discovered because someone looked closer at what looked like just a contaminant, e.g. adeno-associated viruses. The most spectacular, if it pans out, would probably be
However, the easiest way for this to work would be an undiscovered effect of a known bacterial species - especially since the notion of "species" in bacteria is pretty iffy, strains have enormous differences between them and we haven't even approached fully cataloguing what they do and how.
> Why are there no illnesses that do GOOD things to you?
> Like a flu that makes you feel awesome and full of energy.
*Exclusively* good is a hard one, but I'd mention that 'weight loss' *is* both commonly desired and a common effect of disease. 🤔
I have heard that, somehow, the physical effects of tuberculosis became associated with conventional attractiveness; e.g., https://www.smithsonianmag.com/science-nature/how-tuberculosis-shaped-victorian-fashion-180959029/ reports: "[T]uberculosis enhances those things that are already established as beautiful in women [...] such as the thinness and pale skin that result from weight loss and the lack of appetite caused by the disease. [...] Sparkling or dilated eyes, rosy cheeks and red lips were also common in tuberculosis patients—characteristics now known to be caused by frequent low-grade fever. [...] Middle- and upper-class women also attempted to emulate the consumptive appearance by using makeup to lighten their skin, redden their lips and color their cheeks pink."
I think I'd go with a "misaligned incentives" answer. To feel good, you need your body to exhibit the set of behaviors G (for "good"), but for the virus to reproduce, it needs your body to exhibit the set of behaviors V. Since biology is so complex, there are a vast number of ways for G and V to disagree with each, vs only a few for them to align. So just based on probability, the virus probably doesn't want things that you want.
For most viruses, including SARS-CoV2, almost all the symptoms, including death, are caused by your own immune system. A lot of the immune response has to do with killing your own cells, hopefully just the ones that are infected, but mistakes happen. It's generally a destructive process and not likely to make you feel good, whatever the infectious agent.
Teeny tiny nitpick from someone involved in SARS2-sequencing: The British lineage is actually B.1.1.7 -- not B117 -- since there is also a B.1.117 which co-circulates (at least here in Germany).
That already led to some confusion in meetings and emails, and an often repeated clarification that one-one-seven and one hundred seventeen are actually two very different things.
Perhaps I have a bit of a different perspective on the political aspect as I'm from elsewhere (UK), but my biggest concern is the impact on Governance. My concern is that the total suspension of many civil liberties has now been established as acceptable - and what in the future will also be seen as an acceptable reason to implement these.
Also specifically here in the UK, its changed the dynamic of our parliamentary system to something a lot more command and control by the prime minister and his cabinet, with a reduction in public scrutiny by parliament - this concerns me, and I'm one of those actually same side of the political spectrum then them.
And for those who say these are temporary emergency measures, call me tin-foil-hat-wearer but these things have a horrible habit of becoming permanent. I'm still waiting for the 'temporary' income tax to be removed that was put in place in 1799 to cover expenditure during the Napoleonic wars. It would be interesting to predict which government tools become part of daily life, and which will go back on the shelf at least until the next pandemic.
Hey, it's a good name, and one not original to me - I can't hold it against anyone else for wanting it too.
I was going to propose some complicated wager in which we make a set of Scott-style numbered predictions, and whoever predicts more accurately gets to keep the name and title of Psychohistorian. And I'm still open to that if you are, for fun's sake if nothing else.
As an expat currently living in Taiwan who was really hoping to return to the US this year: This feels seriously depressing. It sounds like there is a very good chance I won't be able return without getting some variant of the coronavirus at some point. I'm not in any super high risk group, but I'm really not looking for long-term brain or lung damage. And I don't have quite as much faith in American institutions as does Scott.
Still, it's good to get a sobering dose of reality. Now I can consider what I would need to do in order to stay here longer.
You have an extremely low probability of getting long-term brain or lung damage. Especially because by the time you leave Taiwan, cases will be minimal. COVID is going to become a background flu-like illness for the young, healthy population.
Also: why not just get vaccinated as soon as you come back?
Currently, what I'm expecting midyear is the following:
1. I will have a vaccination, most likely the AstraZeneca one since that's what Taiwan's bought the most of
2. Most of the US will be vaccinated against Coronavirus Classic
3. Other variants will be making their rounds, and I will have a decent chance of catching one if I return to the US (since AstraZeneca seems to be less than great against the mutations).
I am technically "young and healthy" (33, maybe 10-15 lbs overweight) but I do keep hearing an unrelenting stream of horror stories about long covid even in that population. And generally my impression has been that the more research we do, the more long covid we find, and the worse it appears to be. I haven't attempted any rational analysis of that, however, so I could be wrong. It's something I'd like to explore in more depth (unless anyone knows of any good analyses at this point).
I don't know why you keep saying you will have a decent chance of catching a variant. Cases are going to be a fraction of what they are today by midyear. That plus AZ and you're golden. All vaccines reduce viral load. You're not gonna get Long COVID if you're vaccinated.
Does the FDA approval process matter all that much (or is its slowness typical for other vaccine-producing countries)? The rest of the world also creates vaccines. If the FDA is so slow that the rest of the world has vaccinated everyone already whilst they are still playing golf, then traveling US citizens would simply get vaccinated on arrival or be sent back at the border. Assuming they wouldn't have to be quarantined and tested for new strains first, if the US remains a permanent refuge for ever-changing mutations.
So new reader here. Excellent post with which I mainly agree although not sure if we get new vaccines down to 2 months - if we bet early enough based on Southern Hemisphere spread may be okay if it’s a bit longer. But a flu vaccine like model could work. Three other points 1. Therapeutics- if we get some highly effective measures against capacities that are required for the virus that changes the equation. Some interesting studies including one reverse engineering existing drugs at UCSF but not proven yet. Second excellent review recently in Science (sorry don’t know how to do the link thing yet) on how coronaviruses become endemic - they continue to hit young children who have mild disease and are not immune while the rest of the population is as you describe. There were some reports of a tilt to this pattern in the UK and right now in Boston persons between 0-19 are the highest group with almost no hospitalizations thankfully. Is this the beginning of wave 4 or is the UK variant already more widespread than we know ?
Right now Moderna and A-Z have x capacity to make the mRNA vaccines. Thanks to the crazed DIY vaccine article from last week, it appears that making and getting the peptides for the "classic" version of the spike is not hard.
So how do we create 5x capacity? Is it the lipid sheath that holds us back? Lack of trained personnel to run the factories?
We know this works. How do we scale it?
We also need a way to push this out to the 3d world or they will always be a disease reservoir.
Is the problem that the push to get this out fast fast fast meant that they didn't have the time to work on solving how to scale it up to industrial-scale production, or with the process itself that you just can't do it in large batches?
If it can only be done in small batches, we can still mass-produce the small-batch-producing machinery and have a warehouse full of the things running in parallel. But in the age of highly optimized just-in-time manufacturing, there's not enough slack in the system to quickly shift from mass production of what we wanted six months ago to mass production of what we need now. And much of what slack exists, is in places like China.
This isn't entirely or even mostly a bad thing; in 1940, a basic sewing machine cost an inflation-adjusted $500 or so, compared to $100 today. But in 1940, the sewing-machine factory was in the United States and could be retooled to produce e.g. machine guns in a few months if something came up where we needed lots of machine guns.
I like your approach of making testable predictions. Much better than just stating opinions. I am still proud that I landed a good prediction of the number of deaths at the end of March in Germany. I am a bit less proud that in summer, I considered the whole second wave of Covid infections "rather unlikely".
In the interest of keeping myself honest, here are three things that I've gotten definitely wrong in, like, April, about covid:
1) I expected that countries which did well in a first wave will also be relatively fine in second and subsequent waves. Ups. Some of them were, but many weren't.
2) I expected substantially more deaths per capita in Europe than in the US. There are huge reporting issues in parts of postcommunist Europe but nevertheless this was also clearly wrong.
3) I definitely didn't expect that countries in historically Chinese cultural orbit (to which I include also Japan and Singapore) would do as a bloc so much better than the rest of the world, despite big differences between their political systems.
Experiencing a wave doesn't seem well-correlated with how an area handles the subsequent wave.
I don't know how to study this, but I bet the real determinant is how people reacted to the first wave. If it was "I only needed minor adjustments before, I only need minor adjustment now," they may have only gotten lucky the first time and are going to get hit.
If it was "oh, these are the adaptions we need to make, and I can figure out how to tune these as the situation needs it," they're well-adapted to wave N+1.
Ad 2), I thought that postsoviet countries will be a mess (well, that was correct), and that EU will not be able to muster coordinated response while also being unwilling to be sufficiently strict about closing internal borders. That was also correct. What I got wrong was how bad it will get in the US.
re 1) - same. I overestimated national pride at beating the first wave and underestimated lockdown fatigue. By a lot. By the way I'm in one of those countries that nailed the first wave and failed the second.
3) is a weird one. The Chinese cultural orbit has had a much higher population density than europe for much longer than the west. Those societies have had a much stronger historical pressure to deal with pandemics than we have. This is reflected in social norms that deal with hygiene; masks have been the standard in those parts of Asia for decades.
I haven't heard about convalescent plasma therapy in a while. Shouldn't this be easy to scale up now, considering we have so many recovered?
Also can you transfer vaccine protection via blood plasma? Would be lovely, if I could simply let my grandma donate me some plasma, instead of waiting till September when it's my turn.
I'm not a biologist but here is my guess. If grandma got vaccinated in the past few months, she would have antibodies, which would provide you some *temporary* protection and/or ability to fight back, but not give you the longer-term immunity from your body making its own immune response, since I don't think donating blood gives out the T-cells.
That's "access denied" for me. Geo-blocked? I'm in Germany.
But I could have grandma's antibodies fresh in my system, get myself infected, and fight Corona on a battlefield stacked against it and in the process gain more permanent immunity?
Considering that young people are mostly asymptomatic anyway, couldn't we just use this to give all the strong & young people immunity quickly, so they can stop being in lockdown? From what I understand, the younger age groups have seen increased rates of suicide larger than deaths from Corona.
Though I don't understand why lockdown even applies to people who already recovered or are vaccinated.
> But I could have grandma's antibodies fresh in my system, get myself infected, and fight Corona on a battlefield stacked against it and in the process gain more permanent immunity?
That's. . . not a bad idea. I wonder if some rogue group of citizen-scientists could just do this and report what happens.
This could have worked even before the vaccine, for that matter.
It's a bit silly right? We all pretend that we are scared of the Corona-virus.
It's publically communicated, that we should be scared and everyone agrees..... the Corona-virus.... yes, very scary, nod, very serious.
Like if a person is scaring you, fucking them up, before they fuck you up is always a salient option.
But if I was actually really scared of long-term brain damage or being ventilated, I would have done that already.
I don't want to do it, because I don't want to make a fuss or stand out. Actually, I wouldn't mind, I just don't want to bother my grandma.
And I didn't know anyone who had Covid. And that all seems like an effort.
Like those things would matter, if I was scared for my life!
The optimistic interpretation is, that the idea is actually not feasible and that's why nobody is doing it. [well unless someone already did, in which case nvm]
The pessimistic interpretation, that we're all just scared more of breaking with societal norms and acting independently for what is in our best interest.
I think you are interpreting the "neverending lockdown" concerns too narrowly. Mask mandates on subways are one of the least bad scenarios that could happen. "Long Lockdown" in a wider sense can include things like:
- Independent and diverse restaurants going bankrupt and ceding space to chains. This won't be easily reverted, as most customers will be eager to eat out *somewhere* and thus end up supporting the chains.
- Public schools never going back to their pre-pandemic functionality, as parents who care about face-to-face instruction have left, and those who remain are either those without the means to find an alternative or those less concerned with the quality of instruction. Evaporative cooling, to use the language of this blog.
- Women leaving the workforce for good, partly because of the previous point. It remains to be seen whether this will be permanent or will last until the next economic upswing. I don't think men's wages will rise anywhere near enough to make up for this; I expect to see a lot more broken families and delayed pregnancies than successful returns to trad.
- The panda in the room: A new-found trigger-happiness of Western governments to pre-emptively suspend basic civil liberties (freedom of movement, assembly and commerce) based on opinion from medical experts or -- even worse -- epidemiologists. After all, we can't wait for the virus to come to us, can we? This sort of thinking has become popular after COVID-19, to the point that experts are now berating Western politics for not taking previous epidemics (SARS-1, swine flu, avian flu, ebola) seriously enough. But what would it mean to take them seriously? Border closures during travel season? Mandatory quarantines? Countries like Italy and France have taken the axe to civil liberties in ways that no one had seriously entertained since the 1960s; inter-European borders were closed for months. Demonstrations were outlawed in several countries, and at least one (Poland) has used this occasion to ram an unpopular law through. While the most stringent measures that have been actually taken in the US were restrictions on commerce in blue states, the European model was being seriously discussed in media and often positively contraposed against the American laissez-faire one. Unsurprisingly, a general feeling of "it could happen here" has emerged. Meanwhile, no one has bothered to delineate the level of danger that warrants extreme measures like stay-at-home orders and border closures; by the standards that are emerging, we could have a pandemic scare every 3 years, not to mention that a less scrupolous government could easily pull one out of its hat whenever convenient.
All of these concerns would have looked paranoid some 10 years ago, where the typical Westerner believed liberal democracy was self-sustaining at least in the ever-growing Dar al-Democracy, and whatever mistakes politicians would make the market would fix with its gentle invisible hand. Suffice it to say, one thinks of solid ground differently after an earthquake.
Could not agree more. After the first wave (I'm from Belgium) i could still entertain "the democracy is solid and means government by the people with basic rights safeguards in place" illusion: i though that, while incompetent, gouvernement was basically doing his best in the middle of a dangerous pandemic situation, with the interest of a majority of citizens at heart.
After the summer lull and the second wave, i don't think so anymore. We are not yet in a classic dictature, probably never will be (China has shown a more modern, subtler (for most) way is possible and preferable), but we are certainly not in the democracy in the name of which we were so prompt to give lessons to the world...
Regarding the restaurant one, though, don't independent restaurants rise and fall very rapid turnover already? I would expect a new generation of small-business restaurants to arise within a few years, conditional on a state of general economic health.
Regarding your "panda in the room," it's hard to see much reason for optimism. The combination of a semi-permanent "pandemic mindset" among civil authorities combined with overly aggressive crusades against "disinformation" online could be an ugly one.
Backlash to lockdown in Germany lead to superspreader events, maskless demonstrations and a protest movement. This made the lockdown less efficient.
So if a Corona-style epidemic happened again, our government would already know that large parts of the population will not accept prolonged lockdowns. Hence they are a non-viable strategy.
So it will switch to extreme early lockdowns, but with a guaranteed end-date.
Are you sure our government is teachable? I have seen Macron's recent reluctance to impose serious lockdowns attributed to such reasoning, but German politicians delight in any opportunity to show the populace who is boss, *particularly* when it doubles as an opportunity to hit back at the AfD.
Prolonged German-style lockdowns have proven relatively viable so far -- in large part *because* they aren't as disruptive as what the French and Italians had to offer. (Note that even the Querdenken movement has stopped protesting -- although they have promised to come back in Spring.) On the other hand, "extreme early" is exactly the thing that makes me most worried, particularly since it's never a one-time things; Australia and NZ had to declare these lockdowns several times now, and Germany isn't half as well isolated as these.
I don't think it's impossible to secure the border.
Or at least, secure it enough, that it would minimize infection from outside.
Sure, the refugees got in, but as I understand it, there was no political will to stop them. And during a brewing pandemic, I wouldn't expect masses of people to suddenly want to move in, anyway.
I think they can't back down now and have to stick to lockdowns, even if protests would make them pointless in spring. Can't show weakness.
But assuming we don't get a Covid 19, 20, 21, 22, forever-scenario and there will be a round 2 in a couple years (or a decade):
Merkel isn't going to be around any longer, which makes me hopeful that the CDU will be more representative of the right wing again.
Which either kills the AFD or makes it get its act together.
The continued marginalization of a third (?) of the population seems unlikely.
Next time, we can count on everyone already having masks lying around.
And I'd expect that we'd have a strategic supply of 80 million FP2 masks stockpiled, ready to send out at the first sign of a pandemic. Perhaps we'll have something better than FP2. [why wouldn't we?]
Also we won't let all our masks be bought up by Chinese people sending them back to the mainland. [that happened, lol]
I do hope that more houshoulds will have toilet paper stockpiled.
There might be a contact-tracing app mandatorily preinstalled on every phone that isn't a privacy nightmare and activates only when a pandemic has been declared. The Corona-Warn app has a very improvised feel to it.
Something better than that, at least.
VR will be more mature and internet more reliable, homeoffice more common, so restrictions won't be as disruptive or distressing.
And I just expect every citizen, every bureacrat, every politician to have learnt what works and what doesn't. It's awkward to point to "experience", but I do think, that alone matters a lot.
Not to mention, that there's probably going to be institutions that will spend a lot of time analyzing everything with the benefit of hindsight.
And that will turn into the benefit of foresight for round 2.
Italy was overwhelmed with patients dying on the floor, whilst our doctors had nothing to do. Why wouldn't we have agreements in place between EU countries to send doctors and medicine in mass, when any one system gets overwhelmed? We can't do this right now, but it seems doable after this round is over.
Fundamentally, a pandemic just isn't that difficult to contain in a modern society. We just never had to do it before.
So naturally, we fucked it up.
But a second time? I think collectively we're not that stupid or dysfunctional.
Agreed, not teachable, but (until proven otherwise) replaceable. Covid is just the last event that accelerated (on, accelerated a lot) a broad tendency of gouvernents feeling justified in teaching the populace and protecting it against itself, instead of being just a practical and safegarded way to implement majority wishes. This will not go away smoothly. My only hope, apart from an (always dangerous, you often get worse than what you started with) insurrection, is that the judiciary system seems to be the only counter power still sane and willing to react (see the Netherland, but something similar happen everywhere in Europe). Before the covid i did not think highly of the judiciary system, but i was wrong apparently....
I wonder what you predict/think about Covid "long-haulers" and whether that will distinguish Covid precaution from flu precaution. The anecdotal evidence about the persistence of symptoms and the unknown long term damage to lungs, heart, etc. significantly increases my concern about getting it. If vaccination prevented long-haul Covid, that would be great news.
1) Genomic surveillance is so spotty in the US. What are the chances that other variants of concern with similar properties to B.1.1.7 or B.1.531 are currently circulating in the US? I read a paper (can't find it now) suggesting that B.1.1.7 wasn't increasing in relative proportion at quite the same rate in California as it was in the UK. One suggestion I think was that there are other variants that are similarly more infectious out in California. (On the whole, if this is more likely then that should decrease our expectation of a large fourth wave?)
2) To what extent is it possible to form an expectation of a fourth wave without mathematical modeling? I haven't seen a tone of modeling that attempts to take vaccination, seasonality and emerging variants into consideration. I think Youyang Gu does this, and his fourth wave is very moderate: https://covid19-projections.com/path-to-herd-immunity/
So, question: are there other attempts to model this mathematically rather than heuristically?
3) In the endgame where SARS-CoV2 becomes endemic, does it have persistently low IFR because of immunity from prior immunity? And more broadly is this what happened with other currently circulating CoVs? Suppose that you took one of the other "common cold" CoVs and removed it from human circulation for 150 years, and then reintroduced it. Would that cause a pandemic, because of weak prior immunity? And would it be similarly lethal?
4) What countries are most likely to be the next "canaries in the coal mine" for B.1.1.7 waves? Would we expect the US to have a B.1.1.7 wave before (say) France?
Italy is currently at 20% spread (meaning one case in 5 is the variant), with peaks of 59% in some regions. I wouldn't treat the US as a unique nation - go state by state.
1) Moderately high in principle, but convergent evolution seems to be present (E484K was apparently developed independently in South Africa and in Kent, UK). There might be an american B117.
2) I tried and failed, uncertainty just makes numbers meaningless. I'd suggest an approach that differentiates variants as if they were a new virus, introducing a weak "pre-immunity" population group.
3) We actually don't know this is what will happen. The risk that it keeps mutating into a more lethal form, also due to vaccine pressure, is theoretically real (that B117 is more lethal seems to be a fact now).
Appreciate the responses. Re 3), I've also seen the suggestions that B.1.1.7 is more lethal, but B.1.1.7 isn't more lethal to people with prior immunity, right?
>mutating into a more lethal form, also due to vaccine pressure,
Vaccines don't pressure viruses to become more lethal, they pressure viruses to evade the immune response generated by the vaccine. Killing the host is almost always a bad strategy for a parasite, regardless of vaccines.
It turns out antidepressants greatly mitigate Covid symptoms. Nature is an impeccable source. The magnitude of the effect reported is great. I don’t know why this is it getting more publicity
Is this "depressed people are less likely to have severe Covid" or "antidepressants are effective pharmaceutical interventions against Covid"? If it is the former, I'm going to bet it's simply demographics. If it's the latter... why would antidepressants have an immediate effect? I thought it took days or weeks to get enough in your system so they start working.
The article goes into the proposed mechanism in some depth. Antidepressants turn out to have a lot of antiinflammatory activity. It is the overactive immune system which is responsible for much of the covid created havoc. Not for nothing, there is a fair amount of scientific opinion that antidepressants' antiinflammatory powers are at least in part responsible for the benefits in depression, a condition in which the immune response is disrupted.
Maybe. Who knows. Things like this pop up and then disappear later under closer inspection. Famotidine (in Pepcid AC) had a moment of glory early on as mitigating COVID19 symptoms, there was even a plausible MOA for it, then the effect sort of disappeared. Too bad, as Famotidine is OTC and has an excellent safety profile. The p-value they give, <0.001, isn't really that great. Given all the attention COVID19 has gotten, it's unlikely that, over a year later, something common is going to end up being that useful.
That article isn't in Nature, the journal name is "Molecular Psychiatry", part of the SpringerNature group of journals. This isn't the journal that Watson & Crick announced the structure of DNA.
Those on reddit.com/r/skincareaddiction say you shouldn't buy skincare products from them because their problem with fake products. People have said that they've bought from trusted sellers, received brand name packages, and only discovered the product was a knock off because the consistency/color was different from their last bottle (or something worse happened like they got a chemical burn).
My prediction: 100% chance that Joe Biden is going to OWN a coronavirus vaccine failure if his administration does not get its act together and create a national corona vaccine appointment scheduling system. The current every-grocery-store-for-itself mess of vaccine appointment methods is far far worse than the Obamacare rollout site ever was, and is far more infuriating than not having the vaccine at all (ala #trumpolini times)
I'm interpreting your "100%" to mean "high" because it's obviously not literally 100%.
I disagree, because Americans are used to blaming state problems on state authorities, and Biden has already exceeded his early "1 million vaccinations a day" promise as well as his revised "1.5 million shots a day" target and thus can already claim success. Once everyone who wants a vaccine has one everyone's going to look back and remember "Biden came into office, promised us vaccines, we got vaccines" and assuming that occurs before the 2022 midterm elections it's going to be a huge political win for Biden and the Democrats. Only a few contentious nitpickers (like myself) will ever remember that Biden could have done it faster if he'd put someone in charge who knew enough to read rationalist blogs for tips on implementing a vaccine rollout.
Bioprocess engineer here, I wanted to comment on your proposal here:
"They allow anybody to manufacture vaccines and charge market price for them, subject only to usual safety restrictions. If Amazon wants to get into the vaccine distribution business, for God's sake, let them."
This seems like a really unlikely outcome to me, for a few reasons. For a bit of context on drug manufacturing, a drug approval also requires approval of the manufacturing process and the analytical methods testing the quality of the drug. If a drug manufacturer wants to make major changes to their manufacturing process, then they may need to perform new clinical trials to justify the new manufacturing process. This is based on the concept of "quality by design," usually abbreviated as QbD, which is often compared to the older, crappier paradigm of "quality by testing." Quality by testing just means that you ensure product quality by running a bunch of analytical tests on important properties. For the mRNA vaccines, that's probably going to be stuffy like number of copies per dose of the mRNA transcript by qPCR, nanoparticle size by DLS or some other sizing technique, etc. The problem with this approach is that there is always the potential that there is some super important quality attribute that you aren't aware of and don't test for. If you have some critical quality attribute you aren't testing for, then any changes in the manufacturing process that also impact our hidden quality attribute could negatively impact drug safety or drug quality. Therefore, the QbD paradigm was invented, which involves control of drug quality through control of the manufacturing process, so that even if you aren't testing every critical quality attribute, you know you are making a consistent product because your manufacturing process is consistent. All modern drug processes rely to an extent on both testing and manufacturing design for quality control.
Because of the expectations around QbD, it's going to be really hard to open up vaccine manufacturing to all potential manufacturers. You will either need to 1) force the original vaccine maker to transfer all information on their manufacturing process and analytical methods to all prospective manufacturers, 2) make new manufacturers do clinical trials on their drugs or 3) abandon the QbD paradigm and allow manufacturers to develop their own manufacturing processes to make existing vaccines, without a requirement for new clinical trials.
#1 is never going to happen, because the innovators are going to scream bloody murder about having their patents violated. Even potential manufacturers would likely avoid this, because they don't want to set a precedent that the FDA can just seize your manufacturing IP.
#2 is essentially the existing biosimilar pathway, just starting before the existing vaccine patents expire. This is probably feasible in theory if the FDA and Congress nullified all patents on the vaccine drug substance, or they bullied the manufacturers into allowing competition. Even then I can say from experience that making a biosimilar still takes a ton of time and resources. The requirement for new clinical trials will delay the release of the biosimilar vaccines significantly, probably to the point that the biosimilar vaccine is no longer effective against newly circulating strains. I don't really see anybody taking this route.
#3 is basically a supercharged biosimilar pathway where you abandon QbD principles to avoid doing new clinical trials. Without QbD control, you would almost certainly need extensive testing of the biosimilars using the analytical methods of the innovators to ensure comparability. However, you would still need to force vaccine innovators to share their analytical methods, which seems unlikely. And you are still voiding all of the initial vaccine patents to allow early biosimilar competition. And the FDA is super risk averse and is not likely to ever approve of an approach like this.
The more likely scenario for expanded vaccine manufacturing is for the government to subsidize voluntary contract manufacturing relationships. This is already quite common; Lonza for instance is acting as a contract manufacturer for Moderna, for instance. In these relationships, the innovator maintains full control over their IP, and so they can share their full manufacturing process without worrying that the contract manufacturer is going to steal their IP. It's important though that this be voluntary and the innovators get to choose who to work with. While you can sign agreements saying "IP is protected," a contract manufacturer still learns a ton by making a drug. For instance, let's pretend Merck has a fledgling mRNA development program. Moderna is most definitely not going to want to use Merck as a CMO, since that would be giving Merck a huge leg up in terms of manufacturing experience for their potential new mRNA vaccines.
So depending on what vaccine you were getting, storing it in your ordinary system might have ruined it. Letting Jack deliver vaccine in his white van may not be the most efficient method in the end.
That part actually isn't that hard, for the most part. Most of these pharma companies contract out shipping and distribution, so Amazon could just work with the same shippers used by the other Pharma companies.
Before I say any more - full disclosure, I work for a company currently working as a contract manufacturer for a COVID vaccine. I don't actually work on this project myself, but wanted to get that out of the way.
Anyway, if we want to look at crazy big ideas though, my vote is for the US government to buy a controlling stake in Moderna. Moderna's market cap is $70 billion, so the government could probably buy a controlling stake for $40 or $50 billion. Then the government just makes Moderna manufacture as much as possible with all possible partners. After the pandemic ends or winds down, the government sells off it's share, potentially retaining rights to production and distribution of future COVID vaccines. Moderna is probably the best pick for this, since they are much smaller than the other major players in the COVID vaccine space like Pfizer, AstraZeneca and J&J.
This isn't the first time this idea has been brought up. For instance, the company Gilead makes a cure for hepatitis C that is quite expensive. Through Medicare and Medicaid, the US spent pretty large amounts of money on this drug. Someone ran a cost analysis that found that in the long run, it would be cheaper for the US government to buy Gilead and then distribute the drug for free, rather than continuing to buy the drug from Gilead.
I don't fully get your point about intellectual property. Isn't part of the point of the patent system that the inventor gets a temporary monopoly on its invention, but in exchange it has to publish the process? Can a pharma company use both patents and trade secrets to protect its invention at the same time?
At the moment, with our government continuing to impose lockdown while promising that it'll all be relaxed down the line (there will be no St Patrick's Day parades this year, which doesn't have me weeping bitter tears to be honest), I have no idea. Every time something new comes along, e.g. they relaxed restrictions for Christmas, people travelled home from the UK, and we got the new mutant variant and up went the infection rates once again and we're back at Level 5 restrictions https://www.gov.ie/en/publication/2dc71-level-5/
So my natural tendency is to go "things will ALWAYS get worse" but will they get better? No idea.
I find it very hard to care whether covid is eradicated or not, compared to how much I care that the lockdowns end. I feel like people forgot that these are extreme measures that we shouldn't use unless absolutely necessary.
I remember in January when I heard about the lockdowns in China and thought "that's absolutely barbaric, I'm so glad that can't happen in America." Then in March there was talk about lockdowns, and everyone was duly skeptical, but after looking at graphs and statistics and checking the numbers and careful argument we were convinced that it was necessary. Now when I point out that the specific conditions which made the lockdowns rational (despite the incredibly high cost) might stop being true well before the virus is eradicated, I feel like I'm taking crazy-pills. "You can't stop sheltering in place, you might get covid." I'd much rather catch covid and take my chances than spend another year inside, it's only the structural issues around R0 and hospital capacity that I'm worried about.
The only question I want anyone to ask is "when will the risk of overwhelming hospitals go away, when will the death rate be less than 100k/year, even without restrictions?" If you're wondering how long lockdowns would be needed to eradicate the virus, I assume you've lost track of your priorities.
Yes. As a healthy young person living alone in a blue state I could not agree more. I've been alone in my apartment with zero human contact for the better part of a year at this point! Most of my friends in the area are still extremely pro-lockdown and afraid to do anything but the bare minimum outdoor socializing (which is of course unpleasant in winter) despite all of us being young and healthy and not living with vulnerable older relatives. It has made me feel like I am a bad person for wanting lockdowns to end before the virus is completely eradicated, but the reality is that it's extremely hard to keep playing the game of "virtuous blue triber" when it prevents you from meeting your basic human need for social contact. I am well aware that it's not exactly fun to be stuck at home with partners or kids for this long but it's hard to explain to people in those situations just how profoundly bizarre it is to go weeks without seeing another person face to face. I talk to myself all the time now and it's becoming hard to tell the difference between my thoughts and the words I've spoken out loud. I was never a socially anxious person but I've started to feel uncomfortable with the idea of touching another human being, even for a handshake or a hug, as it's been so long since I've done that on a regular basis.
I'm much more concerned about the long term psychological effects of social isolation than I am about what might happen to me if I catch covid. I fear that I will never be a normal person again if social distancing carries on for another year.
I don't belong to a gym but yes, everything is closed except shops and outdoor dining (I think indoor just started reopening at 25% capacity yesterday). No fun sitting at an outdoor restaurant in winter if none of your friends are willing to go :( At least in summer I could convince a few people to meet up in city parks.
Nicely put, Scott, as usual. What's missing is the public health impact, not of the Rona, but of the response. The illness and death caused by closures and lockdowns. First order effects like suicide, alcoholism, drug abuse. Second order effects like domestic violence, child abuse (includes school closures), depression. Third order effects like unemployment, poverty, and stress. I posit that the public health impact of our response far outweighs that of the virus itself. On the whole, Rona is an opportunistic disease that attacks mostly those about to die soon of something else. All the rest of what I mention impacts healthy, middle age people and, especially, children.
In my country of residence, Georgia, all-cause mortality was below the previous five-year average during the months of the initial lockdown, which allowed us to beat the first wave.
During the second wave the government tried not to lock down, but hospitals became overwhelmed (as in, lines of ambulances waiting outside repurposed hotels; people dying at home because they couldn't get medical care which had all been rerouted to covid patients) and so the government had to institute a lockdown. In that second wave, all-cause mortality was significantly above the previous 5-year average.
So just factually, lockdowns do prevent deaths on net, and in some cases on gross as well (as in, lockdowns can reduce not just covid mortality but all-cause mortality when they're done right). But also, your analysis is comparing "lockdown" to "pre-pandemic status quo", which is simply a mistake: you must compare "lockdown" to "full-blown uncontrolled pandemic". Unemployment, poverty, and stress come about due to lockdowns, but you also can't work when you're dead or on a ventilator, and you also face poverty and stress when an income earner in your household gets too sick to work.
Lockdowns should be limited and targeted with specific benchmarks of community spread to be imposed and lifted. Schools should be the last things to close and the first to reopen, instead of caving to pressure and allowing bars and clubs to operate while our kids learn from home. The specific implementation of *some* lockdowns has caused unnecessary suffering but that doesn't mean that all lockdowns are unnecessary.
By the way here's a paper on lockdowns and mortality that both a) illustrates the difference between competent, limited, targeted lockdowns and the chaos in the US and UK and b) shows that all-cause mortality in New Zealand also actually declined slightly during the pandemic, possibly due to lockdowns.
Thank you for your thoughtful reply to my comment, Neal. We do not disagree.
Covid is a remarkable cultural phenomenon that bemuses me endlessly. David Foster Wallace could not have framed it better. There has been nothing like it since the 1960s (when I was a teen). Here in SWFL, where I am now, no one takes it seriously. At my other home, near Boston, it is like Night of the Living Dead. We do, indeed, live in interesting times. (Chinese curse, although not really, I think RFK coined it.)
Well done Scott - I like the way you share your thoughts. I would love to hear your thoughts on "What is the Goal?" or "What exactly is the problem we are trying to solve?" I think all would agree COVID has created many problems, so all the more important that we define the biggest problem clearly. I head a wise saying once that "a problem well defined is more than half solved."
I agree with Scott's sense that COVID will always be with us -- a sort of lingering flu like illness that burns hot in certain regions of the country during coronavirus season in Nov/Dec/Jan -- but I think his introductory predictions that we will have further "waves" in March and next Fall extremely pessimistic and unlikely.
First, what do we mean by wave? At this point, everyone knows that case numbers do not quite equal infections and that the scarcity of testing early on in the pandemic makes our first wave look artificially small. The best estimate for true infections that have occurred in the US come from Youyang Gu, who has run the remarkably excellent website COVID-19-Projections and essentially outperformed anyone else in the COVID modeling game. (Link: https://covid19-projections.com/).
Gu's Super Fancy Model estimates that our peak number of daily infections during wave 1 was ~300k; during wave 2 we hit ~250k; during wave 3 we hit ~660k. I will somewhat arbitrarily define a "wave" as a period in which the US exceeds 200k true infections per day. My prediction (70% confidence) is that this will never happen again.
(2) People underestimate just how good the vaccines are and just how rapidly the US is scaling up.
(3) The new variants are mildly overhyped. Spread has already hit rock bottom in the UK and SA and our best estimate is that both natural immunity and the vaccines offer robust, if diminished, protection against them.
There's a tendency towards COVID pessimism in the Culture right now and it seems pretty strange to me. Our situation is brighter today than it has been in so, so long. The end is in sight.
I agree strongly with pretty much all of this. I also think it applies to the world and not just the 4% that live in the States. Every single country in Europe has seen cases fall in February, most in a dramatic and unpredicted way. I would bet against there ever being a further ‘wave’ that reaches half the height of the last one. To the tune of a hundred pounds sterling, to anyone who is tempted..
And yet most European countries kept strong measures in place, or even introduced new ones.
It looks like the threat simply can not vanish, not until a large part of the population has been vaccinated, and i think that's exactly what's going on here. Not for health reason (but you will find many epidemiologists pushing for it, if you focus only on virus transmission you push for perpetual lockdown), for political reasons : end of the epidemy without vaccine would mean end of political career (at best) for many.
I don't believe that challenge trials are presently used in the development of yearly influenza vaccines, though they may have been in the past. But not having as much to prove is definitely the case on the regulatory front - the process for approving a new flu vaccine is done under different rules for other drugs and vaccines, grandfathered into the system in ~1960. Everybody, even the FDA, trusts that a new flu vaccine developed the usual way will be tolerably safe and effective, and so much less is required in the way of proof.
FDA officials have said the right things about wanting to have a similar system for coronavirus vaccines, but they haven't committed to actually doing it.
The news cycle is currently saying California = Heavy Lock Down but Florida = No Lockdown and Both Have Same Outcomes. What are the best arguments for and against this kind of thinking? Preferably not mechanistic argument (masks and lockdowns HAVE TO do something so this CAN'T BE RIGHT).
Best argument I've heard is masks do stuff, but legal lockdowns do next to nothing. Not because staying away from people & closing businesses do nothing, but because people don't care what the law says and will either visit friends or socially distance as purely a function of the rates of COVID. Similarly, while businesses will listen to the law, many of them will also close down before the government says they need to. Likely as a combination between "politicians don't want to upset business, so more businesses closed means fewer businesses upset, meaning lower opportunity cost to shutting down operating businesses" and "businesses don't want to be seen as irresponsible or not-hygenic, it'd be bad for them if it became known that people got sick from going to them, and the higher the rates of COVID, the lower their customer base anyway, so eventually it becomes unprofitable to continue running".
I think there's also a counter force. Here in MN we had a hard shut down on bars for a while. A few loud-and-proud bars defied the rule, stayed open, and advertised the fact that they did so.
This doesn't mean that they operated just like before COVID. This means that they became a gathering place for people making a statement about COVID response.
But... on the other hand, no one can point to any uptick in infection rates, either.
My personal, totally unsupported, totally based-on-my-priors, is that transmission rates are a function of many, many variables, and "lockdown 1/0" has a very low weight compared to lots of other things that are not convenient nobs to twiddle like the weather, micro-population getting exposed all at once or sequentially, etc. Its all a giant, multi-variable function with non-linear feedback loops. Big policy changes can probably make big impacts in very short time frames (remember 2 weeks to bend the curve) but wash out quickly, the same way pent up demand washes out in economics.
I'm under a curfew right now, in Georgia-the-country. I was opposed initially but I am becoming convinced that it may be effective, in combination with restaurant/bar closures, based on the numbers I've been seeing during the curfew, especially as other measures have been imposed and lifted. So basically they've closed indoor bars and restaurants, so people would naturally want to take their social gatherings to someone's house. But you can't travel after 9pm, so... I mean, I suppose some people will be willing to have overnight house parties and stay locked in until 7am (I've certainly done it, pre-pandemic), but it's far fewer than the number of people who would be willing to go out drinking until midnight or 2am or whatever, and happens far less frequently. So it's (obviously) not that traveling at night causes covid transmission, but rather that traveling at night facilitates other activities that cause covid transmission.
There's been debate locally about whether the curfew + bar/restaurant closures are really a "lockdown" or not but I think they qualify enough to make the point: strategic, targeted lockdowns can indeed reduce transmission rates. If I had to estimate the impact of just the curfew + bar/restaurant closures I'd say it's accounted for about a 15% reduction in infection rates here. That might sound like "next to nothing" but if it pushes R from 1.1 to 0.95 that's a very big and important difference.
Mucocillary clearance is enhanced with higher humidity. Most of this early winter, much of California was in low teens to single digit RH (especially SoCal). The mucocillary clearance effect is true of all respiratory virus ( https://doi.org/10.1073/pnas.1902840116, https://doi.org/10.1146/annurev-virology-012420- 022445). Perhaps part of the current decline in COVID in California comes from the start of noticeable precipitation (my speculation... no references I can provide here).
It's pretty much never less than 45-50% RH in Florida.
Additionally, mask wearing that covers the wearer's nose and mouth with a good seal raises the humidity of the wearer's inhaled air which has recently been proposed to improve the wearer's viral infection resistance: DOI: 10.1016/j.bpj.2021.02.002.
Well, I've seen the exact opposite claim here in europe, where the cold weather + decreasing covid was explained by maximal contamination with 60% RH, 10 degC, because it's favorable to aerosol persistence...
My guess is that many places start to have burned off vectors for virus, that herd immunity is much less than the 70% for some reason. And that indeed coldish not well ventilated places can really boost transmission : too many case clusters in warehouse and slaughterhouses to be by chance, that is often the only cases remaining when the epidemy is slowing down...
I'm having trouble finding an article that supports the statement "maximal contamination with 60% RH, 10 degC because it's favorable to aerosol persistence...". While searching for those conditions in a study, I did find a few other papers with analyses of subtropical regions comparing flu/COVID and factors such as socioeconomic conditions (https://doi.org/10.1016/j.envres.2020.110184) and a systematic review of temperature and humidity on the spread of COVID (https://doi.org/10.1371/journal.pone.0238339).
Perhaps, the "[...]maximal contamination with 60% RH, 10 degC[...]" refers to the outside conditions? Unless active measures are taken, these outside temperature/RH conditions would result in a lower RH at warmer inside temperatures. The studies seem to support that lower RH both increases aerosol persistence and disorders mucocillary clearance.
Perhaps I've just not been able to find the reference for the opposite claim?
Summarizing: very cold or very warm is not favorable for corona transmission, cold weather prevent droplets to stay airborne, warm makes them evaporate, it's intermedaite temperature with 60-80% RI that maximize aerosol dispersion...
My take: the unusual cold weather in western europe last week was making headlines, and corona statistics didn't bulge (i.e. constant if slow drop of all indicators in most of europe). They need to link the two with an hint that we are not out of corona, that once we will be back to normal end-of-winter- early spring crap weather of cold-ish rain, corona may be back with a vengence, so don't relax!
Bingo, this study was exactly what they were looking for. Modern science reporting at its best...
Thanks for the link, Greg. Fortunately, there are translations available for this popular news link.
I tried following through on scholar.google and, as yet, 2/17/21, there aren't any publications, peer-reviewed or pre-viewed, on the stated conclusions of this popular news report. Perhaps the scientific research hasn't gotten through the French Ministry of Health review process yet?
While searching for a more detailed reference to the "60-80% R[H]" claim, I found a multivariate analysis comparing T, RH, elevation, population characteristics (LaborAge vs SchoolAge), sub-national regions (to account for variation in temp/RH/population density in larger countries), etc. Very thorough Methods section.
It includes a consideration for a lag in viral host incubation period (+test/hospitalization/death) plus the implementation of government policies such as lockdowns.
The limitations of the study include the data set analyzed (sources provided) ends with the beginning of June 2020. The authors do propose providing a regular update as fresh data become available.
From the abstract: "The result shows that temperature and relative humidity are negatively correlated with COVID-19 transmission throughout the world. Government intervention (e.g. lockdown policies) and lower population movement contributed to decrease the new daily case ratio. Weather conditions are not the decisive factor in COVID-19 transmission, in that government intervention as well as public awareness, could contribute to the mitigation of the spreading of the virus."
This work covered all available data through May 31, 2020, entered the peer-review process Nov. 2020 and was published Jan 2021. I think we'll be seeing a lot of work getting through the peer-review process covering larger, increasingly accurate data sets over the next several months.
Florida seems to have a higher percentage of its residents vaccinated. Not sure how much of an effect that might have, but probably not nothing.
Florida also seems to have a somewhat higher infection rate right now, contrary to the "Both Have Same Outcomes" claim. Again, not sure how much of a difference we're calling "same" and how much we're calling "different".
I wonder about population structure (age, living arrangements, density of social networks, etc.) and the impact that might have in terms of confounding lockdown effectiveness statistics. Maybe Floridians live in smaller towns and Californians live in bigger cities and so the average Floridian is already exposed to fewer people. Or something along those lines. I'd argue that the better way to measure whether lockdowns are effective would be to look at whether and how much the infection rate changed about two weeks after a lockdown went into effect within a single location. Or maybe you try to compare e.g. urban areas to urban areas and rural areas to rural areas, rather than a whole state to a whole other state.
What I do not get in this whole Covid mess is why no country so far pushes well engineered comfortable masks with a good seal and long lasting efficient filtes with low breathing resistance in a much more aggressive way, espcially since the general effectiveness of masks is no longer really in doubt. Instead we are stuck with cheap one way products that most people either wear wrong or not at all and that get quite uncomfortable after an hour or so and essentially cannot be worn during any kind of serious physical exertion.
It becomes increasingly clear that between mutations that evade the antibody response and the fact that only 70% of people in most countries are willing to be vaccinated vaccination will not be the silver bullet we hoped for. Thus I think implementing such a strategy, at least as backup for the next winter is a very sensible and comparatively cheap strategy that would also protect us from potential future pandemics after Covid.
Does anyoe have a good idea how to make this idea more public?
Because for technocrats, masks are a costless solution. Why would technocrats push to improve on that when there are so many other projects to work on? Technocrats generally are blind to costs like queue length and physical discomfort. That's why, for example, the TSA (last time I checked) has never compared the time spent in line for screening vs the length of lives saved by screening, or attempted to quantify the discomfort and hit to dignity that is experienced when a traveler has their genitals touched (through clothing) by a stranger. Its just not in their decision criteria.
Indeed... Also the incredible attack on non - economical life we had here in europe (gathering forbidden including in your own house, with police allowed to enter your house with barely any check in place). This could help control the epidemy and will not cost a penny, great idea!
1) convincing governments to introduce stricter mask requirements
2) convincing governments to mass produce masks (but maybe the market will take care of this once 1) is achieved)
3) convincing people to wear such masks
I fear that the pandemic has shown that even one of those steps in isolation is really difficult. It took (and is still taking) ages for rapid tests to be approved, and the usefullness of this idea is pretty evident. Broadly, any plan relying on a small group of volunteers to change the government's mind does not have a high chance of success currently.
Also, in particular, people are willing to wear masks in situations where risk is not generally high. Shopping and public transport do not seem to account for a lot of transmissions, but mask mandates focus on these places. Increasing mask efficiency in those situations would not really prevent many transmissions.
On the other hand, meeting friends, going to restaurants, or at the workplace are situations where people do not seem to be willing to wear masks or accept mask mandates (although I have heard that Italy did require mask usage at work, so who knows). With the exception of doctor visits or for teachers, I do not think that increasing mask efficiency has much potential for good. Do you think there are situations that I have missed?
As a lower-contact person, I don't want to be stuck being lower-contact indefinitely, so I'll personally be very happy when I'm vaccinated and can revert to a set of behaviors that would, at this point, put me and my loved ones at great personal risk.
In other words, it may be true that risk-averse people like myself are forming some kind of protective layer over society stopping r from shooting up into the sky by staying home all the time, but we'd rather not do that forever and every day the pressure to defect grows.
"Instead we have a patchwork of approvals and I have 70m doses that I can’t ship because they have been purchased but not approved. They have a shelf life of six months; these expire in April."
Great, thanks for this. Probably waiting for the FDA. There's also AZ doses sitting in a Baltimore factory. I don't understand why this story is not more widely reported!! #UnclogTheFDA
1. Daily deaths is a far better visualization of the waves in the US. Confirmed cases make the first wave appear small, but when you look at deaths you can see the first wave was nearly double the size of the second wave. When you do check your first prediction, accuracy should be determined by checking daily deaths.
2. I highly doubt that once we reach some sort of equilibrium with the coronavirus that we'll need yearly updates to the vaccine. Right now it is "mutating quickly" because there is a huge number of replication events combined with the fact that the virus is still getting to know us. Once infections are down and the virus has discovered most of the "low-hanging fruit" mutations that provide large jumps in fitness, the rate of mutations will drop and the availability of mutations that provide large jumps in fitness will also drop. In fact, my prediction is that the only thing needed to drive the risks of covid down to the levels of the flu is a single exposure to the original strain of the virus, whether that exposure comes from the virus itself or the vaccine. After that, exposure to the newest variants might cause symptomatic infection, but the "old password" will still give previously exposed immune systems a major head start.
2b. My point above isn't a counterargument to your prediction that public health officials will recommend a yearly vaccine for the newest covid strain. Just saying that I think a yearly update will be major overkill after ~2022.
3. Many of your predictions have some vagueness that will make them difficult to check. For example, the prediction about mask usage on an average street in SF Bay Area seems particularly difficult/expensive to check. Maybe change it to focus on something you can easily check, like the proportion of businesses that still require masks (easily checked by viewing signs on doors). Also, this prediction seems to be a prediction about wearing masks OUTSIDE, which could change if people finally get the message that covid doesn't spread well outside. So, its entirely possible that your prediction is "correct" even though we're still living with ridiculous mask requirements.
Nice info as usual! Does anyone have a prediction about when schools get back to normal or what they'll look like in the fall? My 7yo is going to in-person school with restrictions and here's what those restrictions look like - Everyone is masked, which still makes me so sad to see. He gets 15 minutes to eat lunch because that's how long they're allowed to remove the mask at all. Many of the afterschool clubs and extracurriculars have been cut. A lot of typical activities are proscribed at recess and there aren't so many fun or "special" activities to spice things up. Obviously there are no field trips They're still doing a couple of special in-class events but parents are not welcome. Logistical arrangements were required to e.g. hold more class time outdoors, which obviously isn't feasible in lousy weather. Otherwise they stay in the same classroom all day rather than traveling to different rooms for specials like music or art. It sounds like such a grind to me, for both the students and teachers. It all can't possibly be sustainable long-term, and to my perception there's a lot less joy and anticipation at present.
In the US I think things will get back to close to normal in most schools by the Fall 2021 semester (so, August or September), if not earlier. I'm a teacher (but outside the US so take this with a grain of salt) and so I feel some sympathy to US teachers and teachers' unions who are being pushed to open without the recommended safety measures being available and without the recommended benchmarks being met. That said, I think that the natural result of pushing people to take risks they don't want to take is that they will a) not be at all enthusiastic or in the mood to compromise on what little safety precautions they do have available and b) attempt to exercise as much control as possible over the things they actually have some control over, because the thing they want to control - the right to work from home - is unavailable. So I think that explains some amount of the unpleasantness of schooling right now.
But personally, once I'm vaccinated, I'll be ready to step into my classroom again and I'll be ready to advocate for a reduction in mitigation strategies especially in young children in areas with low community spread.
The information I'm seeing now on the US is that those conditions - vaccinated teachers, low community spread - should be widely present throughout the US by the time schools are expected to open for the fall 2021 semester. Perhaps even earlier, if schools go through with suggestions to open this summer to take advantage of the opportunity for teaching outside or having added ventilation due to warmer weather, or if teachers in some states manage to get vaccinated by April or even March due to successful vaccination campaigns which also reduce community spread to within the CDC green zone for schools.
By the way, where I live, my son was offered a similar chance to go back to school under similar conditions, and we've opted to just keep him home. This "half-schooling" under lockdown conditions seems worse than just continuing to learn online, but perhaps that's my privilege speaking.
Frankly, a lot is obscured in looking at “the peaks” across the whole us. At geographically finer resolution, nowhere that had a bad first peak (use deaths not cases) had a bad second peak, let alone 3 peaks. What looks like new peaks is simply the virus reaching new populations. the speculation about strains causing big new peaks are a bit dumb, seeing as the UK and SA covid cases have both fallen 75% over the past month.
Not really, deaths/day seem to have peaked at 1/5 of their spring rate. Cases are an innappropriate comparison since tests were basically impossible to get at that point so the multiplier of deaths to cases has changed dramatically over the pandemic. This 2nd “peak” is about on par with a flu season (1st one was 4-5x as bad).
1. As Scott said, "resistant" does not mean "has no effect." It means the vaccine is *less effective*.
2. Being vaccinated against the currently dominant strain is a great idea and I can't believe I'd have to explain why.
3. It is extremely likely that the current vaccine will provide at least partial protection against being a carrier, which will reduce the ability of a new strain to establish itself.
"Is there a thalidomide-level clusterfuck that I'm not aware of?"
There was a case where the study was conducted with people who hadn't had the disease before. As it turned out when the gave the vaccine to people who had already been infected they had a devastating reaction.
A relatively recent HIV vaccine candidate seemed to increase the likelihood of contracting HIV in some groups https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234358/. I don't think it was a huge increase in risk, but still not something you want to be giving people.
One plausible trajectory is that of the Russian flu of 1889-90. Not only is it now suspected to have been a coronavirus, but the patterns of infection and disease were very similar - severe/deadly in older people, almost no effect on children. Speculation is that children built up immunity early on, so as they grew older they had only mild symptoms; these symptoms now present as a 'common cold'. Given that covid-19 also has very few symptoms in children, it is entirely plausible that they will develop a partial immunity that protects them from all but mild symptoms as they grow older. No vaccine necessary.
I noticed this curious pattern emerging from last week's NERVTAG updates.
1. Using the SGTF bio-marker as an identifier for the B.1.1.7 variant, the B.1.1.7 variant is now at 90% of the strains detected across the UK. Yet UK case rate continues to fall, and the hospitalizations rate continues to fall.
2. By case *percentages* B.1.1.7 seems to have a significantly higher R0 value than the "classic" D614G strain. However, some epidemiologists predicted that there would be a new case surge when B.1.1.7 reached 70 percent penetration in UK's virus pool. B.1.1.7 reached ~70 percent penetration the final week of December in most areas of the UK. By those predictions, the UK is past due for another surge.
I've been discussing this with an immunologist friend, and his only explanation is that people are masking and social distancing better now in the UK. I don't know of any way to accurately measure this variable. And I'm far from convinced.
Has there been any writing/speculation that the mutations we're seeing now represent "low hanging fruit" in the evolutionary space of the COVID spike protein? A few of the point mutations in the different new sub-strains are the same, which may lend credence to this idea but I'm not sure.
If my faulty memory serves me correctly there are ~150 epitopes on the S1 section of the spike protein. The epitopes are what bind to the ACE receptor sites on the cell, and are what are exposed to the antigens created by the vaccine. I don't have any idea what all the permutations of epitope combinations might be. But too many mutations and the spike protein would likely become less infectious. A few key mutations could make it more infectious, though. Considering that the Coronavirus has been around longer than we've known about it, this infectious version might be high-hanging fruit.
However, as long as people are infected, but don't develop full immunity (sterilizing immunity), evolutionary pressure will be selecting for mutations that would balance its R0 (reproductive value) without killing off too many of its hosts (which would reduce to where it couldn't propagate). A Captain Trips scenario is very unlikely according to evolutionary theory. The models suggest it would evolve towards a highly contagious common cold type of infection. But SARS-CoV-2 has proven the limitations of epidemiological models...
I read someone say that humans triumphed over the animal kingdom because while they adapt over evolutionary time, human ingenuity adapted at an exponentially growing rate. But it may be that the tables have turned briefly - the virus evolving new strains faster than we can develop, approve and manufacture vaccines for it.
I've been saying all along that COVID will be with us essentially forever (for the next century at least), so I feel a bit vindicated now.
That said, COVID is more deadly than the flu, and it disproportionately affects old overweight diabetic cardiovascular-compromised people -- which is a sizeable chunk of the American population, which is getting larger every day. For this reason, I still expect mask requirements to become the norm in most public indoor spaces (e.g. grocery stores). I also expect public gatherings of any kind to become a lot less frequent, and of course the same goes for nationwide/international travel.
Alternatively (or perhaps in combination), society might slowly change, so that COVID-vulnerable people are expected to stay indoors all the time. If a person dies from COVID while being old/fat/etc., the public sentiment would be, "well, he knew the risks, so it's sad but it's kind of his own fault".
When I switch back to an ACX tab, my computer is busy for ~10 seconds re-rendering the page. I have a super-nice high-end computer so this must be horrible for people with normal or below-average hardware.
It seems the same whether or not I am using the "ACX Tweaks" extension.
I'm no expert at JavaScript debugging, not at all, but it looks like the "visibilityChange" event is triggering some extensive UI refresh. Can we ("we" meaning the community including me; SubStack Inc could do it too but they are busy and have a long QA process) write an extension that disables that functionality, and perhaps makes refreshing the page a manual event done by a button-press?
Wow, so, when I went to look at the JS console for this page it gave me ascii art with the phrase "substack wants you to build a better business model for writing" and a link to their jobs page.
That's gotta be the most clever placement for a jobs ad I've ever seen, by an order of magnitude.
btw I'm getting the same issue, and investigating it, if that wasn't clear from context - thanks for bringing it to my conscious attention.
oh, wow, I just removed them with the Chrome debugger by hand.
Pop open the console, go to Elements on the left, then "EventListeners" on the right. At the bottom there is visibilityChange. (You might need to have clicked inside a comment to see this list).
There are one or two functions there, with a button to remove. I took them out, and now I don't have a big lag any more when switching tabs.
(If I have another tab open to ACX where I didn't do this, and I switch to it, it will slow down all ACX tabs.)
I don't see a way to intercept this or do it programmatically but maybe someone else can.
This may be a non-standard thing from WebKit but I think it will work in all Chromium browsers.
Now, what functionality did I ruin doing this? We can save the function from the middle there and put it in a new button if it turns out to be important.
Uh oh. Now whenever I re-order comments using the built-in-to-substack "newest first" "top first" "chronological," it re-orders the comments but they are all empty.
I think this is an ACX Tweaks bug, not mine, but I've been messing with so much stuff that who knows. My code may have broken some assumption that the Tweaks code was relying on.
More suggestions for ACX Tweaks. (I'd rather not bother learning Github but if I have to do it, I will.)
When you want to load all the new replies on a page, call
$("button.collapsed-reply").click()
until it doesn't give an error.
I also plain don't get how the "~ n e w ~" logic works. Sometimes I see comments from today without that tag, while comments from yesterday do have it. Maybe we're tracking on *being seen* instead of timestamp?
Oh, ACX Tweaks is up to version 0.14, with more features, including keyboard shortcuts.
I really don't like the "~ n e w~" being hidden from in-browser search, because it would tell me how many new comments there were. Maybe I just need to get used to it.
Also, "getEventListeners()" is only available in the console, not to scripts. Fooey. There's ways of doing it in the script but it involves hooking the addEventHandler() calls.
> "When the fifth wave strikes in late spring/early summer [...] another part of the population (~25%?) will have had the disease already"
Note that more than 25% of the US population has probably been infected already. My best point estimate through 2020 was 29%. See e.g. the CDC's estimate, COVID-19 Projection's estimate, etc.
(I only skimmed the post quickly, but this jumped out at me.)
This isn't working as an open thread. Everything or just about everything is about COVID. I suggest having open threads that don't lead off with highly engaging topics.
>The second wave was in July, when we got sloppy and lifted lockdowns too soon.
When I looked into this "second wave", back in the summer, I concluded that there was no second wave, it was the first wave, just in different places. New York and Massachusetts got hit hard early on, but then it calmed down there and, after a bit, picked up in other parts of the country. If you just looked at the stats for the US (which is a BIG place) as a whole, it looks like a second wave, but that's just an artifact of lumping the whole country together. If there was no second wave, that argues against the notion that "we got sloppy and lifted lockdowns too soon".
Yes, also i don't see how lockdowns could possibly work as eradication tools, all the more if you add animal reservoirs (and they exists, multiple mammals catch it).
lockdowns are control tools (how efficient they are is subject to discussion).
Granted, control tools can sometimes eradicate but only in specific cases (early stage, when the virus is limited to a few very local cases). That was maybe the case in 2019 in wuhan, but certainly not since 2020...
Prediction: lockdowns will continue to have no effect on the virus (compare Florida to California), nor will mask wearing nor social distancing. Also predicted: lockdowns will continue to harm the least-prepared, least-capable, and least-off people in our society. You know ... the people we don't listen to and don't care about.
Sorry if I'm cynical, but this ENTIRE last year has been filled with nonsense.
If you study the Covid Tracking Project's regional & state charts you will see that nearly everywhere in the country there have been two waves, not three. Now that the waves are in sync, it is unlikely there will be another in the next few months. Probably not another wave until next November.
Are we doing the world a disservice by labeling the variants by country of first expression? Is this just a virus with a fast rate of evolution and multiple possible vectors to do so? Would it be better to show how it may outpace a slow vaccination campaign?
> But even if they have it tomorrow, that's...what? Another four months for studies, one month before the FDA is able to meet to discuss an approval (you can't rush meetings!), two months to ramp up production
Shouldn't the approval process and ramping up production run in parallel? If a company is fairly confident that it's vaccine is likely to be approved, it should make sense to start manufacturing it before it's approved.
Indeed, why didn't this happen with the current vaccines against the original strain? At least I assume it didn't, or the initial rollout should have been much faster.
There was *talk* about it, and I certainly *thought* it was going to happen, because someone said Bill Gates was going to do it, but I think it'd actually didn't happen as well as we hoped.
"I bet we'll pick up the Asian custom of wearing masks in crowded areas if we feel sick." Depends on who "we" are. Some people already skew masks. Also, couldn't wearing a mask after the pandemics ends make some people nervous, making them think the mask-wearer is very disease (maybe carrying a new COVID strain or something like that)? To be honest, I would like to see mask-wearing when one feels sick being mainstreaned, but I do not think it will happen.
I have seen polls that suggest nearly half the U.S. population may not opt to be vaccinated. Here Germany the government has tied re-opening to an r factor of 35 or less. The current German lock-down seems to be pushing the number in that direction but new variants have the government prepping the population for continued lockdown. I wonder how the vaccinated population percentage will affect government policy?
Kind of strange reading an article like this, praising lockdowns, not mentioning the data we have on their efficacy (very nearly none as far as the virus is concerned, but with staggering negative side effects). Why is that? Are you, Scott, ignoring the data?
Like most recent waves, this one began in an animal lab or a meat market, i.e. a site where we crowd together and brutally manipulate non-humans. From that filth & degradation, "zoonotic" viruses will continue to arise; and the new global system of control that takes advantage of that spread, like any good Disaster Capitalist, will continue to amplify fear (i e. the meta-virus) to maximize its own hold over us. Prediction: humans will continue to herd and slaughter, and when disease wafts off the kill pile, we'll cage and (medically) torture more animals to "solve" it.
"Over 900 UK health and care workers have died of COVID-19, most due to occupational exposure. They continue to die because infection control in health and care settings is built around an outdated 'droplet' model which ignores that #CovidIsAirborne. 1/"
I apologize if this is a dumb question. I am not a scientist but my sister is, which makes me think I have scientific genes ...
Is it possible that some significant portion of the population is simply not susceptible to COVID? And maybe the recent decrease reflects approaching herd immunity in the susceptible population?
How, at the human mechanical level, is it "more contagious"? What makes it spread more? Does it travel further in the air when sneezed? Does it make people more likely to cough? What's the mechanism?
Most promising predictions. But it depends, what happens in the future, of course. For example, there is no such certainty with vaccine and vaccination in general in Nordic after the situation which happened with 80 old people who vaccinated in Norway. Because of this, Sweden still disputing regarding vaccines. By the way, a strange trend happening because of this uncertainty. Swedish companies started renting additional warehouse space, such as https://www.matchoffice.se/hyra/industri-lager/malmo, in order to fill it up with products. Waiting for a more strict lockdown, I guess.
If it's a seasonal coronavirus like the flu or the common cold then you'll see another surge in late March / April because that's how seasonal coronaviruses behave. The waves we've seen so far also mimic the behavior of seasonal coronaviruses.
I thought y'all might be amused to know that Byrne Hobart (whose Substack is "The Diff") has written at least a short version of the article that Cade Metz originally claimed to be writing for the NYT. "Why Did One Internet Subculture Spot Covid-19 So Early?": https://diff.substack.com/p/why-did-one-internet-subculture-spot.
My favorite snippet: "[Rationalists are] a sort of distributed, mostly open-source monastic order, spending a lot of time contemplating the world and passing down important observations, but less time directly interacting with it."
My prediction: 80% chance that on an average day in mid-2022, inside of an average business (grocery store, hair salon, bookstore, etc.) in the SF Bay Area, more than 20% of people will be wearing face masks. (This of course assumes that the relevant business is open.)
This might or might not conflict with Scott's second-to-last prediction. I would be interested to hear what probability he would give to my statement.
The issue of people believing conspiracy theories is one thing, but the NYT's solution is 'don't try to think for yourself! just trust us! And Wikipedia!'
People forget that the “waves” get bigger because more TESTING became available. Not because there were actually more cases, and not all the tests gave accurate results. This is blown way too far out of proportion.
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.
Hi - new member here, still learning the ropes. 1) the efficacy rate for flu vaccine is between 30% and 50%, which doesn't matter a great deal as the disease for many sufferers is not severe. It would suck if the rate for Covid vaccine stabilises around this number. 2) There was something last week (sorry, I wasn't tracking sources last week) about the vector used to propagate the Astra Zeneca vaccine. It is a chimpanzee vector. The story was, the human body when vaccinated learns how to prompt Covid19 anti-bodies the "chimp way" and that learning sticks - and when a new human-derived mutation arrives, the human body doesn't respond effectively.
Hard to know what you're referring to for sure without the source, but it sounds like you're talking about a common problem with adenovirus vaccines (like the AZ one) if you need to rely on multiple vaccines. Basically the adenovirus is like a 'package' that pass in whatever code you want to become immune to, in this case some covid identifier proteins. The problem is that your immune system also learns to tear up the adenovirus itself, basically ripping up the package before it has a chance to deliver the important bit. So if you've already gotten an adenovirus vaccine, you might not be able to get another one that uses the same base virus.Thats why the AZ vaccine is using a chimp adenovirus, because humans haven't been exposed to it before, but we don't really know for sure if you'll be able to make a small tweak for new variant and have it work the same way. It might be a one time use option (but we really don't know). Here's a link with everything you could want to know in much better detail https://blogs.sciencemag.org/pipeline/archives/2021/02/08/how-you-make-an-adenovirus-vaccine
Thanks Endmash - diligent searching failed to locate the source - my bad entirely. Although I did come across this tidbit from a news report https://www.sunstar.com.ph/article/1883079/Davao/Local-News/AllYouNeedToKnow-AstraZenecas-Covid-19-vaccine : "Based on the interim analysis by Oxford University, which has been peer-reviewed and published in The Lancet on December 8, 2020, Covid-19 Vaccine AstraZeneca "has an acceptable safety profile and has been found to be efficacious against symptomatic Covid-19 in this interim analysis of ongoing clinical trials." Trials were conducted in Brazil, South Africa and the UK." The takeaway is that the AZ trials were conducted in the 3 countries that now have the identified Covid19 variants.
The better news is that COVID-19 prompted the real and serious development and rollout of the mRNA vaccine platform and proved the safety and efficacy of a vaccine developed in literally 48 hours. That gives us an incredible technological platform to be able to use an mRNA influenza vaccine and potentially slash mortality and morbidity because we won't have to "guess" what the dominant strains will be months in advance, we'll be able to literally roll the active strains in…live. As it's happening. This is a huge deal for influenza and it will be a huge deal for other pathogens as well.
I'm not sure the flu vaccine does *anything*. If you graph the year-by-year deaths from the flu, and then try to guess which years they messed up production (wrong strains, production failures), you couldn't pick them out.
I still got my flu shot because it probably doesn't hurt, and we really do not want the flu and covid doing any gene transfer this winter.
Perhaps a prepper-like splinter culture of "CoViD recluses" will develop: people who either move to remote rural locations, or to "filtered communities" with elaborate protection including domes, UV lamps, air filtration, and so on.
Ethnic minorities will be stereotyped as infectious ... wait, that happened before.
It looks like we will have between 125 million and 150 million vaccinated after Biden's first 100 days. Beyond that somewhere between 60 and 100 million already have the antibodies. At the low end 185 million are resistant. At the high end, 250 million. So, there are fewer and fewer people who can spread a March bump.
"It looks like we will have between 125 million and 150 million vaccinated after Biden's first 100 days. Beyond that somewhere between 60 and 100 million already have the antibodies."
Unfortunately, there may be a fair amount of overlap between those two groups.
Where are you getting that from? Metaculus says 150 million vaccinated by July 1.
I'm not sure what Metaculus is pricing in a la vaccine skepticism, but we're doing 1.7 million doses a day right now with ~55 million people already vaccinated, so ~300 million doses around ~July 10th. And I think it's a safe bet that the # of vaccines per day will continue to trend up.
55 million doses already given* not people vaccinated
Even one dose of Pfizer, Moderna can provide significant protection from COVID-19. It's been shown that single dose can prevent hospitalization if people are infected after that 1st dose.
Also some percentage of people infected don't develop full immunity. They're susceptible to a second infection, but so far it looks like second infections are less severe, too.
Does anyone around here (or maybe on Metaculus) have predictions for whether or not there will ever be challenge trials (in the US or elsewhere)? Besides the obvious effect challenge trials should have on all other related predictions, this also potentially impacts my personal decision of whether or not to get a vaccine when it becomes available to me (as I would like to volunteer for a challenge trial).
What would challenge trials be used for? At this point, any testing for future additions to these vaccines will just be for safety, not efficacy.
I'm confused: wouldn't vaccines need to be proved effective against new strains? Or is that part of what fast-tracking means?
We need to prove the first vaccine effective in order to start using it, because we wouldn't want to tell millions of people they are vaccinated if they aren't. But if all we've done is add another strand of protection, then the efficacy test can just be vaccination of the general population - if the new batches start arriving in late March, then everyone vaccinated after that has a possible additional protection, and hopefully a few months later we would have data showing that they do.
The entire point of a challenge trial is to reduce that "a few months later" to a matter of weeks instead.
Also, you're assuming the new vaccines are just the old vaccines + a little bit extra, whereas I was assuming they were their own thing (albeit based on similar technology, so some of the steps could be skipped). I think both options are possible but still personally place a higher probability on my assumption. (I acknowledge that I'm not being very precise here; I haven't been following this whole thing very closely.)
The way the mRNA vaccines work is that they just sequence the RNA of the virus, figure out which part codes for the spike, and then they synthesize that same RNA in their factory and get it into the lipids and then the vials and then people's arms. They're really fast to design and get out there. We wouldn't need to wait until the new bit is proven effective, if it's been proven safe, since it would just go in along with an existing injection that has already been proven effective at what it's doing.
I would imagine you could recruit young military volunteers for human challenge tests of variant vaccines.
A problem with new clinical trials for vaccines is that the really require a major wave to get over and done with in a reasonable number of months. If there is no 4th or 5th wave for six months, we could be twiddling our thumbs for six months waiting for a large enough sample size.
This is especially true with highly efficacious vaccines like mRNA. One reason the Pfizer/Moderna dragged on a long time was because the vaccines were so effective that there were few cases in the vaccine arms, so they had to wait longer to get their agreed-upon sample size almost completely out of the placebo arm. (Of course, another reason was that Pfizer stopped processing samples in late October until the day after the election, blowing past its 32 and 62 checkpoints, in order to not announce results before the election.)
"(Of course, another reason was that Pfizer stopped processing samples in late October until the day after the election, blowing past its 32 and 62 checkpoints, in order to not announce results before the election.)"
Do you have a source for this? Why would Pfizer risk winning the vaccine race (and billions in profits) by waiting until after the election?
I got it from Matthew Herper's interview with Pfizer executive William Gruber in StatNews on November 9, 2020
https://www.statnews.com/2020/11/09/covid-19-vaccine-from-pfizer-and-biontech-is-strongly-effective-early-data-from-large-trial-indicate/comment-page-7/#comment-3047884
“Gruber said that Pfizer and BioNTech had decided in late October that they wanted to drop the 32-case interim analysis. At that time, the companies decided to stop having their lab confirm cases of Covid-19 in the study, instead leaving samples in storage. The FDA was aware of this decision. Discussions between the agency and the companies concluded, and testing began this past Wednesday. When the samples were tested, there were 94 cases of Covid in the trial. The DSMB met on Sunday.
“This means that the statistical strength of the result is likely far stronger than was initially expected. It also means that if Pfizer had held to the original plan, the data would likely have been available in October, as its CEO, Albert Bourla, had initially predicted.”
So, if Pfizer had stuck to its publicly announced plan for when to unblind its results, with a first unblinding after 32 cases and then another after 62 cases, they would likely have announced the vaccine’s success before the election (probably on Monday, November 2nd, one week before the actual public announcement), and Trump might have won. But, instead, they stopped processing samples until the day after the election, by which point they had almost triple the number of cases needed to make a determination.
That's one of the more remarkable news stories of 2020, but virtually nobody has heard it.
"Why would Pfizer risk winning the vaccine race (and billions in profits) by waiting until after the election?"
Probably because Pfizer feared being seen as helping Trump. Recall this gloating article in the New York Times on November 1:
"Welcome to November. For Trump, the October Surprise Never Came.
"Trump’s hope that an economic recovery, a Covid vaccine or a Biden scandal could shake up the race faded with the last light of October."
https://www.nytimes.com/2020/11/01/us/politics/trump-october.html
I sure can't say that Pfizer made the wrong business decision. After all, only about 0.001% of the populace even know that Pfizer shut down their lab's processing of clinical trial results until after the election. They stopped the count. But hardly anybody knows that. It's not like it's easy to learn how clinical trials work and see what Pfizer did.
I laid out the evidence here:
https://www.takimag.com/article/the-new-normal-by-any-means-necessary/
Science Magazine did a detailed fact check of this claim and found it to be completely without evidence.
Company representatives explained that the decision was made to drop the 32-case unblinding because it had to meet a higher efficacy threshold than the 62-case unblinding, and because given the rate of spread at the time they expected it would be days - not weeks or months, as they'd thought when they designed the protocols - between hitting 32 cases and hitting 62.
So the decision was: delay by about a week, and in return get a much higher chance of being approved.
https://www.sciencemag.org/news/2020/11/fact-check-no-evidence-supports-trump-s-claim-covid-19-vaccine-result-was-suppressed
"Ugur Sahin, scientist, CEO, and co-founder of BioNTech, says the initial plan to look at 32 cases stemmed from a conservative assumption about the rate of spread of COVID-19 and the sense of urgency about the need for a vaccine. If the vaccine looked terrific at 32 cases and it was going to take months to get to 62 cases, then waiting seemed like a mistake, he says. “To me, every day counts.” And he had little patience for the debates over when to look at the data. “These protocol discussions are endless, and I’m often leaving the room,” Sahin says.
In mid-October, the companies had yet to confirm 32 cases. But with the epidemic exploding at many of the trial’s locations—which were mainly in the United States—they had second thoughts about FDA’s request that their first interim analysis should have more to support an EUA request. FDA “had strongly recommended to us that we change that, and the pandemic just was spiraling out of control in the United States and elsewhere, and we realized that we probably could get cases much faster than what we had anticipated,” Jansen says.
The math was simple: COVID-19 cases among participants were jumping from one or two per day to up to 10 or more. It became clear that the trial would accrue 62 cases shortly after hitting the 32 mark, and the higher number meant greater statistical power—and fewer debates about the meaning of the data. This 62 cutoff both lowered the efficacy bar the vaccine had to clear, and was also something of an insurance policy: If the vaccine triggered mediocre immune responses and it teetered around 50% efficacy in the trial, it could more easily have been deemed futile at 32 cases because of bad luck."
i'm very curious what people here think about repurposing of already-approved pharmaceuticals for early treatment and pre-/post-exposure prophylaxis. To start the discussion off, i know there's some data for TMPRSS inhibitors: ambroxol/bromhexine and also pretty much like, every antiandrogen since AR affects TMPRSS2 expression. TMPRSS inhibition has direct antiviral activity. Also people have been looking at drugs with immunomodulatory effects such as fluvoxamine and ivermectin. The immunomodulatory part is important because AFAICT the actual damage caused by the disease seems mostly to come from severe immune system dysregulation and its consequences (immunothrombosis, hyperinflammation) so tweaking the immune system's operation so it doesn't fall down that path is very much desired. Doubly so if the immunomodulatory drug in question doesn't affect viral clearance. There's some trials for ivermectin showing faster viral clearance and quicker cessation of anosmia and also an RCT for fluvoxamine with really quite good results. There's also a certain endosomal entry inhibitor that became a culture-war subject but honestly my understanding is that without blocking the TMPRSSes or at least TMPRSS2, blocking endosomal entry is pretty much worthless.
It seems to me that fear is causing us to massively over correct to try to prevent unlikely and unrealistic failure cases. For example:
People are afraid that unsafe vaccines will get approved because the procedure is getting rushed. Instead of trying to maintain the most critical parts of the testing process, and skip the rest, we are scheduling one month of thumb twiddling between when we get the data and when we meet to discuss it.
People are afraid of line cutting so we are prosecuting doctors who distribute vaccine doses out of order instead of letting them get thrown out.
People are afraid of price gouging, so we all decided not to do it, which removed the incentives to scale out production as quickly as possible.
Zvi has been saying this stuff for months now: https://thezvi.wordpress.com/
> we are scheduling one month of thumb twiddling between when we get the data and when we meet to discuss it.
It's not "thumb twiddling", though, as per one of the links in the post: https://www.biospace.com/article/why-is-the-fda-taking-so-long-to-review-a-covid-19-vaccine-/
"""
According to the FDA, “This amount of time will allow the FDA to thoroughly evaluate the data and information submitted in the EUA request before the meeting and to be prepared for a robust public discussion with the advisory committee members.”
"""
What do you expect them to say? That the month is full of thumb-twiddling? Numerous commenters have states the data could be analyzed in a few days at most. The CDC was taking holidays through that period.
The only criticism I read was an article by an academic with no firsthand experience with the FDA's processes saying he could do it in a couple days. Are there more credible sources?
I'm not happy about them taking holidays if that's true. My prior, though, is there's some probability they would have done work off-the-clock, given the incredible importance of expedience here.
Based on my own experience with 'process', the fact that the FDA/CDC/whomever scheduled meetings more than _one_ day in the future is extremely strong evidence of them "thumb-twiddling". What else can they be doing? Literally – what else is more important than them having those meetings ASAP, e.g. flying everyone in on a jet immediately from wherever they are? In fact, why shouldn't those officials be under guard at their offices (or wherever they can most effectively make the relevant decisions as quickly as possibly)?
You could only do the meeting on 1 day notice if there's almost no preparation required, and my prior on that is very tiny. I'm assuming this is the type of meeting where a bunch of department heads get together and say "hey I checked this stuff and the only problems we found are insignificant". I would guess there are hundreds of pages of reports to be filed and a book-sized checklist that people need to go through. The amount of CYA involved in regulatory processes is quite extraordinary and I wouldn't find it surprising if there's multiple weeks of full-time work to do before the meeting.
> The amount of CYA involved in regulatory processes is quite extraordinary and I wouldn't find it surprising if there's multiple weeks of full-time work to do before the meeting.
That reads exactly like "thumb twiddling".
Not being able to ignore the existing "book-sized checklist" – and adjust, as seems warranted, to an emergency of this scale, seems pretty difficult to justify.
I can think of several changes that they could have made to their process, just off the top of my head:
1. Defer 'filing' the reports! Surely that can be delayed while the important work of determining the safety and efficacy of the vaccines is prioritized.
2. Embed FDA/CDC employees in the labs/teams evaluating/testing the vaccines and have them analyze the data as fast as they can, without requiring that anyone 'file an official report'. In machine learning, some models/algorithms work 'online', i.e. as new data comes in. Surely _some_ evaluation of the, e.g. trial data, can be performed near the start of the whole 'project' and updated periodically (or even in something close or closer to 'real time').
3. Do away with 'official meetings' and, like in [2], do as much work as possible ASAP and update the overall evaluation as new evidence is received, i.e. 'learn online'. The final approval should involve a minimal amount of extra work – not "multiple weeks of full-time work".
Practically – 'pragmatically' – you're right that, given the prior status quo, it's not true that, for those meetings, given their role in the current 'process', there's "almost no preparation required". I'm not mad or angry at any individual employee at the FDA (or CDC or whatever), or even any specific bureaucrat higher-up in the hierarchy. Almost all of their incentives align with 'following process'. I'm just frustrated that even a disaster of this scale wasn't enough to push them to _even more_ radically streamline the whole ordeal.
Pretty surprised at the confidence of B117 resulting in a 4th wave so soon. That seems to under emphasize seasonality/immunity and over emphasize behavior to my mind. >10% of the us is currently had at least one shot and a partially overlapping ~10-20% (depending on how much under testing you think there has been) have been infected and gained some level of immunity. If you ballpark guess that in march something like 20% have some degree of protection does that not compensate for the variant being more infectious, or are my estimates way out of line?
Zvi wrote some more details on the model for this here https://thezvi.wordpress.com/2021/01/06/fourth-wave-covid-toy-modeling/
He's since walked some of his pessimism about a fourth wave back though, amid news that B117 might actually be less than 50% infectious: https://thezvi.wordpress.com/2021/02/11/covid-2-11-as-expected/
At this point, Scott is more pessimistic than Zvi, which seems surprising.
The idea that the new variant is more infectious came from the same epidemiologists that have a consistent track record of total failure on pretty much everything (at ICL), not to mention publishing practically fraudulent papers (see Flaxman et al). As with everything else they "know" about COVID it was simply based on looking at case curves and making assumptions.
Additionally the data the ONS released to support this claim actually showed the supposedly super-infectious new variant declining before mid November. The explanation for this was literally, "before mid November this PCR signal we're using meant something different so don't look there" with no explanation of how it was different or what changed. The graphs presented to the public were then truncated to try and hide what had been done.
tl;dr - don't believe anything epidemiologists say about anything. The field is just terrible. Worse than social psychology.
Me too. Cases are dropping in the US at -3% per day for seemingly no reason (I don't buy that this is a seasonal shift yet), implying to me that the population has some partial herd immunity (14% had antibodies last November, it's surely much higher now - even 30% would take a big chunk out of R_eff).
I would expect that there is at least partial immunity to variants, such that population immunity levels, existing restrictions, and favourable seasonality in the coming months will result in the B117 epidemic not blowing up.
Evidence that would convince me otherwise would be a measurement of the current exponential growth rate of the B117 variant in the US. If it's positive (compared to to the regular variant having negative growth), that's evidence that the status quo is not enough to prevent it growing.
But the US is currently averaging R_eff = 0.85 or so. a 30% bump on that due to a variant and cases will be growing at +2% per day. But there'll be more people vaccinated and better seasonal conditions by then so...
80% prediction of no blowup due to B117.
Check Yougang Gu's COVID projections. ~30% have been infected in the U.S. and over 10% have had their first vaccine dose (with substantial overlap), so we are close to 40% with considerable immunity already. There were also studies suggesting 10-15% had substantial resistance due to previous infection with other coronaviruses
We are approaching spring with a virus that is estimated to be 30-70% more infectious than "original" Covid19. There is some level of immunity, but vaccines still haven't got to the people that contribute to spreading the virus more (i.e. young people).
Further, even if this theoretical argument doesn't convince you, if you separate the components as if old Covid and B117 were two different diseases, you see that while the former is declining as expected, the latter is rising exponentially everywhere (Denmark, Italy, France, Germany).
I think that the "fourth wave" is a given. The only thing that might change in this one is that the vaccines will have a strong effect on deaths, since most old people will have had at least one shot of Pfizer/Moderna by the time the wave peaks. This could be, however, counterbalanced by the fact that there might be less restrictions, leading to more people getting in contact with the virus, leading to roughly the same amount of deaths.... especially since many states use hospital occupancies as metric to ease/harden restrictions. Of course this is dumb and we should strongly push for restrictions to stay in place even with less hospitalizations/deaths, but one year of pushing for this has produced absolutely nothing so it's a fool's hope that this time they will listen.
I'm sure there will be a '4th wave' of some kind, but the timing and intensity is what I'm doubtful of. Estimating exponentials is really hard, especially when there are multiple competing drivers (vaccines, behavior, prior exposure, r0) which are also hard to estimate. But it takes time even for exponentials to grow, and there is a huge difference between 30% and 70% more infectious. I think your confidence interval should at least include 'small rise in cases that is brought under control because of increasing vaccination'
There's really no chance that people are going to tolerate more restrictions if there are fewer deaths/hospitalizations. But that is fine? We can pay a high economic/social premium to avoid deaths, but not obviously worth it to pay that to avoid cases. The issue is if you get this runaway exponential growth and hospitalization data are lagging by two weeks, then you can still end up with steeply rising hospitalizations of course and be too late to avert a crisis. However for this to happen you would really need some extreme exponential growth in cases coupled with everyone just ignoring this for weeks, which still seems unlikely to me.
Well, that's only if letting cases spread freely doesn't lead to new strains which put us back on square two (meaning we have vaccines but we need to jab everyone and lockdown again while we do that).
Also, if the virus spreads freely some young (<50) people still die (not enough to overwhelm hospitals, but the number is in the thousands/tens of thousands).
> Further, even if this theoretical argument doesn't convince you, if you separate the components as if old Covid and B117 were two different diseases, you see that while the former is declining as expected, the latter is rising exponentially everywhere (Denmark, Italy, France, Germany).
This is greatly misleading. B117 is rising exponentially *in comparison to vanilla covid*, not in absolute numbers (which are stagnant in France and Italy, have kept falling sharply since late December in Denmark, are slowly but surely falling in Germany).
Huh, no, it's not, it's rising also in absolute numbers! Cases due to B117 are rising exponentially.
Do you have the numbers? I was hasty to declare it couldn't grow exponentially when the overall sum was flat or falling, but it might be indeed possible if the other strain has been going done faster than expected and the starting point was low. I'm still not exactly convinced by the data I can easily find (e.g. https://en.wikipedia.org/wiki/Variant_of_Concern_202012/01#Development_of_the_B.1.1.7_lineage ); the Denmark numbers show a large relative growth but the overall sum is declining sharply, whereas the other countries haven't been measuring much to begin with).
> the other countries haven't been measuring much to begin with.
They did study it in Germany (I only have access to this output sadly, not to the raw data), and this projection was the result: https://pbs.twimg.com/media/Etx5CLyXYAACw3h?format=jpg&name=medium
And at the beginning of December in London it was exponential under restrictions that would (and had!) normally neutralised OGCovid's exponential growth bursts.
As everything with this pandemic, I admit it's not 100% confirmed yet, but the few data points we have now agree with this theoretical argument: a virus with 50% more transmissibility which has shown it can bypass "Tier 3" restrictions in the UK (that's, in a way, how it was discovered) should rightfully have R>1 in every country whose measures are currently "Tier 3"-like (Italy, Germany, France,...).
The good news is that actual lockdown works (see London cases graph, and also cases everywhere else in the UK that never lifted off exponentially due to early introduction of the lockdown when B117 was still low)
The projection you are linking (Der Spiegel?) isn't convincing -- you can extrapolate small numbers to anything. The Danish data ( https://files.ssi.dk/covid19/virusvarianter/status/status-virusvarianter-16022021-ccxh ) is more worrying, but the highest increases in the # of confirmed B.1.1.7 cases has been concomitant with the highest drops in total COVID incidence. Multiplying new variant percentages by total incidence results in a 2.3x increase over 5 weeks, almost all of it however supported by 1 week. My takeaway for now is "we need better numbers".
> the Denmark numbers show a large relative growth but the overall sum is declining sharply
No. You can see the data here (goes up to 10th of february)
https://www.covid19genomics.dk/statistics
Second graph
Number of B1.1.7 cases rising (Colored red) while overall cases dropping
The second-to-last prediction would be more interesting to me if it gave a probability for people wearing masks indoors (say, a grocery store). Outdoors, people are much more cavalier about masks already, and are already drifting down towards mostly-not-wearing (plus generous distancing) in my Silicon Valley neighborhood. Indoors, they're still at nearly 100%. And this fits with what I've heard about transmission-- that indoors is by far the greater risk.
90% confidence in "not much outdoor masking" seems to imply a 10% probability that our mid-2022 masking norms aren't just paranoid and security-theater-y, but actively irrational. One would hope there's a somewhat higher risk that we'd still be wearing masks in grocery stores.
Would it be bad if lots of people kept wearing masks indoors, even if feeling okay? And not out of any requirement of the store.
So some people don't wear them, some people do, and the former doesn't give any shit to the latter.
I think this is too pessimistic. The math on vaccination and herd immunity suggests that once you get to over 50% immune... The r value drops and keeps dropping in an additive manner.
Doesn’t account for a immune escaping variants.
Immune escaping variants are a very definite risk that we should all worry about and strongly try to mitigate, but right now they are not a concern (meaning that the best vaccines are still very effective against all dominant strains) so I wouldn't account for these when thinking about a short-term scenario.
I think this is fairly plausible, and here’s a question not discussed there: Where in this multi-year to permanent cycle do schools again educate all of the kids they were, in the buildings they were, where having 25-35 in a classroom, very often closer than 6 feet apart, was the norm?
The UK is aiming for 'in a few weeks'. Not sure about universities.
"all the kids they were" - probably never. At least some families have found that online school programs, unschooling, or homeschooling suits them better than whatever schools they were in before. I've heard from homeschooling friends that their communities have been growing. Early polling seems to suggest that almost half of parents are at least considering moving to homeschooling or some other non-traditional option even after lockdowns. Even if only a tenth of those go through with it, that would more than double the number of homeschooled kids in the US (which, before the pandemic, was 3-4%).
https://www.federationforchildren.org/national-poll-40-of-families-more-likely-to-homeschool-after-lockdowns-end/
I'm a teacher, in a potentially high-risk group, and I'd be willing to jump back to normal as soon as I can get a vaccine and a two-week period for it to kick in. I'm not even picky - I'd take Sputnik or Sinovac. As a parent, though, it's tricky - I'd want to see good community spread metrics and maybe even vaccines for kids once we get the data in on those, and if my son's school stopped offering online schooling right now and told me to send him back I'd have a *very* tough decision and possibly move him to some kind of homeschooling program. Perhaps it's weird to be a teacher and be so on-the-fence about the benefits of traditional education... or perhaps not. Anyway I think a lot of people will be rethinking schools after this.
One big question is when high risk activities, such as major concerts, sporting events, and conventions happen at 100% capacity. Whole industries, businesses, and urban developments are built around these kind of events happening on a regular basis, and they can't be put on pause forever. At some point things need to resume or people need to figure out what to do with all those useless arenas, stadiums, and hotels.
But I also wouldn't be surprised if future stadiums and arenas are designed with better ventilation, so that a few decades from now, the 20th century ones all feel cramped and unhealthy to people.
People tend not to notice ventilation. I doubt most people could tell the difference between a room with 2 ACH and 6 ACH just by observing it or being in it for a while (assuming nothing obvious like an open window or a breeze).
ACH = air changes per hour
I'd wager it depends on what the person making the air changes had for lunch.
I've read that they're saying the vaccine might not stop the spread: vaccinated individuals could become asymptomatic carriers. To what extent is this a real possibility, versus an abundance of caution?
Like, I understand they haven't run specific trials on that for these specific vaccines, but for all the vaccines we've had in the past, how effective have they been in preventing transmission?
It sounds like asymptomatic people are something like 40% less transmissive than symptomatic people. Since the vaccines turn at least 95% of cases into asymptomatic cases, it seems like they should cut transmission by a significant amount. And if a good number of those aren't just asymptomatic, but actually eliminated, then that's significantly more.
https://www.nature.com/articles/d41586-020-03141-3
The "but we just don't KNOW if the vaccines provide sterilizing immunity" talking point constantly spouted by experts and repeated by the media needs to move beyond a black or white scenario.
It is guaranteed (I would bet on this with 1000 to 1 odds) that being vaccinated provides some sterilizing immunity. If being vaccinated reduces symptoms, and we know that asymptomatic spread is much less prevalent than symptomatic spread (https://www.nature.com/articles/d41586-020-03141-3), this would be logical.
It is all but guaranteed (I would bet on this with 10 to 1 odds) that being vaccinated provides a majority of sterilizing immunity — though it was a small sample size, Moderna's data indicated a 66% reduction in nasal viral load only 21 days after just one dose, and we would expect this to grow in strength with more time and after a second dose (https://imgur.com/tdom2E7).
If I were vaccinated today, in 10 days I would reduce my overall caution by half, and in a month I would reduce it by 80%.
Further discussion: https://old.reddit.com/r/medicine/comments/l6bq5a/is_it_really_likely_that_the_covid_vaccine_doesnt/
By the way, is there an alternative to the term "sterilizing immunity"?
My impression is that a lot of people who are leery of vaccines get freaked out when they encounter the term, thinking it is talking about vaccines sterilizing human reproductive systems.
Has anybody yet seen an authoritative estimate for Quality-Adjusted-Life-Years Lost due to covid? We have them for most other diseases.
How much worse is it for places to want everyone to wear masks than for places to want men to wear underwear and pants nowadays, or for places to want everyone to wear hats or ties at some other points in time? It'll at least be a weird fashion restriction that serves some function in lowering the overall burden of respiratory diseases.
Carjacking came roaring back in 2020, probably partly due to society telling people to mask up like bandits in old Western movies.
Citation?
Why carjackings have skyrocketed in parts of the country during the pandemic
Carjackings have shot up 537% in Minneapolis this year.
By Andy Fies
December 12, 2020, 9:40 AM
https://abcnews.go.com/US/carjackings-skyrocketed-parts-country-pandemic/story?id=74674597&cid=social_twitter_abcn
... The assault on Williams, captured on surveillance video recently released by the Chicago police in an effort to identify and catch his killers, focused attention on a dramatic spike in carjackings there. In all of 2019, there were 501 incidents of that crime. So far that number has more than doubled to 1,125 this year, according to the latest Chicago police statistics.
But Chicago is neither the only nor the worst example of this disturbing crime trend. Minneapolis police report that carjackings there have shot up 537% this year. Carjacking calls to 911 in New Orleans are up 126%. Oakland police cite an increase of 38%. And while many police departments do not keep carjacking-specific numbers, instead classifying them as auto theft or armed robbery, crime experts like Chris Herrmann, a professor at John Jay College of Criminal Justice, say anecdotal reports of a carjacking surge are coming in from metropolitan areas around the country including Milwaukee, Louisville, Nashville and Kansas City.
And he explains that the pandemic, which has normalized mask-wearing, makes these thefts easier.
"If we weren't in a pandemic and you saw a guy coming up to your car with a mask on, you probably would freak out and hit the gas pedal," he explained. "But nowadays, everyone's wearing masks. So there's this anonymity part of the pandemic that I think a lot of criminals are taking advantage of."
Mask-wearing anonymity may be only one way criminals are taking advantage of the pandemic as carjackings, along with other violent crimes, have risen sharply. According to a recent analysis by the Police Executive Forum (PERF): "Preliminary data from 223 police agencies across the United States reveal steep increases this year in homicides and aggravated assaults."
While masks probably contribute to general lawlessness, I think that a bigger factor worth considering is the change in policing tactics in response to the summer protests.
https://reason.com/volokh/2021/02/01/explaining-the-great-2020-homicide-spike/
This article makes this case and backs it up with data. I'm not quite sure how to feel about unconstitutional/hostile policing being effective at suppressing violent crime.
Thanks, good article.
Same thing happened after 2014, when murders in the US went up 22.9% in two years. When the authorities and media decide that every cop is a criminal and all the sinners saints, the police retreat to the donut shop.
But, in an era of video cameras, the aid to lawbreakers provided by not only allowing but encouraging masks can't be negligible. Decades ago, many states passed anti-mask laws to fight the KKK. They seem to work.
Minneapolis resident here. Been in favor of defunding the police for 20 years as a loony libertarian. This is 100% a big deal and has soured most normies on any kind of police reform.
Streets became unsafe for pedestrians within hours of the burning started, because people started driving 60 miles an hour in residential neighborhoods (personal observation and discussion with other parents w/ kids in the age range that can run out into the street). Shootings are way, way, way up (check the www.bringmethenews.com search box). Unreported crime is way, way, way up based on my direct observations and conversations with a friend of mine that owns a private security firm.
Masks are definitely more inconvenient than hats or pants for any situation where people want to eat or drink. I suspect they also add friction to face-to-face socialization due to it being harder to read expressions.
From personal experience: Masks are a substantial hindrance in education, as it's much harder for teachers to convey nuance and also harder for them to "read the room". Granted, the lip-reading deaf teacher down the hall has it much worse than I do...
Also much worse for folks who wear glasses or have hearing problem. Plus they block off a lot of communication that happens through facial expressions which is a big hinderance in social situations.
I volunteer with kids with autism. Opaque masks are a very significant problem for them.
It makes life a lot harder for glasses wearers. A properly secured medical mask of course won’t cause fogging, but a cotton mask (or even a KN95 mask, applied as best I could) results in my glasses fogging up to the point that I can’t see out of them. It’s fine with contacts though, which is my solution, but I don’t think that all glasses wearers will switch to contacts.
Right. A reasonably effective mask like a KN95 fogs up glasses.
washing your glasses with a wet cloth and drop of dish liquid will stop that from happening for the better part of a day
Unfortunately, dish soaps can mess with the glasses, especially if you have anti-glare coating. Can't say for sure whether you're safe with regular, bottom-shelf, no-magical-additives no-name dish soap, or if it's more endemic to the anti-glare coating itself.
I switched to a half-face respirator on the ambulance for exactly this reason. I can walk around a grocery store with lightly-fogged glasses. Driving or caring for another person requires more.
I wear a mask brace on top of my KN95, and it greatly reduces fogging. They're a structure of several stretchy loops, 2 that lay near the edges of the mask and 2 that goes around your head to hold it in place. They pull the mask edges tight against your face. Got mine from fixthemask.com, best 15 bux I've spent in a while.
Is the San Francisco / mask one supposed to be "greater" instead of "fewer"?
"Sorry, things may get worse before they get better."
Depends on how you define "things". I believe the only metrics we should really be looking at are hospitalizations and deaths (yes, Long COVID is a problem, but a lesser one).
34% of America's 65+ population has already been vaccinated. This number is rising quickly (I'm tracking it on a vaccination spreadsheet here and will start tracking longitudinal data as of tomorrow's update: https://docs.google.com/spreadsheets/d/1Kti2ccedNp05K_jlda-jozj55WUIv5VmNMjTDnnS6R4/edit#gid=0).
Cases will quickly start to decouple from deaths and hospitalizations. So a spike in cases is not as big of a deal, and really shouldn't result in many additional restrictions, at least not ones similar to the winter spike.
We are soon entering a period where not getting infected will become a matter of personal preference, rather than an altruistic endeavor to avoid killing someone or causing them serious illness.
This may be true, but it’s a hypothesis not a fact. Beware cargo cult science thinking.
What is the "this" you're referring to?
There is enough evidence and definitely enough theoretical arguments to say that allowing the virus to spread "freely" due to older people being vaccinated can lead to mutations able to escape vaccine immunity.
Even more worrisome is the fact that in a vaccinated population there might be strong evolutional pressure for the virus to evolve in this way.
Now, this might be true, or it might not be true, it is too early to say. But we know enough to say that this is definitely part of the Reasonable Worst Case scenario, which is the one we should be planning policies for.
I'd predict that the cultural effects will be influenced by economics, culture-war factors, or a desire for signaling. Profitable gatherings will continue to be encouraged by advertising; more spontaneous or altruistic ones will stay online. Public group activities will be tilted towards the political factions that are now more likely to engage in them. I'd give a 70% chance that at least one NFL stadium reaches 90% capacity during the 2021 season, a 90% chance that food service workers in Democrat-governed cities will remain obligated to wear masks through the end of 2021 (and beyond), and a 75% percent chance that mass transit ridership stays below 2019 levels for a decade (unfortunately for the climate).
What I have wondered about for a while, is whether a system would arise (or be proposed) for allowing people entry to mass gatherings *only if they provide proof of vaccination*. The Super Bowl this year was eager to announce that it had allowed a few thousand vaccinated health care workers to attend in person. It hasn't come up yet because vaccination rates are still low, but once they are generally available and rates get around 50%, there will be eagerness to push those rates higher, impatience to drop restrictions, and concern about the portion of the population that refuses and the resulting persistence of the virus. Someone will get the bright idea to offer incentives, and someone else will get the bright idea to claim it's the Mark of the Beast; it would be challenging to avoid economic or racial disparities in such a system as well.
One of the first times I ate at a restaurant in the fall (outdoors), I began to suspect that face coverings on waitstaff will be here to stay, at least in certain fancy restaurants. At the sort of place where waitstaff wear a uniform, a facemask will just become part of the uniform, and convey the social separation and subservience of the waitstaff to the guests.
Only if we abolish tipping in the United States. Tipping is driven social signalling, and facial expressions are critical to human social signalling. Waitstaff who can e.g. smile and be seen to smile will have an advantage over those who can't.
If everyone in a given restaurant wears the facemask (as management will insist) then it at least won't affect the relative tips of the different waitstaff. (This might be a secondary benefit of masking, eliminating one of the irrelevant factors in waitstaff compensation.)
Maybe. This was the year I upped my tipping from fifteen to twenty, and I give it to pretty much everyone. My old standard was fifteen or so, up to twenty for good service. As long as covid is still in the air and the staff is still masking, I'll probably keep it at that level.
Back in March or April, I counted the "it's an annual disease like the flu" as the awful-tier outcome. I stand by that, but it's looking even more likely now than it was then, and I have less hope that I was wrong in my estimates.
I think there's an interesting question of whether we've managed to turn the flu into something much more manageable though. We will see if any habits we picked up this year help protect us against the next flue season too.
That would be nice!
New reader here. Excellent article, thanks Scott. Very curious about your predictions on the long term impacts on young children. Like your WW2 analogy, will there will be a whole generation of kids who are fearful of any human contact even after things return to normal(ish)? Or will the extreme social distancing learned behavior fade as we become more integrated into the world again?
People in the older generations who saw polio cases sometimes associate water fountains and even swimming pools/water parks with polio and avoid them - I get the impression that was emphasized when they were children. So maybe.
This reads like a very Bay Area view of Covid and response - or a very myopic view of a particular part of the culture.
I've flown at least 12 times since the pandemic started. We've hosted many visitors from out of state, we go to restaurants multiple times a week - they are fairly full - and most of our friends do the same. We gather indoors and out for various occasions. Family is the same.
We're fragmenting into two covid subcultures, as others have noted. But the simple fact is that the data does not justify anyone who is under 70 and healthy changing the way they live now vs. how they lived in 2019 and prior.
I learned recently that for some destinations, vacation travel actually went *up* this year. The fact that aviation as a whole can be down 80-90%, while vacation travel is steady or rising, indicates just how little aviation was driven by vacation, and how it was mostly business travel.
https://www.youtube.com/watch?v=v_rXhuaI0W8
Vacation travel being up for some destinations doesn’t mean it’s up overall right?
Look up Russell’s Chicken.
This is like saying “I bang a bunch of chicks bareback and haven’t gotten AIDS yet. All you people worried about AIDS are crazy.”
I agree that nobody under 70 should change their lifestyle for selfish reasons. I'm not sure about the altruistic effects - if I catch COVID (and pass it on to a few people before realizing it) am I contributing to someone over 70 dying?
That only seems like a concern for people who have routine close contact with elderly/high risk. If my only unmasked contacts are young people, then it’s extremely unlikely that my infecting them would lead to severe illness or death. It’s possible that one of my low risk contacts would then go on to infect a high risk person, but at that point the chain of causation is interrupted and it wouldn’t be my moral responsibility.
It's not, as some people can't help having close contact with high risk people, so the chain of causation is not interrupted if it wasn't their choice. Doctors, nurses, policemen, firefighters, cleaners in care homes, plumbers, electricians, ...
The "hospitals being overwhelmed" thing still matters, even if the disease doesn't progress to the "severe" stage. The total amount of hospital resources available are more-or-less fixed. A small change in the absolute percentage of the population requiring hospitalization will drastically change the relative utilization of hospital resources. We haven't actually exceeded capacity anywhere yet (NYC hit the brink last year), but people in healthcare are still really worried about that possibility.
"I agree that nobody under 70 should change their lifestyle for selfish reasons."
Why? COVID is pretty bad for those well under 70, as well: https://twitter.com/lymanstoneky/status/1352011344497795073/photo/1
Really? This is pretty surprising for me to hear you say. What about the frequency of long-term effects? That alone makes me pretty reluctant, just on a selfish level, to go back out to bars and the like. Why do you think differently?
From what I have read, the rate of long term effects seems no different than other viral infections
Speaking of which, masks and distancing also reduce the rates of other viral infections. I remember apocalyptic warnings about this being a joint covid/flu season, but instead the flu season apparently didn't happen at all. Whatever measures we took to suppress covid absolutely crushed the flu.
I don't know how much the average person's behavior will change as a result, but I have certainly at least considered switching from teaching to an entirely-online job in order to reduce my exposure to *all* pathogens, pollution, and stressful interactions with other people (while still maintaining my social life at pre-pandemic levels). That idea seemed absolutely crazy before I spent a year doing it. It helps that I have friends who are digital nomads and work abroad from home.
I could imagine a trial lockdown could move the needle, at least a little, on how many people choose to work remotely, is what I'm saying, and not just because of the danger of covid exposure.
A) The "not social distancing" subculture definitely contributes to the spread, and significantly. It might not have got into you specifically, but there are countless examples in the literature of gatherings that lead to superinfection events that lead to tens of deaths. So, if you are at all concerned about not contributing to the killing of elderly/fragile people, you should change the way you're living
B) The more the virus spreads, the more it can mutate. We know this now: this virus is capable of evolving fast. So you could be initiating a worse pandemic by not applying social distancing (it happened in the UK, in South Africa, and god knows where else)
C) An uncontrolled spread of the virus (the one you'd have if everyone under 70 acted as you suggest) would lead to overwhelmed hospitals, which would lead to healthcare being substantially broken for months, possibly years. At all ages, people need healthcare: they break bones, they get cut, they get various treatable diseases, they have car accidents, fall down the stairs, their appendix gets inflamed and needs to be removed.
All this to say: the data definitely justifies changing your life. Acting as you are right now is a sort of prisoner's dilemma scenario, in which you are freeloading on other people's sacrifices. This is morally wrong, but I can see how it could be the best personal choice for selfish reason... but it's definitely not the best societal choice, and the data definitely doesn't support any of it.
And let me add a cynical remark: do you really think that our current selfish cynical society would choose to deal such a blow to the economy if the only benefit in doing so was saving lives of people over 70?
More cynicism: do you think we'd see this much obsession over Covid if it wouldn't have made Trump look bad?
Covid is terrible. But the terribleness seems to be askew to how it's presented.
"More cynicism: do you think we'd see this much obsession over Covid if it wouldn't have made Trump look bad?"
In America? Only from Republicans.
I am from the UK. The rest of the world couldn't care less about Trump, and we are just as "obsessed" with Covid19, which is killing hundreds of thousands of people.
Devil's advocate: The UK media is very closely tied to American media via language, and of course the UK have Boris Johnson to make look bad, who is usually lumped in with Trump/Modi/Erdogan.
Has the media/the "covid-obsessed" crowd suddenly reversed course, as a result of Biden's victory or inauguration? The sources I pay attention to (WaPo, The Atlantic, Zvi) seem to have maintained the same general tenor of presentation, but I don't live in America so maybe there's something I'm missing. But that suggests to me that the presentation isn't caused by "TDS" or anything like that.
I’ve also noticed that LessWrong/SSC types tend to overestimate 1) the extent to which California’s super strict restrictions are typical of US as a whole and 2) the extent to which people conform to those restrictions.
Even if you think people in your area all wear masks and avoid socializing, drive an hour or two and the situation will be different. Or get to know people and you’ll see they make exceptions. The Deborah Birx case is an example: no one, to a first approximation, follows all public health advice, even the people who make it.
The post handwaves that R stays at about 1.0 by stating that people and governments adjust their behavior around surges and lulls. But you should be able to check this with mobility data, or opentable.org, or something. As far as I know, we never observed any consistent correlations with this.
Anecdotally, people in my large liberal city have no idea what local or state R is at. How many cases/deaths there are, or what hospital capacity is. And any discussion of COVID going up is accompanied with derision for hypothesized anti-maskers driving spread, and any discussion about it going down is self-congratulatory with comments about how we need to keep doing locking down hard.
In other words, no one wants R to be 1.0. Pro-lockdowners want it to be 0.0 and anti-lockdowners don't care. People and local governments just have no concept of R, or trends, or absolute vs. relative levels, or anything numerate. So I don't see any way they'd be adjusting their behavior to maintain R at 1.0 when they don't even know what local levels are. They also wouldn't care if the trend was flat even if they knew what it was, since a flat trend is no one's goal. COVID levels could be 10x higher or 10x lower in my area and everything would be the same.
"the data does not justify anyone who is under 70 and healthy changing the way they live now vs. how they lived in 2019 and prior."
WRONG. In percentage terms, deaths rose most for the 45-64 age range: https://twitter.com/lymanstoneky/status/1352011344497795073
I would really like to know about the likelihood of long-term effects from mild covid cases in people who have been vaccinated. I am okay with taking the reduced risk of catching mild covid post-vaccination if we're just talking about the ~two weeks of acute symptoms, but if "long covid" is still occurring frequently (I recall seeing estimates of 10-50% in current inoculated cases) then I'm back to dreading the virus, even post-vaccine.
Whoops, the 10-50% figure is supposed to be about *non*-inoculated cases.
One interesting thing I've been seeing discussed is the question of how much this "long covid" syndrome is common for other viruses. It nearly matches the description I remember hearing when I was in college of mononucleosis, and of chronic fatigue syndrome, which has sometimes been described as post-viral fatigue syndrome. Are there some viruses that cause it more, while others don't cause it at all, or can it happen from any virus? Are there other viruses circulating that we don't even notice, because this is their only symptom?
https://en.wikipedia.org/wiki/Chronic_fatigue_syndrome
Read somewhere respectable recently (sorry, can't remember where) that loss or distortion of smell and taste is common in "long covid." Prevalence of this symptom in long covid group seems important. For one thing, pretty much nixes any idea that these folks aren't really a distinct group at all, just a bunch of people suffering from 2 or 3 of the 10 or so most common ways people feel chronically crummy for miscellaneous reasons (fatigue, headaches, low mood, headaches, mental fog . . .). But also the persisting loss of smell and taste suggests that if long covid is a post-viral syndrome, it is a distinctive one.
Definitely possible. But it's also possible that covid damages smell/taste long term as a *separate* symptom from the "post-viral syndrome" that is also caused by covid as well as other viruses. This article was pretty interesting:
https://www.nytimes.com/2021/01/28/magazine/covid-smell-science.html
Great read, thanks.
In the SUPER long-term, does COVID seem like something we could completely eradicate, like we did with smallpox? Or is it more similar to the seasonal flu?
And why? Why is that smallpox never mutated beyond control? Why is COVID more or less prone to mutation?
I reckon it is because smallpox was so deadly and scarring. If the outcome of being infected was death or permanent disfigurement people would be a lot more careful.
Secondary to that, smallpox was with humanity for a much longer period of time, so likely it was much closer to optimal virulence. Thus any new randomly mutated strains were self extinguishing relative to the dominant strain.
There are a lot of differences that made smallpox easier to eradicate.
The big ones (as well as what Fallacious Thoughtcrime said) are that smallpox had neither animal reservoirs nor asymptomatic transmission. Covid has both.
There might be something about the structure of the virus which makes it less likely to mutate.
Short answer: no we won't be able to eradicate COVID.
Long answer: Coronaviruses hop between species. There are large "reservoirs" of the virus in bats, pangolins, and some other species. Mutations will develop in species populations which don’t have immunity. So future crossover of new strains will be possible, and even probable. In this respect, Coronaviruses are similar to the Influenza viruses, which, are harbored by pigs and ducks in southern China—among other species and places—but southern China is where many of the new flu strains originate.
Smallpox (Variola) does mutate, but Variola is a double-stranded DNA virus, and it mutates at a much slower rate than single-stranded DNA and RNA viruses. And, AFAIK, Variola has no animal reservoirs. At some point a new vaccine may be required—if it hasn't been completely wiped out like the WHO says—or it escapes or is released from a lab. The last known natural case was in Somalia in 1977.
The good news is COVID-19 is longest of the single-stranded RNA viruses. And depending on which research you trust, it mutates between 1/10th as fast or 1/2 as fast as influenza viruses do.
"Short answer: no we won't be able to eradicate COVID."
It's all a matter of will. China, the world's first (or second) most populated country eradicated COVID within its territory, as did Vietnam. Eradicating COVID is straightforward, but most countries don't have the will to do it. Perhaps China could institute economic sanctions against countries that threaten its economy with COVID imports.
No, China hasn't eradicated COVID-19. They're playing whack-a-mole with continual new outbreaks in cities all over China. The Chinese have been very efficient at whacking the COVID moles has their heads pop up, though. They've got an excellent testing program, and they're immediately locking down whole neighborhoods whenever a new infection shows up, but despite their excellent public health response new outbreaks keep happening — and many of them haven't been explained via contact tracing. Which is very disturbing to my mind. I'm starting to think there are SARS-CoV-2 reservoirs which are reinfecting human populations. The government is quite eager to SinoVac rolled out, because there have been unconfirmed reports about unrest and pushback at the sudden lockdowns.
Another big mystery about SARS-CoV-2 is why some countries have been hit much harder than others. A recent study of frequency of HLA protein types and COVID-19 deaths. There are hundreds of different HLAs and they provide natural immunity against various diseases. HLAs are inherited from our parents, and the frequency of different types vary widely across different human populations. This study found a correlation between the ratio of the S to N type HLAs, and the severity of COVID-19 infections.
Correlation is not causation, and I'm not fully convinced by this study. But it's interesting that it pegs countries like Malaysia, Thailand, and China have very high frequencies the N HLA and very low frequencies of the S HLA. And the mortality rate has been lower and rate of severe infections has been lower in those countries. The frequencies are reversed in countries like the US, GB, Sweden, Italy and Brazil, and the mortality rates and severe infection rates have been much higher. Of course, there's a theory the Coronaviruses have been infecting humans for untold millennia, hoping off from animal reservoirs into humans. From an evolutionary perspective, I don't think it's a coincidence that Pangolins and a particular species of bat are native to China and SE Asia — and SARS-CoV-2 seems to have hopped to us from those species. The populations in these countries have developed a natural immunity to the worst that Coronavirus can hand out through their HLAs...
Here’s the chart that shows the relationship...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772148/
Apologies for the typos and grammatical errors. I typed it fast. But I think you get the point.
Note that the annual flu vaccine update does not go through the entire FDA approval process that a brand-new vaccine does. I'm not sure what happens, I'd think there is some FDA involvement, but we manage to get out an updated vaccine for new flu strains every year without the FDA getting in the way of that. So I'm relatively confident we can do the same for coronavirus. (Also, my understanding is that coronaviruses don't mutate as fast as influenza.)
I hear the flu vaccine update thing was grandfathered in from when FDA restrictions were much looser. Might not be as easy to create a new carve-out for covid vaccines
A very California-centric post, short on data and attitudes from other states much less other countries. There are already indications that severe lockdowns cause more harm than good. The fact that vaccinations are touted as no guarantee of anything or a return to maskless lifestyle, the 99.5+ survival rate even without the vaccines, the politicalization and incompetence of the vaccine rollout schemes mean even the most brain-dead CNN watcher will stop listening sooner rather than later. It may be worse than the Flu, but that's not saying much.
What’s your data?
Here's some. Other links posted below as responses to my other comment. https://www.youtube.com/watch?v=LrRijSa8494
And here's a discussion with some evidence regarding who is "ignoring the science" and who isn't. https://dossier.substack.com/p/power-grab-covid-19-reinfection-risk
In the Novavax trial in South Africa, the risk for people with previous infection to be reinfected was equal to the one for people with no previous infections.
Variants exist, arguing as if they don't is foolish at this point.
https://www.washingtonpost.com/health/2021/02/05/virus-variant-reinfection-south-africa/
I'm not arguing that. My position is that corona is now little worse than the a bad season of flu. Particularly now that people like Cuomo aren't sending infected people into susceptible populations on purpose. Or do you deny that happened?
Corona is several orders of magnitude worse than a bad season of flu. And Corona with lockdowns, social distancing, mandated masks, working from home orders, travel industry paralysis, substantial reduction in public events etc.... is still a little worse than a bad season of flu.
It was in the first round. Not in the second or third rounds, mortality is way down.
Severe lockdowns (the ones in spring 2020) do cause more harm than "balanced" lockdowns (the ones in winter 2020), but both cause a net gain on deaths in the population because they stop an exponential spread much, much sooner than it would stop logistically.
This is now known by so many data points that it's essentially beyond any reasonable doubt.
I wouldn't argue against severe lockdowns in spring 2020 either: we didn't know exactly where the balance was, and we chose to be cautious. That's a rational choice.
A personal note: talking about "brain-dead CNN watchers" really doesn't help us give any more weight to your arguments (and in fact...)
Where's your data?
About effectiveness of lockdowns? Everywhere, really. You always see an exponential trend abruptely stop way before logistic curve arguments would kick in.
That's not data.
Sigh.
https://ourworldindata.org/coronavirus/
From: https://www.politico.com/news/2021/02/04/biden-covid-vaccine-strategy-fda-466031
"Public health experts say there are key lessons for FDA in the global, long-held approach to influenza. Shots made yearly to battle the flu rely on a foundational vaccine that is then altered to fight the particular variants that pop up each season. Drawing from flu vaccine practices would mean that manufacturers could skip monthslong trials that enroll thousands of people and instead prove safety and effectiveness in smaller studies that track a few hundred volunteers for weeks.
"Peter Marks, FDA’s top vaccine official, signaled Friday that the agency is leaning toward this approach. [...]"
Seems promising?
Good article (I often find Politico is much more informative about governmental goings-on than the major newspapers). Another promising excerpt:
Adapting the flu strategy is an approach championed by scientists. It’s not practical to run full-fledged late-stage trials for Covid-19 booster shots or revised vaccines, said Paul Offit, a vaccine expert at the University of Pennsylvania who sits on FDA’s vaccine advisory board.
“The flu model is the only thing that makes sense,” Offit said, and not just because the limited trials could be carried out swiftly. “Thirty million people have already gotten vaccines, 20 percent of people are already immune. You would have trouble doing an efficacy trial” enrolling thousands for one strain of the virus.
Thanks, I've added that link in.
I just don't understand how, even after a year-long major life disruption keeping this issue constantly on everyone's mind, the number of people willing to accept a free vaccine against a deadly global plague is STILL only two-thirds.
If only we could get those 33% on and island somewhere and just let nature take its course.... I say that, but I should be more compassionate.
I have some patients who aren't interested. They say they're young and healthy, their chance of dying is basically nil, and they either are concerned about side effects or want to "leave it for someone who needs it more"
"Leaving it for someone who needs it more" makes it sound like they'd be happy to take it once supply is no longer constrained. Are the polls counting that as "does not want it?" I mean, I'm happy to let higher-risk people go before me, but I still want a vaccine as soon as I'm the best marginal use for one.
For the patients who say they're young and healthy, are they socially distancing anyway? Is there an argument for social distancing that doesn't also argue for getting the vaccine? (I guess someone could have a considered preference for social distancing over the risk of side effects, but given how unpopular social distancing is, that seems unlikely to be common.)
I'm wondering how many of those surveys are lacking a "already got the virus, go jab someone more needing" option. (Particularly the ones that report scary numbers of health workers declining vaccination.)
I like the idea of having the FDA give categorical approvals for modular vaccines. What can we do as citizens to make that happen: write to Joe Biden? call our members of Congress? something else?
I feel like people aren't talking enough about rapid testing. It seems like some California schools have managed to open using testing, which seems promising:
https://www.kqed.org/news/11857118/can-rapid-covid-19-testing-for-kids-help-reopen-schools-some-california-districts-bet-yes
But tests need to be made cheaper by removing unnecessary electronics. For a nice advocacy site, see: https://rapidtests.org/
I was able to secure, through a friend of a friend, 15-minute nasal swab antigen rapid tests by way of Germany by way of China for $10 a pop. They're 99.4% effective and pretty easy to use. We have them at our house to use for future group social events - because who wouldn't pay $10 each to have a safe cabin weekend away with 10 friends?
The fact that these aren't being widely touted as the way out of this is maddening.
Where do you get a 99.4% rapid test accuracy number? That seems absurdly high; slow PCR tests don't claim this.
Bah, sorry, I was looking at the specificity numbers for another of their tests. Here's the one we have: https://www.realytech.com/novel-coronavirus-sars-cov-2-antigen-rapid-test-cassette-swab-product/. Apparently it's only 97% sensitive, but 99.9% specific.
I *think* these are the detailed serology results but they have multiple products so I'm not sure if this is the right one: https://www.accessdata.fda.gov/cdrh_docs/presentations/maf/maf3325-a001.pdf
Wow! That' still a far sight better than I thought--my cached belief were current rapid tests being ~80% sensitivity. I wonder if I can talk my friends into using these.
The problem is getting them into the US. They aren't FDA approved and according to the friend of a friend the only way they were able to get them was due to science connections. But I'll be looking for ways to bulk buy a bunch if our supply runs low...
Michael Mina (https://twitter.com/michaelmina_lab) has been flogging rapid tests (https://www.rapidtests.org/) for a year and I am among those baffled by the lack of take-up. I assume it should work against any variant, and by driving the incidence of cases to near zero, vastly reduce the opportunities for variants to emerge in the first place. And then, why not use it for the flu, cold, norovirus (cruise ships ahoy). Use it on pigs, use it on cows, use it on chickens, use it on anything that moves. A virtual population immune system.
Not an expert myself, but after observing Mina shout into the void on this for like 8 months now, I have to assume that any effort to deploy rapid tests is just being blocked.
A cynical take is that the PCR testing companies are making a boatload of money and don't want that gravy-train disrupted.
An even more cynical take is that those companies are funding disinformation about rapid tests. Since the tests don't return the same results as PCR, the companies can exploit that to sow doubts about them.
This is a really helpful piece, but are we *sure* that this approach to vaccines is a good idea? Simply "changing the password" as often as possible and speeding it past normal processes? We don't know how reinfection affects people yet, and immune systems are complicated. It seems *possible* this could increase vaccine-resistant mutations or just somehow become a problem. We're moving really fast without a lot of information, and there isn't precedent for this. There's also the issue that, if we're going to make it like the flu shot, why don't we just do that now, and let those willing to take the risk interact normally, while giving vaccines to those who want them as quickly as possible, and helping them isolate? As you say, only a minority is likely to keep up with yearly injections. It scares me that our public decision-making basically operates, on the surface, according to a zero-risk logic. This is why I'm paranoid as you describe--if we continue validating this logic, it's not that hard to imagine things not going back to normal for decades, especially given the damage to the economy and social trust. I agree that, if I was thinking of it from a purely rational perspective, this would be like the flu in a few years. That's what I thought we'd decide back in March. But we didn't. And maybe that was reasonable given the unknowns early on, but it doesn't seem reasonable to me now. We're not operating like treating it as we do the flu is a comprehensible option, so my purely rational assessment is obviously false. This could change, but it worries me. From my perspective, the practical limitations on our ability to control this long-term, and the extraordinary accumulating costs that would come with trying, were very obvious from the beginning, and definitely not worth it. (Other than sensible, targeted mitigation measures, of course--I'm not saying do nothing, but anything close to eradication is not going to happen.) In the short-term, they seem worth it, but when you think about what would have to happen to keep it going long-term, the game is just unwinnable, and trying to win it just eats up the resiliency and ability to plan we could have used to cope with it and make necessary transitions. Society is a complicated system to be messing with---we don't know what we're disrupting in the long run. That's when you end up with no concerts forever---people may adjust to the risk and treat it like a flu, but there's no money left to sustain the concert industry, and a lot of people have grown to see it as an unnecessarily risk indulgence. If you don't come to a relatively clear-eyed acceptance of the situation, you can just get stuck drifting along as though it is a permanent emergency, even if most people want to live normally. They won't speak up against the others if we're operating under a logic that ignores the question of what the endgame is, and whether any of this is worth it long-term. I'm very uncomfortable with how this has proceeded and is proceeding. I appreciate that covid poses a real danger to some people, but I can't imagine any situation in which I would advise the response we've chosen. If I was high risk, I would want to shelter and be given the resources to do so, but I'd be terrified to have all of society "hibernate" like this. I would not see that as likely to protect my future, but likely to jeopardize it, by disrupting the available resources, conveniences, and stable society that make sheltering possible.
Re: "yearly COVID shot". I just got my second shot out of the two-component vaccine. That means me potentially being immune to two different vaccine vectors, hopefully for less than how long the COVID immunity lasts, but possibly longer. Is there a technology that would help us avoid running out of vectors for the foreseeable future?
As I understand it, since the mRNA vaccines do not use a viral vector, this issue does not apply.
I somehow managed to miss that fact, thanks! This, indeed, solves the problem.
This article does not make me feel good about the wedding I have scheduled for September.
We've already rescheduled twice...
That sucks man. This article really bummed me out too. Scott usually isn’t too far of the mark.
Thought we might be out of this by summer, but we will probably never be out of it.
After reading the comments I think I was overly pessimistic.
It’s good to hear you say that. But if it’s a matter of not wanting to cause your audience to despair vs. writing your sincere thoughts on what direction this is heading..: I would rather hear what you’re really thinking.
Seconding this article causing me to adjust toward more pessimism and not enjoying that, but also appreciating your work specifically because you're so good at accurately capturing the world.
What do you think about "open source vaccines" like Radvac or the one from winiftred Stoecker ?
Same as everyone else - I love the energy but only give them 50-50 chance of working. I wish we had studied these better six months ago.
Shouldn't we start studying them now ? If we need to constantly modify vaccines, it might be worth the effort.
We need to consider just how different humanity is now compared to when Spanish flu arrived. It was allowed to take its natural course because we didn’t know any different. Today if we were told that allowing a virus to run its natural course would likely result in less deaths than fighting it (allowing for more mutations to proliferate), we couldn’t make the call. International travel, coupled with the fact that we are so easily triggered in today’s online world, the ‘panic and fear’ factor could make things worse.
Based on tele-work, tele-medicine and tele-everything else: the current nerdopolis that is the Silicon Valley will start losing its dominance, steadily and surely. Not sure how to quantify it, though.
I think this is long-term true but that COVID won't make much of a difference in itself. Housing prices have barely budged (rent has gotten better, but not buying, which suggests the market expects long-term stability).
Is everybody expecting *other* people to move, then?
You've described what will happen in the US which seems plausible. Here's what would happen in developing countries: people collectively decide to ignore COVID as-is, it kills off 0.3-1% of the population (depending on the median age) allowing the rest to reach herd immunity. New mutations kick in but they're not perfect at beating natural immunity and in any case the most vulnerable people have already been killed at that point, so the IFR consistently hovers around 0.1% which is low enough to let people ignore COVID. So no vaccinations, no "adjusting the vaccines each year", no masks, no social distancing, nothing. Society moves on as it did with every pathogen in human history after suffering some casualties. India is already there: their case counts have been falling for 6 months now despite having very few restrictions in place, all thanks to herd immunity.
There is no way India has herd immunity, last seroprevalence number was ~7%, see https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30544-1/fulltext . Or am I missing something?
India is not at herd immunity but the seroprevalence number is higher and some cities may be quite close to herd immunity which is a big deal given the sparser connectivity of the rest of the country.
a recent article https://www.bbc.co.uk/news/world-asia-india-56037565
"The latest sero survey - studies that pick up antibodies - suggests 21% of adults and 25% of children have been already infected with the virus.
It also found that 31% of people living in slums, 26% of non-slum urban populations and 19% living in rural areas have been exposed to the virus. That's far below 50% - a figure reported by some of the bigger cities, such as Pune and Delhi. Here, there is evidence of much higher levels of exposure to the virus, hinting that these places are likely closer to herd immunity."
IMO it is difficult to explain the data from India without some sort of "prior immunity" being present. Even where Covid is still present (such as my home state of Kerala https://dashboard.kerala.gov.in/index.php), the trajectory of the disease is comparatively benign i.e. no acceleration in cases or deaths, just a low/medium flatline of cases and deaths despite an increasing return to normalcy https://www.bloomberg.com/news/articles/2021-02-14/covid-s-puzzling-decline-sparks-a-shopping-spree-in-india
3/4 of India's coronavirus cases have come after August 18, so the current number is in the 20s %, similar to that in NYC after the first wave.
I am affraid you are far too optimistic about going roughly back to normal. Especially in Europe where lockdowns have been stronger and more general than in the state, with much less political opposition. With the economic crisis looming, governments will not revert back to full democracies naturally, there will need to be popular pressure. At this point, there is a risk to fall to real dictatures, as the power in place feels the risk about having to render counts for last year decision threaten so many political, police and media heads.
The counter power at this time is mostly judiciary, parliament is absent / aligned with executive, and only having the judiciary guard against dictature seems small...
This worry me much more than the covid itself, delation, police violence, scapegoating of tourists / lockdown parties, arbitrary fines linked to ever changing illogical regulations... All of this is up regardless of the epidemy evolution (it keep increasing even when vaccination started and the epidemy stagnate).
Prediction about the future are notoriously hard, but there are more signs about the west transitioning from democracies to fear - powered autocracies than signs that the plagues are back.
What's government's incentive to keep eg mask restrictions if COVID's over?
Perfect for keeping police pressure on the general population, it's a compliance sign, easily allowing to sort good citizen (following government orders) from trouble makers.
Why do you think there is so much opposition on mask wearing while it is certainly not the major annoyance? Same reason, identity marker.
There are also some similarities with the typical identity control in Europe, which is a convenient tool for initiating a authority/compliance interaction between police and citizens. Many incidents start with those, it's one of the main issues raised by "problematic" youth about police behavior but statistics shows those types of checks catch very little criminals...Still, it's maintained....because it allows police to exert authority as it see fit, and demand compliance.
That's my feeling, but there are facts that back up this interpretation: mandating masks outside, even in non-crowded situations, is common in many places in Europe. People walking alone have been fined for not wearing (correcly) their mask. There is no possible medical reason for it (even allowing for the most fringe medical studies), and indeed no medical justification was attempted: it was for "educational purposes", to keep people used to masks.
Only trouble with masks is that it also makes identification more difficult. I expect this will be the main reason we will be back to usual mask restrictions (i.e. forbidden in public places, instead of mandated), especially as soon as another compliance marker can be used (police checking of vaccinal passport would do, but that's a hard pill to swallow....still, I would not be surprised)
As I wrote in my other comment, I feel that masks are somewhat of a red herring. Worse ideas are rearing their heads in the public sphere. I don't necessarily expect stay-at-home regimes to last beyond this summer, but I am almost sure that any political demonstration in the next 2 years will be a target of massive public shaming by the press and the government (and possibly also punitive police action) if it rubs the elites the wrong way.
How is that different from before? In NYC, cops have been beating on demonstrators my whole life. We had protests of cyclists tired of having their friends killed by careless drivers and all they were protesting for was bike lanes, and the cops showed up and beat the crap out of them. Like... cycling isn't even in the culture wars. They weren't protesting police brutality or the Iraq war. They just wanted bike lanes.
First of all, police wilding wasn't a widespread thing in large parts of (Western) Europe. Nor is it now; what I mean is, you aren't comparing apples to apples.
Second, both in Europe and the US, the media has generally been on the side of protesters, or at least not actively demonizing them, until the 2020 anti-lockdown protests. Even the Catalan independence movement, with all the headaches it has caused to the elite (and with real evidence of Russian meddling), has been generally getting the "legitimate grievance, maybe some excesses" treatments from the press.
I don't know - I attempted to test this by Google, using France since it's clearly in Western Europe, and since media coverage there might not have come to my attention because I do not read French news. Google "france protests media coverage" and you get the Yellow Vest protests; here's one of many stories I found alleging that they've received unfair treatment from the media. https://www.france24.com/en/20191116-a-year-of-insurgency-how-yellow-vests-left-indelible-mark-on-french-politics
My recollection of prior US protests is that the media tends to react to them in a partisan way - so the left media actively demonized e.g. the Tea Party protests and many of the various other right-wing protests, while the right media actively demonized the Iraq War protests and OWS (and of course BLM, even before the pandemic).
Conversely, the left media tended towards apologia for BLM protests even during the pandemic (a justified defense, in my opinion, since they were outdoors and the protesters were masked) and, while I sort of stopped paying much attention to right-wing media, I assume they did the same sorts of apologia for anti-mask/anti-lockdown protests.
But I don't think you could really say that "the media" has been on the side of protesters in general, or that the anti-lockdown protests were some kind of outlier. And again - the anti-lockdown protestors stormed a state capitol with guns and didn't get the business from the cops; whereas I've seen video of cops just brutally dismantling protests including, as I said, protests about seemingly non-partisan issues like traffic safety.
Humans don't dominate the planet. Plant life does, and it's not even close in terms of cell count. We should expect more viruses to be selected for infecting the social plants, assuming the virus's "goal" is only to increase its copy count.
All the really bad plant pandemics (Blight, Dutch Elm Disease, Panama Disease) seem to be fungal rather than viral. But viral infections are a problem, especially for nightshades like tomatoes, potatoes and tobacco. And there are fewer ethical quandries associated with torching a field of infected crops than a retirement home with a covid outbreak.
Certain plant viruses are not pathogenic. In these cases the infected host is asymptomatic while the virus co-opts the cellular machinery to replicate itself. Some viruses can even coexist with the host symbiotically. This set me to thinking about viruses in terms of the modern synthesis: If the "goal" of viruses was only to increase copy count, then we should expect that selection by now would have preferred benign plant viruses, not only because they are benign, but also because of the huge opportunity space - LOTS more plant cells to probe compared to other eukaryotic cells.
How much human capital have we lost to covid fatalities. How many potential great works have died with covid patients?
I've been looking at lists of noteworthy people (e.g., people with their own Wikipedia pages) who have died of covid, such as Wikipedia's list:
https://en.wikipedia.org/wiki/List_of_deaths_due_to_COVID-19
Early victims included a couple of Broadway figures in their middle-aged primes, gifted songwriter Adam Schlesinger of Fountains of Wayne and "Crazy Ex-Girlfriend" (who had just signed a big contract to compose a Broadway show with his creative partner Rachel Bloom) and Tony-nominated actor Nick Cordero. So, eleven months ago I figured covid was going to be pretty bad for our human capital.
But, since then, most of the fatalities among semi-famous people have been concentrated in either the elderly or the long-term sickly. I periodically look at the Americans who have died in the Wikipedia list and I don't see much evidence that our culture will deprived of too many great works going forward.
That sounds brusque, but when we are making trillion dollar decisions, we really ought to look at all the evidence, even impolite evidence.
Your impressions may differ, so I encourage you to look at the Wikipedia list or the New York Times' list of people who have died.
It takes exceptional humans some amount of time to become notable enough to have a Wikipedia article, so this method has a selection bias for older people.
How about the New York Times' "Those We've Lost" list:
https://www.nytimes.com/interactive/2020/obituaries/people-died-coronavirus-obituaries.html
When making trillion dollar decisions, we really ought to search out all the fairly easily available evidence.
The best evidence I can find is that covid is the opposite of the 1918 Spanish Flu, which mostly killed 20-40 year olds, thus imposing a huge human capital cost on society.
You might be also interested in the corresponding Wikidata query (currently listing 2955 “notable” people who died of covid): https://w.wiki/zhD
Now I noticed somebody imported lists of “non-notable” covid victims; so trying to exclude those, https://w.wiki/zhL lists 1605 victims.
It's fine to look at non-notable people too.
The advantage of looking at victims with Wikipedia pages is that you can usually see how long ago they did whatever it was that got them a Wikipedia page and estimate whether they'd have been likely to do much else of note if they hadn't died of covid.
Yeah, I know, it is cold-blooded to think this way, but when we are making trillion dollar decisions, we really shouldn't exclude relevant data for reasons of sentimentality.
The rich and powerful probably have access to drugs like casirivimab and imdevimab (what Trump got) which explains why their deaths from corona stopped a while ago.
Maybe, but if you look at the actual list of who has died, many are rich and have connections to the powerful, so they probably have access to any wonder drugs. But they were just, personally, over the hill.
I realize this is a methodology for getting a sense of how bad covid is that seems alien and hard to understand for most people. I've been trying to call attention to it since the late spring with little success.
But this pandemic's social effects seems to be the opposite of the Spanish Flu of 1918, which left a lot of young children orphaned and the like.
Is it safe for people to get additional vaccinations in rapid succession to beat virus variants? I realize that there isn't enough vaccine for that to happen much now, but I wouldn't be surprised if the vaccine process gets sped up.
One more area to hope for progress is for more genome-checking to keep track of mutations.
I am skeptical about the fast track. Any time you change the antigen in the vaccine, it could, by coincidence, resemble some normal body protein and trigger autoimmunity. Or do something else unintended. Not that it is super probable.
I will be glad to be corrected, I am not super sure about this.
I think maybe testing safety but not efficacy is the way to go.
As an Israeli who has been vaccinated, I can confirm that they plan to vaccinate every 6 months. When you get vaccinated, they make it clear that you will have to do it again soon.
Another point: Many many health giants around the world have spent billions on new Coronavirus vaccines. They will want to put them to use. I expect that by 2022 there will be an oversupply of such vaccines covering every extant strain.
What about Covid treatments? So far we had a few proposals but the results were a bit underwhelming (chloroquine, remesdivir, favipinavir, etc), but dexomethason seems to work at least for some severe cases. Now we have the monoclonal antibodies and nano antibodies - so far the results are are still a bit disappointing but in theory antibodies should work and at some point we should be able to produce them in mass quantities cheaply.
And by the way - what do you think about amantadine? I have already asked that question here: https://astralcodexten.substack.com/p/hidden-open-thread-1595#comment-1236759 - but with no replies. I think it is an interesting case of auto-immunology disease in science - that is I think the allergic reaction of the scientific establishment to dr Bodnar is overblown.
A minor terminological point on "If vaccines made R0 go to 0.5 or whatever, we would loosen some restrictions until it was back at 1 again." R0 is defined as the reproduction number in a completely susceptible population; the reproduction number when some people are immune (through having had the infection or vaccination) is called R or Rt (see e.g. https://www.nature.com/articles/d41586-020-02009-w).
All I have to say is I have zero regrets for every midnight movie I've ever seen. You don't know how much I miss them, and I treasure every hour I've spent in a theater after midnight. I'm devastated that they may never come back.
YOU'RE TEARING ME APART 'RONA!!!!1111
I also miss my family too. But can quarantine for a few days and see them.
Maybe I really am that paranoid type. I promise I don't have a political axe to grind. But I am just really curious why you would put the chance of rock concerts not happening again or mask wearing staying majority social pressure at "less than 1%" chance? I think it's literally a 50/50 chance.
You even compared it to child kidnapping panics which I agree with. I personally like to compare mask wearing to no smoking in airplanes. No one can smoke in airplanes anymore. It's never coming back. Same thing with going to a rock concert without a face mask. It's never coming back (except in very exceptional one-off cases). I could be wrong obviously, but I would certainly bet money against anyone putting it at "less than 1%" odds.
Restrictions have gradually gone down every time a COVID wave decreases, then only started going back up again once a new wave starts. This makes me think that restriction level is pretty sensitive to COVID prevalence.
True. And I'd agree with that. But what if it has a higher baseline now? We haven't gone back to the previous normal baseline which was the pre-pandemic. There's no compelling evidence to suggest that normalcy is very similar/identical to the pre-pandemic normal rather than a "new normal." In fact, there's a compelling argument to be made that since COVID will be a fact of life like an additional seasonal flu which didn't exist before (similar to how AIDS is a fact of life), then there is a higher baseline of restrictions for the normal state of society that did not exist prior to COVID's existence. Some examples I would personally bet on:
1.) Most places will have the legal right to enforce their own mask policies at all times forever. Restaurants, entertainment places etc can include "no mask no service" purely at their own discretion and a fair number of conscientious businesses will permanently enforce them as a socio-political stance to signal commitment to public health etc. I would bet that anywhere between 10-30% of people you see in businesses will be required by the business to be masked up.
2.) Big, closed, indoor events/things will have new rules forever unless you live in some rural not-so-dense-population-area where the political stance of freedom over safety trumps health considerations.
3.) Schools, colleges, teacher unions etc that are the exact opposite of #2 (aka their consideration for safety trumps personal freedom rights) will have much more sensitive responses to tiny COVID occurrences (ie: 1 student tests positive for COVID and entire 2nd grade class goes remote for a semester).
These are just my guesses. Admittedly, I'm not as good as you on getting things right so far, Scott. But I feel pretty confident about these.
We didn't see this happen after the 1918 pandemic, why would we see it now?
You have every right to be pessimistic considering our government/societal response here, but I don't think you're correct about this. In a year or two things will basically look like they did in 2019.
People are more risk-averse now than in 1918, both in general, and specifically wrt children. Pinker talks about this in one of his lectures (I think it was a TED talk) - our definition of harm has expanded and our tolerance of harm has decreased. Pinker thinks this (is part of what) creates the illusion that things are bad and getting worse when in fact (at least as of 2012 or whenever) things were objectively getting consistently better. I think Pinker thinks that this is just because people acclimate to whatever the general overall level of harm is in a society and then use that as a baseline from which to demand improvements, and so as the overall harm levels go down, so too does the overall tolerance of harm. I think there's perhaps something a bit deeper going on.
One of the ways that people adjust to a society with less absolute risk is to have fewer children. According to folks like Hans Rosling, when child mortality is high, people have 5 or 6 children, hoping at least 2 will survive. When mortality decreases people have 2 children, feeling reasonably confident that they'll both survive. But that also means that we in some sense are adjusting our per-child risk tolerance down, since it's a lot more catastrophic (at least, from the perspective of gene propagation) when 1/2 of your children die than when 1/6 of your children die.
So if the question is "how much risk will we (adults in society in general, or parents in particular) accept on behalf of our kids?" then there's good reason to believe that answer will be lower now than in 1918. In 1918 the US was right in the midst of the demographic transition from high birth rate, high infant/child mortality to low birth rate, low child mortality; mortality had dropped a lot from 1900-1918 but society hadn't fully caught up yet, and wouldn't until about 1940 (and then it boomed again during the... you know, baby boom... before dropping back down again by around the 1980s). I think this is part of the underlying cause fueling what Scott noticed about unattended kids in playgrounds - to me that looks like a post-baby boom downward adjustment in per-child risk tolerance.
I do think there will be some kind of new baseline after lockdowns. I think at the very least that baseline will include a Korea-post-SARS-like social norm of wearing masks when sick, and possibly more vulnerable people wearing masks during every cold/flu season (that was already the norm here in Georgia-the-country where I live - some of the older teachers at my school wore masks during flu season even before corona). I think it will include more hygiene and safety in school and a greater awareness of ventilation (I have friends who taught in Ukraine who said their school aired every classroom before and after every class, even before pandemic, even during winter, so again, this at least has precedent in at least one place). I think it will include a slight uptick in homeschooling and non-traditional schooling even after the pandemic threat is mostly or entirely over. And I think all of those things are part of broader overall trends that have been accelerated but maybe not created by this particular pandemic.
There is a big financial incentive for rock concerts and fans at basketball games to be a thing again. They're not gone forever, that's a good 99% bet.
I think you're discounting what I mean by "not a thing." I was mainly implying they won't look like anything similar to as we knew them before. If you look at my above reply giving 3 example scenarios you can see that I still believe the financial structures will be intact but that things will look fundamentally different and never change from this new structure post-pandemic. For example, I think that basketball games will be a thing yes, but I don't believe they will allow people to sit tightly close together anymore. During flu/COVID seasons, they'll require masks in all games. New financial innovations will happen to accommodate for this new reality.
Yes, this is what I fear. And I think it will have the effect of making them financially nonviable and less fun, while doing very little to control covid. There are ways this could be rearranged to something close to normal, but I don't see much of a desire to do so. I live in Boston, and no one here is begging for live sports to come back, so that's a bad sign. Maybe it's just me in my bubble, but I know few who would go. If they marketed cheaper tickets at younger people, it might be salvageable, but I feel like there will be too much pressure against allowing that. This really upsets me, because I thought when we got through several concert terror incidents without canceling concerts, that nothing could hold back the desire of people to see live music. But apparently not. I'm very depressed about this. Not just the concerts, but what they represent---a culture that considers basic human fun and interaction to be a privilege or luxury. That's not a world I want to live in. Hope I'm wrong.
Nope, it's not clear that they're not gone for long (forever is a very long time, let's focus on 20y ;-) )...and that's (for me) the biggest lesson of COVID: we have seen the limit of big financial incentive (i.e. economical power) v.s. political power. We knew it was the latter in past regime and current dictatures, but since the 70's I have believed it was the first that controlled western world. Apparently no, classic state power never went away, it was more a parenthesis and it can be back in the front seat once conditions are ripe. Now I am awaiting to see if it will "naturally" take the back seat again, or will find the front seat very comfortable stay there. I think it will stay there, as power usually do: it's rare for people exerting it to let it slip without a fight, if they have a chance to keep it. The Chinese model with a fear-from-crisis (epidemic, climate change, terrorism,...) justification seems to have seduced the western governments.
Thanks for the article!
Did anyone encounter data on woman fertility and vaccinations?
The FDA report on Pfizer has very little actual data (~20 pregnancies, ~half in placebo).
WebMD and other sources just claim that the evidence suggesting a link between infertility and vaccinations is fake.
My friend found this information insufficient, so I am looking for more serious research if any exists yet.
Thanks :)
I also researched this claim. The WebMD article was atrociously written and argued primarily with tone, rather than evidence.
The claim about Pfizer Covid vaccinations and sterility pings back to an original claim that the vaccine produces a protein that causes the placenta to detach. But this is false. Although there is a small bit of nucleic acid that the vaccine and the syncytin-1 protein share, they are not similar at all. Furthermore, if it was the case that the vaccine caused miscarriage, then the virus itself would also cause miscarriage. The virus does not cause miscarriages, thus it is unlikely that the vaccine causes miscarriages either.
I am not an expert in any way. The best source I found for this information was this:
https://www.health.nd.gov/sites/www/files/documents/COVID%20Vaccine%20Page/COVID-19_Vaccine_FAQ_General_Public.pdf
Question number 28.
The power of suggestion brought the concern to people's minds, but the suggestion comes from a misinformed place about the relationship between the vaccine and this other protein.
Agree with the above. I'm worried that this rumor will has enough pseudo-scientific resonance with the minimally health literate to discourage vaccination in childbearing women. Or just that because it's centered on something like fertility, which is already somewhat mysterious and not well understood by the medical community, that it will cause anyone worried about their fertility to be fearful of vaccination. Not sure if this would be helpful, but if a professional society rather than the lay media would be more persuasive, this is from the American Society for Reproductive Medicine: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/covid-19/covidtaskforceupdate12.pdf I am in healthcare and was recently vaccinated; at least at my institution, they were collecting data on whether or not an individual was pregnant and/or lactating at the time of vaccination. I thought this was strange because these physiologic states are not contraindications to vaccination according to all the relevant professional societies' recommendations and the common sense of the mechanism of the vaccines. However, when I asked the nurse vaccinating me whether answering yes to these questions would lead to those folks not getting the vaccine, he said he didn't know. So that was strange. My hope is that this information is going to some centralized database and that they will be able to do some post-vaccination analysis of the vaccine's effect on pregnant and lactating individuals. Or that formal studies will be done soon so there is more hard evidence on the safety of the vaccine in this population.
I have the feeling that a lot of peaople assume that new virus-strains generally should be less lethal than old strains, not due to previous infection but because viruses will tend to mutate towards an equilibrium were it does not kill the host (because there will be a selection-pressure to let the host live and further spread that virus-strain). Is this a valid assumtion? Couldn't it be that "equilibrium-viruses" is selected for over (long) evolutionary time, and that they also depend on the virus in question acting as a selection-pressure on the host? So that, any given mutation is random and might as well be much more (or less, or equally) lethal compared to Corona Classic. Only in the long run will this pan out to be a more flu-like situation. (Confidence in this speculatory line of thought is low.)
I find it strange that people have stopped questioning our response to COVID19 and whether or not it's been a) justified, b) effective and c) cost effective. Now that the vaccines are here, those questions have been sidelined and stigmatized. I think we should continue to interrogate every aspect of our response to the pandemic.
I would be interested in reactions to this piece. The extensively researched claim is that in UK at least, COVID has been massively systemically over-countered: https://architectsforsocialhousing.co.uk/2021/01/27/lies-damned-lies-and-statistics-manufacturing-the-crisis/
Then there's the issue of the mixed at best evidence for lockdown effectiveness. https://inproportion2.talkigy.com/do_lockdowns_work_2021-01-15.html
How should we view clearly costly policies that are not supported by the overwhelming body of empirical evidence? I can see a case being made for lockdowns being so intuitively effective and studying them so fraught that we should proceed regardless of the evidence. But I think this case needs to be made explicit so it can be interrogated. Currently that's not what's happening.
In Georgia-the-country, all-cause mortality was actually down (from the previous five-year average) for the first six months of the pandemic, during which time we had three months of lockdowns which were so effective that we received international press coverage for it, and 37 cases per 100,000 for the whole country for the whole six months. In fact by day 180 (with day 1 being the first detected case in country) we had 17 covid deaths in a country of almost 4 million. In contrast, in our second wave, the government didn't do a lockdown until our hospitals overflowed, and our all-cause mortality shot up to about 1500 excess deaths per month before the government did a second wave of lockdowns to control the pandemic again. Once those lockdowns were in place, cases very predictably began dropping within 14 days. Now, the lockdown has been partially phased out and the infection rate is increasing again. On February 1st the first set of restrictions was removed; by February 9th my calculation of R jumped from .72 to .89 and is currently still hovering up around there.
That seems like pretty clear-cut evidence, to me, that a) lockdowns can prevent covid mortality, b) despite claims to the contrary, lockdowns don't (necessarily) cause an increase in non-covid mortality (e.g. through suicides, missed cancer diagnoses, or whatever else) - at least, not one that can be detected in the medium-term of six months, c) lockdowns can decrease case numbers and mortality rates when put into effect even if they're applied late, and d) effective lockdowns are clearly detectable in infection rates after a delay of 8-14 days.
The UK would seem to be a difficult case study because policy has been so scattershot and the government has veered from lockdown to handing out lunch vouchers for restaurants as a stimulus, so it may be hard to tease out confounding factors or localize public policy measures to infection rates. The US is probably worse, because of the politicization on top of the atomization and incompetent, incoherent policymaking and policy enforcement. But I believe if you look at countries with someone more coherent governance you'll see a clearer effect of lockdowns.
I've also seen studies suggesting that lockdowns have decreased all-cause mortality in other countries as well, due to a drop in pollution, injuries, and traffic-related fatalities. None of these have been particularly high-quality but it's something to consider in the face of people talking only about the costs of lockdowns - they may also have benefits outside of just slowing down covid.
ack, "somewhat more coherent governance", not "someone more coherent governance".
Presumably the virus is going to become and remain endemic, and we'll see perpetual annual or semi-annual vaccination for the most likely variants, just like (and along with) flu vaccines.
Question about different vaccines: To what extent do they "stack" and to what extent do they make each other less effective?
E.g., if I get two shots of AZ but J&J turns out to be more effective, is it possible the antibodies in my body will render an additional J&J shot ineffective?
If so, is it clear whether this cannot happen with mRNA vaccines?
Calling it the "China virus" makes you a really bad person, but calling it the "UK strain" is 100% fine?
The OG strain is being referred to around my parts as the "Wuhan strain", so at least we're equal opportunity here. Others are pushing to call the UK strain by its designation "B117".
It's much easier for the average person to remember a place name like English strain than an arbitrary term like B117.
I can't imagine many Brits will have a problem with this, though I can only speak for myself. "China virus" was at best geopolitically motivated, and at worst intentionally xenophobic.
As a UK citizen I don't feel that I'm likely to be given a hard time because B117 was first identified here. The worst stereotypes I have to deal with are bad teeth and bad food - there's no history of stigmatising us as dirty, unhygienic or sneaky. Sadly the same can't be said by Chinese people.
Oh absolutely, couldn't care less about the feelings of the CCP. The Chinese diaspora is made up of individuals with feelings, though.
As for dumping on my own country, insofar as it makes sense to be proud of your country, I am. We've made our share of mistakes in recent years, and I'm certainly not defending our colonial history - but I'm glad to live in a country where self-deprecation is an art, and punching down is seen as bad form.
I think the first prediction is not well defined. What is a "wave", i.e. what is the y-axis? Case numbers (as everyone knows well) are dependent on testing which changes over time. A more reliable metric (although it changes over time as well) is hospitalisation rates. I would predict that we will not see another wave of hospitalisation in the US similar to the previous 3: the majority of older people will have been vaccinated and the protection against severe illness is very high
For now I'm not sure what to think about all those "mutants". Because it seems researchers "threw" something in petri dishes and made some conclusions with that. But I don't really see any "real world" implications with that... Great-Britain - you know, this country, that "named" one of those highly-infections mutants - got their daily infections down from 60k/day to now around 10/k day in just a month! You could theorize if it was the "old virus" that their lockdown did that even faster. But that is basically impossible to prove in either way! So ... *meh* you mutants, I don't care!
My thinking is more along the lines of this diagram in the German wikipedia about the spanish-flu:
https://de.wikipedia.org/wiki/Spanische_Grippe
We are currently in this second, really big and deadly "wave". We will have a third one, that is smaller, but I don't think it will be the "same" months as in this diagram. Because at least here in Germany nothing happened last years summer and we basically opened up "everything": bars, restaurants, cinemas, even concerts happened (but with fixed seating). And "our" second wave started in october/november; so it seems very seasonal! And sorry, for now I don't think these mutations change anything about that! Maybe time will prove me wrong.
But important about this diagram: it ends after the third wave! And I think that is something we do too with Covid19!
There has been progress recently on making a general flu vaccine that will work against all sorts of flu: https://www.sciencemag.org/news/2020/12/innovative-universal-flu-vaccine-shows-promises-it-first-clinical-test
So, I would imagine this sort of thing bodes well for the prospect of a universal Covid vaccine as well?
Seems there are multiple teams working on exactly this:
https://www.msn.com/en-us/health/medical/scientists-hope-to-save-world-from-next-pandemic-with-work-on-universal-coronavirus-vaccine/ar-BB1dDxIU
https://news.gsu.edu/research-magazine/spring2020/preventing-the-next-pandemic-covid-19-vaccine
I was hoping to see a discussion of the so-called "Long Covid", since as far as I can tell from picking through various studies over the past 6 months, still has limited evidence that it actually exists as a unique effect of the coronavirus.
Studies all seem to fall into two camps: either a very small study of like 50 patients who were hospitalized, are elderly & obese, and demonstrate lung damage in scans taken 1 or 2months after being discharged. Or a survey of people from the "Long-Covid Support Group" on Facebook, who self-report suffering varied symptoms several months on, such as Fatigue, Tiredness, and feeling worn out.
Neither of these are remotely what we are interested in though. There have been enough studies, even without large samples or controls, that suggest lung damage in survivors that I expect there is a real effect, but if it mostly appears in hospitalized patients, who have pre-existing conditions, are elderly, etc. then chances are it's very rare overall. And that's assuming it's actually long term and doesn't go away after 6months.
The surveys get towards what we're interested in: what are the chances that an average person who gets infected with coronavirus has to suffer long term issues, even if the disease itself isn't a danger. But self reports of very vague terms like fatigue are just way too unreliable, and again we want to know if these are long term, not just for one or two months. One particular survey did ask for effects at 12 weeks and found sufferers fell away to almost nothing. At that point you have to ask whether this isn't just standard post-viral syndrome?
Ultimately I can't spend much time tracking down medical papers so perhaps there has been more definite evidence emerging recently as to the prevalence of long term sequelae and the possible effects.
Standard post viral syndrome is probably likelier in a depressing lockdown world bereft of fun and gyms. Disrupted exercise and socializing routines makes many people more vulnerable than they otherwise would be. And prone to sitting around all the time. If we were chickens, we'd call this "species inappropriate living conditions".
Would we notice if the flu (or some other viral infection) causes post viral more often these days, if it did? Not sure if good data is available.
> At that point you have to ask whether this isn't just standard post-viral syndrome?
I agree with you on the facts, but possibly not the interpretation: if the population of people with post-viral syndrome goes up by 10x, 100x, 1000x, or whatever - isn't that really bad?
Years ago I had "long norovirus" - no acute symptoms after about a day, but I felt run down and uncomfortable for several weeks after. I wouldn't want that again!
Oh for sure it's a bad outcome if thousands of people suffer illness for several months, but it's not the kind of bad outcome that actually warrants taking action. Much of the debate around long covid is how it demonstrates the need for control of the virus, even if people aren't dying from it.
Well unless being cooped up in lockdown is a strong contributing factor to developing post viral syndrome, in which case it also demonstrates the need to stop controlling the virus.
A thing I recently wondered about: Why are there no illnesses that do GOOD things to you?
Like a flu that makes you feel awesome and full of energy.
There are literally hundreds of disease strains that kill you, which is, we should not forget, a bad ending for the disease, in the coffin, it will not spread. If a disease made you feel great, you'd go out and meet people, which is great for as disease, and we would not spent billions to develop vaccinations and social distancing and such against it. From an evolutionary perspective, there should be massive advantages for a disease that makes you feel good vs. ones that make you feel bad. Yet I know of not a single one.
Now, there are a few obvious counterpoints.
1) Most of the symptoms we have when we are sick are not the disease, but the body fighting the disease. A body would fight a foreign substance no matter whether we like ot or not. But there are a lot of diseases that the body cannot successfully fight, from HIV to Herpes, that if you have them you are stuck with them. Why only those that will eventually kill you? And not all illnesses are so noticable as the flu, the body fights other sicknesses with us barely noticing. So a sickness where the signs of the body fighting it are low and the effect of the sickness making you feel great is at least thinkable.
2) If it was good, it would be a symbiote, and the body would just incorporate it, like the colon bacteria. True, but only over millions of years. Bacteria and viruses evolve much faster, so one evolving into a feelgood plague could happen spontaneously without cumbersome human evolution having had the time to give it an estabished niche.
Also, circumstances change. An illness that makes you feel awesome would have led our anchestors to be eaten by tigers or starving in winter, because they didn't build up stores in time. In our modern time, the same illness would just improve how you feel living your life.
Personally, I feel the reason for this is to show us that there are no loving gods, that, if something can be created to be good or bad, it most often is created to be as bad as possible (I kid, partially). But I really wonder. There are diseases that can manipulate an ants' brain to make the ant walk up a leaf of grasss and bite down at the end and wait for a cow to eat it. Some are that sophisticated. But none has the effect of releasing whatever hormone or neurotoxin would make you feel better, despite the huge evolutionary advantages that would have for it? It is easier for a disease to jump from bat to human than to be nice for humans?
Something is wrong here.
Nothing is wrong here. You can't improve a complex, well-tuned, functional system with any simplistic outside intervention. And viruses are extremely simple in comparison to us.
Creating hormones or neurotoxins (other as a sideffect of disrupting the preexisting system) is far beyond what a virus can do.
That is generally true, however, some diseases seem to have very fine-tuned effects. If the ant is too simple for your tastes, I read that Toxoplasmose makes mice find cat urine attractive instead of repellent. Now, mice are higher developed mammals, and the degree of fine control needed to change the emotional reaction to one specific smell tells me that it is at least not theoretically impossible for a simplistic outside intervention to change how the brain reacts to things.
Toxoplasma gondii is a single-celled eukaryote and much more complex than any virus. And it also affects humans in the same dimension. Men find cat urine more pleasant, women less.
But this is not a positive change for people nor is it even useful for the parasite itself (I don't think the effect is strong enough, that some men would get eaten by a lion, because of this). That's just us being similar enough to mice, that it works on us to a lesser degree.
Also, it's easier for an organism to finetune a mice manipulation, given that they have a generation time of 10 weeks as opposed to our 25 years [plus/minus 10].
The most plausible vector to achieve any such "positive change" would be the brain.
The brain does not need a random outside intervention to regulate itself.
We have the blood-brain barrier to prevent most vectors of attack so that this system stays largely uncompromised from external influence.
We even have trouble getting meds to cross this barrier oureselves, it's that good at it.
It's there for a reason, any kind of infection in the brain is usually burnt out soon or a death sentence.
Sure, maybe we had parasites that could make us feel happier/more confident or make us more energetic without killing us, but if feeling that happy/that confident or that muscular would be universally good for us, we would already have evolved to be that happy/confident/energetic in the first place.
[not clear what's in it for the parasite or if effects like that are plausibly achievable]
This would come out the same as randomly dosing people with antidepressants, stimulants or anabolic steroids. [think of the side-effects of all that!]
It would do way more harm than good.
Actually, there are fairly simple drugs like amphetamines which do make people feel better and more energetic, even if it's at a cost to the person-- and not always at a cost. Careful doses can be good for people.
For that matter, a disease that produced the effect of alcohol would be helping itself spread.
So I don't think there's a general argument against diseases with pleasant symptoms. Perhaps we don't notice them and/or blame their ill effects on diseases that do have painful symptoms.
[epistemic status: sloppy but mostly right I think. Sloppy must suffice, because I don't want to look up the role and structure of ribosomes (eukaryote protein factories), neurotransmitters and hormones and compare the complexity of DNA vs RNA, bits of info between human DNA vs virus RNA..... cell biology is too long ago for me to get the details right and it would be an infinite rabbit hole, since too many things are plausibly relevant to the question; a cell biologist could explain this better]
Yes, simple molecules can have strong effects.
But hormones, neurotransmitters or amphetamines are not replicators.
They are less alive than even a virus. Products, not producers.
Human cells specialize and create specialized environments.
And we already do produce hormones and neurotransmitters ourselves thru specialized cells in protected environments (ribosomes in organs, various glands and all that). Multi-celled eukaryotes like us can do that, because it's coordinated by the same DNA.
Specialized cells don't have to worry about being hunted by the immune system. [unless you have an autoimmune disease]
Or about plundering access to energy, that's also a given.
They don't have to compete with anything else either.<br>A foreign organism is in a hostile environment, because it's not part of the larger multi-cell system. All the resources it takes, detract from what's available for native cells. It won't be protected, it will be hunted down.
HIV manages to not get hunted down, but it does so by attacking the T-Cells of our immune system, which fatally compromises it.
Let's assume that creating a specific (undiscovered) aphetamine saves your life from AIDS and makes you immortal as well. [like.... such a molecule just exists, is fairly simple and it works reliably on most people it infects, so that HIV could be symbiotic]
And that the HIV virus could mutate into that miracle-amphetamine factory.
What's in it for HIV? An immortal host would be neat.
But HIV has a generation time of 14 hours. In order to evolve into producing those miracle-amphetamines, a lot of mutations would have to occur in-between, since evolution happens only in minimal incremental steps.
But each incremental step to building a factory would have to be competetive. And there's no reason why having a quarter, half or 90% of the parts of a factory would be a competetive advantage against non-mutated HIV-virusses.
But in that time, there is no incentive for HIV viruses to evolve to produce amphetamine for you.
Hypothetically, a virus wouldn't have to produce significant amounts of neurotransmitters, it could just prod the body to produce them.
The Toxoplasma Of Love?
In a very very naive and simplicistic way, the virus wants to use some of your energy to replicate itself. You want to use your energy to survive. So your body will always be trying to kill the virus (a defense system that assumes that every virus is bad will fare better than a system that tries to differentiate good and bad virus, in the long term).
I would not expect the body to stop fighting an infection just because the human thinks its nice. However, having the conscious mind not trying to fight the disease, so not holing up in bed, taking medicine, avoiding contact, all that should be an evolutionary advantage for a disease, while killing their host should be a severe evolutionary disadvantage. The body may fight the disease, but that can be helped or hindered by the conscious acts.
Yet we have hundreds of cases where the evolution of the disease goes towards "kill the host" and none where it goes towards "make him feel good". That is surprising to me.
(I remember reading in a book by neurologist Oliver Sacks that syphilis can have such an effect, that he had a patient who suddenly felt more positive and energetic and deduced that that must be "amor's arrow", a resurgence of syphilis she had in her youth. So the mechanism even seems to work in practice, only it plays out like this only in a tiny number of cases, and usually syphilis tortures and kills you.)
If the virus manages to spread before killing the host, that's enough. It's like the reason why diseases that affect just the elderly don't quite disappear with evolution: you've already had kids.
We're going in an area that's not my expertise, so take my words with a pinch of salt but: I'd argue that most of the "fighting" the disease is our body trying to stop its cells being repurposed as viral factories. It's not that the virus desires us to feel bad/hole up in bed etc, it's more that our body forces us to do it in order to save energy and be in the optimal condition to win the fight.
https://walnet.org/sos/cupidsdisease.html
Yeah, that's an interesting anecdote.
But Natasha was a whore in her early 20s, which got her infected with syphilis in the first place.
So having syphilis for her was strongly associated with being horny and having sex all the time.
Compare with Marta here who has Alzheimers, but hearing Tchaikoski she moves like a ballerina again.
https://www.tiktok.com/@overtime/video/6893656762864372998?lang=de-DE
That and.... well.... neurosyphilis causes brain damage, which can cause disinhibition.
Disinhibition isn't generally a good thing, but it can spice up a 90 year old's life.
Random brain damage can certainly be subjectively good.
Arguably there are some advantages (as well as many disadvantages) to having ADHD (developmental brain damage).
https://en.wikipedia.org/wiki/Orlando_Serrell
This fellow got hit by a baseball and got savant superpowers.
I would say, that neurosyphilis is about as symbiotic as a baseball to the head.
There's no evolutionary mechanism behind it.
There are plenty of viruses (perhaps including Coronavirus?) that your immune system is capable of ignoring rather than fighting. Hepatitis is like that - in which case the virus will live inside you permanently with no detectable symptoms until it eventually kills you via liver cirrhosis ~50 years later (unless something else kills you first). There's a higher short term cost for the body to pitch a fight against the virus, but in the case of hepatitis it's probably preferable.
Well the immune system certainly doesn't ignore Covid19, but yes I agree on your broad point. I think it's a fool's errand to try and simplify virology to first principles to be fair.
If there was such a 'pathogen', how would you tell? Maybe there's a whole bunch of them, but nobody goes to the doctor because they feel great. In fact, given the shenanigans the gut-brain axis is capable of, there's almost certainly a whole bunch of them.
So, an extraversion/hypomania virus? Cf. toxoplasma getting mice all excited about cats, except it turns out modern cats are pretty chill and give you well-paid murine jobs and hot mice of your preferred gender.
We would have noticed it under a microscope and asked ourselves "what the hell is that". And then we would know about it, after studying the unknown pathogen.
I don't think we're reached the "what the hell is that?" level of knowledge about micro-organisms in people. There are just too many kinds.
There's a disturbing amount of new things discovered because someone looked closer at what looked like just a contaminant, e.g. adeno-associated viruses. The most spectacular, if it pans out, would probably be
https://www.colorado.edu/lab/neurodegeneration/there-brain-microbiome (no paper yet, just some conference talks and wild speculation).
However, the easiest way for this to work would be an undiscovered effect of a known bacterial species - especially since the notion of "species" in bacteria is pretty iffy, strains have enormous differences between them and we haven't even approached fully cataloguing what they do and how.
> Why are there no illnesses that do GOOD things to you?
> Like a flu that makes you feel awesome and full of energy.
*Exclusively* good is a hard one, but I'd mention that 'weight loss' *is* both commonly desired and a common effect of disease. 🤔
I have heard that, somehow, the physical effects of tuberculosis became associated with conventional attractiveness; e.g., https://www.smithsonianmag.com/science-nature/how-tuberculosis-shaped-victorian-fashion-180959029/ reports: "[T]uberculosis enhances those things that are already established as beautiful in women [...] such as the thinness and pale skin that result from weight loss and the lack of appetite caused by the disease. [...] Sparkling or dilated eyes, rosy cheeks and red lips were also common in tuberculosis patients—characteristics now known to be caused by frequent low-grade fever. [...] Middle- and upper-class women also attempted to emulate the consumptive appearance by using makeup to lighten their skin, redden their lips and color their cheeks pink."
I think I'd go with a "misaligned incentives" answer. To feel good, you need your body to exhibit the set of behaviors G (for "good"), but for the virus to reproduce, it needs your body to exhibit the set of behaviors V. Since biology is so complex, there are a vast number of ways for G and V to disagree with each, vs only a few for them to align. So just based on probability, the virus probably doesn't want things that you want.
Also see Scott's "Meditations on Moloch" if you haven't already, for a classic discussion on Why Are Things Not Built To Be Good For Us?
"Like a flu that makes you feel awesome and full of energy."
The flu (kinda): https://pubmed.ncbi.nlm.nih.gov/20816312/
There's also this classic from Oliver Sacks about syphilis: https://walnet.org/sos/cupidsdisease.html
For most viruses, including SARS-CoV2, almost all the symptoms, including death, are caused by your own immune system. A lot of the immune response has to do with killing your own cells, hopefully just the ones that are infected, but mistakes happen. It's generally a destructive process and not likely to make you feel good, whatever the infectious agent.
Teeny tiny nitpick from someone involved in SARS2-sequencing: The British lineage is actually B.1.1.7 -- not B117 -- since there is also a B.1.117 which co-circulates (at least here in Germany).
That already led to some confusion in meetings and emails, and an often repeated clarification that one-one-seven and one hundred seventeen are actually two very different things.
Also, if you want to be all fancy with your lineage nomenclature:
The South African lineage is B.1.351 and the Brazilian one is P.1
You can track them here: https://cov-lineages.org/global_report.html
"There are whole countries whose cuisines are still built around weird decisions they made as part of World War II rationing."
There are whole religions whose cuisines are still built around logical decisions they made when camels were the main mode of transport!
Perhaps I have a bit of a different perspective on the political aspect as I'm from elsewhere (UK), but my biggest concern is the impact on Governance. My concern is that the total suspension of many civil liberties has now been established as acceptable - and what in the future will also be seen as an acceptable reason to implement these.
Also specifically here in the UK, its changed the dynamic of our parliamentary system to something a lot more command and control by the prime minister and his cabinet, with a reduction in public scrutiny by parliament - this concerns me, and I'm one of those actually same side of the political spectrum then them.
And for those who say these are temporary emergency measures, call me tin-foil-hat-wearer but these things have a horrible habit of becoming permanent. I'm still waiting for the 'temporary' income tax to be removed that was put in place in 1799 to cover expenditure during the Napoleonic wars. It would be interesting to predict which government tools become part of daily life, and which will go back on the shelf at least until the next pandemic.
Your comment is quite interesting, but I fear one of us will have to switch usernames or risk confusion.
Ha, well as I created my name a few hours ago, only fair I tweak first :)
Hey, it's a good name, and one not original to me - I can't hold it against anyone else for wanting it too.
I was going to propose some complicated wager in which we make a set of Scott-style numbered predictions, and whoever predicts more accurately gets to keep the name and title of Psychohistorian. And I'm still open to that if you are, for fun's sake if nothing else.
Before now, I'd hardly seldom seen a Hari Seldon
As an expat currently living in Taiwan who was really hoping to return to the US this year: This feels seriously depressing. It sounds like there is a very good chance I won't be able return without getting some variant of the coronavirus at some point. I'm not in any super high risk group, but I'm really not looking for long-term brain or lung damage. And I don't have quite as much faith in American institutions as does Scott.
Still, it's good to get a sobering dose of reality. Now I can consider what I would need to do in order to stay here longer.
I'll echo this exact message, except I'm expecting to return from Thailand at the end of this year.
You have an extremely low probability of getting long-term brain or lung damage. Especially because by the time you leave Taiwan, cases will be minimal. COVID is going to become a background flu-like illness for the young, healthy population.
Also: why not just get vaccinated as soon as you come back?
Currently, what I'm expecting midyear is the following:
1. I will have a vaccination, most likely the AstraZeneca one since that's what Taiwan's bought the most of
2. Most of the US will be vaccinated against Coronavirus Classic
3. Other variants will be making their rounds, and I will have a decent chance of catching one if I return to the US (since AstraZeneca seems to be less than great against the mutations).
I am technically "young and healthy" (33, maybe 10-15 lbs overweight) but I do keep hearing an unrelenting stream of horror stories about long covid even in that population. And generally my impression has been that the more research we do, the more long covid we find, and the worse it appears to be. I haven't attempted any rational analysis of that, however, so I could be wrong. It's something I'd like to explore in more depth (unless anyone knows of any good analyses at this point).
I don't know why you keep saying you will have a decent chance of catching a variant. Cases are going to be a fraction of what they are today by midyear. That plus AZ and you're golden. All vaccines reduce viral load. You're not gonna get Long COVID if you're vaccinated.
Does the FDA approval process matter all that much (or is its slowness typical for other vaccine-producing countries)? The rest of the world also creates vaccines. If the FDA is so slow that the rest of the world has vaccinated everyone already whilst they are still playing golf, then traveling US citizens would simply get vaccinated on arrival or be sent back at the border. Assuming they wouldn't have to be quarantined and tested for new strains first, if the US remains a permanent refuge for ever-changing mutations.
So new reader here. Excellent post with which I mainly agree although not sure if we get new vaccines down to 2 months - if we bet early enough based on Southern Hemisphere spread may be okay if it’s a bit longer. But a flu vaccine like model could work. Three other points 1. Therapeutics- if we get some highly effective measures against capacities that are required for the virus that changes the equation. Some interesting studies including one reverse engineering existing drugs at UCSF but not proven yet. Second excellent review recently in Science (sorry don’t know how to do the link thing yet) on how coronaviruses become endemic - they continue to hit young children who have mild disease and are not immune while the rest of the population is as you describe. There were some reports of a tilt to this pattern in the UK and right now in Boston persons between 0-19 are the highest group with almost no hospitalizations thankfully. Is this the beginning of wave 4 or is the UK variant already more widespread than we know ?
Right now Moderna and A-Z have x capacity to make the mRNA vaccines. Thanks to the crazed DIY vaccine article from last week, it appears that making and getting the peptides for the "classic" version of the spike is not hard.
So how do we create 5x capacity? Is it the lipid sheath that holds us back? Lack of trained personnel to run the factories?
We know this works. How do we scale it?
We also need a way to push this out to the 3d world or they will always be a disease reservoir.
Lipid sheath. The details seem to be trade-secret but our best guess is that they can't get this to work at scale apart from running a load of lab-bench-scale setups in parallel. https://blogs.sciencemag.org/pipeline/archives/2021/02/02/myths-of-vaccine-manufacturing (also it's Pfizer and Moderna that are mRNA. AZ is modified Adenovirus)
Is the problem that the push to get this out fast fast fast meant that they didn't have the time to work on solving how to scale it up to industrial-scale production, or with the process itself that you just can't do it in large batches?
If it can only be done in small batches, we can still mass-produce the small-batch-producing machinery and have a warehouse full of the things running in parallel. But in the age of highly optimized just-in-time manufacturing, there's not enough slack in the system to quickly shift from mass production of what we wanted six months ago to mass production of what we need now. And much of what slack exists, is in places like China.
This isn't entirely or even mostly a bad thing; in 1940, a basic sewing machine cost an inflation-adjusted $500 or so, compared to $100 today. But in 1940, the sewing-machine factory was in the United States and could be retooled to produce e.g. machine guns in a few months if something came up where we needed lots of machine guns.
I like your approach of making testable predictions. Much better than just stating opinions. I am still proud that I landed a good prediction of the number of deaths at the end of March in Germany. I am a bit less proud that in summer, I considered the whole second wave of Covid infections "rather unlikely".
In the interest of keeping myself honest, here are three things that I've gotten definitely wrong in, like, April, about covid:
1) I expected that countries which did well in a first wave will also be relatively fine in second and subsequent waves. Ups. Some of them were, but many weren't.
2) I expected substantially more deaths per capita in Europe than in the US. There are huge reporting issues in parts of postcommunist Europe but nevertheless this was also clearly wrong.
3) I definitely didn't expect that countries in historically Chinese cultural orbit (to which I include also Japan and Singapore) would do as a bloc so much better than the rest of the world, despite big differences between their political systems.
Experiencing a wave doesn't seem well-correlated with how an area handles the subsequent wave.
I don't know how to study this, but I bet the real determinant is how people reacted to the first wave. If it was "I only needed minor adjustments before, I only need minor adjustment now," they may have only gotten lucky the first time and are going to get hit.
If it was "oh, these are the adaptions we need to make, and I can figure out how to tune these as the situation needs it," they're well-adapted to wave N+1.
For 1) and 3) I would have agreed with you - and so, I think, would many other people. Why did you think 2)?
Glad to see posts like this. Which reminds me - I’m happier to be wrong on Scott’s blog than anywhere else in my life.
Ad 2), I thought that postsoviet countries will be a mess (well, that was correct), and that EU will not be able to muster coordinated response while also being unwilling to be sufficiently strict about closing internal borders. That was also correct. What I got wrong was how bad it will get in the US.
re 1) - same. I overestimated national pride at beating the first wave and underestimated lockdown fatigue. By a lot. By the way I'm in one of those countries that nailed the first wave and failed the second.
3) is a weird one. The Chinese cultural orbit has had a much higher population density than europe for much longer than the west. Those societies have had a much stronger historical pressure to deal with pandemics than we have. This is reflected in social norms that deal with hygiene; masks have been the standard in those parts of Asia for decades.
I haven't heard about convalescent plasma therapy in a while. Shouldn't this be easy to scale up now, considering we have so many recovered?
Also can you transfer vaccine protection via blood plasma? Would be lovely, if I could simply let my grandma donate me some plasma, instead of waiting till September when it's my turn.
I went looking for a source, but only found "we don't know for sure so we can't say anything" butt-covering:
https://www.kare11.com/article/news/verify/blood-donations-not-plasma-after-coronavirus-vaccine/507-bd10c561-3a19-4fde-9f25-99a8b475ba94
I'm not a biologist but here is my guess. If grandma got vaccinated in the past few months, she would have antibodies, which would provide you some *temporary* protection and/or ability to fight back, but not give you the longer-term immunity from your body making its own immune response, since I don't think donating blood gives out the T-cells.
That's "access denied" for me. Geo-blocked? I'm in Germany.
But I could have grandma's antibodies fresh in my system, get myself infected, and fight Corona on a battlefield stacked against it and in the process gain more permanent immunity?
Considering that young people are mostly asymptomatic anyway, couldn't we just use this to give all the strong & young people immunity quickly, so they can stop being in lockdown? From what I understand, the younger age groups have seen increased rates of suicide larger than deaths from Corona.
Though I don't understand why lockdown even applies to people who already recovered or are vaccinated.
> But I could have grandma's antibodies fresh in my system, get myself infected, and fight Corona on a battlefield stacked against it and in the process gain more permanent immunity?
That's. . . not a bad idea. I wonder if some rogue group of citizen-scientists could just do this and report what happens.
This could have worked even before the vaccine, for that matter.
It's a bit silly right? We all pretend that we are scared of the Corona-virus.
It's publically communicated, that we should be scared and everyone agrees..... the Corona-virus.... yes, very scary, nod, very serious.
Like if a person is scaring you, fucking them up, before they fuck you up is always a salient option.
But if I was actually really scared of long-term brain damage or being ventilated, I would have done that already.
I don't want to do it, because I don't want to make a fuss or stand out. Actually, I wouldn't mind, I just don't want to bother my grandma.
And I didn't know anyone who had Covid. And that all seems like an effort.
Like those things would matter, if I was scared for my life!
The optimistic interpretation is, that the idea is actually not feasible and that's why nobody is doing it. [well unless someone already did, in which case nvm]
The pessimistic interpretation, that we're all just scared more of breaking with societal norms and acting independently for what is in our best interest.
I think you are interpreting the "neverending lockdown" concerns too narrowly. Mask mandates on subways are one of the least bad scenarios that could happen. "Long Lockdown" in a wider sense can include things like:
- Independent and diverse restaurants going bankrupt and ceding space to chains. This won't be easily reverted, as most customers will be eager to eat out *somewhere* and thus end up supporting the chains.
- Public schools never going back to their pre-pandemic functionality, as parents who care about face-to-face instruction have left, and those who remain are either those without the means to find an alternative or those less concerned with the quality of instruction. Evaporative cooling, to use the language of this blog.
- Women leaving the workforce for good, partly because of the previous point. It remains to be seen whether this will be permanent or will last until the next economic upswing. I don't think men's wages will rise anywhere near enough to make up for this; I expect to see a lot more broken families and delayed pregnancies than successful returns to trad.
- The panda in the room: A new-found trigger-happiness of Western governments to pre-emptively suspend basic civil liberties (freedom of movement, assembly and commerce) based on opinion from medical experts or -- even worse -- epidemiologists. After all, we can't wait for the virus to come to us, can we? This sort of thinking has become popular after COVID-19, to the point that experts are now berating Western politics for not taking previous epidemics (SARS-1, swine flu, avian flu, ebola) seriously enough. But what would it mean to take them seriously? Border closures during travel season? Mandatory quarantines? Countries like Italy and France have taken the axe to civil liberties in ways that no one had seriously entertained since the 1960s; inter-European borders were closed for months. Demonstrations were outlawed in several countries, and at least one (Poland) has used this occasion to ram an unpopular law through. While the most stringent measures that have been actually taken in the US were restrictions on commerce in blue states, the European model was being seriously discussed in media and often positively contraposed against the American laissez-faire one. Unsurprisingly, a general feeling of "it could happen here" has emerged. Meanwhile, no one has bothered to delineate the level of danger that warrants extreme measures like stay-at-home orders and border closures; by the standards that are emerging, we could have a pandemic scare every 3 years, not to mention that a less scrupolous government could easily pull one out of its hat whenever convenient.
All of these concerns would have looked paranoid some 10 years ago, where the typical Westerner believed liberal democracy was self-sustaining at least in the ever-growing Dar al-Democracy, and whatever mistakes politicians would make the market would fix with its gentle invisible hand. Suffice it to say, one thinks of solid ground differently after an earthquake.
Could not agree more. After the first wave (I'm from Belgium) i could still entertain "the democracy is solid and means government by the people with basic rights safeguards in place" illusion: i though that, while incompetent, gouvernement was basically doing his best in the middle of a dangerous pandemic situation, with the interest of a majority of citizens at heart.
After the summer lull and the second wave, i don't think so anymore. We are not yet in a classic dictature, probably never will be (China has shown a more modern, subtler (for most) way is possible and preferable), but we are certainly not in the democracy in the name of which we were so prompt to give lessons to the world...
I agree with all these concerns.
Regarding the restaurant one, though, don't independent restaurants rise and fall very rapid turnover already? I would expect a new generation of small-business restaurants to arise within a few years, conditional on a state of general economic health.
Regarding your "panda in the room," it's hard to see much reason for optimism. The combination of a semi-permanent "pandemic mindset" among civil authorities combined with overly aggressive crusades against "disinformation" online could be an ugly one.
contrary/optimistic take:
Backlash to lockdown in Germany lead to superspreader events, maskless demonstrations and a protest movement. This made the lockdown less efficient.
So if a Corona-style epidemic happened again, our government would already know that large parts of the population will not accept prolonged lockdowns. Hence they are a non-viable strategy.
So it will switch to extreme early lockdowns, but with a guaranteed end-date.
Are you sure our government is teachable? I have seen Macron's recent reluctance to impose serious lockdowns attributed to such reasoning, but German politicians delight in any opportunity to show the populace who is boss, *particularly* when it doubles as an opportunity to hit back at the AfD.
Prolonged German-style lockdowns have proven relatively viable so far -- in large part *because* they aren't as disruptive as what the French and Italians had to offer. (Note that even the Querdenken movement has stopped protesting -- although they have promised to come back in Spring.) On the other hand, "extreme early" is exactly the thing that makes me most worried, particularly since it's never a one-time things; Australia and NZ had to declare these lockdowns several times now, and Germany isn't half as well isolated as these.
[epistemic status: eh..... yeah probably]
I don't think it's impossible to secure the border.
Or at least, secure it enough, that it would minimize infection from outside.
Sure, the refugees got in, but as I understand it, there was no political will to stop them. And during a brewing pandemic, I wouldn't expect masses of people to suddenly want to move in, anyway.
I think they can't back down now and have to stick to lockdowns, even if protests would make them pointless in spring. Can't show weakness.
But assuming we don't get a Covid 19, 20, 21, 22, forever-scenario and there will be a round 2 in a couple years (or a decade):
Merkel isn't going to be around any longer, which makes me hopeful that the CDU will be more representative of the right wing again.
Which either kills the AFD or makes it get its act together.
The continued marginalization of a third (?) of the population seems unlikely.
Next time, we can count on everyone already having masks lying around.
And I'd expect that we'd have a strategic supply of 80 million FP2 masks stockpiled, ready to send out at the first sign of a pandemic. Perhaps we'll have something better than FP2. [why wouldn't we?]
Also we won't let all our masks be bought up by Chinese people sending them back to the mainland. [that happened, lol]
I do hope that more houshoulds will have toilet paper stockpiled.
There might be a contact-tracing app mandatorily preinstalled on every phone that isn't a privacy nightmare and activates only when a pandemic has been declared. The Corona-Warn app has a very improvised feel to it.
Something better than that, at least.
VR will be more mature and internet more reliable, homeoffice more common, so restrictions won't be as disruptive or distressing.
And I just expect every citizen, every bureacrat, every politician to have learnt what works and what doesn't. It's awkward to point to "experience", but I do think, that alone matters a lot.
Not to mention, that there's probably going to be institutions that will spend a lot of time analyzing everything with the benefit of hindsight.
And that will turn into the benefit of foresight for round 2.
Italy was overwhelmed with patients dying on the floor, whilst our doctors had nothing to do. Why wouldn't we have agreements in place between EU countries to send doctors and medicine in mass, when any one system gets overwhelmed? We can't do this right now, but it seems doable after this round is over.
Fundamentally, a pandemic just isn't that difficult to contain in a modern society. We just never had to do it before.
So naturally, we fucked it up.
But a second time? I think collectively we're not that stupid or dysfunctional.
Agreed, not teachable, but (until proven otherwise) replaceable. Covid is just the last event that accelerated (on, accelerated a lot) a broad tendency of gouvernents feeling justified in teaching the populace and protecting it against itself, instead of being just a practical and safegarded way to implement majority wishes. This will not go away smoothly. My only hope, apart from an (always dangerous, you often get worse than what you started with) insurrection, is that the judiciary system seems to be the only counter power still sane and willing to react (see the Netherland, but something similar happen everywhere in Europe). Before the covid i did not think highly of the judiciary system, but i was wrong apparently....
You can see more covid predictions from various platforms here: https://metaforecast.org/?query=covid&starsThreshold=2&numDisplay=72&forecastsThreshold=0&forecastingPlatforms=CSET-foretell|Good%20Judgment|Good%20Judgment%20Open|Guesstimate|Hypermind|Metaculus|PolyMarket|PredictIt
I wonder what you predict/think about Covid "long-haulers" and whether that will distinguish Covid precaution from flu precaution. The anecdotal evidence about the persistence of symptoms and the unknown long term damage to lungs, heart, etc. significantly increases my concern about getting it. If vaccination prevented long-haul Covid, that would be great news.
Some random questions:
1) Genomic surveillance is so spotty in the US. What are the chances that other variants of concern with similar properties to B.1.1.7 or B.1.531 are currently circulating in the US? I read a paper (can't find it now) suggesting that B.1.1.7 wasn't increasing in relative proportion at quite the same rate in California as it was in the UK. One suggestion I think was that there are other variants that are similarly more infectious out in California. (On the whole, if this is more likely then that should decrease our expectation of a large fourth wave?)
2) To what extent is it possible to form an expectation of a fourth wave without mathematical modeling? I haven't seen a tone of modeling that attempts to take vaccination, seasonality and emerging variants into consideration. I think Youyang Gu does this, and his fourth wave is very moderate: https://covid19-projections.com/path-to-herd-immunity/
So, question: are there other attempts to model this mathematically rather than heuristically?
3) In the endgame where SARS-CoV2 becomes endemic, does it have persistently low IFR because of immunity from prior immunity? And more broadly is this what happened with other currently circulating CoVs? Suppose that you took one of the other "common cold" CoVs and removed it from human circulation for 150 years, and then reintroduced it. Would that cause a pandemic, because of weak prior immunity? And would it be similarly lethal?
Oh right, another question:
4) What countries are most likely to be the next "canaries in the coal mine" for B.1.1.7 waves? Would we expect the US to have a B.1.1.7 wave before (say) France?
Italy is currently at 20% spread (meaning one case in 5 is the variant), with peaks of 59% in some regions. I wouldn't treat the US as a unique nation - go state by state.
1) Moderately high in principle, but convergent evolution seems to be present (E484K was apparently developed independently in South Africa and in Kent, UK). There might be an american B117.
2) I tried and failed, uncertainty just makes numbers meaningless. I'd suggest an approach that differentiates variants as if they were a new virus, introducing a weak "pre-immunity" population group.
3) We actually don't know this is what will happen. The risk that it keeps mutating into a more lethal form, also due to vaccine pressure, is theoretically real (that B117 is more lethal seems to be a fact now).
Appreciate the responses. Re 3), I've also seen the suggestions that B.1.1.7 is more lethal, but B.1.1.7 isn't more lethal to people with prior immunity, right?
I haven't seen any data on that particular group, I don't know
>mutating into a more lethal form, also due to vaccine pressure,
Vaccines don't pressure viruses to become more lethal, they pressure viruses to evade the immune response generated by the vaccine. Killing the host is almost always a bad strategy for a parasite, regardless of vaccines.
Ah shoot I keep forgetting questions.
5) Cases seemed to have peaked in North America, Europe and South America at the same time and are declining in all these regions. I'd say "seasonal factors" except South America? Maybe seasonal factors in the Northern Hemisphere plus travel equals simultaneous waves? https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&country=Europe~NorthAmerica~SouthAmerica~Africa®ion=World&casesMetric=true&interval=smoothed&perCapita=true&smoothing=7&pickerMetric=total_cases&pickerSort=desc
It turns out antidepressants greatly mitigate Covid symptoms. Nature is an impeccable source. The magnitude of the effect reported is great. I don’t know why this is it getting more publicity
https://www.nature.com/articles/s41380-021-01021-4
Is this "depressed people are less likely to have severe Covid" or "antidepressants are effective pharmaceutical interventions against Covid"? If it is the former, I'm going to bet it's simply demographics. If it's the latter... why would antidepressants have an immediate effect? I thought it took days or weeks to get enough in your system so they start working.
The article goes into the proposed mechanism in some depth. Antidepressants turn out to have a lot of antiinflammatory activity. It is the overactive immune system which is responsible for much of the covid created havoc. Not for nothing, there is a fair amount of scientific opinion that antidepressants' antiinflammatory powers are at least in part responsible for the benefits in depression, a condition in which the immune response is disrupted.
Maybe. Who knows. Things like this pop up and then disappear later under closer inspection. Famotidine (in Pepcid AC) had a moment of glory early on as mitigating COVID19 symptoms, there was even a plausible MOA for it, then the effect sort of disappeared. Too bad, as Famotidine is OTC and has an excellent safety profile. The p-value they give, <0.001, isn't really that great. Given all the attention COVID19 has gotten, it's unlikely that, over a year later, something common is going to end up being that useful.
That article isn't in Nature, the journal name is "Molecular Psychiatry", part of the SpringerNature group of journals. This isn't the journal that Watson & Crick announced the structure of DNA.
I don't know if I'd trust Amazon vaccines.
Those on reddit.com/r/skincareaddiction say you shouldn't buy skincare products from them because their problem with fake products. People have said that they've bought from trusted sellers, received brand name packages, and only discovered the product was a knock off because the consistency/color was different from their last bottle (or something worse happened like they got a chemical burn).
My prediction: 100% chance that Joe Biden is going to OWN a coronavirus vaccine failure if his administration does not get its act together and create a national corona vaccine appointment scheduling system. The current every-grocery-store-for-itself mess of vaccine appointment methods is far far worse than the Obamacare rollout site ever was, and is far more infuriating than not having the vaccine at all (ala #trumpolini times)
I'm interpreting your "100%" to mean "high" because it's obviously not literally 100%.
I disagree, because Americans are used to blaming state problems on state authorities, and Biden has already exceeded his early "1 million vaccinations a day" promise as well as his revised "1.5 million shots a day" target and thus can already claim success. Once everyone who wants a vaccine has one everyone's going to look back and remember "Biden came into office, promised us vaccines, we got vaccines" and assuming that occurs before the 2022 midterm elections it's going to be a huge political win for Biden and the Democrats. Only a few contentious nitpickers (like myself) will ever remember that Biden could have done it faster if he'd put someone in charge who knew enough to read rationalist blogs for tips on implementing a vaccine rollout.
Bioprocess engineer here, I wanted to comment on your proposal here:
"They allow anybody to manufacture vaccines and charge market price for them, subject only to usual safety restrictions. If Amazon wants to get into the vaccine distribution business, for God's sake, let them."
This seems like a really unlikely outcome to me, for a few reasons. For a bit of context on drug manufacturing, a drug approval also requires approval of the manufacturing process and the analytical methods testing the quality of the drug. If a drug manufacturer wants to make major changes to their manufacturing process, then they may need to perform new clinical trials to justify the new manufacturing process. This is based on the concept of "quality by design," usually abbreviated as QbD, which is often compared to the older, crappier paradigm of "quality by testing." Quality by testing just means that you ensure product quality by running a bunch of analytical tests on important properties. For the mRNA vaccines, that's probably going to be stuffy like number of copies per dose of the mRNA transcript by qPCR, nanoparticle size by DLS or some other sizing technique, etc. The problem with this approach is that there is always the potential that there is some super important quality attribute that you aren't aware of and don't test for. If you have some critical quality attribute you aren't testing for, then any changes in the manufacturing process that also impact our hidden quality attribute could negatively impact drug safety or drug quality. Therefore, the QbD paradigm was invented, which involves control of drug quality through control of the manufacturing process, so that even if you aren't testing every critical quality attribute, you know you are making a consistent product because your manufacturing process is consistent. All modern drug processes rely to an extent on both testing and manufacturing design for quality control.
Because of the expectations around QbD, it's going to be really hard to open up vaccine manufacturing to all potential manufacturers. You will either need to 1) force the original vaccine maker to transfer all information on their manufacturing process and analytical methods to all prospective manufacturers, 2) make new manufacturers do clinical trials on their drugs or 3) abandon the QbD paradigm and allow manufacturers to develop their own manufacturing processes to make existing vaccines, without a requirement for new clinical trials.
#1 is never going to happen, because the innovators are going to scream bloody murder about having their patents violated. Even potential manufacturers would likely avoid this, because they don't want to set a precedent that the FDA can just seize your manufacturing IP.
#2 is essentially the existing biosimilar pathway, just starting before the existing vaccine patents expire. This is probably feasible in theory if the FDA and Congress nullified all patents on the vaccine drug substance, or they bullied the manufacturers into allowing competition. Even then I can say from experience that making a biosimilar still takes a ton of time and resources. The requirement for new clinical trials will delay the release of the biosimilar vaccines significantly, probably to the point that the biosimilar vaccine is no longer effective against newly circulating strains. I don't really see anybody taking this route.
#3 is basically a supercharged biosimilar pathway where you abandon QbD principles to avoid doing new clinical trials. Without QbD control, you would almost certainly need extensive testing of the biosimilars using the analytical methods of the innovators to ensure comparability. However, you would still need to force vaccine innovators to share their analytical methods, which seems unlikely. And you are still voiding all of the initial vaccine patents to allow early biosimilar competition. And the FDA is super risk averse and is not likely to ever approve of an approach like this.
The more likely scenario for expanded vaccine manufacturing is for the government to subsidize voluntary contract manufacturing relationships. This is already quite common; Lonza for instance is acting as a contract manufacturer for Moderna, for instance. In these relationships, the innovator maintains full control over their IP, and so they can share their full manufacturing process without worrying that the contract manufacturer is going to steal their IP. It's important though that this be voluntary and the innovators get to choose who to work with. While you can sign agreements saying "IP is protected," a contract manufacturer still learns a ton by making a drug. For instance, let's pretend Merck has a fledgling mRNA development program. Moderna is most definitely not going to want to use Merck as a CMO, since that would be giving Merck a huge leg up in terms of manufacturing experience for their potential new mRNA vaccines.
I think part of the problem with "let Amazon start its own distribution programme" is that some of the vaccines needed specialised cooling - the Pfizer vaccine needed ultra low-temperature freezers: https://www.thejournal.ie/freezers-covid-19-vaccine-5286334-Dec2020/
So depending on what vaccine you were getting, storing it in your ordinary system might have ruined it. Letting Jack deliver vaccine in his white van may not be the most efficient method in the end.
That part actually isn't that hard, for the most part. Most of these pharma companies contract out shipping and distribution, so Amazon could just work with the same shippers used by the other Pharma companies.
Before I say any more - full disclosure, I work for a company currently working as a contract manufacturer for a COVID vaccine. I don't actually work on this project myself, but wanted to get that out of the way.
Anyway, if we want to look at crazy big ideas though, my vote is for the US government to buy a controlling stake in Moderna. Moderna's market cap is $70 billion, so the government could probably buy a controlling stake for $40 or $50 billion. Then the government just makes Moderna manufacture as much as possible with all possible partners. After the pandemic ends or winds down, the government sells off it's share, potentially retaining rights to production and distribution of future COVID vaccines. Moderna is probably the best pick for this, since they are much smaller than the other major players in the COVID vaccine space like Pfizer, AstraZeneca and J&J.
This isn't the first time this idea has been brought up. For instance, the company Gilead makes a cure for hepatitis C that is quite expensive. Through Medicare and Medicaid, the US spent pretty large amounts of money on this drug. Someone ran a cost analysis that found that in the long run, it would be cheaper for the US government to buy Gilead and then distribute the drug for free, rather than continuing to buy the drug from Gilead.
I don't fully get your point about intellectual property. Isn't part of the point of the patent system that the inventor gets a temporary monopoly on its invention, but in exchange it has to publish the process? Can a pharma company use both patents and trade secrets to protect its invention at the same time?
At the moment, with our government continuing to impose lockdown while promising that it'll all be relaxed down the line (there will be no St Patrick's Day parades this year, which doesn't have me weeping bitter tears to be honest), I have no idea. Every time something new comes along, e.g. they relaxed restrictions for Christmas, people travelled home from the UK, and we got the new mutant variant and up went the infection rates once again and we're back at Level 5 restrictions https://www.gov.ie/en/publication/2dc71-level-5/
So my natural tendency is to go "things will ALWAYS get worse" but will they get better? No idea.
On the other hand, D:Ream assure me "Things Can Only Get Better" https://www.youtube.com/watch?v=V6QhAZckY8w
I find it very hard to care whether covid is eradicated or not, compared to how much I care that the lockdowns end. I feel like people forgot that these are extreme measures that we shouldn't use unless absolutely necessary.
I remember in January when I heard about the lockdowns in China and thought "that's absolutely barbaric, I'm so glad that can't happen in America." Then in March there was talk about lockdowns, and everyone was duly skeptical, but after looking at graphs and statistics and checking the numbers and careful argument we were convinced that it was necessary. Now when I point out that the specific conditions which made the lockdowns rational (despite the incredibly high cost) might stop being true well before the virus is eradicated, I feel like I'm taking crazy-pills. "You can't stop sheltering in place, you might get covid." I'd much rather catch covid and take my chances than spend another year inside, it's only the structural issues around R0 and hospital capacity that I'm worried about.
The only question I want anyone to ask is "when will the risk of overwhelming hospitals go away, when will the death rate be less than 100k/year, even without restrictions?" If you're wondering how long lockdowns would be needed to eradicate the virus, I assume you've lost track of your priorities.
Yes. As a healthy young person living alone in a blue state I could not agree more. I've been alone in my apartment with zero human contact for the better part of a year at this point! Most of my friends in the area are still extremely pro-lockdown and afraid to do anything but the bare minimum outdoor socializing (which is of course unpleasant in winter) despite all of us being young and healthy and not living with vulnerable older relatives. It has made me feel like I am a bad person for wanting lockdowns to end before the virus is completely eradicated, but the reality is that it's extremely hard to keep playing the game of "virtuous blue triber" when it prevents you from meeting your basic human need for social contact. I am well aware that it's not exactly fun to be stuck at home with partners or kids for this long but it's hard to explain to people in those situations just how profoundly bizarre it is to go weeks without seeing another person face to face. I talk to myself all the time now and it's becoming hard to tell the difference between my thoughts and the words I've spoken out loud. I was never a socially anxious person but I've started to feel uncomfortable with the idea of touching another human being, even for a handshake or a hug, as it's been so long since I've done that on a regular basis.
I'm much more concerned about the long term psychological effects of social isolation than I am about what might happen to me if I catch covid. I fear that I will never be a normal person again if social distancing carries on for another year.
Are you in some place where restaurants and bars are closed? Gyms?
I don't belong to a gym but yes, everything is closed except shops and outdoor dining (I think indoor just started reopening at 25% capacity yesterday). No fun sitting at an outdoor restaurant in winter if none of your friends are willing to go :( At least in summer I could convince a few people to meet up in city parks.
Nicely put, Scott, as usual. What's missing is the public health impact, not of the Rona, but of the response. The illness and death caused by closures and lockdowns. First order effects like suicide, alcoholism, drug abuse. Second order effects like domestic violence, child abuse (includes school closures), depression. Third order effects like unemployment, poverty, and stress. I posit that the public health impact of our response far outweighs that of the virus itself. On the whole, Rona is an opportunistic disease that attacks mostly those about to die soon of something else. All the rest of what I mention impacts healthy, middle age people and, especially, children.
In my country of residence, Georgia, all-cause mortality was below the previous five-year average during the months of the initial lockdown, which allowed us to beat the first wave.
During the second wave the government tried not to lock down, but hospitals became overwhelmed (as in, lines of ambulances waiting outside repurposed hotels; people dying at home because they couldn't get medical care which had all been rerouted to covid patients) and so the government had to institute a lockdown. In that second wave, all-cause mortality was significantly above the previous 5-year average.
So just factually, lockdowns do prevent deaths on net, and in some cases on gross as well (as in, lockdowns can reduce not just covid mortality but all-cause mortality when they're done right). But also, your analysis is comparing "lockdown" to "pre-pandemic status quo", which is simply a mistake: you must compare "lockdown" to "full-blown uncontrolled pandemic". Unemployment, poverty, and stress come about due to lockdowns, but you also can't work when you're dead or on a ventilator, and you also face poverty and stress when an income earner in your household gets too sick to work.
Lockdowns should be limited and targeted with specific benchmarks of community spread to be imposed and lifted. Schools should be the last things to close and the first to reopen, instead of caving to pressure and allowing bars and clubs to operate while our kids learn from home. The specific implementation of *some* lockdowns has caused unnecessary suffering but that doesn't mean that all lockdowns are unnecessary.
By the way here's a paper on lockdowns and mortality that both a) illustrates the difference between competent, limited, targeted lockdowns and the chaos in the US and UK and b) shows that all-cause mortality in New Zealand also actually declined slightly during the pandemic, possibly due to lockdowns.
https://www.scimex.org/newsfeed/more-than-200,000-deaths-from-secondary-effects-of-pandemic
Thank you for your thoughtful reply to my comment, Neal. We do not disagree.
Covid is a remarkable cultural phenomenon that bemuses me endlessly. David Foster Wallace could not have framed it better. There has been nothing like it since the 1960s (when I was a teen). Here in SWFL, where I am now, no one takes it seriously. At my other home, near Boston, it is like Night of the Living Dead. We do, indeed, live in interesting times. (Chinese curse, although not really, I think RFK coined it.)
It appeared in a novel before the RFK speech.
Well done Scott - I like the way you share your thoughts. I would love to hear your thoughts on "What is the Goal?" or "What exactly is the problem we are trying to solve?" I think all would agree COVID has created many problems, so all the more important that we define the biggest problem clearly. I head a wise saying once that "a problem well defined is more than half solved."
I agree with Scott's sense that COVID will always be with us -- a sort of lingering flu like illness that burns hot in certain regions of the country during coronavirus season in Nov/Dec/Jan -- but I think his introductory predictions that we will have further "waves" in March and next Fall extremely pessimistic and unlikely.
First, what do we mean by wave? At this point, everyone knows that case numbers do not quite equal infections and that the scarcity of testing early on in the pandemic makes our first wave look artificially small. The best estimate for true infections that have occurred in the US come from Youyang Gu, who has run the remarkably excellent website COVID-19-Projections and essentially outperformed anyone else in the COVID modeling game. (Link: https://covid19-projections.com/).
Gu's Super Fancy Model estimates that our peak number of daily infections during wave 1 was ~300k; during wave 2 we hit ~250k; during wave 3 we hit ~660k. I will somewhat arbitrarily define a "wave" as a period in which the US exceeds 200k true infections per day. My prediction (70% confidence) is that this will never happen again.
Reasons:
(1) "Herd immunity" reached far lower than is commonly thought, when paired with pro-social behavior (See: NYC, https://gothamist.com/news/coronavirus-statistics-tracking-epidemic-new-york).
(2) People underestimate just how good the vaccines are and just how rapidly the US is scaling up.
(3) The new variants are mildly overhyped. Spread has already hit rock bottom in the UK and SA and our best estimate is that both natural immunity and the vaccines offer robust, if diminished, protection against them.
There's a tendency towards COVID pessimism in the Culture right now and it seems pretty strange to me. Our situation is brighter today than it has been in so, so long. The end is in sight.
I agree strongly with pretty much all of this. I also think it applies to the world and not just the 4% that live in the States. Every single country in Europe has seen cases fall in February, most in a dramatic and unpredicted way. I would bet against there ever being a further ‘wave’ that reaches half the height of the last one. To the tune of a hundred pounds sterling, to anyone who is tempted..
And yet most European countries kept strong measures in place, or even introduced new ones.
It looks like the threat simply can not vanish, not until a large part of the population has been vaccinated, and i think that's exactly what's going on here. Not for health reason (but you will find many epidemiologists pushing for it, if you focus only on virus transmission you push for perpetual lockdown), for political reasons : end of the epidemy without vaccine would mean end of political career (at best) for many.
How are flu vaccines able to get approved on a yearly basis? Do they spend 6 months out of the year proving their efficacy to the FDA?
They don't have as much to prove, and can do challenge trials to show efficacy and safety.
I don't believe that challenge trials are presently used in the development of yearly influenza vaccines, though they may have been in the past. But not having as much to prove is definitely the case on the regulatory front - the process for approving a new flu vaccine is done under different rules for other drugs and vaccines, grandfathered into the system in ~1960. Everybody, even the FDA, trusts that a new flu vaccine developed the usual way will be tolerably safe and effective, and so much less is required in the way of proof.
FDA officials have said the right things about wanting to have a similar system for coronavirus vaccines, but they haven't committed to actually doing it.
The news cycle is currently saying California = Heavy Lock Down but Florida = No Lockdown and Both Have Same Outcomes. What are the best arguments for and against this kind of thinking? Preferably not mechanistic argument (masks and lockdowns HAVE TO do something so this CAN'T BE RIGHT).
Best argument I've heard is masks do stuff, but legal lockdowns do next to nothing. Not because staying away from people & closing businesses do nothing, but because people don't care what the law says and will either visit friends or socially distance as purely a function of the rates of COVID. Similarly, while businesses will listen to the law, many of them will also close down before the government says they need to. Likely as a combination between "politicians don't want to upset business, so more businesses closed means fewer businesses upset, meaning lower opportunity cost to shutting down operating businesses" and "businesses don't want to be seen as irresponsible or not-hygenic, it'd be bad for them if it became known that people got sick from going to them, and the higher the rates of COVID, the lower their customer base anyway, so eventually it becomes unprofitable to continue running".
Also, the argument goes that mask mandates do next to nothing for the same reasons.
My personal observation is that mask compliance varies wildly among different groups. That scream natural experiment to me. I hope people study it.
I think there's also a counter force. Here in MN we had a hard shut down on bars for a while. A few loud-and-proud bars defied the rule, stayed open, and advertised the fact that they did so.
This doesn't mean that they operated just like before COVID. This means that they became a gathering place for people making a statement about COVID response.
But... on the other hand, no one can point to any uptick in infection rates, either.
My personal, totally unsupported, totally based-on-my-priors, is that transmission rates are a function of many, many variables, and "lockdown 1/0" has a very low weight compared to lots of other things that are not convenient nobs to twiddle like the weather, micro-population getting exposed all at once or sequentially, etc. Its all a giant, multi-variable function with non-linear feedback loops. Big policy changes can probably make big impacts in very short time frames (remember 2 weeks to bend the curve) but wash out quickly, the same way pent up demand washes out in economics.
I'm under a curfew right now, in Georgia-the-country. I was opposed initially but I am becoming convinced that it may be effective, in combination with restaurant/bar closures, based on the numbers I've been seeing during the curfew, especially as other measures have been imposed and lifted. So basically they've closed indoor bars and restaurants, so people would naturally want to take their social gatherings to someone's house. But you can't travel after 9pm, so... I mean, I suppose some people will be willing to have overnight house parties and stay locked in until 7am (I've certainly done it, pre-pandemic), but it's far fewer than the number of people who would be willing to go out drinking until midnight or 2am or whatever, and happens far less frequently. So it's (obviously) not that traveling at night causes covid transmission, but rather that traveling at night facilitates other activities that cause covid transmission.
There's been debate locally about whether the curfew + bar/restaurant closures are really a "lockdown" or not but I think they qualify enough to make the point: strategic, targeted lockdowns can indeed reduce transmission rates. If I had to estimate the impact of just the curfew + bar/restaurant closures I'd say it's accounted for about a 15% reduction in infection rates here. That might sound like "next to nothing" but if it pushes R from 1.1 to 0.95 that's a very big and important difference.
Mucocillary clearance is enhanced with higher humidity. Most of this early winter, much of California was in low teens to single digit RH (especially SoCal). The mucocillary clearance effect is true of all respiratory virus ( https://doi.org/10.1073/pnas.1902840116, https://doi.org/10.1146/annurev-virology-012420- 022445). Perhaps part of the current decline in COVID in California comes from the start of noticeable precipitation (my speculation... no references I can provide here).
It's pretty much never less than 45-50% RH in Florida.
Additionally, mask wearing that covers the wearer's nose and mouth with a good seal raises the humidity of the wearer's inhaled air which has recently been proposed to improve the wearer's viral infection resistance: DOI: 10.1016/j.bpj.2021.02.002.
Well, I've seen the exact opposite claim here in europe, where the cold weather + decreasing covid was explained by maximal contamination with 60% RH, 10 degC, because it's favorable to aerosol persistence...
My guess is that many places start to have burned off vectors for virus, that herd immunity is much less than the 70% for some reason. And that indeed coldish not well ventilated places can really boost transmission : too many case clusters in warehouse and slaughterhouses to be by chance, that is often the only cases remaining when the epidemy is slowing down...
I'm having trouble finding an article that supports the statement "maximal contamination with 60% RH, 10 degC because it's favorable to aerosol persistence...". While searching for those conditions in a study, I did find a few other papers with analyses of subtropical regions comparing flu/COVID and factors such as socioeconomic conditions (https://doi.org/10.1016/j.envres.2020.110184) and a systematic review of temperature and humidity on the spread of COVID (https://doi.org/10.1371/journal.pone.0238339).
Perhaps, the "[...]maximal contamination with 60% RH, 10 degC[...]" refers to the outside conditions? Unless active measures are taken, these outside temperature/RH conditions would result in a lower RH at warmer inside temperatures. The studies seem to support that lower RH both increases aerosol persistence and disorders mucocillary clearance.
Perhaps I've just not been able to find the reference for the opposite claim?
Sorry, in french: https://www.europe1.fr/sante/covid-19-comment-la-meteo-influence-la-circulation-du-virus-4024703
Summarizing: very cold or very warm is not favorable for corona transmission, cold weather prevent droplets to stay airborne, warm makes them evaporate, it's intermedaite temperature with 60-80% RI that maximize aerosol dispersion...
My take: the unusual cold weather in western europe last week was making headlines, and corona statistics didn't bulge (i.e. constant if slow drop of all indicators in most of europe). They need to link the two with an hint that we are not out of corona, that once we will be back to normal end-of-winter- early spring crap weather of cold-ish rain, corona may be back with a vengence, so don't relax!
Bingo, this study was exactly what they were looking for. Modern science reporting at its best...
Thanks for the link, Greg. Fortunately, there are translations available for this popular news link.
I tried following through on scholar.google and, as yet, 2/17/21, there aren't any publications, peer-reviewed or pre-viewed, on the stated conclusions of this popular news report. Perhaps the scientific research hasn't gotten through the French Ministry of Health review process yet?
While searching for a more detailed reference to the "60-80% R[H]" claim, I found a multivariate analysis comparing T, RH, elevation, population characteristics (LaborAge vs SchoolAge), sub-national regions (to account for variation in temp/RH/population density in larger countries), etc. Very thorough Methods section.
https://doi.org/10.1016/j.jclepro.2021.125987
It includes a consideration for a lag in viral host incubation period (+test/hospitalization/death) plus the implementation of government policies such as lockdowns.
The limitations of the study include the data set analyzed (sources provided) ends with the beginning of June 2020. The authors do propose providing a regular update as fresh data become available.
From the abstract: "The result shows that temperature and relative humidity are negatively correlated with COVID-19 transmission throughout the world. Government intervention (e.g. lockdown policies) and lower population movement contributed to decrease the new daily case ratio. Weather conditions are not the decisive factor in COVID-19 transmission, in that government intervention as well as public awareness, could contribute to the mitigation of the spreading of the virus."
This work covered all available data through May 31, 2020, entered the peer-review process Nov. 2020 and was published Jan 2021. I think we'll be seeing a lot of work getting through the peer-review process covering larger, increasingly accurate data sets over the next several months.
Florida seems to have a higher percentage of its residents vaccinated. Not sure how much of an effect that might have, but probably not nothing.
Florida also seems to have a somewhat higher infection rate right now, contrary to the "Both Have Same Outcomes" claim. Again, not sure how much of a difference we're calling "same" and how much we're calling "different".
I wonder about population structure (age, living arrangements, density of social networks, etc.) and the impact that might have in terms of confounding lockdown effectiveness statistics. Maybe Floridians live in smaller towns and Californians live in bigger cities and so the average Floridian is already exposed to fewer people. Or something along those lines. I'd argue that the better way to measure whether lockdowns are effective would be to look at whether and how much the infection rate changed about two weeks after a lockdown went into effect within a single location. Or maybe you try to compare e.g. urban areas to urban areas and rural areas to rural areas, rather than a whole state to a whole other state.
I've been seeing articles about a treatment being developed in Israel: https://mynorthwest.com/2567116/inhalable-covid-treatment-israel/
Any chance this will be a game changer?
What I do not get in this whole Covid mess is why no country so far pushes well engineered comfortable masks with a good seal and long lasting efficient filtes with low breathing resistance in a much more aggressive way, espcially since the general effectiveness of masks is no longer really in doubt. Instead we are stuck with cheap one way products that most people either wear wrong or not at all and that get quite uncomfortable after an hour or so and essentially cannot be worn during any kind of serious physical exertion.
I have written about this at length (https://www.lesswrong.com/posts/yKYg6D7HNxLuJDcLS/hammer-and-mask-wide-spread-use-of-reusable-particle) back in April last year before wide spread mask use was a thing and think I deserve some credibility for calling the "masks don't do anything" bullshit hard and early.
It becomes increasingly clear that between mutations that evade the antibody response and the fact that only 70% of people in most countries are willing to be vaccinated vaccination will not be the silver bullet we hoped for. Thus I think implementing such a strategy, at least as backup for the next winter is a very sensible and comparatively cheap strategy that would also protect us from potential future pandemics after Covid.
Does anyoe have a good idea how to make this idea more public?
Because for technocrats, masks are a costless solution. Why would technocrats push to improve on that when there are so many other projects to work on? Technocrats generally are blind to costs like queue length and physical discomfort. That's why, for example, the TSA (last time I checked) has never compared the time spent in line for screening vs the length of lives saved by screening, or attempted to quantify the discomfort and hit to dignity that is experienced when a traveler has their genitals touched (through clothing) by a stranger. Its just not in their decision criteria.
Indeed... Also the incredible attack on non - economical life we had here in europe (gathering forbidden including in your own house, with police allowed to enter your house with barely any check in place). This could help control the epidemy and will not cost a penny, great idea!
Generally, it seems that your proposal requires
1) convincing governments to introduce stricter mask requirements
2) convincing governments to mass produce masks (but maybe the market will take care of this once 1) is achieved)
3) convincing people to wear such masks
I fear that the pandemic has shown that even one of those steps in isolation is really difficult. It took (and is still taking) ages for rapid tests to be approved, and the usefullness of this idea is pretty evident. Broadly, any plan relying on a small group of volunteers to change the government's mind does not have a high chance of success currently.
Also, in particular, people are willing to wear masks in situations where risk is not generally high. Shopping and public transport do not seem to account for a lot of transmissions, but mask mandates focus on these places. Increasing mask efficiency in those situations would not really prevent many transmissions.
On the other hand, meeting friends, going to restaurants, or at the workplace are situations where people do not seem to be willing to wear masks or accept mask mandates (although I have heard that Italy did require mask usage at work, so who knows). With the exception of doctor visits or for teachers, I do not think that increasing mask efficiency has much potential for good. Do you think there are situations that I have missed?
You didn't discuss the possibility that higher-contact people have gotten COVID already and the remaining vulnerable population is lower-contact.
From contact tracing we know that COVID spread is highly differential -- super spreader events and other infections going nowhere.
Maybe enough of the super spreader pathways have been exhausted.
As a lower-contact person, I don't want to be stuck being lower-contact indefinitely, so I'll personally be very happy when I'm vaccinated and can revert to a set of behaviors that would, at this point, put me and my loved ones at great personal risk.
In other words, it may be true that risk-averse people like myself are forming some kind of protective layer over society stopping r from shooting up into the sky by staying home all the time, but we'd rather not do that forever and every day the pressure to defect grows.
You didn't discuss the possibility that higher contact people have gotten COVID already and the remaining vulnerable population is lower contact.
From contact tracing we know that COVID spread is highly differential -- super spreader events and other infections going nowhere.
Maybe enough of the super spreader pathways have been exhausted.
India apparently has a bunch of vaccines but can't get them deployed for various reasons.
https://www.theguardian.com/global-development/2021/feb/14/we-took-a-huge-risk-the-indian-firm-making-more-covid-jabs-than-anyone
"Instead we have a patchwork of approvals and I have 70m doses that I can’t ship because they have been purchased but not approved. They have a shelf life of six months; these expire in April."
Great, thanks for this. Probably waiting for the FDA. There's also AZ doses sitting in a Baltimore factory. I don't understand why this story is not more widely reported!! #UnclogTheFDA
1. Daily deaths is a far better visualization of the waves in the US. Confirmed cases make the first wave appear small, but when you look at deaths you can see the first wave was nearly double the size of the second wave. When you do check your first prediction, accuracy should be determined by checking daily deaths.
2. I highly doubt that once we reach some sort of equilibrium with the coronavirus that we'll need yearly updates to the vaccine. Right now it is "mutating quickly" because there is a huge number of replication events combined with the fact that the virus is still getting to know us. Once infections are down and the virus has discovered most of the "low-hanging fruit" mutations that provide large jumps in fitness, the rate of mutations will drop and the availability of mutations that provide large jumps in fitness will also drop. In fact, my prediction is that the only thing needed to drive the risks of covid down to the levels of the flu is a single exposure to the original strain of the virus, whether that exposure comes from the virus itself or the vaccine. After that, exposure to the newest variants might cause symptomatic infection, but the "old password" will still give previously exposed immune systems a major head start.
2b. My point above isn't a counterargument to your prediction that public health officials will recommend a yearly vaccine for the newest covid strain. Just saying that I think a yearly update will be major overkill after ~2022.
3. Many of your predictions have some vagueness that will make them difficult to check. For example, the prediction about mask usage on an average street in SF Bay Area seems particularly difficult/expensive to check. Maybe change it to focus on something you can easily check, like the proportion of businesses that still require masks (easily checked by viewing signs on doors). Also, this prediction seems to be a prediction about wearing masks OUTSIDE, which could change if people finally get the message that covid doesn't spread well outside. So, its entirely possible that your prediction is "correct" even though we're still living with ridiculous mask requirements.
Nice info as usual! Does anyone have a prediction about when schools get back to normal or what they'll look like in the fall? My 7yo is going to in-person school with restrictions and here's what those restrictions look like - Everyone is masked, which still makes me so sad to see. He gets 15 minutes to eat lunch because that's how long they're allowed to remove the mask at all. Many of the afterschool clubs and extracurriculars have been cut. A lot of typical activities are proscribed at recess and there aren't so many fun or "special" activities to spice things up. Obviously there are no field trips They're still doing a couple of special in-class events but parents are not welcome. Logistical arrangements were required to e.g. hold more class time outdoors, which obviously isn't feasible in lousy weather. Otherwise they stay in the same classroom all day rather than traveling to different rooms for specials like music or art. It sounds like such a grind to me, for both the students and teachers. It all can't possibly be sustainable long-term, and to my perception there's a lot less joy and anticipation at present.
In the US I think things will get back to close to normal in most schools by the Fall 2021 semester (so, August or September), if not earlier. I'm a teacher (but outside the US so take this with a grain of salt) and so I feel some sympathy to US teachers and teachers' unions who are being pushed to open without the recommended safety measures being available and without the recommended benchmarks being met. That said, I think that the natural result of pushing people to take risks they don't want to take is that they will a) not be at all enthusiastic or in the mood to compromise on what little safety precautions they do have available and b) attempt to exercise as much control as possible over the things they actually have some control over, because the thing they want to control - the right to work from home - is unavailable. So I think that explains some amount of the unpleasantness of schooling right now.
But personally, once I'm vaccinated, I'll be ready to step into my classroom again and I'll be ready to advocate for a reduction in mitigation strategies especially in young children in areas with low community spread.
The information I'm seeing now on the US is that those conditions - vaccinated teachers, low community spread - should be widely present throughout the US by the time schools are expected to open for the fall 2021 semester. Perhaps even earlier, if schools go through with suggestions to open this summer to take advantage of the opportunity for teaching outside or having added ventilation due to warmer weather, or if teachers in some states manage to get vaccinated by April or even March due to successful vaccination campaigns which also reduce community spread to within the CDC green zone for schools.
By the way, where I live, my son was offered a similar chance to go back to school under similar conditions, and we've opted to just keep him home. This "half-schooling" under lockdown conditions seems worse than just continuing to learn online, but perhaps that's my privilege speaking.
Frankly, a lot is obscured in looking at “the peaks” across the whole us. At geographically finer resolution, nowhere that had a bad first peak (use deaths not cases) had a bad second peak, let alone 3 peaks. What looks like new peaks is simply the virus reaching new populations. the speculation about strains causing big new peaks are a bit dumb, seeing as the UK and SA covid cases have both fallen 75% over the past month.
> seeing as the UK and SA covid cases have both fallen 75% over the past month.
That is what it means to come off a peak. By definition.
> At geographically finer resolution, nowhere that had a bad first peak (use deaths not cases) had a bad second peak, let alone 3 peaks.
I'm not sure this is true. New York is getting hit hard, again. https://polimath.substack.com/p/every-states-covid-numbers-in-context-c50
Not really, deaths/day seem to have peaked at 1/5 of their spring rate. Cases are an innappropriate comparison since tests were basically impossible to get at that point so the multiplier of deaths to cases has changed dramatically over the pandemic. This 2nd “peak” is about on par with a flu season (1st one was 4-5x as bad).
UK strain vaccine resistant? Omg. So what is the point in getting the current mRNA vaccines?
1. As Scott said, "resistant" does not mean "has no effect." It means the vaccine is *less effective*.
2. Being vaccinated against the currently dominant strain is a great idea and I can't believe I'd have to explain why.
3. It is extremely likely that the current vaccine will provide at least partial protection against being a carrier, which will reduce the ability of a new strain to establish itself.
Quick questions:
Why is there an approval process for vaccines, at all?
Has any vaccines ever done more harm than good, historically?
Like did some vaccine actually cause autism?
Is there a thalidomide-level clusterfuck that I'm not aware of?
[or if you think those are leading questions......]
What is the argument for regulating vaccine-production?
Here are a few https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html
The Cutter incident was likely the worst, but it was also a production issue rather than a development and testing limitation.
"Is there a thalidomide-level clusterfuck that I'm not aware of?"
There was a case where the study was conducted with people who hadn't had the disease before. As it turned out when the gave the vaccine to people who had already been infected they had a devastating reaction.
A relatively recent HIV vaccine candidate seemed to increase the likelihood of contracting HIV in some groups https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234358/. I don't think it was a huge increase in risk, but still not something you want to be giving people.
One plausible trajectory is that of the Russian flu of 1889-90. Not only is it now suspected to have been a coronavirus, but the patterns of infection and disease were very similar - severe/deadly in older people, almost no effect on children. Speculation is that children built up immunity early on, so as they grew older they had only mild symptoms; these symptoms now present as a 'common cold'. Given that covid-19 also has very few symptoms in children, it is entirely plausible that they will develop a partial immunity that protects them from all but mild symptoms as they grow older. No vaccine necessary.
I noticed this curious pattern emerging from last week's NERVTAG updates.
1. Using the SGTF bio-marker as an identifier for the B.1.1.7 variant, the B.1.1.7 variant is now at 90% of the strains detected across the UK. Yet UK case rate continues to fall, and the hospitalizations rate continues to fall.
2. By case *percentages* B.1.1.7 seems to have a significantly higher R0 value than the "classic" D614G strain. However, some epidemiologists predicted that there would be a new case surge when B.1.1.7 reached 70 percent penetration in UK's virus pool. B.1.1.7 reached ~70 percent penetration the final week of December in most areas of the UK. By those predictions, the UK is past due for another surge.
I've been discussing this with an immunologist friend, and his only explanation is that people are masking and social distancing better now in the UK. I don't know of any way to accurately measure this variable. And I'm far from convinced.
Has there been any writing/speculation that the mutations we're seeing now represent "low hanging fruit" in the evolutionary space of the COVID spike protein? A few of the point mutations in the different new sub-strains are the same, which may lend credence to this idea but I'm not sure.
If my faulty memory serves me correctly there are ~150 epitopes on the S1 section of the spike protein. The epitopes are what bind to the ACE receptor sites on the cell, and are what are exposed to the antigens created by the vaccine. I don't have any idea what all the permutations of epitope combinations might be. But too many mutations and the spike protein would likely become less infectious. A few key mutations could make it more infectious, though. Considering that the Coronavirus has been around longer than we've known about it, this infectious version might be high-hanging fruit.
However, as long as people are infected, but don't develop full immunity (sterilizing immunity), evolutionary pressure will be selecting for mutations that would balance its R0 (reproductive value) without killing off too many of its hosts (which would reduce to where it couldn't propagate). A Captain Trips scenario is very unlikely according to evolutionary theory. The models suggest it would evolve towards a highly contagious common cold type of infection. But SARS-CoV-2 has proven the limitations of epidemiological models...
I read someone say that humans triumphed over the animal kingdom because while they adapt over evolutionary time, human ingenuity adapted at an exponentially growing rate. But it may be that the tables have turned briefly - the virus evolving new strains faster than we can develop, approve and manufacture vaccines for it.
Unrelated question: why wasn't there a Metaculus Monday post yesterday?
Scott would have been busy, given the circumstances. Reading responses to the NYT article and to his statement, licking wounds, answering questions, …
I've been saying all along that COVID will be with us essentially forever (for the next century at least), so I feel a bit vindicated now.
That said, COVID is more deadly than the flu, and it disproportionately affects old overweight diabetic cardiovascular-compromised people -- which is a sizeable chunk of the American population, which is getting larger every day. For this reason, I still expect mask requirements to become the norm in most public indoor spaces (e.g. grocery stores). I also expect public gatherings of any kind to become a lot less frequent, and of course the same goes for nationwide/international travel.
Alternatively (or perhaps in combination), society might slowly change, so that COVID-vulnerable people are expected to stay indoors all the time. If a person dies from COVID while being old/fat/etc., the public sentiment would be, "well, he knew the risks, so it's sad but it's kind of his own fault".
I wish people would stop posting graphs that look the first one in this post; that's the number of confirmed cases, but our ability to test in the first half of 2020 was abysmal. Almost all of the models predict that wave #2 was smaller than wave #1. https://ourworldindata.org/grapher/daily-new-estimated-infections-of-covid-19?tab=chart&stackMode=absolute&time=2020-03-01..latest®ion=World
Non-COVID question, meta for the forum:
When I switch back to an ACX tab, my computer is busy for ~10 seconds re-rendering the page. I have a super-nice high-end computer so this must be horrible for people with normal or below-average hardware.
It seems the same whether or not I am using the "ACX Tweaks" extension.
I'm no expert at JavaScript debugging, not at all, but it looks like the "visibilityChange" event is triggering some extensive UI refresh. Can we ("we" meaning the community including me; SubStack Inc could do it too but they are busy and have a long QA process) write an extension that disables that functionality, and perhaps makes refreshing the page a manual event done by a button-press?
Glad you mentioned that - I thought the problem was my phone with its smallish brain. Even though other websites load instantly.
same here
Wow, so, when I went to look at the JS console for this page it gave me ascii art with the phrase "substack wants you to build a better business model for writing" and a link to their jobs page.
That's gotta be the most clever placement for a jobs ad I've ever seen, by an order of magnitude.
btw I'm getting the same issue, and investigating it, if that wasn't clear from context - thanks for bringing it to my conscious attention.
I think I see the function that is slow. Or, at least, one of them. But how can I refer to them to overwrite them?
In a pretty-printed version of https://cdn.substack.com/min/main.bundle.js?v=12178b-177b02a2500:formatted it is the _() function at line 203. They are anonymous functions so maybe they cannot be referred to? Can we find the elements that have the trigger and overwrite *that*?
oh, wow, I just removed them with the Chrome debugger by hand.
Pop open the console, go to Elements on the left, then "EventListeners" on the right. At the bottom there is visibilityChange. (You might need to have clicked inside a comment to see this list).
There are one or two functions there, with a button to remove. I took them out, and now I don't have a big lag any more when switching tabs.
(If I have another tab open to ACX where I didn't do this, and I switch to it, it will slow down all ACX tabs.)
I don't see a way to intercept this or do it programmatically but maybe someone else can.
Hot damn I did it!
document.removeEventListener( "visibilitychange", getEventListeners(document)["visibilitychange"][0].listener )
This may be a non-standard thing from WebKit but I think it will work in all Chromium browsers.
Now, what functionality did I ruin doing this? We can save the function from the middle there and put it in a new button if it turns out to be important.
Uh oh. Now whenever I re-order comments using the built-in-to-substack "newest first" "top first" "chronological," it re-orders the comments but they are all empty.
I think this is an ACX Tweaks bug, not mine, but I've been messing with so much stuff that who knows. My code may have broken some assumption that the Tweaks code was relying on.
This one looks like the "apply comment styling" option in ACX Tweaks. Some comment on this page probably has poorly-formatted Markdown.
Firefox: add-on "FoxReplace" > replace the source. (Not tested)
More suggestions for ACX Tweaks. (I'd rather not bother learning Github but if I have to do it, I will.)
When you want to load all the new replies on a page, call
$("button.collapsed-reply").click()
until it doesn't give an error.
I also plain don't get how the "~ n e w ~" logic works. Sometimes I see comments from today without that tag, while comments from yesterday do have it. Maybe we're tracking on *being seen* instead of timestamp?
Seems the dynamically loaded ("New Reply") comments are not (or not reliably?) marked as 'new'.
I haven't figured out what it *does*, but I think I know what I *want*, because reloading the page is so expensive:
* to be able to "mark all as read" without reloading the page
* to be able to load all unread without reloading the page
I know how to do the second, but not the first without rebuilding the extension. It looks like I don't have access from the console based on https://developer.chrome.com/docs/extensions/mv2/content_scripts/#execution-environment
Oh, ACX Tweaks is up to version 0.14, with more features, including keyboard shortcuts.
I really don't like the "~ n e w~" being hidden from in-browser search, because it would tell me how many new comments there were. Maybe I just need to get used to it.
Also, "getEventListeners()" is only available in the console, not to scripts. Fooey. There's ways of doing it in the script but it involves hooking the addEventHandler() calls.
A weird thing is that "~ n e w ~" is searchable with control-F on some tabs, but not on others.
> "When the fifth wave strikes in late spring/early summer [...] another part of the population (~25%?) will have had the disease already"
Note that more than 25% of the US population has probably been infected already. My best point estimate through 2020 was 29%. See e.g. the CDC's estimate, COVID-19 Projection's estimate, etc.
(I only skimmed the post quickly, but this jumped out at me.)
This isn't working as an open thread. Everything or just about everything is about COVID. I suggest having open threads that don't lead off with highly engaging topics.
It's meant to be specifically a *Covid* open thread. There were a number of those on the old blog as well.
>The second wave was in July, when we got sloppy and lifted lockdowns too soon.
When I looked into this "second wave", back in the summer, I concluded that there was no second wave, it was the first wave, just in different places. New York and Massachusetts got hit hard early on, but then it calmed down there and, after a bit, picked up in other parts of the country. If you just looked at the stats for the US (which is a BIG place) as a whole, it looks like a second wave, but that's just an artifact of lumping the whole country together. If there was no second wave, that argues against the notion that "we got sloppy and lifted lockdowns too soon".
Yes, also i don't see how lockdowns could possibly work as eradication tools, all the more if you add animal reservoirs (and they exists, multiple mammals catch it).
lockdowns are control tools (how efficient they are is subject to discussion).
Granted, control tools can sometimes eradicate but only in specific cases (early stage, when the virus is limited to a few very local cases). That was maybe the case in 2019 in wuhan, but certainly not since 2020...
Prediction: lockdowns will continue to have no effect on the virus (compare Florida to California), nor will mask wearing nor social distancing. Also predicted: lockdowns will continue to harm the least-prepared, least-capable, and least-off people in our society. You know ... the people we don't listen to and don't care about.
Sorry if I'm cynical, but this ENTIRE last year has been filled with nonsense.
If you study the Covid Tracking Project's regional & state charts you will see that nearly everywhere in the country there have been two waves, not three. Now that the waves are in sync, it is unlikely there will be another in the next few months. Probably not another wave until next November.
If you're holding your breath near an infected person, you won't contract their infection (until you breathe in). I've summarized this idea with other insights here: https://garethidris.medium.com/mask-of-the-mind-8147fff8ea0c
Are we doing the world a disservice by labeling the variants by country of first expression? Is this just a virus with a fast rate of evolution and multiple possible vectors to do so? Would it be better to show how it may outpace a slow vaccination campaign?
> But even if they have it tomorrow, that's...what? Another four months for studies, one month before the FDA is able to meet to discuss an approval (you can't rush meetings!), two months to ramp up production
Shouldn't the approval process and ramping up production run in parallel? If a company is fairly confident that it's vaccine is likely to be approved, it should make sense to start manufacturing it before it's approved.
Indeed, why didn't this happen with the current vaccines against the original strain? At least I assume it didn't, or the initial rollout should have been much faster.
There was *talk* about it, and I certainly *thought* it was going to happen, because someone said Bill Gates was going to do it, but I think it'd actually didn't happen as well as we hoped.
Any reason Overcoming Bias isn't on the blogroll? Seems like a surprising omission.
"I bet we'll pick up the Asian custom of wearing masks in crowded areas if we feel sick." Depends on who "we" are. Some people already skew masks. Also, couldn't wearing a mask after the pandemics ends make some people nervous, making them think the mask-wearer is very disease (maybe carrying a new COVID strain or something like that)? To be honest, I would like to see mask-wearing when one feels sick being mainstreaned, but I do not think it will happen.
I have seen polls that suggest nearly half the U.S. population may not opt to be vaccinated. Here Germany the government has tied re-opening to an r factor of 35 or less. The current German lock-down seems to be pushing the number in that direction but new variants have the government prepping the population for continued lockdown. I wonder how the vaccinated population percentage will affect government policy?
Why not wonder how angry citizens will affect policy? Are we all autistic now that we don't care anymore about what people feel?
Kind of strange reading an article like this, praising lockdowns, not mentioning the data we have on their efficacy (very nearly none as far as the virus is concerned, but with staggering negative side effects). Why is that? Are you, Scott, ignoring the data?
Well written. I feel like you just wrote all of my intuitions in a meaningful way. Thank you. Sharing.
“Classic” = Wuhan, China strain?
Like most recent waves, this one began in an animal lab or a meat market, i.e. a site where we crowd together and brutally manipulate non-humans. From that filth & degradation, "zoonotic" viruses will continue to arise; and the new global system of control that takes advantage of that spread, like any good Disaster Capitalist, will continue to amplify fear (i e. the meta-virus) to maximize its own hold over us. Prediction: humans will continue to herd and slaughter, and when disease wafts off the kill pile, we'll cage and (medically) torture more animals to "solve" it.
"Over 900 UK health and care workers have died of COVID-19, most due to occupational exposure. They continue to die because infection control in health and care settings is built around an outdated 'droplet' model which ignores that #CovidIsAirborne. 1/"
https://twitter.com/trishgreenhalgh/status/1362386480975540224
I apologize if this is a dumb question. I am not a scientist but my sister is, which makes me think I have scientific genes ...
Is it possible that some significant portion of the population is simply not susceptible to COVID? And maybe the recent decrease reflects approaching herd immunity in the susceptible population?
Technical question about B.1.1.7
How, at the human mechanical level, is it "more contagious"? What makes it spread more? Does it travel further in the air when sneezed? Does it make people more likely to cough? What's the mechanism?
The idea that it is more contagious is theoretical. Scientists acknowledge this but the media often forgets to mention it.
At this point it requires a certain level of denial to think that it's not more contagious.
Check out the data from Denmark, where they're aiming to sequence every pcr test https://www.covid19genomics.dk/statistics
The way the british strain manages to keep an r0 above 1 while overall cases were dropping is extremely strong evidence.
Most promising predictions. But it depends, what happens in the future, of course. For example, there is no such certainty with vaccine and vaccination in general in Nordic after the situation which happened with 80 old people who vaccinated in Norway. Because of this, Sweden still disputing regarding vaccines. By the way, a strange trend happening because of this uncertainty. Swedish companies started renting additional warehouse space, such as https://www.matchoffice.se/hyra/industri-lager/malmo, in order to fill it up with products. Waiting for a more strict lockdown, I guess.
If it's a seasonal coronavirus like the flu or the common cold then you'll see another surge in late March / April because that's how seasonal coronaviruses behave. The waves we've seen so far also mimic the behavior of seasonal coronaviruses.
I thought y'all might be amused to know that Byrne Hobart (whose Substack is "The Diff") has written at least a short version of the article that Cade Metz originally claimed to be writing for the NYT. "Why Did One Internet Subculture Spot Covid-19 So Early?": https://diff.substack.com/p/why-did-one-internet-subculture-spot.
My favorite snippet: "[Rationalists are] a sort of distributed, mostly open-source monastic order, spending a lot of time contemplating the world and passing down important observations, but less time directly interacting with it."
My prediction: 80% chance that on an average day in mid-2022, inside of an average business (grocery store, hair salon, bookstore, etc.) in the SF Bay Area, more than 20% of people will be wearing face masks. (This of course assumes that the relevant business is open.)
This might or might not conflict with Scott's second-to-last prediction. I would be interested to hear what probability he would give to my statement.
Well, everyone here knows the NYT is infallible, right? /sarc
https://www.nytimes.com/2021/02/18/opinion/fake-news-media-attention.html
The issue of people believing conspiracy theories is one thing, but the NYT's solution is 'don't try to think for yourself! just trust us! And Wikipedia!'
Generally, it is well established in the scientific literature that
survival times (and therefore infection rates) for enshrouded-RNA
viruses (such as CoV-19, influenza, SARS, MERS, common cold) are
strongly influenced by ambient humidity and (to a lesser extent)
temperature. (Homeland Security's research department confirms that the
CoVID-19 virus conforms to this pattern.) This pattern has been known
for more than a decade.
One Mayo Clinic study in schools showed a factor-of-2.3 decrease in
influenza when in-school humidity was raised to 50%
(https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204337).
An Australian study found that a reduction in relative humidity of 1%
was predicted to be associated with an increase of COVID-19 cases by
6.11% (https://onlinelibrary.wiley.com/doi/full/10.1111/tbed.13631)
You may find this US Department of Homeland Security CoVID-lifetime
calculator interesting: compare the usual (less than 20%) indoor winter
humidity with 50% --
(https://www.dhs.gov/science-and-technology/sars-airborne-calculator)
Making it a policy that public-building humidity should be set at 50%
and temperature set at 75 degrees F would substantially reduce the
infection rates for not only CoV-19 but also for influenza and common
colds. Given that tens of thousands of people die each year from
influenza, this is a simple *prevention* measure would have saved
hundreds of thousands of lives from that disease alone; if it had been done
already, it might well have prevented this epidemic, or might prevent more
"bumps" -- and much less intrusively than the currently fashionable measures.
For what it's worth...
People forget that the “waves” get bigger because more TESTING became available. Not because there were actually more cases, and not all the tests gave accurate results. This is blown way too far out of proportion.