Earlier this week, a judge overturned the transportation mask mandate, which I covered here. I will also be covering the situation in China in its own post.
No one asked this time around, but a friend recommends this P100 mask if you’re looking to go big rather than go home.
The biggest other news is that Omicron continues to cycle into new variants.
There’s BA.2.1.12, there’s BA.4 and there’s BA.5.
All seem to be more infectious than BA.2.
Which was more infectious than BA.1.
Which was much more infectious than Delta.
Which was more infectious than Alpha.
Which was more infectious than the original strain.
We’ve come a long way. China is still attempting Zero Covid, which I will cover in the China post, but that is looking more and more like state failure to adapt to reality than a reasonable policy choice. Covid-19 is here to stay, at least until we can get a nasal vaccine that prevents transmission, research towards which is not currently something we are even willing to properly fund.
Executive Summary
Moderna booster candidate looks great.
Cases and deaths radically down on paper due to Easter, mostly ignore.
Things increasingly returning to normal, travel mask mandates lifting.
China situation is scary, will be covering that in its own posts.
Let’s run the numbers.
The Numbers
Predictions
Prediction from last week: 250,000 cases (+13%) and 3,900 deaths (-10%).
Results: 231,576 cases (+4%) and 2,402 deaths (-45%!).
Prediction for next week: 277,800 cases (+20%) and 4,100 deaths (+71%!?)
Easter (and perhaps Passover) suppressed cases and somehow even after two years I seem to not properly adjust for such things – but even then, I mean, that death number, come on. When I break things up into regions it seems likely that last week wasn’t getting ahead of itself, and we should expect some ‘catch up’ growth in cases this coming week.
The death count is clearly artificially low, at least in terms of comparing it to expected future calculations, especially in the South. I am anticipating many of those missing deaths being counted in the coming week. There is however also the possibility that this also partly represents the drop-off of ‘legacy’ deaths that are only sort-of Covid deaths, as it is still above 1% of cases reported a few weeks ago whereas the real IFR is going to be a lot lower than that. So it’s not like the number is fully impossible.
I will note that there has been no mention of the decline in deaths among all the people talking about the transportation mask mandate being lifted. Now more than ever, this is not about death.
Deaths
A number of states reported zero deaths. A lot of others had epic drops of more than half.
Cases and deaths in the UK have diverged, which many say is due to the decline in testing.
In such situations, the place to look is the positive test percentage.
This confirms that the undercount got larger during March before peaking, and there was likely a similar undercount to what we saw in the January peak. Yet the number of cases recorded was far lower while the number of deaths was briefly higher. I do not think the death count was ever actually higher than it was in January, but despite that this is still suggesting that the test percentage stat was underestimating the degree of undercounting.
Saying that case counts ‘no longer have value’ seems to me like going too far. It definitely has some value, and especially it has value in relative terms now that we have a baseline for the new policy regime in the UK. What we can’t do is directly compare free-test world to not-free-test world without making the right adjustments.
As always, if you wait long enough, deaths tell the story. The story they are telling is that things in the UK are roughly 75% as bad as they were before. I expect this to start improving again soon. This level of cases simply cannot be sustained for very long. We peaked at over 2,500 recorded cases per million people, which is 0.25% of people per day, almost certainly implying 1%+ of the population per day. That was four months ago. How long, mathematically speaking, could one possibly keep that up?
Cases
At some point I should have looked more into the details of holiday reporting across states and regions and built robust adjustments, but at this point I look at it and it does not seem like a worthwhile use of time. The drop in the South is echoed in deaths so it seems clearly that everyone simply thinks that Easter week is not the time to be tabulating public health statistics.
Either way, seems clear cases should be rising substantially in the coming week.
Physical World Modeling
Moderna has a booster candidate, and it is looking remarkably great. Apologies for the all-caps but this was by far the best source (manuscript), trial design, NIH announcement).
Participants are randomly assigned to one of six vaccine regimens:
One 50-microgram (mcg) injection of the mRNA-1273 (Spikevax) prototype vaccine, which is the same vaccine currently authorized in the United States as a booster shot for adults
One 50-mcg injection consisting of mRNA-1273.351 (an investigational vaccine targeting the Beta variant) and mRNA-1273.529 (an investigational vaccine targeting the Omicron variant)
Two vaccinations administered two months apart: each vaccination is one 50-mcg injection containing both mRNA-1273.351 and mRNA-1273.529
One 50-mcg injection consisting of mRNA-1273.617.2 (an investigational vaccine targeting the Delta variant) and mRNA-1273.529
One 50-mcg injection of mRNA-1273.529
One 50-mcg injection consisting of mRNA-1273 (Spikevax) and mRNA-1273.529The
The takeaway, again not that this lasted a minimum of six months:
The virus will continue to evolve, but so will our response. Superior boosters are coming, and once again it seems we have an invisible graveyard due to the barriers put in their way but this time the damage is much lower in magnitude. I am not so worried about the medium-term future of the pandemic, leaving more time to worry about the medium-term future of other problems.
About Paxlovid, the drug that cures Covid but which no one can be bothered to take, a reminder.
Demand also has been hampered by the perception that Omicron infections are not that severe.
Paxlovid was expected to be a major tool in the fight against COVID after it reduced hospitalizations or deaths in high-risk patients by around 90% in a clinical trial.
…
“We’re just not seeing as many people coming in for testing,” said Dr. Timothy Hendrix, senior medical director of AdventHealth Centra Care in Florida, which has more than 40 urgent care locations.
Hendrix said he had not prescribed Paxlovid in a few weeks. Eligible patients have turned down prescription, because they believe the Omicron variant causes mild illness.
“Most of our patients (say) … ‘I’m just going to go home and tough this out,’” Hendrix said.
We have a drug that has essentially no side effects and cuts down on severe disease and death risk by 90%. Yet most people who get Covid can’t be bothered to take it, and doctors can’t be bothered to fix this or in many cases even know about it.
If I got Covid, I would want to take Paxlovid. It is an important fact about the world that many people do not agree with me and would not want this for themselves.
I can only conclude that most people do not much care about Covid. Which is fair.
And this is despite there being universal overestimationof how dangerous Covid is for most people, which in other circumstances would rightfully be called ‘misinformation.’
When you listen to debates about risk in children remember that most people overestimate it by something like two orders of magnitude.
BA.1, 2, 3, 4, 5
First there was BA.1, then BA.2 took over in April. Now we are looking at new challengers. In NY/NJ there’s BA.2.12.1.
We have seen this movie before. When it happens, the new variant takes over, in this case BA.2.12.1, and for a bit cases go higher.
If we are going to continue to have such ‘resets’ as variant replaces variant, it means that suppression of cases in an area only helps that area in the short-term. Cases you have now and cases you have four months from now have no causal relationship if the variants in question are different, except insofar as the extra cases caused the new variant to come into existence. We are not so much in an ‘equilibrium’ state as we are dealing with a continuous set of very similar but essentially physically distinct pandemics.
Trevor Bedford thread on the various variants and on the rise of BA.4 and BA.5 in South Africa along with BA.2.12.1 in the USA.
BA.4 being focused on Gauteng definitely raises my ‘this is not a coincidence because nothing is ever a coincidence’ alarm bells, but I will decline to speculate further.
The takeaways from that thread per Scott Gottlieb:
This seems right to me. Omicron spreading more effectively makes it impossible for us to stop it in practice, but that mostly impacts our perception of our ability to stop it since we already couldn’t stop it, which makes that good news. It also confirms that these will be Omicron variants that we can cover with vaccines and won’t create important new escape and likely won’t be all that much more deadly, all of which is straightforwardly excellent news.
Prevention and Prevention Prevention Prevention
The CBS News article was from April 11. The whole point is that the time spent on airplanes is not when people are at risk, even for airline staff, who got little benefit from the mandate because their risk was in their time inside the terminals. Exactly.
I also keep being amused by the continuous outrage that people might be happy about the whole situation of not wearing masks and be encouraging others to join them, many comments sounding a lot like this.
When someone walking by you casually suggests you can do something you might find more pleasant, that is ‘imposing their beliefs on others.’ I think this is a lot of why such folks don’t see a problem actually imposing their beliefs on others and forcing them to engage in physical actions. They do not see a difference between ‘hey man you’d be better off if you did X’ and ‘do X or else.’
I am curious if there is a way to make such people notice this difference.
The mask story so far, presented in a fashion I can only call ‘tough but fair.’
Nate Silver offers some examples of ways in which we are almost or fully back to normal.
It is early in the season, but it is right after a lockout and also rather cold, so this should fully count.
Air travel should decline somewhat permanently, given the decline in business travel. I am very curious what happens to air traffic now that the mask mandates have been lifted. How many will be afraid to fly, versus how many will be less annoyed to fly? The airlines expect the second effect to dominate, and I do as well, but I am not so confident.
Spain ends its indoor mask mandate except for public transit and healthcare.
A newfound perspective on public health:
I agree that public health broke the social contract. I do not think public health ever had any intention of honoring the social contract, but even so played its hand quite badly and burned an epic amount of political and social capital on all these fronts and more. Yet that should not cause judges to strip it of power. That is not what judges are here to do. That is what the legislature is here to do. The judges, once again, should not be stripping anyone of power. Either public health officials had the legal authority to do a given thing, or they didn’t. If we still had a nation of laws, not making good decisions would not change that either way unless new laws are passed.
Think of the Children
The joys of honest grading, and a great time to reverse any advice you hear.
Direct link was blocked, but that originally linked to this resource.
If as Covid Safe Campus does you label no vaccine mandate an F, a vaccine mandate a C and a booster mandate an A, that is not any more or less helpful than going A-C-F instead. This won’t go into your GPA or your permanent record. It is merely convenient shorthand. Partisans know this well. Some people love to see when their representative has a perfect rating from the NRA. Others very much want to confirm someone has a perfectly bad NRA rating, for exactly the same reason.
In Other News
According to poll, our vaccination efforts are so bad that vaccination rates somehow went down. Not that this is physically possible, but still, not a great sign.
Medicare adjusts payments for domestically produced N95s. I am not going to wade through a 1700+ page document to figure out if the changes would actually matter for future pandemic preparedness, and it could easily end up going either way. Favoring American products tends not to be worthwhile, but this could be one of the notably rare exceptions since in a crisis no one is willing to sell to you. What would likely be much more helpful would be removing unnecessary FDA and other barriers to manufacturing our own masks, as that was the biggest barrier this time around, as well as guarding against future Federal banditry (which also happened this time) and making credible promises pay premium prices in a crisis rather than imposing price controls. The best of all would be to get the masks in place in advance via a Strategic Mask Reserve.
Even better than that, we need a program for true mass production of P100 and other superior masks. When the next crisis hits, there is a good chance N95 is not going to cut it, especially in the most dangerous but essential places.
Chris Hobson update thread on the state of NHS. System is under unprecedented pressure, as Covid cases continue to be higher than anyone (including me) expected at this stage, and even though the majority are ‘with Covid’ rather than ‘for Covid’ such cases still need to be isolated and Covid is also still causing staffing shortages. Despite this, work continues on clearing up the years-long backlog. Mostly sounds like everyone is doing their best and remarkably well under the circumstances.
Estimating how many people died due to the FDA delaying their vaccination program. Economic graveyard is bigger still.
Are American institutions unusually bad and thus undeserving of our trust, or are they actually pretty good by historical standards? One can see this either way. It is reasonable to assert that almost all government institutions are horribly broken everywhere at all times, and thus ‘undeserved’ trust in institutions is necessary for institutions to function. Our standards are incompatible with the reality of public choice and the public sector. Then again, they need not stay that way.
To follow up a bit on the transportation mandate ruling’s legal wisdom, here is a detailed post with one perspective. The problem with judges not overreaching in a situation like this is that it does not seem reasonable to say ‘the judge should say that the ruling applies to this particular plaintiff only’ because it is not remotely reasonable to ask each person who desires to not wear a mask to file a year-long federal lawsuit.
Not Covid
Math that Florida finds objectionable (McSweeney’s, remarkably good).
Math in Florida policy might actually have nothing to do with any social justice issues and be purely about corruption? Suddenly only one textbook supplier is available across all of Florida’s K-12 math classes. Never rule out that it might be taxes or fraud.
Biden requiring US-made steel, iron for infrastructure. Both create and kill it with fire. This is not what one does when there are huge problems with inflation and supply chains.
This is an interesting point. As a teenager I was invited to parties a few times, and there were very strong social expectations and peer pressure to drink alcohol. Having to consistently resist that stuff was utterly exhausting, and I very quickly lost all interest in the whole concept of parties. A similar dynamic occurs during group meals when some people have dietary restrictions, and these restrictions then become the topic of discussion.
On the one hand, I would absolutely call people in those situations “imposing their beliefs on others”. I utterly detested these experiences, and I responded by becoming more contrarian and disagreeable.
On the other hand, I wonder what would have happened if the peer-pressure positions (“must drink alcohol at this party”, “must eat meat at this restaurant”, “must not eat meat at this family gathering”, whatever) had been not only socially mandated, but also legally mandated. I guess I would’ve had to resist at an earlier point, when being invited to a party, rather than when I was already there?
Anyway, my point here is that what seems like an innocuous comment like ‘hey man you’d be better off if you did X’ for one person, can feel like an attack to another. As if it’s part of a relentless barrage of attempts to make you conform to whatever is the current social consensus. (To give another example, I imagine this may also be a part of how women experience catcalling.)
Uh, do I understand it correctly that there is only one publisher in the entire Florida providing math textbooks without critical race theory?
And I thought that the communists of my youth were overzealous by pushing the mentions of Marxism-Leninism into all kinds of school subjects! Yet they mostly left math alone...
By the way,
I find it a quite disgusting type of humor, because it is based on lying. “Critical race theory is just the usual math, people who object against CRT just don’t understand math haha.”
You know that it is a lie. Your opponents know that it is a lie. You know that your opponents know that it is a lie. So we are just having fun bullying our opponents, because the only thing more amuzing than punching your opponents is punching them while yelling “I am not punching you, stop punching yourself”.
(Yet somehow countries outside USA find it quite simple to print math textbooks without CRT.)
Seems more likely it’s just corruption.
It seems like you don’t realize how annoying this is to experience. It’s like strangers telling me to smile. Fuck them! It’s a boundary violation to assume that you know what’s good for someone who you know nothing about, especially if they don’t look particularly comfortable.
I also think the phrase you use is euphemistic. I can see instances of “casually suggesting something you might find more pleasant” that are totally fine. For instance, for some reason I used to keep on my school backpack when I sat down in trams in Switzerland because my route was only 8 minutes and I thought taking it off isn’t worth it for such a short amount of time. But sitting that way was actually quite uncomfortable. And sometimes people would say “Why aren’t you taking off your backpack and put it in front of you, you don’t look comfortable.” And once I started doing that, I realized “Oh yeah, this is clearly worth it.”
By contrast, with the mask example, it just wouldn’t make sense to assume that the thought of not wearing the mask (now that requirements have long been lifted) had never occurred to the other person. Therefore, I don’t buy that people are trying to be helpful. Instead, they’re disrespectful for giving “advice” (from the position of being a literal stranger!) that the other person must have already considered and decided against. That’s implicitly judging someone to be bad at deciding what’s good for them, which is why I think “imposing your views on others” is accurate. In particular, it’s something like “imposing your typical mind fallacy on others.”
...or people don’t have the resources to be able to afford Paxlovid.
...or ‘have you had a positive test in the past 14 days; if so you cannot work’-style questions, especially combined with nontrivial false-positive rates, have lead people to avoid getting tested in the first place.
...or people think that the cost to get tests outweighs the expected benefit.
...or people think that the cost to get Paxlovid outweighs the expected benefit.
...or people have started to discount ‘do X to stop Covid; we really mean it this time’ in general.
...or people simply haven’t heard of Paxlovid.
64% (!)[1] of the US is living paycheque-to-paycheque. Missing a couple of shifts due to having to stay home can be the difference between making rent and becoming homeless.
https://ir.lendingclub.com/news/news-details/2022/48-Percent-of-Americans-with-Annual-Incomes-over-100000-Live-Paycheck-to-Paycheck-9-percentage-points-higher-than-first-reported-in-June-2021/default.aspx—admittedly not a giant study.
These seem mostly non-responsive to the described situation.
Paxlovid itself is free at point-of-sale (or at least the current supply is), so there’s no monetary concern.
These patients have already been tested.
Not only did they get tested but they tested positive.
See “paxlovid is free”.
They already have covid, they aren’t being asked to do something unusual and unpleasant to prevent an uncertain future harm.
They’re literally being offered a prescription by a doctor and turning it down.
Admittedly, I am not super familiar with the US hospital system, but I believe Paxlovid is only available by prescription—which itself is a nontrivial cost for many.
Note this quote:
(Emphasis added.)
A possible reason for being cautious about prescribing Paxlovid to just anyone (regardless of underlying risk factors and severity) from a public health standpoint is the issue of rebounds. The Paxlovid might hold the infection at bay for a while, and then people could start testing positive again a few days later, so quarantine protocols become a bit more complex.
https://www.bostonglobe.com/2022/04/21/metro/puzzling-phenomenon-patients-report-rebound-covid-19-symptoms-after-taking-antiviral-paxlovid/
If vaccines and boosters don’t do much against Omicron variants right now, but might do really well against Omicron variants in a month or so, then right now is the perfect time to draw down campaigns encouraging people to get vaccinated.
People expect to get vaccinated only 2 times, 3 times, or 4 times and then be done. If the current strain of vaccine doesn’t do much, then vaccine encouragement clearly should be dialed down, even without the reputation risks that affect the reputation of vaccination in general (forever).
tl;dr people expect vaccination to work well and they expect to permanently stop getting vaccinated after a specific number of doses. So there should be more vaccination when the vaccines work more effectively, i.e. not right now.
1. It’s twitter. So yes, saying ‘take your mask off’ (what’s that, command form?) isn’t going to be appreciated. ‘Everybody knows you don’t have to wear a mask’ etc.
2. People don’t like this when it happens, over and over. (So yes, it will look like ‘it’s a small thing’.) Shockingly, people use social media to blow off steam.
Both is good.
Can people buy these? In advance, enough to get production to go up?
If something lies, then, yeah, don’t trust it. You might distinguish this from ‘egregious lies’, etc. That said,
Looking at the future, how do we want institutions to operate? Are there ways we can structure efforts to be transparent, or otherwise better than existing stuff (like say, about lying, or catching ‘academic’ fraud faster)? Maybe to find out if something will work better, we’ll have to try it.
My understanding is that the math textbooks were banned in Florida for their use of the “Common Core” framework. I was a math educator, and my experience is that resistance to Common Core comes primarily from parents who hate math, and are confused why they can’t do their child’s math, and who somehow take this as a failure mode.
I looked at that mask but I’m worried about the fit; if air gets in through the side then it’s P0 (0%), not P100 (100%).
Could you compare it to this mask? It looks like the fit is better. and I know it says “dust mask”, but that’s probably because it’s amazon; if you look up “covid mask” on amazon, you get cloth masks, and no other mask on amazon states that it is meant for covid. I checked, and there should be research confirming that covid droplets are a specific size.
It’s a bit of trouble, but it’s probably worth it since covid causes permanent brain damage and incurable sleep deprivation
I used to use the same mask that Zvi’s friend recommends, but switched to 3M’s model 7502 respirator with model 7093 P100 filters. The mask I use is made of silicone and because of that is more comfortable for extended wear and easier to securely fit. The filter cartridges are less visually obtrusive than the pink ‘pancake’ filters and last longer before clogging (more of a concern for construction work than general covid wear).
I don’t have first-hand experience with the GVS Elipse series, but the most compact model looks easier to fit a surgical mask over, should you go somewhere that enforces that bit of theater.
Part of the Covid endgame we should probably be considering right now—and feel free to down vote me until I add links (if you hate me) or add links for me (if you love me) should probably be—underlying genetic resistance (or susceptibility). There are tantalizing clues that this might be relevant:
the UK challenge study—about half of the participants stubbornly refused to catch Covid
actual progress in identifying genes for susceptibility, lots of data
experience with other viruses, often with tradeoffs (e.g. HIV vs West Nile virus—weird, right?)
waves often don’t go past about 60%
lots of breakthroughs and re-infections and lots of people not getting it (consistent with my own social circle)
household secondary attack rates surprisingly low
myxomatosis in rabbits and virus/host co-evolution. As with humans and covid, interferons seem to be the key to understanding innate resistance/susceptibility to novel pathogens
At this point, I’m really starting to think I’m one of the lucky ones, since I’ve been plenty exposed and I test myself fairly frequently. Just like if I were to flip a coin and get 10,000 heads, at some point I start to wonder if it’s biased. I don’t feel too guilty about this, since swine flu got me pretty bad in 2009 and I’m old enough to have had chickenpox pre-vaccine (fun fact—everybody who gets chickenpox has “long chickenpox”—the body never clears it)
For my own personal closure on all this mishuggass I recently sent my spit to 23andme to get a sense of where I fall on the innate susceptibility spectrum. Don’t try this at home, dear reader. It’s pretty safe for me to do this, since I’ve got no plans to buy life insurance (no kids!) and I have a stable unionized government job with a great benefits.
Clever title for your post! (Hint: XTC ”… one, two, three, four, five …”)