(2021-02-18) ZviM Covid-02/18 Vaccines Still Work

Zvi Mowshowitz: Covid-19 2/18: Vaccines Still Work.

Vaccinations

This was a deeply disappointing week on the vaccine front, with the 7-day average declining over the last few days, and on net almost no progress week over week

The English Strain

The NBA once again delivers us reliable data on the things we care about.

Clustering means that this can’t be presumed to be a random sample

If we interpret that as the new strain about to become impactful and take over, it’s bad news. But, if we interpret it as the new strain is already here in force then it gets more ambiguous and could even be good news!

The timing of the transition between strain, however, wasn’t what was being studied here

these are in some ways highly atypical cases. NBA players are not representative of the population

the typical infected person with the classic strain being acutely infectious for a brief period, whereas the new strain makes them sick and infectious over a longer period

That means that it will grow slower, relative to its increased infectiousness, than the old strain

This also means that if the English strain is a major factor, and this data is accurate, quarantine periods will have to get longer

The South African Strain

It is clear that antibodies from our current vaccines are less effective against the South African strain. The question is how much less effective

#YouHadOneJob (to Appoint Someone To Fill)

President Biden continues not to have named his new head of the FDA (WaPo). The two top candidates continue to be Janet Woodcock and Josh Sharfstein.

Janet Woodcock is the current acting commissioner, and thus directly responsible for our failure to approve vaccines.

It seems from a brief investigation that Sharfstein’s primary mission would be to stop evil drug companies from potentially earning a profit

Vaccines Work

clearly point to the correct response (first doses first)

we all want to directly measure infectiousness, since it’s genuinely unclear exactly how much protection against this various vaccines offer at various points

The result of 75% lower average viral loads in vaccinated people, conditional on infection at all, reinforces our previous understanding. First, it confirms that, conditional on infection at all, vaccinated people are less infectious even after one dose.

Practical Model of Vaccine Effectiveness

my current model is that the vaccines all improve your chances at each step of the illness, cumulatively. This fits the data and also my understanding of immunology.

What we notice in every vaccine study is that #6 comes out to 100% protection, and #5 at least comes damn close.

My current prior on Pfizer/Moderna vs. Classic is that they’re something like 90% vs. infectiousness (step #2 or so), 95% vs. moderate symptoms (#4), 99%+ versus death

Even in the worst case, where the AZ vaccine is not so effective against the SA strain in terms of infection and transmission, it’s more effective than nothing at all even against infection and transmission, doesn’t block getting a second vaccine later, and it would still prevent a lot of deaths

Or to put it another way, vaccines are so good that mild cases after vaccination are clickbait news items

Vaccine Work So Well We Can Vaccinate More People

Moderna half doses illicit robust immune response in healthy adults, including those over the age of 55.

There is no lower hanging fruit available than this.

What would it mean if we put so many doses into each vial? Well, good news, the FDA only took a few weeks to give their sign-off on that one

The data seems very clear that if you’ve already had Covid you need at most one vaccine dose.

Bubble Bursting

Peter Diamandis attempted to create an immunity bubble via PCR testing.

If you go from testing negative one day to highly infectious the next day, at least one of those tests almost certainly gave the wrong answer, even if you’re only or primarily interested in infectiousness

Masks were encouraged between venues, but not required.

Mostly what I see is a badly designed protocol. You can’t have a bubble without an initial quarantine period.

This stuff is complicated, and people are not explaining it well. As a result, even super smart people like Peter Diamandis are often getting it importantly wrong.

No, Really, Andrew Cuomo Is The Worst

It seems clear now that not only did Cuomo put Covid-19 positive nursing home residents back into nursing homes where they could infect other residents, he also covered up the resulting deaths.

New York Times Is Permanently Banned

insinuation of guilt by association so brazen it should be used as an example in textbooks, and condemnation of the very idea of freedom of speech.

Scott Alexander

As further proof of its principled opposition to free speech, The New York Times took this position to its logical conclusion, and also warned us this week about the nefarious Clubhouse and its dangerous potential for ‘unfettered conversation.’

Remember that this is how they conduct themselves in the arena you know. Why would you think they do any differently elsewhere?

Scott Alexander Predictions on Covid-19

When writing on a weekly basis, it’s easy to forget to step back and look at the longer term picture more broadly. I’ve done it somewhat, but haven’t focused enough on the longer term, so this is a welcome reminder

The most promising thing is that the fourth-wave narrative has become fully accepted by the Very Serious People in advance, which is plausibly why we’re seeing such strong declines in cases now

The core question to be decided is, are we going to emerge with a new appreciation for life into a new roaring 20s, or are we going to do to adults what we’ve already done to childhood, and extend life-crippling restrictions indefinitely because of a recalibration of risk and new cultural norms?

There will be rock concerts and music festivals once again. There will be more than there have ever been, because there have to be.

Covid could well end up being used as a framework for the denial of our basic rights. If elites can break the rules in an emergency they will create an emergency in order to break the rules, and thank you for coming to this Ted Talk. It could also do the opposite, and embolden people to not listen to elites the next time they try something like this, given their performance record.

Covid-19 safety is a group effort where we must contain spread, so safety concerns are at least understandable, but the overarching reach of most such concerns are about blameworthiness, liability and people’s inability to do or intuitively understand or appreciate statistics and math.

Metaculus Redux

I continue to be very happy Metaculus exists (and that Good Judgment Project exists) which is why I am willing to discuss them and why I am sad that they are not better. I’ve written extensively about prediction markets, and these aren’t prediction markets. They also aren’t entirely not prediction markets

Vitamin D As It Ought To Be

New study claims that it confirms that Vitamin D is very important for Covid and is highly effective even when administered at the hospital. Alas, it looks like the methods and statistics they used were highly suspect to say the least.

That doesn’t change the fact that everyone should be supplementing Vitamin D, and it’s plausible I should be talking about this way more often lest people forget.

Scott makes three probabilistic assessments (they’re not predictions exactly) at the end:

Tyler Cowen notes that he is even more skeptical than Scott.

I still think Vitamin D supplementation in advance of infection is a favorite to significantly decrease the risk of getting Covid and give that maybe a 60% chance

The problem is that we both agree on the correct course of action – give everyone Vitamin D supplements now, and give every Covid patient more intense ones in the hospital – because there’s so little downside to doing that.

A final note is that no one is denying that Vitamin D deficiency is very highly correlated with bad Covid-19 outcomes

In Other News

Stimulus plan wants to spend $500 per person on distribution alone, and The Grumpy Economist asks why it costs so much. For all things vaccines I prefer to ask why we are spending so little rather than pinch pennies

Medical students are at risk more from socializing than from treating patients, in one study in Denmark. This matches priors.

Your periodic reminder (in this case from Bryan Caplan) that bioethicists are mustache-twirling villains and without them we wouldn’t have a pandemic

Your periodic reminder that rapid tests would end this pandemic and could be had en masse for about $5 each, but we don’t allow them to be sold, so what few exist languish in places where the people involved don’t want them.

Department of it could always be worse: A current hypothesis that China is holding off on vaccinating anyone until it can have sufficient supply for the whole country.

We ran an experiment to see people’s willingness to pay for less crowded planes (MR linking to WSJ), and it was low

I’ve noted before that the ventilation of the planes themselves seems rather good, and I’d be more worried about the taxi and getting through the airport

Regulatory hold-ups are worse than you thought. Ada Poonawalla of the Serum Institute of India reports that they have 70 million doses that exist but can’t be shipped because the countries that have purchased them haven’t approved them, and they are already four months old and expire in April.

Part of this ‘vaccine nationalism’ seems obviously good to me. If every country decides it needs its own manufacturing sufficient to make everything it needs, that seems great, because then we might have something approaching enough overall manufacturing capacity

Whereas restrictions on importing vaccines, requiring one’s own regulatory hurdles everywhere, is pure downside.

Non-Covid Civilization Watch: Large parts of Texas continue to be without power under dangerously cold conditions. Now there are reports of lots of people losing water as well. Explosions shut off power to large parts of Portland. California’s power grid is increasingly unreliable each year. We should be alarmed about this.