Great news, everyone. The Pfizer vaccine has been approved. Woo-hoo!

It will be marketed under the name Comirnaty. Doh! 

(Do we all come together to form one big cominraty? Or should you be worried about the cominraties of getting vaccinated, although you should really be orders of magnitude more worried about the cominraties of not getting vaccinated? Did things cominraty or was there a problem? Nobody knows. Particle man.) 

My understanding is that if a doctor were to prescribe the vaccine ‘off label,’ say to give to an 11 year old or to get someone an early booster shot, then they could potentially be sued for anything that went wrong, so in practice your doctor isn’t going to do this. 

A reasonable request was made that my posts contain Executive Summaries given their length. Let’s do it!

Executive Summary of Top News You Can Use

1. Pfizer vaccine approved under the name Cominraty. 
2. Vaccines still work. If you have a choice, Moderna > Pfizer but both are fine. 
3. Boosters are still a good idea if you want even better protection. 
4. Cases approaching peak.

Also, assuming you’re vaccinated, Krispy Kreme is offering two free donuts per day from August 30 until September 5. 

Now that that’s out of the way, let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 1,000,000 cases (+14%) and 8,040 deaths (+45%).

Results: 935k cases (+7%) and 7,526 deaths (+35%).

Prediction for next week: 950k cases (+2%) and 9,400 deaths (+25%).

I was confused how there could be such sharp peaks in other countries. It looks like we won’t get one of those. The trend lines seem clear, and it looks like we are approaching the peak. It would be surprising if we were still seeing increases week over week by mid-September, with the obvious danger that things could pick up again once winter hits.

Deaths

Date	WEST	MIDWEST	SOUTH	NORTHEAST	TOTAL
Jul 1-Jul 7	459	329	612	128	1528
Jul 8-Jul 14	532	398	689	145	1764
Jul 15-Jul 21	434	341	732	170	1677
Jul 22-Jul 28	491	385	1009	157	2042
Jul 29-Aug 4	693	477	1415	304	2889
Aug 5-Aug 11	705	629	2181	234	3749
Aug 12-Aug 18	912	851	3394	388	5545
Aug 19-Aug 25	1281	1045	4692	508	7526

Deaths continue to lag cases. News was slightly good, so adjusting expectations slightly in response. Peak should still be a month out or so.

Cases

Date	WEST	MIDWEST	SOUTH	NORTHEAST	TOTAL
Jul 1-Jul 7	27,413	17,460	40,031	7,065	91,969
Jul 8-Jul 14	45,338	27,544	68,129	11,368	152,379
Jul 15-Jul 21	65,913	39,634	116,933	19,076	241,556
Jul 22-Jul 28	94,429	60,502	205,992	31,073	391,996
Jul 29-Aug 4	131,197	86,394	323,063	48,773	589,427
Aug 5-Aug 11	157,553	110,978	409,184	66,686	744,401
Aug 12-Aug 18	183,667	130,394	479,214	78,907	872,182
Aug 19-Aug 25	188,855	152,801	502,832	91,438	935,926

Vaccination Statistics

How much will full FDA approval matter? Survey says not much.

I am more hopeful than this, and expect more than a 10% increase. Some of this will be people for whom this really was the true rejection. Other parts of it will be as mandates are handed down and people anticipate further mandates. 

Vaccine Effectiveness

I continue to find this very telling in terms of vaccine effectiveness versus Delta:

The argument is simple. The Delta vaccines are designed and would be easy to get approved, yet there has been no move to manufacture them quickly. The only reasonable explanation for this is that there isn’t actually much if any difference with the old vaccine. Or at least, that’s what the pharma companies that have every financial incentive acting against this are revealing they believe.

A new paper on vaccine effectiveness concurs (preprint).

I will for now accept the principle that a single dose provides substantially less protection against Delta than Alpha, but this is another data point that Delta isn’t different from Alpha once you get your second shot. I always find maddening the ‘confidence intervals overlapped, so nothing here’ reaction to differences like 67% vs. 79% – yes, you can’t be confident in that, but that’s mostly saying your study was underpowered, since that’s the kind of difference one would expect if there was a difference, and again, the word evidence does not mean what they think it means. 

The paper’s findings then get worse, if you believe them, claiming rapid reduction in effectiveness over time.

They then go on to say this, which given how vaccinations were timed seems likely to be confounding indeed:

There’s no one good money quote on it, but the findings robustly say that vaccinated people’s cases tend to be lower viral load, less dangerous and less severe.

Looking at their section on statistical analysis, they’re doing some of the necessary and reasonable things but I can’t tell if it’s enough of them. Such studies are better than nothing if treated with caution, and this seems like a relatively well-done one, but I’m still more focused on the population numbers and what makes the models work out. 

When I see things like this:

My core reaction is, the very idea of a 22% decline in vaccine effectiveness per month doesn’t make any mathematical sense, until I figured out it meant a 22% increase in vaccine ineffectiveness. As in, if you are 99% effective in month one, and then you have a 22% ‘decline in effectiveness’ you would be… 98.8% effective. Or if you were 95% before, you’re 94% now. Which doesn’t sound to me like a 22% decline in effectiveness, even if true. 

Israeli data continues to suggest extreme fading of vaccine effectiveness if you look at it naively, along with yet another reason to, as post puts it, proceed with caution. 

New data from Denmark:

One presumes that the improvement against hospitalization in Pfizer is a data artifact or failure to control for something or some such, which shows how easy it is to get misleading results, especially since infection went the other way. And this big Pfizer versus Moderna difference against Alpha isn’t found elsewhere, which makes me think that once again there’s confounding going on all over the place.

Here’s a thread analyzing some of the results, and takes the declining protections and other study data fully seriously, putting the burden of proof on finding something specific that is wrong with the studies, and otherwise taking their results and details seriously and forming the model around that. As usual, the broader context of what such results would mean for all the other data we see isn’t incorporated – but again, I don’t see anyone doing that.

Here’s another good long thread explaining what vaccine effectiveness means then listing lots of different findings and real world results. Putting them all together like that makes it striking how much the different numbers don’t agree if you take them all at face value. 

I continue to think that the decline in vaccine effectiveness over time is in large part a mirage, and for practical purposes the decline is relevant but small. 

This week’s representations of how those vaccines are doing, after having vaccinated about 70% of adults and most of the elderly.

Virginia offers a dashboard:

Doesn’t look like vaccines are losing effectiven

Houston, via PoliMath:

And another:

And another:

That’s disappointing at face value since it’s only a 90% reduction in deaths but after correcting for age it would look a lot better. Weird that so much of the vaccine advantage here seems to be coming after hospitalization. 

A worry is that the studies are selecting for ways to show vaccinated people are at risk, and another worry is that the real world statistics being reported are selecting for showing that the vaccines are super effective, because they are the same information but the Official Story is on two contradictory propaganda tracks and is pretending not to notice that this is a physical world question with a correct answer (whether or not we are confident we know what it is). 

Anecdotal in Tampa, Florida

:

Here in New York:

Meanwhile also this:

Note that yes, we are excluding the first wave infections here as per her follow-up note, but note the graph and adjust accordingly, and I think the point stands.

That does bring up that UK cases are clearly rising again, so we can no longer use that as an important signpost that things will turn around rapidly and that will be that. If anything, it’s now making the case that such a turnaround is unlikely. I don’t know of anyone who has offered an explanation other than a shrug for the decline followed by a reversal here.

As for the reinfections versus vaccine effectiveness, my hypothesis is that this is not a case of ‘immunity from infection holds up but vaccine immunity is losing ground.’ Remember when we were worried that natural immunity faded with time but vaccines solved that problem? The actual difference is in the methods of observation. When similar observational methods are used, we seem to get similar results. 

How infectious are breakthrough cases? We now have two studies for that. They found that vaccinated people who get infected are still infectious, but their viral loads are substantially lower, so this was what we previously expected. And also they clear the virus faster, which was also expected. 

Weirdly, they’re two different studies that find the two different results, although depending on how you measure, fading quickly implies lower average viral loads, so the results are compatible with the graph and it’s possible what we’re seeing is a shorter period of infectiousness rather than less at the peak. That seems unlikely to be the whole effect to me, but could easily be the majority of the benefit. 

How much comfort that brings depends on the situation and on what you previously believed. If you’re as bad at this as the CDC and were saying the vaccines ‘prevent transmission’ full stop and now that they ‘don’t prevent transmission full stop’ it gets confusing. 

Vaccine Hesitancy and Mandates

Formal approval is in, so here… we… go.

I saw this about one minute after I saw the FDA had approved the Covid vaccine, perhaps someone planned something in advance for once:

On her first day on the job now that The Worst Is Over, our new governor lays down the law:

She also raised New York’s total death count by 12k, which once again highlights that maybe Cuomo went down in a similar way to Al Capone (who was indeed guilty of tax evasion).

Although she’s also mandating ‘ethics seminars’ so you win some and you lose some.

LSU is going to mandate vaccination or a negative test for all fans at Tiger Stadium. 

Whereas the University of Georgia is going the other way.

Here’s the owner of the Dallas Cowboys:

Who else we got (WaPo)? They found CVS Health, Deloitte and Disney, but so far, not an impressive set of additional mandates. It seems not many were standing by ready to go. 

Delta Airlines is charging unvaccinated employees $200 a month extra for health insurance, on the very reasonable premise that every hospital stay for Covid costs them an average of $50,000 and they end up in the hospital for Covid more often. Insurance companies can’t do this, but it seems corporations employing you can do it. 

NYPD has threatened to sue if the city attempts to implement a mandate.

Texas Governor once again mandates against vaccine mandates, this time ensuring it applies despite FDA approval. 

When you’re fully anti-vax, you’re anti-vax, and it’ll be hard to tell you different, as Donald Trump learned:

Others are less fully anti-vax, but still unvaccinated, thanks to various ways we botched things.

As Ranu notes there are two distinct things here. First, we botched the logistics, and could have done much better if we’d made sure to beware trivial inconveniences that aren’t always trivial. Second, our authorities are untrustworthy so people don’t trust them. This is framed here in the standard blue-tribe way as ‘the system fails such people and they remember the legacy of all that’ with it being ‘hard to make up’ during a pandemic, rather than the simple ‘these people lied about the pandemic over and over again’ model. Both are presumably relevant, but my guess is that handling the pandemic in a trustworthy fashion would have largely solved both problems. Yes, such people will absolutely ask why you weren’t helping them before, but that’s different from turning your help down if you’re here now.

One aspect of vaccination decisions is that patients in America do not pay for their health care. Almost everyone who can get it has health insurance because if you don’t the medical system bills you personally and attached some number of extra zeros to the bill because they can, so you can’t opt out. For a while, they even waved ‘cost sharing’ on Covid, so you didn’t even pay the fraction you normally pay, but that’s increasingly no longer true. Would be good if more people knew. Incentives matter, but only if people are aware of it. One could note that this policy could be taken farther, if the government permitted this, so we’re doing mandatory mandates with one hand and mandatory massive subsidies to those who don’t follow those mandates with the other. 

State employees, you will get vaccinated as many times as is legal, or else.

This is an explicit ‘everything that is not forbidden is mandatory, and everything that is not mandatory is forbidden’ rule. You can get exactly this many shots at exactly these times, and you either get them or you’re fired. There’s no concept of a booster that is optional, based on someone’s situation, and the full mandate applies to teleworkers.

This is where things are going to be tricky. Requiring ‘full vaccination’ so far has been simple. You get two shots and that’s it. Now there are signs that this in many places is going to morph into getting periodic boosters with different places (at a minimum, nations, Austria and Croatia are already setting expiration dates) having different requirements, and those boosters will have a much less slam-dunk risk-benefit profile. 

I will happily take the third shot without any need for outside incentives, but it is a very reasonable position to not want the third one, and it seems likely that requiring boosters will have far less robust support than requiring two shots. 

A cheap shot, but I think a necessary one so putting it here anyway, without any need for further comment.

One can definitely say shots fired:

Masking, Testing and NPIs

This is nuts, actively counterproductive on every level, and what must be fought against:

To be fair, it is only required ‘when social distancing is not possible,’ most of the time this will definitely apply, and I assure you that it’s always possible. 

It’s always adorable when people think the constitution is a meaningful limiting factor, and all recursive mandate sentences are fun.

In practice, this is technically true, but there is a known way around it known as withholding federal funding. And another easier way around it, called ignoring the constitution, since presidents mostly do what they want without any actual legal authority under the constitution and mostly no one calls them out on it. Eviction moratorium, anyone? 

If you’re in NYC and either old or immunocompromised, make sure you know about this:

You can also buy one at the pharmacy, although not like in Europe where the tests are super cheap and abundant. FDA Delenda Est.

Also, a periodic reminder that the reason younger children can’t get vaccinated, which in practice is causing super massive freakouts although there’s almost zero risk there, is that the FDA moved the goalposts to require additional data. Thus we almost certainly won’t get this before the end of 2021, and I’d double check but this market sure looks a lot like free money.  

Here’s a graph of how afraid people have been over time:

The lack of an increase in fear over the winter surge is the most surprising thing here. Otherwise it all makes sense, with fear going down when things were improving, then fear starting to go back up as cases rise. Fear isn’t a perfect proxy for the private control system, but changes in fear likely predict marginal changes in private actions and we’re back at levels similar to April.

Here’s a survey on activity:

As one would expect by now, vaccinated people are taking more precautions than unvaccinated people. Almost half of vaccinated people are ‘avoiding people as much as possible’ and they’re claiming it’s because of the pandemic. However I share Nate’s skepticism here minus the word ‘little’ because math:

Perhaps ‘as much as possible’ means until one is hungry, or has somewhere to go. It’s on the margin. 

Study does some modeling and finds that according to its model masks work, ventilation works even better.

From the study:

Filters win out here over windows, if one has to choose, and of course if possible you’d do both. Also you can’t cheat on the windows, you gotta actually leave them open. When we’re considering actions like mask mandates or shutting down living life entirely I find it odd that people worry about energy costs this much, but there you go. Also fresh air remains a Nice Thing. As always, one must be highly skeptical when translating such results into predictions for actually preventing cases. 

A potential issue with price controls:

An argument against weaning masks on the margin, and a good question about presenting that argument.

I found the tweet more compelling than the full post. Getting into the details mostly highlighted places I disagreed with Bryan.

Booster Shots

Governor of Texas gets a third shot as a booster. I have no issue with people in high positions getting superior medical treatment when there’s a supply or resource shortage, but meanwhile we have vaccines expiring in some places. That’s from Scott’s post with further comments on the topic of FDA Delenda Est, which is interesting but inessential. 

The new argument against booster shots is that they… might cause us to produce too many antibodies against Covid, and then maybe Covid mutates and the antibodies become dangerous or unhelpful because they’re overtrained? When it’s not Officially Sanctioned even antibodies are labeled bad, it seems. Meanwhile this is doubtless supposed to make people worried about Delta, but this worry definitely does not apply to Delta, and an additional customized booster would be necessary in the cases being described either way. Don’t worry, such arguments will go away once the Official Sanction comes down, which is coming soon.

Meanwhile, an argument for booster shots is that the first two doses were so close together that they count as a primary immunization, claiming it looks like this:

Which is so insane it doesn’t even bother putting any impact from the second shot into the chart at all, and puts the peak of the ‘primary’ response more than halfway down the graph when it’s almost fully effective. There’s obvious nonsense available on all sides.

Think of the Children

We really do have a large class of Very Serious People, with a lot of influence on policy and narrative, who think that living life is not important, that the things you care about in life are not important, and that our future is not important, because saying the word ‘safety’ or ‘pandemic’ should justify anything. 

This week’s case in point, and like my source MR I want to emphasize that this is not about the particular person in question here.

If anything, I’d like to thank Dr. Murray for being so clear and explicit. If you think that safety trumps the need for love, for friends and for living a complete life in general, then it’s virtuous to say that outright, so no one is confused. 

In case you think she doesn’t mean that (or that others don’t mean that), no really, she does:

Ellie Murray does not believe that school is terrible, so she is simply saying that the claimed benefits of school are not important relative to the marginal impact of schools on Covid-19. 

That reply was one voice in a chorus, as the replies are what you’d expect and rather fun to read through. Nate Silver sums this up well:

There was also a side debate over whether school is the future of our children and our children are our future, or the alternate hypothesis that children are also people and school is a prison and dystopian nightmare. The thing to remember is that this view is not driving most of the anti-school rhetoric. Such folks mostly think school is vital to children, but don’t care.

Yes, I was aware, and I’d rank my concerns regarding school in this order:

1. Kids going to school. School is a prison and a dystopian nightmare.
2. Kids not going to school. Remote school as implemented is somehow so much worse.
3. Getting Covid. I’d rather not get Covid.

But yeah, we can beat that take this week, because the The Times Is On It:

Technically I’m sure it is true that masks represent an ‘educational opportunity’ in the sense that whenever anything happens you can use it as an opportunity to learn. The main such opportunity is to learn about those making the decisions.

In Other News

Have you tried using a market clearing price? No? Well, then.

I strongly agree that lawn care is a terrible use of water when there’s a limited supply, but the way we figure such things out in a sane world is we charge more money for water and if desired or needed give people a credit to avoid distributional concerns. Yes, I know, don’t make you tap the sign, go write on the blackboard, etc etc. 

Biden still hasn’t appointed anyone to head the FDA, but at least he floated a name. The name is someone who said that living past 75 is a waste, but hey, pobody’s nerfect, right?

Obama literally hired a doctor to ensure everyone was vaccinated and safe and his party was still a huge issue, so now everyone in Washington is afraid to throw parties. Also for other reasons, I’d imagine, but those are beyond scope.

A calculation of whether the benefits of exercise in a gym exceed the risk of Covid finds that it very much does in her case. Often the choice really is between going to the gym or not exercising. Her calculation did depend on the lack of other people in the gym, however, so if the gym had sufficiently more people in a tight space the calculation could have gone the other way. She has a spreadsheet you can play around with if you’d like to explore this more.

Denmark gives up on the mystical ‘herd immunity.’ Usual misunderstandings here but I suppose this is better than the practical alternative of not giving up.

Thread reminding us that the control system has many facets, and they work together at least additively and often multiplicatively. You don’t need any one factor to control the virus or get you mystical ‘herd immunity’ on its own, you care about the combined effects. 

Zeynep reminds us that plastic barriers are likely to be net harmful because they interfere with airflow. I got this one wrong early on, same as everyone else. The key is to update.

Monoclonal antibodies are free and effective against Covid, but few people are getting them (WaPo).

From MR: You can get flown home if you get Covid while abroad, but you’ll need a special service. 

Germany moves to using hospitalizations as the primary measure of whether Covid is under control. This makes sense for policy, since what matters is whether the hospitals are overwhelmed and whether people are sick and dying. 

Australian stockpile of AZ continues to grow, over 6 million doses (via MR).

Australians who are vaccinated overseas can register that vaccination, but only if the vaccine was approved in Australia at the time of vaccination. Which was not a rapid process.

I like how transparently the ‘at the time’ restriction is purely harmful. No fig leaf.  

Also via MR, due to continued Covid restrictions down under, they shot dogs due to be rescued by a shelter to prevent shelter workers from travelling to pick them up. Meanwhile, they’ve uncovered people getting fresh air. It’s becoming an epidemic of fresh air getting after 200 days in lockdown. 

But good news, if you’re fully vaccinated, you’re about to get new freedoms!

So, how do you think Australia did, all things considered?

Poison control is lonely work. Not many people call, and when they do, it’s usually something like ‘I took prophylactic Ivermectin that was intended for animals, thinking that was a good idea.’ We have some news.

General warning for anyone who needs it: Animal formulations of a given medicine are often different from the human version, and could be highly dangerous to humans. Do not perform this regulatory arbitrage assuming that the two things are the same. 

Also, this:

They didn’t know the two things were different, and it’s a perfectly reasonable hypothesis that a thing could be vastly cheaper and easier to get if you can do an end run around the FDA, or around pharmacists earning praise for refusing to fill prescriptions for Ivermectin. This simply was not one of those times.

Also note the numbers. One individual was told to ‘seek further evaluation,’ and 85% of the cases were mild. The definition of ‘mild’ can be whatever people want it to be, but if it’s ‘no need to seek further evaluation’ it seems like there were six poison control calls out of eight total calls? I’m guessing it’s higher than that, and please if you decide to take Ivermectin make sure you’re sourcing and dosing it safely and properly, but this isn’t an epidemic of cases, and this was going around enough it felt important to point that out, even if I’m highly skeptical that Ivermectin does anything useful. 

Rob Bensinger offers his advice on what to personally do about Covid. Not endorsed.

Inessential but fun case of an elected official saying very much the wrong thing.

Not Covid

Reminder, purely about actual cars:

Remember that if you own an Oculus, and your Facebook account gets suspended because of reasons (such as saying facts that contradict local health authorities) you will lose all your games and save data permanently, no refunds, no fixes. Might want to consider a secondary Facebook account for this purpose, unless you’re using your Oculus to recover your Facebook account, which is also a thing.

In Scott’s recent post, he reckons with his struggles to not make mistakes despite the need to quickly produce a lot of content. I have this problem as well, and last week failed to check something I should have checked. My solution so far has essentially been to state my epistemic confidence in my statements, and to carefully put conditionals on statements that I haven’t verified. So last week I wrote “I am not aware of any X” and it turns out there are a bunch of common Xs and I really should have known that already and also should have checked even though I didn’t know, but I did know I hadn’t checked so I wrote I wasn’t aware. I ended up editing the paragraph (on pregnancy) a few times. There wasn’t anything false when I wrote it but once it was pointed out it obviously needed to be fixed quickly. This occasionally happens, also there are occasional typos, broken links and other stupid mistakes, and occasionally one of the sources turns out to be fake, as was the case with a British account a while back.