Cases increased this week, as expected. Deaths also increased, which I did not expect so soon, indicating a bigger and faster winter wave. That was not the big event in the West this week with respect to Covid.

The big event this week in the West’s Covid experience was a memory of events past. Patrick McKenzie wrote a very long and very worthwhile magnum opus about his efforts in VaccinateCA to get vaccine shots into arms, and what he learned about our government and public health systems along the way. If you read one thing this week, read his story. You can also read my key facts and takeaways post, and this thread with another person’s remembrances (here are Patrick’s takes on that). Patrick also offers his thoughts on implications for charitable efforts at the EA Forum, which includes this gem:

If I had to point at any one artifact in particular, Inadequate Equilibria is a good articulation of a larger memeplex that made me comfortable with “If the evidence of a system’s operation contradicts what the Efficient Market Hypothesis counsels is the probable functioning of the system, trust the evidence. Thousands of lives savable by one dedicated team of non-specialists is actually not all that low probability.”

Yes.

What else happened recently?

China stopped attempting to contain Covid-19. They have accepted that the costs of continuing to do this are unacceptably high. Instead, they have decided they are content to contain official case numbers while they brace for the impact of the Covid surge they have successfully put off for three years. It is their turn to have trouble staffing hospitals, to have panic buying and shortages and voluntarily deserted streets. I wish them the best of luck in getting through this as best they can.

Executive Summary

1. Patrick McKenzie wrote about VaccineCA. You should read it, and remember.
2. China is finally experiencing the Covid wave they have postponed for three years.
3. Cases and deaths are on the rise, the winter wave is looking a bit larger.

Let’s run the numbers.

The Numbers

Predictions

Predictions from Last Week: 371k cases (+5%) and 2,240 deaths (-6%).

Results: 391k cases (+10%) and 2,610 deaths (+9%).

Predictions for Next Week: 435k cases (+10%) and 2,900 deaths (+10%).

(Note: North Dakota dumped a lot of deaths on us after reporting no deaths at all for months, so I reduced that number to something high but not impossible.)

Case number came in modestly higher than expected. Compounding the expectation there makes things likely to get substantially worse than previously expected, yet still nothing at all like what we saw last winter.

Deaths being up again rather than down (despite the ND adjustment), in a way I did not expect, since the timing on it seems premature, makes it that much more clear this is a real and large winter wave, and indicates that cases have likely gone up a bunch more than the numbers show, with the extra cases not being reported.

Deaths

Cases

Physical World Modeling and Long Covid

Observational study on Paxlovid in age 50+ population (paper).

Results:

During the study period, 12 541 (28.1%) patients were prescribed nirmatrelvir plus ritonavir, and 32 010 (71.9%) were not. Patients prescribed nirmatrelvir plus ritonavir were more likely to be older, have more comorbidities, and be vaccinated. The composite outcome of hospitalization or death occurred in 69 (0.55%) patients who were prescribed nirmatrelvir plus ritonavir and 310 (0.97%) who were not (adjusted risk ratio, 0.56 [95% CI, 0.42 to 0.75]). Recipients of nirmatrelvir plus ritonavir had lower risk for hospitalization (adjusted risk ratio, 0.60 [CI, 0.44 to 0.81]) and death (adjusted risk ratio, 0.29 [CI, 0.12 to 0.71]).

Strange to say this might be not worth the cost in dollars, even from a system perspective. Here’s a news article noting the cost is going to get into the thousands of dollars next year. How much is an 0.1% chance of preventing a death supposed to be worth? Presumably at least a few thousand, so still reasonably priced. It is a hell of a thing to tell people who put their lives on hold for years to avoid Covid risks that those same risks don’t justify giving them Paxlovid. The real downside, as I see it, remains that Paxlovid is a nasty drug with real side effects.

A lot of doctors continue to do their best to deny patients Paxlovid. Here’s another recent example.

Very (unnecessarily) long piece in The American Conservative about Long Covid, essentially attributing most cases of it to people expecting its presence, without denying that their suffering is real. Despite being long it did not offer much evidence, and I did not update.

This quote stands out and summarizes the perspective therein.

I have a colleague with a huge heart. One of the kindest people I know. She mostly treats brain tumors but, like all of us, she has patients with other illnesses. We are among friends, discussing the search for biomarkers for fibromyalgia.

Because she has a huge heart, she says what we are all thinking, out loud. That would be terrible, she says. Think of all the patients who wouldn’t have the biomarker. What would happen to them?

White House takes what little Covid funds remain and uses them to give out more free tests. Model what they prioritize.

A reminder of correlation not equaling causation, people who are not vaccinated for Covid are more likely to be involved in car crashes.

In Other Covid News

The ADA could potentially be used to force schools into having mask mandates. This seems like something we very much want to pass laws to prevent. If we don’t otherwise want such a mandate as a society, it seems quite bad to have one imposed by a lawsuit and court in this fashion.

In general I have not found The Twitter Files all that surprising or enlightening. I do want to highlight one thing about the timeline of events.

After long refusing to do so, Twitter finally suspended Trump’s Twitter account on January 8th. The mechanism seems have been ‘our employees yelled a lot until we decided we’d found a way to decide to do this’ which is not my preferred way of making such decisions, although one could certainly make a much better distinct case for taking the same action (or a strong case for not doing so).

By the next day, suddenly there was a large push to tackle ‘medical misinformation’ as soon as possible.

Or: Now that you have decided we get to be arbiters of truth, I have some truth I’d like to arbitrate.

Here’s to an old but amazing short (4 minute) interview.

China

China reduces case number reporting as virus surges. Yep, that’s China.

A notice on the commission’s website said it stopped publishing daily figures on numbers of COVID-19 cases where no symptoms are detected since it was “impossible to accurately grasp the actual number of asymptomatic infected persons,” which have generally accounted for the vast majority of new infections. The only numbers they’re reporting are confirmed cases detected in public testing facilities.

…

Inquiries to health hotlines have increased six-fold, according to state media.

…

Since Tuesday, the U.S. consulates in the northeastern Chinese city of Shenyang and the central city of Wuhan have been offering only emergency services “in response to increased number of COVID-19 cases,” the State Department said.

…

Hospitals have also reportedly been struggling to remain staffed, while packages were piling up at distribution points because of a shortage of China’s ubiquitous motorized tricycle delivery drivers.

BBC report here about hospitals struggling to remain staffed. This is a clear, classic Covid surge.

To be fair, it’s not like America reports a bunch of non-official or asymptomatic cases reliably. The difference is that the reporting here is inconsistent. In particular, this graph and reality currently seem to have very little intersection:

Official cases in China are down. Actual cases are clearly way up by all reports, as this section will detail. When the WHO is gaslighting us about what is causing the surge, they know it’s pointless to deny the surge is happening. Yet the above chart exists.

The protests seem to be over. The Chinese put up blue barriers to block repeat protests, then… decided they might as well do some road work to justify the existence of the barriers?

What else is over? A lot of Chinese Covid restrictions, at long last. Location tracking is turned off. The era of lockdowns seems to be over.

However horrifying a vision it might be to consider several years of such conditions, there is no question that the measures getting suspended were highly load bearing. This was the part of the system that worked to suppress cases, and things were previously in a delicate balance. It seems implausible that Covid could be contained under this new regime.

China is racing to vaccinate its elderly population, as usual lots of people wait until the last minute for such things. Then again, if the Chinese vaccine’s effectiveness fades over time (I don’t know either way), there was never any avoiding that problem.

What else might be over soon? What little is left of the Chinese Covid restrictions.

What is not over is the virus. The wave is here, starting with Beijing, and they are not locking down.

Beijing CNN — Empty streets, deserted shopping centers, and residents staying away from one another are the new normal in Beijing – but not because the city, like many Chinese ones before it, is under a “zero-Covid” lockdown.

This time, it’s because Beijing has been hit with a significant, and spreading, outbreak – a first for the Chinese capital since the beginning of the pandemic, a week after leaders eased the country’s restrictive Covid policy.

The impact of the outbreak in the city was visible in the upmarket shopping district Sanlitun on Tuesday. There, the usually bustling shops and restaurants were without customers and, in some cases, functioning on skeleton crews or offering takeout only.

Similar scenes are playing out across Beijing, as offices, shops and residential communities report being understaffed or shifting working arrangements as employees fall ill with the virus. Meanwhile, others stay home to avoid being infected.

Remember headlines like this? It’s their turn.

Or remember headlines like this? Except this time everyone’s eyes are open.

China Covid: ‘Panic-buying’ and shortages as restrictions are eased.

In China, as elsewhere in the world, it has been common to see people sharing pictures online of bare grocery aisles in major cities ahead of strict “stay at home” orders being imposed.

But now the country has eased track-and-trace rules, and has allowed people to self-isolate at home and self-test for the virus, people appear to be panic-buying medicines in anticipation of a winter wave.

There was never going to be any other equilibrium, once it was clear things were opening back up. Who wouldn’t stock up?

Scott Gottlieb also reminds us that the reason America is mostly fine is that we do not have an immune-naïve population, either in terms of infections or vaccinations. China will get there over time, but will go through a period, if Covid is allowed to proceed, that could be quite not fine.

(Note the contrast here with sources such as the New York Times that continue to spread misinformation and gaslight people by denying that infections provide protection, or provide protection for longer than a few months.)

I do think that in the long run, letting this happen is a better option than continuing to not let it happen. The timing of doing this is December, exactly when weather conditions might be at their worst, seems not great, and I’d have tried to do it either earlier or later. That is an additional sign that this was not planned, rather circumstances forced Xi’s hand.

In case you were wondering if the WHO was willing to spout obvious nonsense and gaslight us on behalf of the CCP, not sure why you were wondering, also you can stop wondering now.

China’s COVID spike not due to lifting of restrictions – WHO director

GENEVA (Reuters) -COVID-19 infections were exploding in China well before the government’s decision to abandon its strict “zero-COVID” policy, a World Health Organization director said on Wednesday, quashing suggestions that the sudden reversal caused a spike in cases.

The comments by the WHO’s emergencies director Mike Ryan came as he warned of the need to ramp up vaccinations in the world’s No. 2 economy.

Speaking at a briefing with media, he said the virus was spreading “intensively” in the nation long before the lifting of restrictions.

“There’s a narrative at the moment that China lifted the restrictions and all of a sudden the disease is out of control,” he said.

“The disease was spreading intensively because I believe the control measures in themselves were not stopping the disease. And I believe China decided strategically that was not the best option anymore.”

So this narrative exists because the following things happened in order:

1. China lifted Covid restrictions.
2. Which seems like it would cause Covid to get out of control.
3. All of a sudden Covid got out of control.

An understandable misunderstanding, you see. What is fair is that China’s Zero Covid policy was slowly failing to work, although this too was due to a loosening of those restrictions. Things would have eventually spiraled out of control, one way or another, the necessary level of restrictions was unsustainable.

Still, the fundamental story of the last few weeks is that China dramatically changed its Covid policies and the result of this is a lot more Covid. The WHO suddenly transforming to ‘no the giant additional number of Covid cases has nothing to do with suddenly doing much less to prevent Covid,’ after spending years desperately telling everyone to destroy their economies in the name of preventing Covid, is… well, exactly what I would expect from them. Yet somehow also remarkable.

On another topic entirely: Further reflections on the ProPublica/VanityFair lab leak story a few weeks ago, which James Fallows finds to have aged poorly, largely due to poor translation.

Other Medical and Research News

Monkeypox zero in both NYC and LA.

StatNews: CDC says it needs more congressional authority to collect public health data. Very You Had One Job, and cites no cases in which a lack of congressional authority impeded data collection. The example of data it did not collect was race data on monkeypox infections, which sounds based on the description like a coordination issue rather than a lack of authorization. Yet somehow, in normal circumstances, they’re not allowed to tell us things?

Ending the Covid-19 public health emergency, which could conclude as early as next year, will make it even harder, Walensky said.

“The context of a public health emergency allows us a little bit more flexibility to see those data,” Walensky said. “In two years will I be able to report on Covid-19 community levels? I can’t tell you that.”

This is so weird, and the information that would clarify is not in the post.

Demons of Density Do Higher-Density Environments Put People at Greater Risk of Contagious Disease? Here is the abstract.

We study the relationship between density and COVID during three distinct waves of the pandemic in New York City. Unlike prior work, our analysis uses individual Medicaid claims records, which include a rich array of demographic characteristics and pre-existing medical conditions and cover a near universe of low-income New Yorkers. In brief, our results suggest that living in higher density neighborhoods did not heighten the risk of COVID hospitalization. The size of a multifamily building made little difference either, and people living in public housing developments, which are typically highly dense environments, were less likely to be hospitalized for COVID.

However, while neighborhood and building density do not seem to matter, we find significant, positive relationships between COVID hospitalization rates and household size. Specifically, we see that people living in large households or in neighborhoods with high levels of crowding were more likely to be hospitalized for COVID. In other words, our results suggest that crowded living quarters – which can occur at any level of population density – and not density itself, increase the risk of COVID hospitalization. We also see a strong correlation between being unstably housed or living in institutional settings and COVID hospitalizations.

Using Medicaid claims restricts you to those eligible for Medicaid, not exactly a representative subsection of New York, although comparisons should still largely be valid within the group. The conclusion here, that density as such is fine so long as sufficient space exists but crowding matters, makes sense within the sub-context of NYC. It does not make a ton of sense if comparing the countryside to the city.

‘Constant turmoil’ at FDA’s food regulatory agency, report says. Everyone involved is appalled by how slow the FDA has been. Given the standard speed is ‘real soon now, might even do something this year’ that is saying something, and I certainly agree. What they want the FDA to do are things like ‘appoint strong leadership’ and work to ‘improve’ its programs, with the implication that the FDA is supposed to be getting Americans to ‘eat healthy’ and any health issues ‘associated with food’ can be placed on its doorstep no matter how tenuous are multiple steps in the connection.

Despite gains, acute foodborne illness still sickens millions each year and kills thousands. According to the report, 46 percent of foodborne illness outbreaks in 2019 were attributed to FDA-regulated products. Chronic diseases, such as cardiovascular disease, diabetes and some cancers are also “associated with food consumption” and kill more than a million Americans each year. Some advocates have called for a greater focus on chronic diseases attributed to food.

The problem that initiated the review is that the FDA engineered a shortage of baby formula that did not exist anywhere else in the world and refused to get out of the way to allow others to fix it. In response, there are calls for bold leadership so we can stop more people from eating the foods they want because we think we know better.