Important note, fleshed out a bit more in Omicron Post #14: From various sources, I have become convinced that rapid tests taken from nose swabs are likely to often be several days slower at detecting infections than rapid tests that use throat swabs.

So if you are testing with the goal of actually learning whether you have Covid or are infectious, that’s what you should do. Otherwise, you’re mostly testing in order to have conducted a test.

Your call.

We’re on the way down in the Northeast – we have the wastewater in Boston, which is already down 50%, we have a clear peak in New York City, and several states are clearly stabilized or better. Within a week, I expect the peak to be hit on average throughout the country.

That doesn’t mean things suddenly end, of course. Assuming no worries about hospitals, the highest value to vigilance actually comes right after the peak, if you think you’ve avoided infection until now. You’ve survived roughly half the risk at that point, making it more reasonable to try and avoid infection entirely, yet risk is still very close to its maximum on a per-day basis.

Yet it is time to start once again making plans for The After Times, which will be with us sooner than it might seem. Right now, the schools are a mess, everything is facing staff shortages and it all feels a little scary, but (death counts and a few hospital conditions aside) this is as bad as it’s going to get, and within a few weeks things will be improving on all fronts.

Executive Summary

1. If you do a rapid test and want to know the real answer, you need to do a throat swab.
2. Cases peaking in the Northeast now, rest of country within two weeks.
3. Schools are a complete disaster, but that’s another entire post.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 6mm cases (+71%) and 9,700 deaths (+10%).

Results: 4.9mm cases (+37%) and 11,856 deaths (+34%).

Prediction for next week: 5.6mm cases (+13%) and 15,000 deaths (+30%).

That’s a clear miss on cases. My presumption is that we were missing more cases than I realized, and for that and/or other reasons we peaked earlier than I expected and a lot of the Northeast is on its way back down shortly. The rest of the country will follow within a few weeks. On net I still expect an increase because I don’t expect big drops in measured cases in the places that have peaked, not quite yet.

On deaths, the wonkiness continues. The West came back to its early-December rate, despite the Omicron wave having arrived late. Other areas also so increases that seem a little early slash a little big, I definitely expected things to go better on this front. I still don’t expect things to get that much worse, and presume that the declines the previous two weeks involved holiday wonkiness, and the number now is nowhere near as scary as it looks without that context.

I still do expect a rise next week, and it’s possible it could be substantially bigger than this – the ‘real’ bump should be bigger than the one I’m predicting, the uncertainty is both the real size and the measured size of the increase.

Deaths

Cases

Almost a full doubling out West, but not in other regions and the Northeast has likely stabilized. A lot of cases are being missed right now and that should continue for a bit.

Vaccinations 

Omicron version of the Pfizer vaccine will be ‘ready’ in March, but not sure if anyone will even want them.

Pfizer will produce the doses to be ready in case countries want the shots, but Bourla noted that it was unclear if a vaccine targeting variants was necessary or how exactly it would be used.

Moderna boosters now also down to five months from second dose. No confusion here.

Vaccine Effectiveness

Fourth doses, how would they even work?

Moderna to report data on children ages 2-5 in March. I wonder if in expectation this would make us more or less crazy.

Not including the people you are most worried about in your clinical trials results in exactly what you would expect. Thanks, ‘bioethics.’

Vaccine Mandates

You need proof of vaccination to buy hard liquor in Quebec, which did result in a lot more vaccinations, because the people believe that they need hard liquor. You don’t need that proof to sell hard liquor, because working at the liquor store isn’t exactly an enticing reward and we want someone willing to do it.

By all accounts the Supreme Court did not cover itself in glory during its hearings about Biden’s vaccine mandate, with justices revealing deep misunderstandings about the facts on the ground. One could almost say there was dangerous misinformation involved. The ‘good news’ is that it was not at all obvious that the facts would have any material impact on the court’s decisions.

Isolation Guidelines

The UK says that 30% of people will be infectious on day 6. Scott Gottlieb tells us that yes, such people might be non-zero amounts of infectious, but the pandemic is mostly being spread by people who are positive and don’t know it. He notes that if the CDC had been more straightforward and open about the whole thing, and presented the actual logical situation, it would have been better. A good reminder.

Without that, we end up with this.

It all actually does make sense, it’s the difference between what you ‘can’ do versus ‘should’ do, and what you need to do to keep things running versus what you don’t have to do until next week, and what can and can’t adjust privately with grace. That doesn’t mean it sounds sensible to people who hear it.

Some new research is out on that question of how long people remain infectious, showing 3 out of 16 samples still infectious on days 7-9 after first positive, which is then cited as evidence that we are going to render our children unsafe. Infectiousness is not Boolean, so the effect size here is presumably small, with the first five days of isolation still (if we take this at pure face value) accounting for the vast majority of new infections.

I want to point out how completely incompetent we are as a civilization at running this experiment. That sample size was sixteen! And Michael Mina thinks this is important enough to take seriously. What the hell? The experiment only requires testing people, we do that all the time anyway, is running this with a few hundred samples this hard?

When I try to do simulations and look for estimates of generation times – the average time from when I get infected by you to the time at which I infect someone else – reasonable estimates go from 2.2 days in a South Korean study on the low end, to an upper range of 3 to 4 days. The data don’t make sense with anything longer.

So if the mean time between infections is about three days, and your first day is mostly safe since the virus has to multiply first, then how many cases can happen more than five days after your symptoms start, which is also at least one or two days after you get infected? Assuming any reasonable distribution, only a very small number.

Thus my guess is that the results here were a fluke due to small sample size, and the UK’s guess of more like 15% on Day 6 is about right.

Or, to respond to the link’s claim – if something does not ‘drive the pandemic’ it by definition is not ‘putting people at risk’ in the general sense, so we should only worry about vulnerable people in context, which sure isn’t students.

Tests

Thread introducing the concept of the Default Difficulty of Life.

Can I afford it? Mu.

I can, of course, afford any given tiny little dystopian nightmare like filing for reimbursement on a diagnostic test, where the payment is capped at $12 and the market clearing price is twice that. I am capable of navigating quite a bit of difficulty, in a way that many others cannot. But those navigations are expensive in time and focus.

Remember, when things are Out to Get You, to take your Slack, their favorite line is that You Can Afford It, and if you allow the things you can afford, soon you will have no slack, and you can afford nothing.

And, indeed, increasingly it seems most people have gotten got, have no slack, and can barely afford to keep their heads above water, especially in the most important ‘raise a family’ sense.

I strongly agree this is an underappreciated concept, both regarding Covid and not regarding Covid. Also the Default Difficulty of Doing Thing, for any given thing, matters too. Every time you raise it, whether or not this involves monetary expense, less Doing of Thing will occur, both in particular and in general. Related to Beware Trivial Inconveniences. We need to lower the Default Difficulty, and look highly suspiciously on everything that raises it.

Not run the government by offering three easy payments and a mail-in rebate, knowing full well that almost no one gets the rebate.

Meanwhile, the strategy continues to be to buy doses rather than buy capacity, without long term commitments that can be relied upon to justify ramping up capacity, same as vaccines, which inevitably results in shortages because there’s less free supply, no ability to ration via price and no expansion of capacity.

And how are those coming along? The very definition of Real Soon Now, and a missed opportunity to use the Exact Words.

Meanwhile, they plan to make it an even billion tests in time for us not to need them.

NPIs Including Mask and Testing Mandates 

You want to know what being truly anti-mask looks like? It looks like Bryan Caplan staring death in the face, and saying ‘hey, I’m having trouble seeing your face, can you take off that mask?’

What if the choice was between masks and a 50% annual chance of death?  The reasonable reaction would probably be, “Fine, we’ll be severely dehumanized, but we’ll survive.  Just like war.  I guess I’ll take it until a better deal comes along.”  When the choice is between masks and a 0.5% annual chance of death, however, the reasonable reaction is rather, “I’ll take my chances and live like a human being.”  Indeed, once you’re old enough, even a 50% annual chance of death starts to look like a good deal.  My considered judgment: If another Covid strikes when I’m 80, I do not want my grandchildren to wear masks around me.  I want to enjoy their laughter while I still can.

The dehumanization thing is being undervalued, although I still think it’s something like the third or fourth most important problem in practice with masks. And for Bryan, that alone is overwhelmingly sufficient, given that the risk level here is way above the real one. An annual 0.5% chance of death is much worse than getting Covid-19 yearly, and masks prevent much less than one Covid-19 case per year. This is a very overdetermined opinion being offered here. I am impressed.

The alternative might be simple defeatism, like the administration not distributing N95-quality masks because they despair that anyone would use them. Which is wrong, trivial inconveniences are a big deal.

Thread of practical mask advice non-memes for pandemic adjacent teens.

Think of the Children

Don’t worry, we haven’t forgotten about them, I split this section off into another post this week.

In Other News

Confirmation that the FDA is advocating for and directly causing discrimination in the distribution of life saving medicine on the basis of race.

Djokovic update: He won his case, and he will play. What is the law? Depends who you ask. Got to hear both sides.

Here is a transcript of him talking to government agents about his situation when he was first detained.

Bari Weiss is done with Covid, whether or not Covid is done with her.

And why not? Walensky comments on Good Morning America, unabridged (part that was cut is in red).

Latest Long Covid paper, showing vaccination reducing Long Covid symptoms 50%-80% as one might expect. Given no controls on what gets reported, it’s an interesting question what that translates to in terms of real symptom frequency – vaccinated people are more likely not to attribute things to Covid, and also some of the symptoms being reported aren’t from Covid, so could go either way. I didn’t see the kinds of controls here that would let me update much in other ways.

The latest Pirate Wires hits many of the familiar notes, while pointing out that the new tone from on high are the familiar notes that would have gotten one marked as a wisher of death upon (largely immune, not that this fact stopped anyone) children until quite recently. I mention it because of a particular turn of phrase (which I’ve bolded) I want to notice, rest is for context and a smile.

Three days after Christmas Biden revealed his new Covid brand direction, in what essentially amounted to the shrug emoji, rejecting the notion there was anything the federal government could or even should attempt to stop the pandemic. It was truly as if the White House’s prior message of doom was delivered only to ruin one, last family gathering before finally admitting the hysteria had gotten out of control, was best-case futile, and was in the case of our nation’s youth probably actually killing people. The partisan swarm activated.

That phrase, ‘could or even should,’ stood out to me as importantly insightful. You would think that could would proceed should, three times fast. We used to worry that those preoccupied with whether they could wouldn’t stop to think if they should. Instead, we have people so preoccupied with whether they should that they don’t stop to think if they could. For two years, we’re told what we should do, in some weird moral sense, by those who never much cared about whether we could do it, whether it would accomplish anything useful or the mission at hand, or whether doing so passed any sort of cost-benefit analysis.

Things we already mostly knew, many scientists chose not to talk about the lab leak hypothesis because they thought that it would harm science in China. This is not my prior on how science works, but it is exactly how Science(TM) works.

CNN suggests not intentionally catching Covid right now, offers Five Good Reasons. They are:

1. It’s bad.
2. Long Covid is bad.
3. Think of the children.
4. You’ll stress the health care system.
5. ‘Don’t mess with mother nature.’

As evidence of the last one, they offer this, oh my is this classic Liberal Media, chef’s kiss.

“Oh, that was a bad idea too,” Offit said. He told a story about an educational film on vaccines he made years ago, and the cameraman revealed he had a sister who had taken her child to a chicken pox party. Tragically, the child died from the infection.

I give this Five Good Reasons a two out of five. Long Covid is a consideration (and there’s a non-zero chance you never need to get infected, and have gotten through something like 30%-60% of the risk depending on where you are, already), and the health care system is still under above average stress. I do think that’s enough that getting infected on purpose at this time is an error.

Robin Hanson, as one might predict, is not impressed, but respects the asking of the question and describes it the way I would, as ‘overstated.’

Not Covid

What they had actually discovered was boredom, or rather, the practical function of boredom. But can they program it to like herring sandwiches?

Living the dream, an NYC subway car of one’s own.

Living the dream is also having one of the good dishwashers, which luckily we already have, since they are once again being made illegal. We’ve been saved from the danger of properly washed dishes, good job everyone. If you haven’t yet, get a good one while you can.

Saying the quiet part you were saying out loud, except a lot louder.

They are who we thought they were. Will we let them off the hook?

From Marginal Revolution: What’s the best example of an experiment or trial that could be scientifically useful and informative but which can’t be done for legal, ethical or logistical reasons? Mostly uninspired answers, but good thought experiment.

The Bed of Procrustes

Taleb shared the new aphorisms in the latest addition. Regardless of the extent to which you agree with them, they’re good food for thought, and I figured it would be a fun exercise to divide them into a few categories. Would be interesting to flesh this out, but for now, quick takes sounds like fun. Note emphasis on quick – I might or might not give same evaluations on reflection.

1. Full agreement – take this seriously and literally.
2. Great aphorism – take this seriously but not literally.
3. Good aphorism – take this more seriously on the margin than you’d expect.
4. Disagreement – take this neither seriously or literally.
5. Opposition – take the reverse of this more seriously than you take this.
6. Abstain – take a pass, because of reasons

Full agreement: 4, 5, 7, 8, 9, 17, 18, 19, 20, 27, 28, 29, 32, 34, 36, 38, 39, 40, 41, 44, 46, 48, 52, 53, 54, 55, 56, 57, 61, 62, 63, 64, 65, 67, 68, 69, 72, 76, 77, 81, 83, 84, 85, 86

Great aphorism: 11, 23, 25, 33, 37, 50, 59, 66, 70, 73, 88

Good aphorism: 1, 2, 3, 14, 15, 43, 45, 47, 49, 51, 58, 60, 71, 74, 79

Disagreement: 6, 10, 12, 13, 26, 31, 35, 42, 75, 78, 80, 87

Opposition: 21, 22, 24, 82, 89, 90

Abstain: 16, 30

That’s a really good ratio there, these aren’t trivial statements or obvious truths. Full agreement with half the non-abstains, remarkably little disagreement and opposition. Most disagreement essentially comes from Taleb believing strongly that it’s important to have the right enemies. I am more inclined to suggest taking a card, writing on it “There Is No Enemy Anywhere” and putting it into one’s pocket. These days that’s the one most people need. Taleb likes enemies he can call idiots. Where there must be an enemy, I prefer a (ideally non-evil) Worthy Opponent.