(2021-01-28) Zvi Covid 1/28 Muddling Through

Zvi Mowshowitz: Covid-19 1/28: Muddling Through. There’s the situation short term, there’s the new strains, there’s the vaccines.

On the short term front, forward looking news continues to improve, but not at the pace we’d like or that I expected

On the new strain front, the news is mixed.

For the non-English new strains, things got less scary

For the English strain (B117), things got much scarier

On the vaccine and policy front, we had excellent news, as the Biden administration announced a deal for an additional 200 million doses of vaccine from Pfizer and Moderna.

There’s still a ton to do.

I’ll also take the numbers we are seeing on vaccinations

The exception to that is our failure in long term care facilities, which isn’t getting enough focus.

The Numbers

Part of the story about deaths is that our nursing home vaccination efforts have been dreadfully awful

Both the South and West had substantially more deaths this week. The question remains why

I have no explanation for why we did less testing this week than we did the previous week, and did so everywhere including New York

Vaccinations

Last week we were averaging under a million doses, now we’re over 1.2 million. That’s a solid rate of increase if it can be sustained. Yesterday saw the seven day average decline slightly, which is always scary

The English Strain (B117)

It is now accepted that the English strain is here, it is rapidly taking over, and it is substantially more infectious than our previous strains

We know it does not evade vaccines, and prior immunity protects against it. The new worry is that the new strain might be deadlier.

The Other New Strains

It is also accepted now that the South African variant is super scary

Biden imposed travel restrictions on South Africa this week, which was long overdue. Belgium closed its borders entirely to non-essential travel.

Developments in Brazil with their new strain continue to seem not great either

What is the New Administration Doing About Covid-19?

My main take on all these executive orders is that it seems the government is no longer capable of carrying out its basic functions without explicit executive orders, and that seems like a problem?

I’ll skip over the stuff that isn’t pandemic-focused.

He directed FEMA to expand reimbursement to states to fully cover the cost for National Guard personnel and emergency supplies. It’s scary to think that failure to do this was slowing down emergency supply provision including the vaccine, but this seems to be true. Also, this is a transfer to the states, which is urgently needed.

He signed an order to establish the Pandemic Testing Board to expand US Covid-19 testing capacity

The problem is that the main obstacle to testing is the FDA banning people from running tests, and I don’t see any signs that this is likely to change much.

He directed FEMA to create federally-supported community vaccination centers. Good show.

He directed the Department of Education and HHS to provide guidance for safely reopening schools and childcare and higher education, and directed OSHA to release clear guidance

So, if nothing else, major points for nothing being actively unhelpful. You love to see it.

What was missing were the things that were most maximally helpful

If I was in charge of the administration response, my top priorities would be the first three or four here, then the rest:

• Approval of Astra-Zeneca and Johnson & Johnson Vaccines
• Approval of all reasonable Covid-19 tests, and ramp up capacity.
• Ramping up manufacturing capacity for vaccines, and/or buy more doses, by paying more money

From Biden’s first batch, I’d say the job got done on #8, and some reasonable efforts were being made on #5

But then a miracle occurred, and it turned out that yes if you are the United States you can just buy more vaccine doses and then you get more vaccine doses, so we did that!

wait, we could have just done this the whole time?

A lot of the executive orders that were issued highlight exactly how deep a hole things started in, making it hard enough to merely stop digging. It’s still worth noting that many of the high leverage potential actions are not being taken.

That may be why he said “There’s nothing we can do to change the trajectory of this pandemic for the next several months” in the context of pushing for economic relief. Which is a deeply troubling thing for him to say. Of course there are lots of things we can do! A bunch of the things that Biden did on day one are going to do it. The extra vaccine purchases will definitely do that! We could end the pandemic in the next several months if we wanted that badly enough.

The Quest to Sell Out of Covid Vaccine

I would feel bad about my massive confusion and inability to figure out how many doses we have, except that I am not alone and this is real.

It is a real question how much this lack of knowledge matters. On the one hand, yes it makes planning on the part of states, counties, sites and people much harder. No one knows how much vaccine they will be getting. On the other hand, aside from having to cancel and schedule pending appointments, it’s not that clear how much value of information is here.

One danger is that doses might be held back en masse more often as second doses when they could be used now as first doses, because there is no confidence in future deliveries

Cuomo vehemently disagrees, and says the state is fresh out, and certainly the state has been cancelling appointments like they’re fresh out

The Quest for More Vaccine and More Vaccines

Johnson & Johnson’s vaccine is potentially a true game changer. It is one dose, does not require special temperatures, and they are claiming 100 million doses by the end of April.

Meanwhile, Pfizer has decided that since we’ve managed to extract more doses out of their vials, that means they’ve delivered extra doses, and so based on their contract they can ship us less vials, as they did with Denmark

I have zero problem with Pfizer getting paid for the extra doses

In the short term, looks like supply will be increasing slowly, but definitely increasing

In ‘actually being helpful’ news, while they wait for their own candidate to become ready, Sanofi to produce 100 million Pfizer vaccine doses, CEO says

AstraZeneca meanwhile is suffering supply problems, and cut their first quarter allocation of vaccine to Europe by 60% this week. I hope that they’re giving Europe all the doses we’ve refused to approve here in America, so they’re not sitting on the shelf unused.

This led to a fight between the EU, UK and AstraZeneca, because the EU wants you to know that when they pay for second class vaccine distribution three months late, they will not be treated as ‘second class citizens’

Meanwhile, they haven’t even approved the vaccine in question yet.

Don’t get me wrong, AstraZeneca absolutely messed up their trials in several ways and this is one of them, they’ve been a disaster as good vaccine candidate shepards, but punishing the world to spite AstraZeneca’s face in a way that mysteriously lets them make more money because they get paid higher prices for later sales doesn’t seem like a punishment that fits the crime.

One Dose, Two Dose, Half Dose, Who Knows

The ultimate low hanging fruit in expanding vaccine doses is to give half doses of vaccine to young healthy people

Vivek Murthy also used the term “driven science” as code for “anything not in a proper study isn’t evidence.” Ezra Klein correctly pushed back hard on this, asking if “following science” meant only “certainty.” Vivek thanked him for the question, said no we look at all the available information and make the best decision we can, and entirely disregarded the contradiction.

On the other hand, he was quite promising on questions of rapid testing

We have great news. Half doses are being seriously considered for at least for Moderna!

None of that means that we shouldn’t test tiny doses.

What this all definitely drives home, once again, is that we have had it in our power the whole time to put a stop to all this.

Vaccine Allocation by Politics and Power

I’d urge those who know they have already had Covid-19 to wait on their vaccinations until we have enough supply for whoever wants it, but I wouldn’t introduce any formal rules or checks on that basis.

The long term care facilities still aren’t getting their shots into arms. It’s going rather epically badly, and not appreciating the extent until now is one reason why I undershot the death count this week by so much

The partnership with CVS and Walgreens does not appear to be working. The question is why. My presumption is that we’re asking CVS and Walgreens to do exactly what they don’t normally do, and go other places to deliver medicine, rather than asking them to give shots in their stores which is what they know how to do

Stop Living in Fear After Vaccination

The vaccine protects against Covid-19, better than we could have hoped for

If you’re fully vaccinated, please do keep wearing masks, and otherwise reinforce good pandemic norms. But don’t keep putting your life on complete hold

The talking point that “we have no proof that vaccinated people can’t spread the virus” is successfully freaking out a lot of people who really, really should know better.

For the most extreme cases of all, I’ve seen reports from several places of support for suspending schools indefinitely even after teachers are vaccinated

Given what I think about schools, I have mixed feelings about such stands, but if I instead felt as almost everyone does that school is highly valuable to children rather than primarily a prison sentence, I would treat such responses as insane

Sports Go Sports

mostly we got to have our season and all the joys that come along with it.

The NFL did it by learning from its experiences and early mistakes, doing the math, figuring out what was actually risky, and using testing, mandatory masks, contact tracing and quarantines.

Over the course of the monitoring period (August 9–November 21), 623,000 RT-PCR tests were performed among approximately 11,400 players and staff members

The NFL shows what you can do the hard way. The NBA is more ambitious, playing its playoffs in a bubble, and now using trained dogs to detect Covid-19 for fans looking to attend games.

You Should Know This Already

Masks are great, premium masks are better. If you haven’t already, it’s time to step up to at least KN95s

In-person higher education spreads Covid-19 and no our precautions are not adequate to stop this

Note that this doesn’t mean that it’s impossible to safely run an in-person college, only that a lot of them did so highly unsafely.

Even most relatively smart people fail to appreciate the benefits of forecasting. They instinctively seek to avoid information, because information causes Not Okayness and blameworthiness. And one usual reaction to anything you want to shut down is to force it to show its concrete benefits, and then only count the benefits that can be proven and quantified. Whereas in my culture, the quest to get good forecasts is useful in so many different ways. Not only do those forecasts have humongous value of information compared to the cost of getting them, but the act of figuring them out causes us to learn all sorts of useful things and train all sorts of useful skills, gives us valuable discipline and a proper tax on bullshit, and allows us to identify valuable sources of future information. Among other things.

It is one thing to not exclude the previously infected, it’s another thing to actively encourage them to try and get vaccinated during an acute shortage, but then again, Andrew Cuomo is the Worst

Poorly ventilated spaces spread Covid-19 highly effectively, and make talking highly dangerous.

Periodic reminder that we could win now if we used a sufficient quantity of rapid tests, and that the entire pandemic continues to be the fault of FDA regulations.

The CDC Should Know This Already

The CDC did manage this week to fix its crazy overestimate of the true number of Covid-19 cases

but the lack of a new released methodology is still kinda suspicious

CDC admits that mixing Pfizer and Moderna vaccines is acceptable in ‘exceptional cases,’ continues to insist they are technically not interchangeable. Also admitted up to a six week wait between doses is fine.

FDA should also know this already, and also eases up its guidelines on second dose timing exactly when it becomes logistically necessary to do that

Competition for being The Worst is always intense. Consider the latest entry, a Harris County DA who (I am assuming Gokal’s account is accurate) literally arrested a doctor for stealing vaccines when he took otherwise expiring doses and gave them to whoever he could find:

The WHO also ups its game to stay in competition to be the worst, taking the classic “no evidence” line rather explicitly to deny life saving medicine to pregnant women, as in and I quote “there is no reason to think there could be a problem” but still, don’t do it

It also made the move of ‘don’t provide any word on Moderna until the end of January” which you have to admit is a strong move in this competition

I am strongly in favor of experimentation in general but I’m going to make an exception and say that we’d all be better off if Pfizer didn’t test its vaccine in children ages 12-15

California continues to make strange decisions regarding its lockdown procedures, lifting regional stay-at-home orders that encompassed 90%+ of their population on Monday. All hail the control system. Things in California do not seem to be going sufficiently well that, given you’d instituted such an order, it would make sense to lift it unless your priorities (and perhaps something else that isn’t the level of infections) had suddenly changed.