(2021-07-29) ZviM Covid 7/29 You Play To Win The Game

Zvi Mowshowitz: Covid-19 7/29: You Play to Win the Game. Few things warm my heart more than playing to win the game. Few things sadden me more than observing someone not playing to win the game. Usually, that means they are playing a different game instead, whether they admit it or not, and whether or not they know it themselves. The game, from this perspective, is simply that which you are playing to win, and your revealed preferences define the game’s rules and objectives.

The lowest hanging fruit remains (FDA) fully approving the vaccines, which we somehow still have not done.

Then on Wednesday, Pfizer came out with data that the vaccine remains effective after six months. That’s the headline. The actual data is not as encouraging:

Contrary to Pfizer, that’s quite the drop in effectiveness. The protection against death remains robust, and yes 84% is still quite good compared to what we would have asked for a year ago, but ‘remains effective’ is giving the wrong impression if this data holds up.

Israeli data has been suggesting remarkably low effectiveness of vaccinations against Delta variant. This thread suggests this comes from… using the wrong denominator.

On That Israeli Data on Delta’s Effectiveness

the Israeli numbers simply didn’t make any sense. They were incompatible, even with each other, let alone with what we were seeing elsewhere

Delta Variant

CDC has reversed course on its mask mandates. Masks will be back in schools

There are two central facts about Delta one’s model must explain. First, the dramatic takeover of the pandemic and rise in overall cases across countries. Second, the sudden reversal of those trends in many places, including India, the UK and the Netherlands:

If you zoom out, the case numbers are still large.

But the death numbers barely register:

This graph is pretty bizarre when taken at face value, and I presume it shouldn’t be, and is only the county of San Diego, but still seems worth noting

At the lefthand side, we have about 3 cases per 100k among the vaccinated and 9 among the unvaccinated, a ratio of 3:1. That’s a surprisingly small ratio.

Then the cases among the unvaccinated shoot up, and at the end, we have 16 unvaccianted cases per 100k and 2 vaccinated cases, for an 8:1 ratio. In July, this is most definitely representing a pandemic of the unvaccinated.

The question is, why would this ratio suddenly get much bigger?

Vaccinations are great, but what matters is immunity, and vaccines are only one way to get immunity.

and the numbers in the UK on antibodies are very, very high…

If 90% of people are immune, then each additional 1% that becomes immune reduces spread after that by a full 10%

It is possible that this is simply what it takes to turn the corner on Delta. If so, then if the USA has roughly 70% of adults having been vaccinated, than we would turn the corner when about two thirds of the unvaccinated have been infected at some point sufficiently to develop antibodies

You Play to Win the Game

Last year, the NBA figured out how to do Covid testing. This year, it’s all about vaccinations, and the NFL is stepping up.

Yes, it turns out that not protecting yourself against infectious disease can put you in a position to hurt your team. Who knew?

The Pac-12 is considering following suit.

Most of the Pac-12 schools have vaccine mandates in place in any case

Others Playing To Win the Game

New York and California are requiring government workers who don’t get vaccinated to get weekly tests and wear masks indoors. New York at least is not providing a testing option for health care workers, it’s vaccination or you are (very understandably) fired. Virginia is mandating vaccinations for health workers, as is the veterans administration.

Reports are that Biden will follow shortly with a similar rule for federal employees, if he hasn’t already by the time you read this.

My hope is that this effort continues and spreads, and more and more private employers will be emboldened to enact similar policies. If I was a private employer whose employees were interacting with each other in person or with customers in person, I’d hope to be more worried about what would happen if I didn’t mandate vaccination

And once again, we gotta get full authorization as soon as possible. A huge amount of the lack of mandates is the lack of full authorization

Long Covid

We finally have some real data to look at.

Should we believe the results of this study? Do these effects seem real?

as usual, studying such things is really hard and there are lots of problems

Here’s what they controlled for:

basic demographic information and socio-economic status.

there are three potential confounding factors

The first is that choosing to take the test could be a function of one’s situation and practical intelligence. If I had Covid and fully recovered and felt fine, I would not be so curious about taking an intelligence test. If I had Covid and had continued problems, then I would plausibly be much more interested

The second is that being intelligent helps prevent Covid-19, after controlling for the other factors. The study was done in 2020 so vaccination isn’t relevant, but plenty of other decisions matter

The third is that it looks like they’re using self reports of Covid-19.

The huge advantages of doing what they actually did were that it was practical, it was ‘ethical’ and it was relatively inexpensive

Lower in the same table, it’s clear that almost none of these people had a positive Covid-19 biological test, so this is almost all self-diagnosis:

The first thing to note is that this effect that grows as symptoms get more severe makes a hell of a lot more sense than the mysterious ‘Long Covid doesn’t care how bad your case was’ nonsense

So that adds a lot of credibility to the findings.

As always, also, there’s the question of whether this effect is unique to Covid or is a general property of many infectious diseases. In some sense it does not matter, but in other senses it matters a lot – or at least points to our failure to be consistent, with several potential ways to address that.

This is their note that the effect size here is indeed a big deal, which it is:

The line that the 0.47 SD drop is more than 10 years of decline in global performance between 20 and 70 is very interesting, because it suggests an intuitive way to measure how much we should care about this effect – we can think of this as similar to aging.

Then there’s the question of how this interacts with vaccinations and children.

You’d also want to adjust for Delta variant, since all this data was from 2020. My presumption is degree of symptoms mostly controls for that, but it’s plausible that this doesn’t fully control for that.

This Long Covid effect definitely would still be a bigger danger for most people than death, even before vaccinations. I’d much rather take the very small risk of death than accept this level of accelerated cognitive decline, plus any longer term non-cognitive effects, and it isn’t close even under relatively minimizing assumptions, and multiplying for the uncertainty that this effect is real.

Vaccine Hesitancy

We are doing a rather terrible job conveying the information about vaccines in a way that is accessible, understandable and credible to such people, and the fact that vaccines happen to be highly safe and effective doesn’t excuse that.

Regardless, under such a model, lowering costs of vaccination is the obvious choice for getting people vaccinated, and it continues to be a highly efficient strategy. Drive that cost negative. More precisely, one wants to reduce perceived costs, which can involve changing people’s models of vaccine effectiveness and/or safety, and/or changing the difficulty and costs of vaccination.

Periodic Reminders (You Should Know This Already)

Your periodic reminder: The FDA and cost benefit analysis are not on speaking terms, nor does the decision process much correspond to what is safe and effective let alone what is in the public interest

WaPo reminds us that Japan is failing at vaccinations by doing the things you would do if you wanted to fail at vaccinations. This includes insisting on distribution by only doctors and nurses, holding out until way too late for a homegrown vaccine, a labyrinth approval process and demands for domestic testing of the vaccines, confusion about rules and a general lack of urgency, among other things

In Other News

In the monthly links post at ACX, Scott also points to the poll that showed remarkable support for permanent lockdown in the UK:

But then reminds us that if you ask the questions with slightly different wording, people act more sane, and a permanent lockdown then only gets the 3% support

That makes this most of all a manufacturing consent story. Merely by changing a few words and giving people the correct word associations, you can get many people to agree to give up their freedoms and way of life, permanently