(2022-03-17) ZviM Covid 3/17/22 The Rise Of BA2

Zvi Mowshowitz: Covid-19 3/17/22: The Rise of BA.2. Omicron has made its way through every major country except one: China. Its time seems to have come

Unlike previous rounds where China was able to fully take extreme measures only it could take but that held the promise of physically working, this round’s efforts seem like the exact kind of hope that is not a strategy. They’ll help to slow things down

Meanwhile, Europe and the United States are dealing with the rise of BA.2, which is overtaking BA.1. My estimate is it is 25% more infectious than BA.1, which means its raw numbers should indeed be increasing for now, putting as at risk for an additional wave.

So it’s not the best time to notice that it looks like the administration really is out of money for Covid-related things. The standalone bill to provide the funding seems unlikely to pass the Senate

Executive Summary
BA.2 is taking over for BA.1, perhaps resulting in a small new wave.
China is probably about to be forced out of its Zero Covid policy.
A new highly promising therapeutic has been announced.

The Numbers

The lack of a further decline in deaths is getting increasingly weird. The implied CFR keeps going up, no matter what pattern of time lag one uses

My new theory is that these are mainly ‘with Covid’ deaths rather than ‘from Covid’ deaths and the definition somehow includes anyone with recent Covid, so people who have actually fully recovered, who then died of something else, are being counted as Covid deaths. I haven’t heard that expressed elsewhere, but if that’s not true, then I got nothing.

Europe, South Korea and Hong Kong

Cases in Europe are up, and a common line is that Europe is ‘ahead’ of us by a few weeks and represents America’s pandemic future.

For whatever reason, current conditions in the United States are far more favorable in terms of spread than conditions in Europe. It seems highly plausible that BA.2 could be enough to make things in Europe importantly bad but not do so in the United States. Everyone talking about this will say the opposite, it seems, citing our vaccination rate, because Covid-19 is supposed to be a morality play, despite its stubborn refusal to adhere to the script.

China

It seems increasingly clear that China has lost. The will to do what it would actually take to stop Omicron simply is not there

The core problem is, as noted in the last Omicron post, they’re using half measures, and those measures cannot possibly work in the sense of keeping an outbreak fully contained.

I do still think it is possible that China achieves containment and retains its zero Covid policy in reality but the chances are in the single digits and fading fast

What I don’t know is how much time. What makes it sufficiently clear that China will pivot to doing its best to handle the inevitable?

Then the next question is, once China gives up zero Covid, what happens next?

The optimistic picture is that things work out like they did in Japan (or like Omicron in India).

Hong Kong and South Korea suggest the other path. A very steep climb up fueled by an immunologically naïve population, leading to a peak that no hospital system could handle, and a lot of deaths.

The key is not to jump the gun.

This is very much a limited ammunition, ‘don’t fire until you see the whites of their eyes’ type of scenario. You’d want to wait until things were about to get rather desperate, then lock down hard

Starting that process now for over 50 million people is burning up those precious resources.

If we get the optimistic scenario, China will be adapting to using Covid prevention procedures in widespread fashion indefinitely

I think this is the less likely way for things to go, but it’s definitely plausible, so I’d give it a maybe 25% chance once full containment fails.

Also note that the peak won’t look as high as it does in Hong Kong or South Korea because China is very big and far less interconnected, so its peaks will be more local and diffused in time. Depending on ability to shift medical resources this could be a big advantage in minimizing human costs

Great News, Everyone

New therapeutic just dropped. From the people who brought you repurposed Fluvoxamine, this morning we give you… Peginterferon Lambda

The biological frameworks appear distinct, so chances are this will be cumulative with the effects of Paxlovid, and the treatment appears well-tolerated.

That’s the catch. We have not yet heard anything about supply, so it might be quite a while before this has a major impact.

Physical World Modeling

Observations that filter masks are indeed a big deal in practice, and get in the way of human interactions quite a lot. Interesting throughout.

Masks were still very much the right move early in the pandemic, even with these higher costs, but this is yet another reminder that we’re being continuously gaslit about the costs involved.

Zeynep Tufekci speculates on what would have happened if the whole world had reacted like South Korea and Taiwan, and China had been honest. What if the world had indeed, in Sam Bankman-Fried’s term from his excellent Conversation with Tyler, had its s--- together? Could Covid-19 have been suppressed? If not, what would happen?

This wasn’t that close to happening, but it also wasn’t that far from happening either.

Once it got out of control anywhere, however, it was over even in such a scenario. We either all win very quickly, we have a much more rough counterfactual in terms of our abilities, or we all lose. That still would have bought us substantial time. We would have avoided March 2020, but after that if Covid isn’t fully suppressed I’m not sure what the alternative world gets to look like.

BA.1 vs. BA.2

there are signs that vaccine might be slightly less effective against infection by BA.2 even though protection against death seems the same.

If anything, BA.2 might be slightly less severe than BA.1. That’s not the concern, though. The concern is whether it will cause a wave of cases

*The good news is, it doesn’t mean they’re rising all that much. I get R0 ~ 1.03 for BA.2, with cases down by 36% for BA.1, and up by 7% for BA.2 over the week, to average out to -30%.

That’s still a little scary, since it adds up over time*

There’s still reason to think the resulting wave if it happens will not get that large, and also strong reason to think it will not be very lethal.

From all accounts, BA.2 and BA.1 give full cross-immunity, so the weird part of all this is why didn’t BA.2 dominate from the start?

My bottom line here would be that BA.2 might cause something of a bump or even a wave, but it is unlikely to be sufficient to justify a general reversal of restrictions.

The Federal Funding

In practice, this is another sign that congress has zero intention of allocating serious money to things that won’t have an impact before the next election and does not expect pandemic preparedness to backchain in the minds of many voters.

Then there’s the bigger practical problem that we have zero current pandemic funding.