First:
Charles Gaba: America in One Image <https://twitter.com/charles_gaba/status/1416208984365846529>:
We are a half-vaxxed country. And a country that looks like it is going to stay half-vaxxed: there is just too much money to be made by media grifters and too much political hay to be made by right-wing politicians seeking to win the Trump base for vaccination rates in the country as a whole to get above 50% before the Delta Variant sweeps through.
This is a catastrophe.
While hiking in Claremont Canyon earlier last week, I found myself to Andy Slavitt’s podcast. Andy had been one of the most positive influences on the rolling what-to-do-about-coronavirus debate. Yet I found it extremely disappointing to listen to:
On one of the podcasts I listened to he had as his guest Trump FDA Commissioner Scott Gotlieb. Gotlief had been one of the best of the Trump political appointees. (And, yes, I realize how incredibly low a bar that is, and how brutal is this damnation-with-faint-praise.) As I hiked down from Panoramic Ridge back to the house, I found myself depressed and let down.
The first reason I was let down was what seemed to be a constant mantra repeated over and over again by Slavitt and his guests alike: if you are vaccinated, resume your normal life without masks and without social distancing—you can do everything except go into a moist, crowded, hot batcave and sing for hours. And maybe you can do that. That seems to me to completely ignore the fact that we are a half-vaccinated country. If you do get the Delta Variant in a breakthrough case, since we are a half vaccinated country and the Delta Variant’s R[0] is between 4 and 8, you will give the disease to between 2 and 4 people—say 3. And in two weeks, they will each give it to 3 people—now we are at 12. After two months your downstream chain of infections will have given the disease to about 363 people. And odds are that 4 of them will die.
If you mask up, and maintain social distancing, so that you don’t give your breakthrough case to anyone during the three days after which you are infectious before you realize you have symptoms, you save four lives. Now you can say that a breakthrough case is a low-probability event, and it is. You can say that it is no worse than drunk driving at night. Yes, you can say that.
Or you can say that the antivaxxers are immovable, and that each of them will catch the Delta Variant sooner or later, so all your giving the disease to them would do is move their death date forward in time by six months to a year: they had their chance to get vaxxed, they rejected it, so their deaths from drowning in their own mucus are none of their concern. Yes, you can say that.
The second reason I was let down was what seemed to be a constant mantra repeated over and over again by Slavitt and his guests: risk to you, risk to YOU, RISK to YOU, risk to YOU, risk to you, risk to you. Very rarely—in fact, if I counted correctly, more mentions from the snippets of recorded person-on-the-street than from Slavitt and his guests—was there any talk about the risks to us.
On September 26, 2020, now-Supreme Court Justice Amy Coney Barrett allowed the Trump White House to host a crowded party for her. 30 people. Risks to her from having this nomination party were not that large. But, approximately, caught COVID-19 at that party. With a fourteen-day infection cycle, those 30 then gave it to 50 in mid-October, who then gave it to 80 in early November, who then gave it to 150 at the end of November, who then gave it to 200 more in mid-December, 200 in early-January, and 200 in mid-January. Then it drops off—another 620 between then and now. A total of 1530 people. And that’s if the guests at Amy Coney Barrett’s party and their contacts behaved like normal Americans. They may not have—it might be much, much more. Or it might be much less: some fraction of that 1530 would have rejected immunization, and we know that with the Delta and other variances eventually more than 90% of Americans will acquire immunity either through vaccination or through getting a strong enough case of COVID-19 to trigger an immune response.
Odds are that, of those people, 15 are now dead. 15 people who would now be alive had Supreme Court Justice Amy Coney Barrett said “I don’t think that’s a great idea” when having a big party for her was mooted. Maybe it is more—maybe the chains of infection went to elderly Trumpists. Maybe it is less—maybe a good many of those who got infected would have gotten the disease anyway in the winter or the future, and that for many of the 15 it just cut their life short by 4 months or so. I can’t tell.
But 15 is the number to keep in your head. Amy Coney Barrett, I guarantee, does not think of herself as some ca. 1450 Mexica priestess watching her hench-priests sacrifice 15 people with obsidian knives on one of the pyramids of Tenochtitlan to celebrate her ascendancy to power. She does not light fifteen candles every Sunday, and pray on her knees that if any of those fifteen died unshriven that their sins descend upon her rather than upon them.
But maybe she should?
Slavitt and his guests’—all of their risk to you, risk to YOU, risk to you, risk to you—greatly discourages in his listeners the kind of systemic equilibrium thinking that we economists and you epidemiologists do as a matter of course. And we very badly need Americans to think that way: “vaccination is of very little risk to me, and may do a lot of good for others” is the way the thinking should go. And Slavitt’s vibe… discourages that.
I do not know why his podcast is doing this. Has the elite public health community decided that the best way to get as many people vaccinated as possible is to say that the reward for getting vaxxed is that you get to resume your normal life, and that whatever spread to the unvaxxed is produced by the vaxxed who do not social distance is outweighed by the reduction in spread because that carrot will induce more vaccination? If so, show me the arithmetic.
If not, what are Slavitt and company thinking?
And there was a third reason I was let down. Scott Gotlieb was all about “Let’s not point fingers at Trump and his enablers! Let’s talk about the systemic bureaucratic defects that have led to this… disaster!” If every Scott Gotlieb who wants to preserve his standing among professional Republicans by “moving on” from Trump and his enablers would actually, you know, act like somebody with real ovaries, the country would be in a much better position than it is. And Slavitt did not challenge him, at all. Sick, in an almost Cultural-Revolution sense…
One Video:
Al Green (1974): Come & Take Mehttps://www.youtube. com/watch?v=LKh00Zi7ql8
Very Briefly Noted:
James Arvin: How Climate Change Fueled the Devastating 2021 Floods in Germany & Northwest Europe<https://www.vox.com/22577431/germany-flooding-europe-climate-change>
Richard Reis: Welcome to Tomorrow’s Professor <https://tomprof.stanford.edu/>
Coda: A New Doc for Teams <https://coda.io/welcome>
Cassie Kozyrkov: MFML Part 2 Has Arrived: ‘You can now enjoy 3 hours of Making Friends with Machine Learning. The wait is finally over. Today, Part 2 of Making Friends with Machine Learning, Google’s legendary AI course designed for technical and non-technical folks alike, is here… LINK: <https://decision.substack.com/p/mfml-part-2-has-arrived>
Marc Chandler: Deja Vu All Over Again: ‘Palak Patel[’s]… “The Tyranny of Nations”… shows striking parallels between America today and the latter stages of the Dutch and British dominance… LINK: <http://www.marctomarket.com/2021/07/deja-vu-all-over-again.html>
Ed Yong: The Delta Variant Is Surging in Missouri: ‘For America as a whole, the pandemic might be fading. For some communities, this year will be worse than last… <https://www.theatlantic.com/health/archive/2021/07/delta-missouri-pandemic-surge/619456/>
Ed Yong: The Danger of Delta Holds to 3 Simple Rules: ‘Vaccines are still beating the variants, but the unvaccinated world is being pummeled… <https://www.theatlantic.com/health/archive/2021/07/3-principles-now-define-pandemic/619336/>
Twitter:
John Holbo & al.: Manic Pixie Dream Girls <https://github.com/braddelong/public-files/blob/master/pdfmakerapp-holbo-2021-07-18.pdf>
Matt O’Brien & al.: Jerome Powell & Lael Brainard <https://github.com/braddelong/public-files/blob/master/pdfmakerapp-obrien-2021-07-18.pdf>
Amber Schmidtke & al.: Delta COVID <https://github.com/braddelong/public-files/blob/master/pdfmakerapp-schmidtke-2021-07-18.pdf>
Paragraphs:
Eric Topol: ‘How to give a potent vaccine a Delta stress test…. The variant’s viral load ~1,000X higher than previous strains (reflected by low CTs), more infectious in the early stages of the illness <https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724>. Part of the challenge that Delta presents may be tied to this finding…
LINK: <https://twitter.com/EricTopol/status/1416213177398743049>
Chi Xu & al.: Future of the Human Climate Niche: ‘For thousands of years, humans have concentrated in a surprisingly narrow subset of Earth’s available climates… [with] mean annual temperatures around ∼13 °C. This distribution likely reflects a human temperature niche related to fundamental constraints. We demonstrate that depending on scenarios of population growth and warming, over the coming 50 y, 1 to 3 billion people are projected to be left outside the climate conditions that have served humanity well over the past 6,000 years…
LINK: <https://www.pnas.org/content/117/21/11350>
Lant Pritchett: How Do I Do Research That Is Both Reliable & New?t: ‘But then the question for younger academics and researchers is: “But isn’t everything that can be shown at 5 sigma levels already known?”… Here are some examples of empirical work of mine that has been 5 sigma and reliable but nevertheless got attention as examples of situations in which this is possible…. Digging into the data to address a big conceptual debate…. What made the paper therefore a paper was to dig into the DHS reports and see that the DHS reported women’s future fertility desires… so one could see the fraction of women who reported wanting to have another child… who had, say, 2, 4 or 6 existing births… a measure of demand…. Use some (compelling) outside logic to put data and debates in a new light…. Making the argument that GDP per capita has a lower bound as a demographically sustainable population requires at least some minimum level of output…. Sometimes one can make progress by bringing some common sense into numbers made comparable to existing data. So everyone knows that people have to eat to stay alive, I just said “what would be the GDP per capita of a country that produced just enough food to produce caloric adequacy sufficient for demographic stability?”… Combine data not normally combined…. Claudio… had assembled a collection of labor force surveys from many countries…. The US data had information on people’s income and their birth country and at what age they moved to the USA. So we couldcountry… estimate a wage regression for people born in Guatemala, educated in Guatemala, but now working the USA to a wage regression for people born in Guatemala, educated in Guatemala and working in Guatemala and therefore compute the wage gap for observationally equivalent workers between the two places. And we could do this for 40 countries…. Combine data sets whereas all of the existing labor market studies did analysis on each of these data sets separately. Do the robustness by estimating the same thing for many countries…
LINK: <https://lantpritchett.org/how-do-i-do-research-that-is-both-reliable-and-new/>
Hunter: Paint[ing] Ivanka as saint, Trump as Incapacitated, & Mike Pence as America’s hHero: ‘“And lo, I did hold daddy’s stubby-fingered hands until he agreed to not do a coup, and then had to keep doing it throughout the day because he kept coming back to the idea…”. All right, fine, whatever. Let’s talk about the new book excerpt published in The Washington Post that attempts to put detail to Donald Trump’s actions during the Jan. 6 insurrection…. Donald Trump…considerably closer to doing mostly unspecified worse things than had previously been reported. We again hear that Trump was completely checked-out, unable and/or unwilling to participate in chain of command decisions to protect the Capitol, lawmakers, or his own vice president. We again are told that it was Mike Pence who ordered Trump’s military commanders to get troops the hell over to the Capitol building right-the-hell-now, and that Trump had no part of it. But the most important thing we learn from this Very Important New Insider Look is that absolutely everybody except for Donald Trump was being noble and patriotic and doing all the right things during this time of crisis. From Mike Pence to Mitch McConnell to an ill-described grandfather clock inside the Oval Office, anyone who had any input on how the story was told was, it turns out, an absolute damn hero. And, as usual, there was nobody more heroic than Ivanka Trump, presidential daughter and official White House crazyperson wrangler…. Ivanka wants readers to know that she was “upset” with Rudy Giuliani’s advice to her father that Mike Pence be made to overthrow American government….. She was only at the Jan. 6 rally because she needed to keep “tending to her father,” who was off his damn rocker at that point, and not because she was an active participant in the family’s seditious plans. Melania could not make it to the event, because, and this is the actual damn excuse used, she needed to oversee a previously scheduled photo shoot of White House rugs…. The whole story revolves around Trump’s top allies watching him push sedition and contemplate doing even worse, and the heroism of the story is well at least we got through that. Nobody directly opposed Trump. Nobody told him to go to hell. During their angriest moments, a few Republican senators referred to him mostly obliquely as a cause of the violence they were denouncing—before joining ranks to block all further attempts to either investigate or punish his acts. The “good” story is that Donald Trump was, by Jan. 6, so incapacitated that he could not make decisions, so traitorous that he refused to condemn a violent insurrection on his behalf, organized by his own allies, and so dysfunctioning that his adult daughter had to repeatedly intervene after his staff lost all ability to calm him. That’s the cleaned-up version that his longest-serving allies are freely admitting to. The true version is assuredly much, much worse, and there’s still no assurance that we’ll hear it…
LINK: <https://www.dailykos.com/stories/2021/7/15/2040105/-New-book-excerpt-paints-Ivanka-as-saint-Trump-as-incapacitated-and-Mike-Pence-as-America-s-hero>
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Wilful stupidity continues.
My Central valley county's public health doctor at the end of last week was interviewed and said it looks like there will be no surge of cases in the county. Yet just a day later, bay Area and a neighboring county all declared masking up requirements. I don't know if this is wilful stupidity or not.
California (and I assume the US) is looking purely inward and in the mirror. The UK is the country to watch - higher vax rate, more compliance with government orders, yet the infection rate is already approaching the last winter's rates, and "freedom day" starts tomorrow on the 19th. The scientists are saying this is a highly risky move....
While the hospitalizations and deaths are largely disconnected from the previous wave, this looks to me due to a different demographic - it is largely younger people getting infected now. But they are subject to "Long Covid".
Lastly, even if the vaccinated are largely safe from the current variants, there is no reason to assume that this situation will continue. The unvaccinated populations are a Petri-dish for new variants to emerge, which may make the vaccine far less effective. Pfizer is already pushing for a 3rd jab. I suppose a new deadly variant can be sequenced and a new vaccine made very quickly, but having to go through the whole rigamarole of mass vaccine centers will be tedious, to say the least. Do we want to be doing this every 6 months or so?
I think we may be in for a "phony peace" regarding the virus and that it is possible we might be experiencing "war" by late fall, and winter. Just as with the Spanish Flu, the economic agents have again won the battle with public health agents. Worse, there are "leaders" intent on ensuring that public health measures are minimized or ignored for the "protection of the economy". [The conflicting articles on remote vs office work look like part of this campaign to me.) The result will be no protection and a longer-term decline in business profits.
Is it any wonder why we are likely to succumb to the greater existential threat of global heating?
[@Graydon - I am already reading about agriculture being unsustainable. I may have to correct my Pollyanna-ish view on this after all.]
I think Brads thinking is missing a couple of important details/effects, although I am in roaring agreement with his excoriation of the Risk to Me is the only thing that matters ethic.
(1) Transmission efficacy is not a single number, at a minimum we should use four R values.
Rvv is the number of new cases a new infection would create if he/she were surrounded only
by vaccinated people. Clearly Rvv is pretty low, most likely below one. Then Rvn would be
the number of new infections if the vaccinated infected person were surrounded only by
unvaccinated. This is very likely much lower than Rnn, which is the the number of new infections from an initial unvaxed infected surrounded only by other unvaxed people. This is Brad's R, to which he assigns the value of 8. Finally there is Rnv, how many new infections would be caused
by a single unvaxed infection surrounded by vaxed people only. If we take the efficacy number of .64 from Israel as correct, then a first guess for Rnv would be .36*Rnn or 3. I don't know of any data that can be used to pin down Rvn or Rvv, however they are likely lower still.
(2) There is somewhat of an adaptive response -as infections spread and people become more aware of the danger they are more likely to take preventive measures -more social distancing and/or getting the vaccine. This adaptive response, to the extent that is real damps out the effect of the initial infection as time goes by. Now I heard a report that in Southwest Missouri, an epicenter of the growing Delta wave, a church sponsored vax clinic got something like 150 vaxed in one day, so the combination of fear and a trusted messenger can make a sizable dent in
vaccine-hesitancy.
So, there is reason to hope, that things aren't quite as dire as Brad's picture, nevertheless the almost complete absence of appeals to systems thinking is more than depressing. I have been surprised by the extent that smart well-meaning people have been surprised when I make the argument to them. This is undoubtedly caused by the almost complete absence of the argument in public discussion. I think officials are afraid that the argument would fall on deaf ears, so make an argument solely on self risk.