I mean reading something that provides no value and wastes your time makes your life worse. If it makes your life a large amount worse, then your point stands.
Short term loss, hopeful long term gain. Although long term yes, might need to go subscriber-only comments, or do so for some posts. For now it's not necessary.
Strongly disagree with this. I’m constantly blown away by how many smart people are over there, and even the commenters I disagree with usually make cogent arguments.
So I don’t think restricting comments to paid subscribers is necessarily a good solution.
My review of _your_ comments on ACX leads me to believe that you just don’t agree with a lot of them, though you never explain why.
I'm going to go ahead and say this comment made my life worse, so less of this - I think the previous two were actual useful model sharing even if I disagreed, but this was largely something else. While also noting that I disagree with the model-based part, and think that one shouldn't stoop to things one thinks are terrible simply because others are doing it, if you think ACX comments are terrible you should respond by not commenting at ACX. I almost never comment on ACX.
Could the still-receding delta wave be what's confounding the death rate?
Also, while the Boston wastewater numbers are pretty good as a within-wave comparison I wouldn't take them too seriously for between-wave comparisons. Omicron seems to be better at entering cells without TMPRSS2 and so is found in different places in the body, probably leading to different amount in a person's feces for the same respiratory viral load.
I find myself not super surprised that deaths have stopped tracking past trends for two reasons (whether they are actually valid is an empirical question). More young people are getting COVID than earlier in the pandemic and more people are getting infected for the second time. One or both of these outcomes would lead to fewer deaths.
I applaud your go forward comments policy. Anything one can do to make life more polite is worthwhile.
At a middle school in Washington Heights (Manhattan), attendance today was about 60%. This is a school that in normal times has 95%+ attendance.
I want to self-report a psychological phenomenon, which i call the Covid reverse slot machine syndrome. The longer I go without an infection, the more value I place on not getting infected. Given that I'm vaccinated and boosted and the evidence about Omicron, I know I rationally should be less worried, but my lizard brain tells me "you've invested so much care up until now..."
A behavioral expert would cite, perhaps, some strange "variant" of the :Endowment Effect.
I think it's basically sunk cost fallacy? But yeah, it is definitely a thing, I feel it too.
And there's some amount of real effect there too. The longer you don't get infected, the better your chances of actually getting through without ever being infected (or without being infected pre-Paxlovid slash pre-normal-hospitals).
I don't know if it's the lizard brain at work here, it's the higher function that likes to construct narratives about our lives.
"I changed my lifestyle and avoided covid, I am very clever" is a good narrative that you can feel good about. "I got covid, but at least I didn't have to change my lifestyle, I am very clever" is another good narrative you can feel good about. But "I changed my lifestyle and still got covid" is a narrative you can't possibly feel good about. You fear the actual suffering of covid less than you fear the loss of a good narrative to tell yourself about yourself. (I'm the same way.)
Regarding health care staffing, it is probably worth remembering that many place (e.g. Philadelphia and environs) required employees to get vaccinated or be fired, regardless of whether they had gotten COVID or not, with the deadline around late summer. Around here that was an estimated 10-15% of the workforce, although I never saw a final count. We should remember this because present lack of staff is partially because policy makers in government and the healthcare industry decided they wanted to have fewer staff around. I would say they are now trying to cover up their mistake by talking about quit rates, but who knows if they even believe it was a mistake.
This is consistent with what I’ve read about other places. 10 - 15% _threaten_ to quit, but only about 1% actually do, when push comes to shove.
Personally, I have zero problems with vaccine mandates for health workers. And if 1% of your medical workers don’t believe in medicine, having them opt themselves out of the system is probably a feature, not a bug…at least in the long run.
In general, shouldn't we expect health care workers to have ample exposure and thus a high likelihood of immunity from infection? If that's the case what would a vaccine mandate buy them?
As a contrast to your point, a family member recounted that in residency exactly 2 of 12 doctors had smoked cigarettes habitually. This was brought up because of how tone def the others sounded when talking about patients they saw who didn't simply stop smoking when told its dangerous. His general view was having people who could tangibly understand where a patient was coming from was valuable, and allowed for a better understanding of how to convey medical advice in a way that a patient would positively respond to (presumably the ultimate goal). Given the incredibly tone def cultural response I've seen in the US to people who were hesitant of getting vaccinated, it seems his smoking example carries forward. Telling people they don't believe in medicine, or otherwise conveying some negative implication about them, has pretty clearly not been a great way to incentives them to change their minds and thus get vaccinated (again, presumably the goal).
We see a ton of health care workers getting infected and being out sick, and we have statistics from earlier that not that crazy a number were infected in the past, so we can be reasonably confident this is wrong. Plus vaccine+infection is still better than only infection, same as booster>vaccine, and in this crunch every vaccination helps a lot.
The example I think doesn't hold, because you can smoke while realizing smoking is killing you and dumb but be unable to stop, whereas if you realize not vaccinating is dumb you just vaccinate, so if you wouldn't have complied with the mandate you wouldn't have convinced anyone else.
Thanks for the update on infection/past infections in health care workers; I had recalled you mentioning some data about it but didn't particularly want to dig through older posts until I found it.
It still is an interesting calculation to me, and again I don't have any real numbers to put behind it so I will just pose it as a question and hope people with access to better data can answer. To me, a vaccine mandate (lets just narrow it to nurses and doctors) in a hospital has two first order effects: group a people who held out for whatever reason but are willing to will get vaccinated (~14%?) and group b people with a very strong ideological complaint will not get vaccinated and leave (~1%?). The second order benefit for group a is they will have milder infections and be able to stay staffed for the most part (I guess, testing throws all this up in the air kind of), thus buying the hospital a more reliable set of employees who wont be out sick for covid. However, the hospital also loses group b from their workforce and it seems they aren't likely to find a bunch of new people who will be joining soon enough for the current wave. I am also intentionally leaving out any discussion of a second or third order effect of vaccinated health care workers being less infectious in a hospital, because it seems likely to me that if you as a patient enter a hospital, odds are you either have, or will soon catch covid (or probably something much worse) just from other sick people in there. Thus, on the net do you buy more people from group a staying working because their infections are milder with a vaccine mandate in a hospital than you lose from group b, who left due to the mandate? This also all seems like a silly question, as frankly I don't think I would give various decision makers the benefit of the doubt for giving a mandate this much thought, but hopefully I am being overly cynical.
With respect to the smoking example; I agree with what you say, but man, personal experience makes me skeptical at the same time. Even pre-covid, so many people had such a strong aversion to medical institutions because they felt like there was no common ground or common understanding. Bed side manners, etc etc all matter sure, and I am certainly not trying to argue you must literally experience something to advocate for or against it to patients, but generally most people view doctors specifically as an almost alien class of people. I have no evidence or counter-factual, but publicly messaging we are purging the unvaccinated from our institution feels like it would bias vaccine hesitant people from wanting to discuss or express doubts about vaccination, which seems necessary as a first step to opening dialog which will lead them to voluntarily coming around to the idea of getting vaccinated. But, again this is all conjecture from my end.
Not just health care workers. Workforce. Janitorial staff. Accountants. They have been 100% silent as to how many of these people have face time with patients. You can decide for yourself if that's a signal or absense of evidence.
But if one does decide its a signal, and if Mayo has professed a concern about dissparate impacts, that's worth noticing.
I generally agree with this, but for the timing. If there's a staffing crisis that very accute right now specifically, and Mayo does this right now specifically, that's a revealed preference. It suggests they have preferences higher than "minimize staffing problems". It's probably a slavish dovotion to vogon poetry (IE why they won't put it off for a month or two) but its hard for me to completly discount a punish the outgroup motive.
"There is a story to be written about academics who where too willing to amplify a message..."
Of course, as in all important moral questions, CS Lewis did it nearly a century ago. And because he's one of the greats of all time, he included some bears in the story.
"One of the biggest problems with the Trusted Authorities is that if it’s very important that they never be seen as importantly wrong, it’s extremely difficult to ever be importantly right."
In war, the old peacetime generals get shitcanned because the state can't hide the dead bodies and moving line. Then new wartime generals get promoted who are usually better at fighting a war but bad at checking boxes. We still have no mechanism for shitcanning our peacetime FDA/CDC/etc.
"Radicalization"
Yeah. I've shown more normies how to pack a bug out bag, how to defund the police, how to stock up food and supplies for an emergency, how to order veterinary antibiotics from the internet, and how to use a firearm this last year than I care to think about. It's really screwed with my self-image as a crazy person.
My pediatrician told my vaccinated son to "be smart, wear a mask when they tell you you have to, but don't drink the Kool-Aid." Also told him he needs to read 1984 and Fahrenheit 451 this year. Guess what they look like. Did you imagine a neck-bearded 40 year old dude with "Taxes are Theft" bumper stickers? Nope, 65 year old church lady with diabetic socks.
Very recently, it became possible to edit comments on ACT. This is a test to see if that works here.
EDIT: Yes , it does. Clicking on the … to the right of the Reply EDIT #2 and Delete buttons (which you will only see on _your_ comments) gives you the edit option.
Could you link the German study on long covid that you said there is a replication of? AFAICT there's only one study, out of France, from months ago, but that wouldn't be anything to update on now.
Lower death rate than expected is because early cases skew towards younger, more pro-social people (i.e. those who natural will have milder outcomes, and those have already been exposed to SARS-CoV-2).
Hi, just a quick comment on novavax - the Politico article is using speculation based on unknown sources. The company has reiterated that it will produce at least 2 billion vaccines in 2022. It has already started supplying some countries (Indonesia) or produced vaccines awaiting the final approval (South Korea).
EU should get its first package of Novavax vaccines by January, so they are on track with their 100 mil in 2022 order.
FDA and US is another beast. There were speculations, but it is unclear. They had submitted the full CMC package now so the EUA should be granted (since it was granted everywhere else incl. WHO, India, EU) and Novavax can broaden the American arsenal of vaccines.
“Today, six health experts on President Biden’s transition team called for Biden to adopt an entirely new pandemic strategy — one that does not have a “single-minded focus on vaccines” and that is geared to the “new normal” of living with the virus indefinitely, not to wiping it out.“ some of their points look very interesting. What do you think?
Post-exposure vaccination is a thing in a number of diseases with longer incubation - smallpox, rabies, ...
There are potential reasons to believe that it might help for covid too, you might gain your antibodies a day or too sooner. Research is needed, but it can't be excluded.
Great blog, Zvi, as always. Could you elaborate on your optimism - "our lives beckon"? This seems to be predicated on reasonable behaviour by policymakers. It is very possible that another immune-evading variant will appear in the coming months, or perhaps we'll get a second omicron wave in the spring once antibodies have dwindled. If we didn't collectively move on last summer, once most vulnerable people were double vaccinated, why would we move on now? Mutations of this virus will likely continue to put significant pressure on hospitals for many years, especially during winter. Why would this by now deeply-ingrained fear of overflowing hospitals suddenly disappear after the current wave - perhaps I am missing something?
Well, they definitely beckon. When you're in school and you look out the window, it beckons, even if you can't leave. I do think we were in the process of moving on last summer, the only tangible thing left in my daily life was a mask requirement for public transit. That's not exactly life-destroying, just annoying.
The next wave will be of a population mostly already infected, so it won't get people that sick unless we get very unlucky, and also there's zero point in trying to be paranoid about it in advance.
I mean reading something that provides no value and wastes your time makes your life worse. If it makes your life a large amount worse, then your point stands.
Short term loss, hopeful long term gain. Although long term yes, might need to go subscriber-only comments, or do so for some posts. For now it's not necessary.
> ACX has awful and generally useless comments
Strongly disagree with this. I’m constantly blown away by how many smart people are over there, and even the commenters I disagree with usually make cogent arguments.
So I don’t think restricting comments to paid subscribers is necessarily a good solution.
My review of _your_ comments on ACX leads me to believe that you just don’t agree with a lot of them, though you never explain why.
I'm going to go ahead and say this comment made my life worse, so less of this - I think the previous two were actual useful model sharing even if I disagreed, but this was largely something else. While also noting that I disagree with the model-based part, and think that one shouldn't stoop to things one thinks are terrible simply because others are doing it, if you think ACX comments are terrible you should respond by not commenting at ACX. I almost never comment on ACX.
Could the still-receding delta wave be what's confounding the death rate?
Also, while the Boston wastewater numbers are pretty good as a within-wave comparison I wouldn't take them too seriously for between-wave comparisons. Omicron seems to be better at entering cells without TMPRSS2 and so is found in different places in the body, probably leading to different amount in a person's feces for the same respiratory viral load.
I find myself not super surprised that deaths have stopped tracking past trends for two reasons (whether they are actually valid is an empirical question). More young people are getting COVID than earlier in the pandemic and more people are getting infected for the second time. One or both of these outcomes would lead to fewer deaths.
I applaud your go forward comments policy. Anything one can do to make life more polite is worthwhile.
At a middle school in Washington Heights (Manhattan), attendance today was about 60%. This is a school that in normal times has 95%+ attendance.
I want to self-report a psychological phenomenon, which i call the Covid reverse slot machine syndrome. The longer I go without an infection, the more value I place on not getting infected. Given that I'm vaccinated and boosted and the evidence about Omicron, I know I rationally should be less worried, but my lizard brain tells me "you've invested so much care up until now..."
A behavioral expert would cite, perhaps, some strange "variant" of the :Endowment Effect.
I think it's basically sunk cost fallacy? But yeah, it is definitely a thing, I feel it too.
And there's some amount of real effect there too. The longer you don't get infected, the better your chances of actually getting through without ever being infected (or without being infected pre-Paxlovid slash pre-normal-hospitals).
I don't know if it's the lizard brain at work here, it's the higher function that likes to construct narratives about our lives.
"I changed my lifestyle and avoided covid, I am very clever" is a good narrative that you can feel good about. "I got covid, but at least I didn't have to change my lifestyle, I am very clever" is another good narrative you can feel good about. But "I changed my lifestyle and still got covid" is a narrative you can't possibly feel good about. You fear the actual suffering of covid less than you fear the loss of a good narrative to tell yourself about yourself. (I'm the same way.)
What you write about relative fears (narrative vs. getting sick)makes sense. That said, I'm a real (almost sixty year old) baby when I get sick!
Was comment editing only added to ACX by Substack? Let me test!
I have an 'edit' option (under the "..." popup menu thingy) for the comment to which this comment is replying.
Huh, if it's available for everyone that's great. Wordpress still doesn't give people that option, which I'm sad about.
Regarding health care staffing, it is probably worth remembering that many place (e.g. Philadelphia and environs) required employees to get vaccinated or be fired, regardless of whether they had gotten COVID or not, with the deadline around late summer. Around here that was an estimated 10-15% of the workforce, although I never saw a final count. We should remember this because present lack of staff is partially because policy makers in government and the healthcare industry decided they wanted to have fewer staff around. I would say they are now trying to cover up their mistake by talking about quit rates, but who knows if they even believe it was a mistake.
Mayo clinic just announced today that they are firing about 1% of their workforce that refuses to vaccinate.
This is consistent with what I’ve read about other places. 10 - 15% _threaten_ to quit, but only about 1% actually do, when push comes to shove.
Personally, I have zero problems with vaccine mandates for health workers. And if 1% of your medical workers don’t believe in medicine, having them opt themselves out of the system is probably a feature, not a bug…at least in the long run.
> It's a waste of vaccines
If we had a shortage of vaccines, like we did for a long time, this would be true.
But we've got plenty of them now. Anyone on Earth who wants a vaccine and can't get one is because of local distribution problems, not supply.
Tell us who on Earth is missing a vaccine because their country doesn't have them and wants to buy them.
It used to be that the factories had orders before they even made the vaccine. That's long past. Orders have dropped.
There are definitely issues of local distribution. But pouring more vaccines into African ports isn't going to help with that.
In general, shouldn't we expect health care workers to have ample exposure and thus a high likelihood of immunity from infection? If that's the case what would a vaccine mandate buy them?
As a contrast to your point, a family member recounted that in residency exactly 2 of 12 doctors had smoked cigarettes habitually. This was brought up because of how tone def the others sounded when talking about patients they saw who didn't simply stop smoking when told its dangerous. His general view was having people who could tangibly understand where a patient was coming from was valuable, and allowed for a better understanding of how to convey medical advice in a way that a patient would positively respond to (presumably the ultimate goal). Given the incredibly tone def cultural response I've seen in the US to people who were hesitant of getting vaccinated, it seems his smoking example carries forward. Telling people they don't believe in medicine, or otherwise conveying some negative implication about them, has pretty clearly not been a great way to incentives them to change their minds and thus get vaccinated (again, presumably the goal).
We see a ton of health care workers getting infected and being out sick, and we have statistics from earlier that not that crazy a number were infected in the past, so we can be reasonably confident this is wrong. Plus vaccine+infection is still better than only infection, same as booster>vaccine, and in this crunch every vaccination helps a lot.
The example I think doesn't hold, because you can smoke while realizing smoking is killing you and dumb but be unable to stop, whereas if you realize not vaccinating is dumb you just vaccinate, so if you wouldn't have complied with the mandate you wouldn't have convinced anyone else.
Thanks for the update on infection/past infections in health care workers; I had recalled you mentioning some data about it but didn't particularly want to dig through older posts until I found it.
It still is an interesting calculation to me, and again I don't have any real numbers to put behind it so I will just pose it as a question and hope people with access to better data can answer. To me, a vaccine mandate (lets just narrow it to nurses and doctors) in a hospital has two first order effects: group a people who held out for whatever reason but are willing to will get vaccinated (~14%?) and group b people with a very strong ideological complaint will not get vaccinated and leave (~1%?). The second order benefit for group a is they will have milder infections and be able to stay staffed for the most part (I guess, testing throws all this up in the air kind of), thus buying the hospital a more reliable set of employees who wont be out sick for covid. However, the hospital also loses group b from their workforce and it seems they aren't likely to find a bunch of new people who will be joining soon enough for the current wave. I am also intentionally leaving out any discussion of a second or third order effect of vaccinated health care workers being less infectious in a hospital, because it seems likely to me that if you as a patient enter a hospital, odds are you either have, or will soon catch covid (or probably something much worse) just from other sick people in there. Thus, on the net do you buy more people from group a staying working because their infections are milder with a vaccine mandate in a hospital than you lose from group b, who left due to the mandate? This also all seems like a silly question, as frankly I don't think I would give various decision makers the benefit of the doubt for giving a mandate this much thought, but hopefully I am being overly cynical.
With respect to the smoking example; I agree with what you say, but man, personal experience makes me skeptical at the same time. Even pre-covid, so many people had such a strong aversion to medical institutions because they felt like there was no common ground or common understanding. Bed side manners, etc etc all matter sure, and I am certainly not trying to argue you must literally experience something to advocate for or against it to patients, but generally most people view doctors specifically as an almost alien class of people. I have no evidence or counter-factual, but publicly messaging we are purging the unvaccinated from our institution feels like it would bias vaccine hesitant people from wanting to discuss or express doubts about vaccination, which seems necessary as a first step to opening dialog which will lead them to voluntarily coming around to the idea of getting vaccinated. But, again this is all conjecture from my end.
"vaccine mandates for health workers"
Not just health care workers. Workforce. Janitorial staff. Accountants. They have been 100% silent as to how many of these people have face time with patients. You can decide for yourself if that's a signal or absense of evidence.
But if one does decide its a signal, and if Mayo has professed a concern about dissparate impacts, that's worth noticing.
I generally agree with this, but for the timing. If there's a staffing crisis that very accute right now specifically, and Mayo does this right now specifically, that's a revealed preference. It suggests they have preferences higher than "minimize staffing problems". It's probably a slavish dovotion to vogon poetry (IE why they won't put it off for a month or two) but its hard for me to completly discount a punish the outgroup motive.
"There is a story to be written about academics who where too willing to amplify a message..."
Of course, as in all important moral questions, CS Lewis did it nearly a century ago. And because he's one of the greats of all time, he included some bears in the story.
"One of the biggest problems with the Trusted Authorities is that if it’s very important that they never be seen as importantly wrong, it’s extremely difficult to ever be importantly right."
In war, the old peacetime generals get shitcanned because the state can't hide the dead bodies and moving line. Then new wartime generals get promoted who are usually better at fighting a war but bad at checking boxes. We still have no mechanism for shitcanning our peacetime FDA/CDC/etc.
"Radicalization"
Yeah. I've shown more normies how to pack a bug out bag, how to defund the police, how to stock up food and supplies for an emergency, how to order veterinary antibiotics from the internet, and how to use a firearm this last year than I care to think about. It's really screwed with my self-image as a crazy person.
My pediatrician told my vaccinated son to "be smart, wear a mask when they tell you you have to, but don't drink the Kool-Aid." Also told him he needs to read 1984 and Fahrenheit 451 this year. Guess what they look like. Did you imagine a neck-bearded 40 year old dude with "Taxes are Theft" bumper stickers? Nope, 65 year old church lady with diabetic socks.
Very recently, it became possible to edit comments on ACT. This is a test to see if that works here.
EDIT: Yes , it does. Clicking on the … to the right of the Reply EDIT #2 and Delete buttons (which you will only see on _your_ comments) gives you the edit option.
Could you link the German study on long covid that you said there is a replication of? AFAICT there's only one study, out of France, from months ago, but that wouldn't be anything to update on now.
It's from a few weeks ago, I wrote about it then, if I get a chance I'll dig it up.
Lower death rate than expected is because early cases skew towards younger, more pro-social people (i.e. those who natural will have milder outcomes, and those have already been exposed to SARS-CoV-2).
Hi, just a quick comment on novavax - the Politico article is using speculation based on unknown sources. The company has reiterated that it will produce at least 2 billion vaccines in 2022. It has already started supplying some countries (Indonesia) or produced vaccines awaiting the final approval (South Korea).
EU should get its first package of Novavax vaccines by January, so they are on track with their 100 mil in 2022 order.
FDA and US is another beast. There were speculations, but it is unclear. They had submitted the full CMC package now so the EUA should be granted (since it was granted everywhere else incl. WHO, India, EU) and Novavax can broaden the American arsenal of vaccines.
“Today, six health experts on President Biden’s transition team called for Biden to adopt an entirely new pandemic strategy — one that does not have a “single-minded focus on vaccines” and that is geared to the “new normal” of living with the virus indefinitely, not to wiping it out.“ some of their points look very interesting. What do you think?
I can't say much without the source.
A look into the 40% rise in death rate for working age people, by an actuary in the life insurance field.
https://marypatcampbell.substack.com/p/excess-mortality-for-working-age?justPublished=true
(TL;DR - COVID, drug overdoses)
Post-exposure vaccination is a thing in a number of diseases with longer incubation - smallpox, rabies, ...
There are potential reasons to believe that it might help for covid too, you might gain your antibodies a day or too sooner. Research is needed, but it can't be excluded.
Great blog, Zvi, as always. Could you elaborate on your optimism - "our lives beckon"? This seems to be predicated on reasonable behaviour by policymakers. It is very possible that another immune-evading variant will appear in the coming months, or perhaps we'll get a second omicron wave in the spring once antibodies have dwindled. If we didn't collectively move on last summer, once most vulnerable people were double vaccinated, why would we move on now? Mutations of this virus will likely continue to put significant pressure on hospitals for many years, especially during winter. Why would this by now deeply-ingrained fear of overflowing hospitals suddenly disappear after the current wave - perhaps I am missing something?
Well, they definitely beckon. When you're in school and you look out the window, it beckons, even if you can't leave. I do think we were in the process of moving on last summer, the only tangible thing left in my daily life was a mask requirement for public transit. That's not exactly life-destroying, just annoying.
The next wave will be of a population mostly already infected, so it won't get people that sick unless we get very unlucky, and also there's zero point in trying to be paranoid about it in advance.
> one man is still trying to find the answers to life’s persistent questions.
Garrison Keillor has a substack! https://garrisonkeillor.substack.com/