Covid 4/28/22: Take My Paxlovid, Please

Many have made the observation that if you had told people two years ago that we would have a cure (not a vaccine, but a cure!) for Covid-19 that was free, safe and effective, but that no one wanted to take it, and Congress wasn’t willing to fund further purchases, people would not have believed you. And yet here we are.

The White House is trying to fix the situation. I’ll cover the details below.

We haven’t learned much new about China. When we do, it will go into its own post. I did get private supporting evidence that the situation in Shanghai is being characterized roughly correctly.

Executive Summary

1. Paxlovid is available, no one wants it.

2. Case counts up now that we’re past Easter.

3. Cases hit local peaks including in NYC, indicating BA.2 wave won’t be too bad.

Also, did you hear? Elon Musk is buying Twitter.

Let's run the numbers.

The Numbers

Predictions

Prediction from last week: 277,800 cases (+20%) and 4,100 deaths (+71%!?)

Results: 328,762 cases (+41%) and 2,485 deaths (+2%!)

Prediction for next week: 400,000 cases (+22%) and 2,720 deaths (+10%?)

On deaths this is one of the biggest misses I’ve had, and it’s not one of the ones I look back on and instantly feel was simply stupid - often it’s obvious in hindsight why I messed up, and mostly this isn’t one of those cases

There was a huge drop for Easter, and it was sustained even as cases popped back up even more than I expected. I don’t understand it, but the distributions involved look real. I can only interpret this as ‘we had inflated death numbers for a while that weren’t real, and now we have less of that’ because I can’t think of any other way to make sense of this. I guess I’m predicting a small increase next week here, but I mostly notice I am confused.

I believe a lot of this jump in cases is related to Easter, and the details suggest that we are going to be reaching another local peak soon especially in the northeast.

Deaths

That is not many deaths. I don’t know how to interpret the drop being sustained in a way that makes the drop ‘real’ which is why I’m assuming this means that the death counts were previously artificially high.

This in turn makes me wonder if death counts have been artificially high at other times as well.

Cases

New York City cases have plateaued and are falling. This is a big deal because New York was ‘ahead of the curve’ on the current BA.2 wave, and there is uncertainty about how far things are likely to go before they stabilize. If NYC is stabilizing at this low level, it strongly suggests there is nothing to worry about.

The Northeast echoes this, with only a small increase. The larger increases in other areas seem like they have a lot to do with Easter, and involve being ‘farther along’ and/or different weather conditions. Yes, cases are up quite a bit, but the upside risks have diminished, which is the most important thing.

Physical World Modeling

Elizabeth finds Home Antigen tests useless in terms of keeping your gathering safe, based on them failing to find Covid cases. Cue tests were most effective although potentially overly sensitive and definitely expensive. $250 fixed cost for the reader plus $65 per test is not a reasonable additional cost to impose in most circumstances. If my job asked for such testing daily (as did the workplace in the post) and I wasn’t paid at least mid six figures, I’d be pretty upset. She did note that the antigen tests are still good at knowing if you had gotten over Covid yet and could end your isolation, which is a different use case.

Alas, public health information in many places continues to say the opposite, and even cancelling rapid test appointments for people with recent Covid.

For any ‘normal’ gathering, at this point in the pandemic, I do not think asking people for tests is reasonable. I can see an exception for exceptionally risky things like group indoor singing.

Paxlovid! Get Your Paxlovid! Anyone? Buehler?

It seems no, basically no one. It is quite the scandal that we have life saving medicine and we mostly cannot use it to save people’s lives.

So far we have administered about 500k courses of Paxlovid, which is less than 1/3rd of what was distributed or 1/10th of what was purchased.

That does not mean it is time to throw up our hands and stop buying it. If another wave comes, we will need it badly. Even if one doesn’t, over time we should presumably get at least somewhat better at getting Paxlovid to people who need it. Worst case, we can open it up to everyone and make it clear there is sufficient supply, until there isn’t sufficient supply anymore.

The White House is trying to address the situation (links to the announcement). Here are some of the things they are doing:

That all sounds like ‘tell people about the new life-saving medicine and enable them to get it’ except now we mean it and we’re going to do more of these things. Which is better than doing less, I have nothing against any of these steps. Yet given how things have gone so far, this will all presumably be inadequate to the job at hand.

The Stat News article about this pinpoints a key part of the problem quite nicely, but fails to label that it did so.

The treatments are authorized only for those with risk factors for severe illness — but as much as 60% of those who are contracting Covid may be eligible for the antivirals, because common risk factors like age and diabetes are included.

Our policy, as illustrated by this short advice video from the White House correctly advising people to try and get Paxlovid, here is the worst of both worlds. We are giving people the impression that they are not eligible and that taking Paxlovid for themselves would be selfish and unfair to those who need it more, so much so that no one uses our supply at all. Also we are not buying as many doses as we could and soon may be buying none at all.

This might be another issue.

In other White House news, the Vice President has Covid.

Which is relevant here, because she took Paxlovid (obviously) and, well…

That’s what we call ‘medical ethics.’ A call to not give the best available life-saving medicine to the literal Vice President of the United States.

If you think it’s ‘unfair’ that the VP gets the best possible medical treatments even when they are expensive or in short supply, what does one even say to that?

So yes, I have some idea how we ended up not giving out a lot of our Paxlovid.

New York City is doing an excellent job of all the things on Biden’s agenda here, other than overall communication. Communication is hard, even with no one trying to stop you.

Evusheld is also much harder to get than it needs to be.

Pandemics Are Bad and We Should Prevent Them

Maybe even spend some money towards that goal. Congress previously made a deal to take $10 billion in previously allocated funds for Covid and allow them to be used for Covid in a different way so we wouldn’t be totally out of money for things like making sure people who have Covid get tests and medical treatments, and letting us purchase things like Paxlovid.

That deal fell through. No money.

The ‘step up’ in statements like this is ‘be willing to spend any money on basic Covid things, at all.’

The op-ed has no revelations for us, all standard things that seem reasonable enough. It’s not that we should do all of the things, but it’s that we should have a sufficiently functioning government that we should be able to spend some money on some of the things. Yet we don’t. We spent trillions on “stimulus” much of which was clearly unnecessary, and always a tiny fraction of that for actual pandemic prevention, medical treatments, healthcare and research. Thus we have a lot of inflation and a high chance that future pandemics go no better than this one that cost us trillions of dollars and killed quite a lot of people.

Reasonable people can disagree on the number, and on exactly what to do with it. They can’t claim the right number is zero.

Prevention and Prevention Prevention Prevention

FDA Delenda Est, and even so, for Christ’s sake, yes this is happening no really.

The FDA is forbidding you from vaccinating your child because they worry that if they approve one vaccine, then later approve another vaccine, then that might be confusing. I have typed that sentence. It is composed of words.

Can we find anyone out there, anyone at all, who said “Well you know they approved the Pfizer vaccine, but then they also approved the Moderna vaccine, and now I’m so confused”? Are those words that have ever come out of anyone’s mouth? If they did, how would you react to this person?

The good news is Moderna has now asked for authorization so we can get both vaccines approved without any confusion over the total lack of confusion.

Bunch of people expressed confusion about why I talked about P100 and other ‘super-masks’ as an option. It is because they provide much stronger physical protection in ways that are very obvious, at the cost of mild social awkwardness (plus some actual physical awkwardness and a little bit of money), assuming you are permitted to wear one. Which before you sometimes were not, because that’s not what the mandate said and we are here to fulfill mandates rather than prevent Covid.

In other news, Philadelphia imposed a mask mandate, then lifted it four days later, claiming it was due to ‘reduced cases,’ which is not even a plausible lie. It was a scary sign when they imposed the mandate, so it’s highly reassuring to know the people refused to stand for it.

Think of the Children

Masks interfere with life in lots of small ways that add up to quite a lot, latest expression of this:

I feel it too, and I sense it in others. That’s so much more clear now that the masks are mostly gone except for the subway.

I also agree with this take in reply that this is part of a much larger, slower moving and more encompassing crisis of safetyism.

In Other News

The Atlantic suggests taking this opportunity to end security theater more broadly. As you know I strongly agree. Would be great if this becomes a cultural moment and political issue.

What is holding up Novavax’s vaccine? Manufacturing problems. We were luckier than we know to get Pfizer and Moderna ‘on time.’

Healthcare null hypothesis watch, labeling potential donors to a hospital so they’d get better care led to them dying more often edition.

Not Covid - Elon Buys Twitter Edition

Elon Musk is buying Twitter. I thought about buying some stock at various points but ultimately did not do so, which I consider at least a little bit a mistake but it is hard to know what probability I should have assigned on the deal going through at various points (including before Musk was involved at all and I simply thought someone should buy the place).

I have indeed been saying, when in conversations with those in EA who have the kind of money to at least think about such matters, that it would be an excellent idea to buy Twitter. It has long been one of my short list of clearly good uses of large amounts of money. To be fair, it was out of the relevant people’s price range, but it still feels like a lost opportunity and maybe I should have tried harder.

Then again, if Musk does what he says he is going to do and turns Twitter into a bastion of real free speech and open sources the algorithm and opens up the protocol and doesn’t care about profits and adds lots of great new features and other neat stuff like that, then Musk spent $44 billion dollars so the rest of us didn’t have to. That’s pretty sweet, even if I’m sad for the distraction in terms of electric cars and space colonization and even tunnels. Then again, can this man even be distracted?

The opposition to Musk buying Twitter is diverse, here are the opposition’s Top 10:

1. Being rich bad. Elon Musk bad.

2. Orange man bad.

3. Free speech bad because kiddie porn and terrorism, ban political dissent.

4. Free speech bad because trolls and spam, ban political dissent.

5. Free speech bad because misinformation, ban political dissent.

6. Free speech bad because ‘hate speech,’ ban political dissent.

7. Free speech might be good/bad but haha good luck with those regulators.

8. Free speech good but endangered by this man who wants free speech.

9. Free speech good but free speech means safe spaces without political dissent.

10. Free speech good for me but not for thee. There, I said it.

The only remotely interesting version of this is a take on #8 where people point out Tesla’s interests in China, and that Musk may thus be forced to play along with them. It is best summed up here, with so many people quoting the first Tweet and no one mentioning the other two:

If you’re looking for particular examples, the internet had a clear winner.

The whole thing made it very clear that while there is widespread support for the concept ‘free speech’ few of those people even understand the concept of what I would consider free speech, and they would not enjoy the increased commerce and cultural production thereby.

The best part is: Were you wondering who is for free speech, and who is against free speech? Real free speech? Now you know.

Also good to get this periodic reminder when it seems others are losing their minds.