This week’s news is that the FDA advisory committee voted overwhelmingly to update the vaccine for Omicron, after a delay of only six months, which means they’ll get to deciding which way it should be updated Real Soon Now and then they can tell the pharma companies what requirements they want to place on that.
Long time reader - thanks again for all your work on these updates!
Had a pretty specific question, appreciate your thoughts. Thinking about going to the WSOP in vegas, but there is an ongoing massive spike in cases in Vegas + anecdotally ~50% of people I know there contracted COVID (regardless of vaccine status / previous infections etc.). I've been having a hard time dimensioning the safety of attending the WSOP given I am personally: vaxx+boost+already got Delta varient last fall, and would expect to wear some level of mask protection.
Chance of getting Covid at a poker table where no one else cares seems reasonably high if others have it, but I don't see any statistical signs of a big wave in Nevada. Could be concentrated at WSOP easily enough. I don't know if they'd let you wear a P100+ mask at a poker table or not. Chance of anything actually happening to you if you get it is still low of course, but I do think this is a 'how much do you mind a bunch of Covid risk' situation.
I want to push back a little on this part: "This is public health. This is what very serious people actually believe. It is also flat out anti-vax. This is the face of the enemy."
I think we want to be a bit careful with the anti-vax language around the COVID vaccines. While the FDA is making very strange decisions on the assumption that the COVID vaccines work and have more benefits than costs, there is are a lot of reasons to believe that these vaccines do not pass this test. Being anti-this-particular-vaccine is very different than anti-vaccines in general, but even still, anti-vax probably shouldn't be demonized.
I get that you were largely making a rhetorical point, speaking to the anti-anti-vax crowd to point out how their beloved FDA is acting against their stated goals. I just don't quite think anti-vax is the enemy here. Especially considering the data coming out of Europe about adverse effects, birth rates, etc.
It is of course true that vaccines can (and do/have) cause adverse effects. But it's _not_ true that that implies that weighing costs and benefits shouldn't instead be done 'normally', as it should be for anything important.
I agree that "anti-vax" "shouldn't be demonized" – no "probably" qualification needed for me.
They _might_ have real/legitimate concerns! But it also doesn't mean that, even if there were/are extreme/terrible adverse effects, it still might not also be best to rollout vaccines anyways.
Who suggested that we shouldn't be weighing costs and benefits normally? I am not clear what you are responding to. I wasn't saying that the FDA's decisions make sense given their stated assumptions. I was pushing back against lumping in the FDA's bizarre behavior with the anti-vax people, and implying that anti-vax people are the enemy.
I am going to point out now that if the vaccines have "extreme/terrible adverse effects" we absolutely should not rollout the vaccines, because we know the risk of COVID are low overall. I am not sure you know that.
I think I agree that "anti-vax people are the enemy" but I must admit that now I'm confused as to what you mean by that. Who are "the enemy", in your opinion (and on any subject/issue)?
> I am going to point out now that if the vaccines have "extreme/terrible adverse effects" we absolutely should not rollout the vaccines, because we know the risk of COVID are low overall.
This makes me think there _is_ a disagreement between us. I interpreted your previous comment as basically condoning/supporting/approving-of 'more caution', e.g. from the FDA. Based on the "extreme/terrible adverse effects" that have been reported (AFAIK), yes, _maybe_ there are some extreme/terrible adverse effects – among a _tiny_ number of people. The risks of COVID are low overall, but then so (probably) are the risks of vaccines.
I can't tell if you're "weighing costs and benefits normally" by 'adding up 'utilons' or whether you're doing the far more common 'here are some points for a thing and here are some points _against_ the thing' and like refusing to 'do any math' or, e.g. consider base rates.
Do you think the FDA (and similar) should ban acetaminophen (Tylenol)? Do you think it would fare well, in a 'normal cost benefit analysis', compared to COVID-19 vaccines? I'm not sure myself actually! A LOT of people die from acetaminophen ODs. But modal users probably aren't as adversely effected as modal COVID-19 vaccine recipients.
I didn't get that we were "very much in disagreement" and your last sentence just seems needlessly inflammatory.
Are you uninterested in answering any of the specific questions I asked in my previous comment because you think I'm arguing/discussing in bad faith? Why would even a disagreement about "basic areas of facts about reality" imply that?
What "basic areas of facts about reality" do you think we even disagree about?
Must confess there's some small vindictive part of me that wishes for a new vaccine rollout, even if/especially if the adverse effects clearly outweigh the benefits, just because it'll primarily be Those People who end up taking them. That last royal "we" does more heavy lifting than I think is strictly necessary; there's a lot of Venn diagram overlap between "thinks covid is apocalyptic" and "will take any and all shots offered, twice".
But, adverse effects notwithstanding, I think it'd at least help shake the foundations of covid maximalism a bit. I notice that many people giving off those kinds of vibes, explicitly or implicitly, seem to have the futility of any meaningful progress as a load-bearing part of that schema. When I try to tell them about bivalent vaccines, mucosal immunity, etc. it's like a goddamn sunbeam reaching down from Heaven to personally light their benighted existence. So it'd set good historical precedent anyway that Yes, We Can Actually Do Things (If Doing Things Isn't Illegal) to lay cultural norm groundwork for the next pandemic.
“Hospitals should be exempt from all local building codes.” -- hard disagree. Building code is tricky, bitchy and often pisses me off, but it’s written in the interest of actual safety. Most of it is about structural integrity and not causing fires, and the lessons that led to writing it were penned in blood and soot. If by the quote you and original author mean _zoning_ ordinances which are all about character and access and pleasant views, yes 100%, hospitals provide a good and don’t need to comply when they’re setting up triage tents out front in a global pandemic.
Some if you may have noticed from my other comments that I’m an angry libertarian (full stop that’s actually how I describe my politics, but especially about overweening regulation), but I can’t condone skipping fire code and building code as a general rule, especially where you have hundreds of people going in and out, many of whom may have no ability to consent to this building or that one for their care.
Long time reader - thanks again for all your work on these updates!
Had a pretty specific question, appreciate your thoughts. Thinking about going to the WSOP in vegas, but there is an ongoing massive spike in cases in Vegas + anecdotally ~50% of people I know there contracted COVID (regardless of vaccine status / previous infections etc.). I've been having a hard time dimensioning the safety of attending the WSOP given I am personally: vaxx+boost+already got Delta varient last fall, and would expect to wear some level of mask protection.
Chance of getting Covid at a poker table where no one else cares seems reasonably high if others have it, but I don't see any statistical signs of a big wave in Nevada. Could be concentrated at WSOP easily enough. I don't know if they'd let you wear a P100+ mask at a poker table or not. Chance of anything actually happening to you if you get it is still low of course, but I do think this is a 'how much do you mind a bunch of Covid risk' situation.
Thank you!
Thanks again for the updates.
I want to push back a little on this part: "This is public health. This is what very serious people actually believe. It is also flat out anti-vax. This is the face of the enemy."
I think we want to be a bit careful with the anti-vax language around the COVID vaccines. While the FDA is making very strange decisions on the assumption that the COVID vaccines work and have more benefits than costs, there is are a lot of reasons to believe that these vaccines do not pass this test. Being anti-this-particular-vaccine is very different than anti-vaccines in general, but even still, anti-vax probably shouldn't be demonized.
I get that you were largely making a rhetorical point, speaking to the anti-anti-vax crowd to point out how their beloved FDA is acting against their stated goals. I just don't quite think anti-vax is the enemy here. Especially considering the data coming out of Europe about adverse effects, birth rates, etc.
It is of course true that vaccines can (and do/have) cause adverse effects. But it's _not_ true that that implies that weighing costs and benefits shouldn't instead be done 'normally', as it should be for anything important.
I agree that "anti-vax" "shouldn't be demonized" – no "probably" qualification needed for me.
They _might_ have real/legitimate concerns! But it also doesn't mean that, even if there were/are extreme/terrible adverse effects, it still might not also be best to rollout vaccines anyways.
Who suggested that we shouldn't be weighing costs and benefits normally? I am not clear what you are responding to. I wasn't saying that the FDA's decisions make sense given their stated assumptions. I was pushing back against lumping in the FDA's bizarre behavior with the anti-vax people, and implying that anti-vax people are the enemy.
I am going to point out now that if the vaccines have "extreme/terrible adverse effects" we absolutely should not rollout the vaccines, because we know the risk of COVID are low overall. I am not sure you know that.
I think I agree that "anti-vax people are the enemy" but I must admit that now I'm confused as to what you mean by that. Who are "the enemy", in your opinion (and on any subject/issue)?
> I am going to point out now that if the vaccines have "extreme/terrible adverse effects" we absolutely should not rollout the vaccines, because we know the risk of COVID are low overall.
This makes me think there _is_ a disagreement between us. I interpreted your previous comment as basically condoning/supporting/approving-of 'more caution', e.g. from the FDA. Based on the "extreme/terrible adverse effects" that have been reported (AFAIK), yes, _maybe_ there are some extreme/terrible adverse effects – among a _tiny_ number of people. The risks of COVID are low overall, but then so (probably) are the risks of vaccines.
I can't tell if you're "weighing costs and benefits normally" by 'adding up 'utilons' or whether you're doing the far more common 'here are some points for a thing and here are some points _against_ the thing' and like refusing to 'do any math' or, e.g. consider base rates.
Do you think the FDA (and similar) should ban acetaminophen (Tylenol)? Do you think it would fare well, in a 'normal cost benefit analysis', compared to COVID-19 vaccines? I'm not sure myself actually! A LOT of people die from acetaminophen ODs. But modal users probably aren't as adversely effected as modal COVID-19 vaccine recipients.
Yes, we are very much in disagreement. I expect that disagreement goes into some very basic areas of facts about reality.
I didn't get that we were "very much in disagreement" and your last sentence just seems needlessly inflammatory.
Are you uninterested in answering any of the specific questions I asked in my previous comment because you think I'm arguing/discussing in bad faith? Why would even a disagreement about "basic areas of facts about reality" imply that?
What "basic areas of facts about reality" do you think we even disagree about?
Must confess there's some small vindictive part of me that wishes for a new vaccine rollout, even if/especially if the adverse effects clearly outweigh the benefits, just because it'll primarily be Those People who end up taking them. That last royal "we" does more heavy lifting than I think is strictly necessary; there's a lot of Venn diagram overlap between "thinks covid is apocalyptic" and "will take any and all shots offered, twice".
But, adverse effects notwithstanding, I think it'd at least help shake the foundations of covid maximalism a bit. I notice that many people giving off those kinds of vibes, explicitly or implicitly, seem to have the futility of any meaningful progress as a load-bearing part of that schema. When I try to tell them about bivalent vaccines, mucosal immunity, etc. it's like a goddamn sunbeam reaching down from Heaven to personally light their benighted existence. So it'd set good historical precedent anyway that Yes, We Can Actually Do Things (If Doing Things Isn't Illegal) to lay cultural norm groundwork for the next pandemic.
"The Numbers" section seems incomplete. The last sentence just cuts off.
Aaaaaaah – we're living in an Ayn Rand novel!
("Atlas Shrugged")
(It's a collaborative work tho, so it's not _purely_ her unique work :))
Also – thanks for these posts!
Sorry, I feel like I'm out of the loop here... can someone explain this?
"It’s especially unacceptable given that if it wasn’t for Topol we likely could have done better than 10 months for the initial vaccine"
I think this is what Zvi is referring to: https://www.technologyreview.com/2020/10/19/1010646/campaign-stop-covid-19-vaccine-trump-election-day/
“Hospitals should be exempt from all local building codes.” -- hard disagree. Building code is tricky, bitchy and often pisses me off, but it’s written in the interest of actual safety. Most of it is about structural integrity and not causing fires, and the lessons that led to writing it were penned in blood and soot. If by the quote you and original author mean _zoning_ ordinances which are all about character and access and pleasant views, yes 100%, hospitals provide a good and don’t need to comply when they’re setting up triage tents out front in a global pandemic.
Some if you may have noticed from my other comments that I’m an angry libertarian (full stop that’s actually how I describe my politics, but especially about overweening regulation), but I can’t condone skipping fire code and building code as a general rule, especially where you have hundreds of people going in and out, many of whom may have no ability to consent to this building or that one for their care.