For the second week in a row little has changed. The biggest news is that Merck has a new anti-viral pill that looks to be somewhat effective as a treatment. Otherwise, it should be a quick week. Which is good, since I spent the week moving (to New York City! to Manhattan! Woo-hoo!) and am quite exhausted. There were a few non-Covid things worth discussing given the lack of Covid news, but due to the time crunch I’m at least pushing them to next week.

Executive Summary

Merck has a new anti-viral pill that’s promising but not a full solution.
Cases continue to decline.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week: 630k cases (-10%) and 13,700 deaths (-1%).

Results: 621k cases (-11%) and 12,405 deaths (-13%).

Prediction for next week: 560k cases (-10%) and 11,500 deaths (-8%).

Often it’s tricky to make a prediction, but this is not one of those weeks. I expect only a small error here.

Deaths

A dramatic decline outside of the Northeast indicates we have turned the corner. The Northeast number is quite unexpectedly bad and does not seem to be an obvious data error, but I’d presume it’s mostly a fluke in some non-obvious way anyway, although the accurate death count shouldn’t peak there for another week or two.

Cases

Progress continues, slightly ahead of predicted pace. There’s no reason to expect that to stop for at least another few weeks, and a good chance it keeps going for a lot longer.

Vaccinations

There’s been a clear uptick in vaccinations, presumably due to mandates having an effect, but it’s also possible a lot of this is disguised booster shots.

Johnson & Johnson gives data overwhelmingly supporting booster shots, files for boosters. Those boosters remain technically forbidden.

Moderna plans to build a plant in Africa to produce 500 million vaccine doses per year. That’s excellent long term news (it will take 2-4 years to build because there’s no rush or anything) and reinforces that yes we could have built more capacity and decided not to.

Vaccine Effectiveness

New study out of the United States shows immunity to infection (but not hospitalization or death) waning over time (paper).

Between Dec 14, 2020, and Aug 8, 2021, of 4 920 549 individuals assessed for eligibility, we included 3 436 957 (median age 45 years [IQR 29–61]; 1 799 395 [52·4%] female and 1 637 394 [47·6%] male). For fully vaccinated individuals, effectiveness against SARS-CoV-2 infections was 73% (95% CI 72–74) and against COVID-19-related hospital admissions was 90% (89–92). Effectiveness against infections declined from 88% (95% CI 86–89) during the first month after full vaccination to 47% (43–51) after 5 months. Among sequenced infections, vaccine effectiveness against infections of the delta variant was high during the first month after full vaccination (93% [95% CI 85–97]) but declined to 53% [39–65] after 4 months. Effectiveness against other (non-delta) variants the first month after full vaccination was also high at 97% (95% CI 95–99), but waned to 67% (45–80) at 4–5 months. Vaccine effectiveness against hospital admissions for infections with the delta variant for all ages was high overall (93% [95% CI 84–96]) up to 6 months.

He points out that these results are still super awesome. I continue to be highly skeptical of the idea that protection against infection declines by an order of magnitude, yet protection against hospitalization remains unchanged, which implies that the hospitalization rate for infections went down by an order of magnitude, and yes I’ve confirmed that such things are physically possible but it’s still downright bizarre.

Most of my previous speculations about past studies and how they might have gotten their results still apply here, and I’d definitely accentuate the positive. Even if we take the result at face value, one must presume that most of these new infections are quite mild (since they result in essentially zero hospitalizations) and probably not that infectious, which is how the math is then able to work out.

Vaccine Mandates

Mandates work to get you a vaccinated workforce in multiple ways. The obvious ones are that your workers get vaccinated in response, others who don’t want to quit, and then you fire the ones that don’t do either.

Both methods are good, but causing vaccinations is better, so it’s good to keep track of which is which and not pretend they’re the same.

A non-obvious way is that you then get to hire a bunch of people who want to work in a fully vaccinated workplace. It turns out this is rather good for business, in a labor market where it’s tough to find good hires.

Here’s a new mandate, for those who want organ transplants.

In other news, I was informed that congratulations are due to most of my readers, you’re anti-vaxxers:

This joins the long list of terms that used to have a useful meaning, so at least some people are trying to extend that meaning, and now it’s hard to know what anything actually means.

EDIT: It seems like this change, while real, took place in 2018. So while this is totally an example of the thing, it’s not an example of the thing due to Covid. (Also edited other paragraphs to reflect this.)

Do you think the people who change the officially approved meanings of words in such ways think they are helping? I’d like to have a word for ‘thinks people should not take vaccines’ as opposed to ‘people should not be forced to take vaccines.’ Alas few can see a difference.

NPIs Including Mask and Testing Mandates

FDA finally approves Flowflex Covid test.

It’s about time, because, well…

I wonder how big this effect was, but I don’t wonder about whether the effect size was zero:

In Other News

Washington Post presents booster situation as ‘leading doctors’ asking to have boosters scaled back, and it looks like the reasoning of these ‘leading doctors’ is something like ‘because the CDC and FDA said so.’ If the authorities want people to die and you want to be an authority, you back them up.

On that note, Dominic Cummings has a post mainly not about Covid, this part seemed worth quoting here:

Just as bureaucracies resist changes to their current direction as if governed by Newton’s First Law, so they are governed by Newton’s Third Law: the more force you exert to simplify and remove ludicrous proecess, the more demented the bureaucratic resistance becomes.
How demented?
In March 2020 I had meetings in the Cabinet room to strip insane processes out of the way. What did I discover one day? That PPE equipment would not arrive in the NHS for months because we had ordered it to be SHIPPED. Why? Because ‘the rules’ said that FLYING it was ‘not value for money’ and we always follow ‘the rules’ even when they kill people. So I told them to call the airlines and commandeer their planes (all grounded) and fly them to Asia and collect the PPE and fly back. And they asked for a letter from the PM’s office indemnifying them in the event of legal challenges and/or disciplinary action. And now much of Westminster is fighting NOT to remove the insane rules but to ensure that the insanity revealed by covid is NOT used as an excuse to remove them. And they have had much success, and got the High Court to agree that avoiding killing people is not a good enough reason to move quickly. And the lesson has been duly learned — even in a crisis killing tens of thousands, make sure you prioritise the insane rules if you want to keep your job.’

The Promising Pathway Act (MR) would greatly speed up new drug approvals going forward. Not sufficient, but at least a start, and this is a good window to attempt such matters.

Wonderful news: Merck has an anti-viral that looks like it works against Covid-19.

It takes a certain mentality to make this the first place one’s mind goes. If people want the vaccine less now that the benefits of the vaccine are reduced, then I’d ask you to consider what the alternative would mean.

Vaccines are held to impossibly high safety standards compared to drugs. This is in part because the person was previously healthy, and partly because vaccines have become a boogeyman that drives people nuts.

Yes, if one can contain the virus, the best thing to do is minimize circulation, but it’s quite possible we essentially failed to contain Covid-19 in the end, and it mostly burned itself out among the unvaccinated. Plus many are now arguing effectiveness against infection over time goes way down. Combine those, and it seems like vaccination is more of a ‘reduce severity’ play similar to treating the ill, and combining that with good treatment seems like a perfectly acceptable solution, at which point we wouldn’t need to do prevention. That’s what most excites me about a new treatment – that it could reduce the ‘price of infection’ for the vaccinated sufficiently to make many people sane again.

Here’s a technical explainer thread on the drug. Definitely not a full answer or better than the vaccine, but also seems better than nothing, and if I was sufficiently sick I would want it.

Finally, a fable about epistemics and Bayesian updating.

These are two rich, powerful, world-renowned institutions, and when they reveal a lack of interest in the truth, the general attitude is a complete lack of surprise. It just makes me want to cry.
Now, don’t get me wrong, I’m not saying that Harvard or the CDC or any institution deserves our deference. What I do think is that institutions are important in our society. Harvard’s supposed to be all about the truth, and the CDC is supposed to be all about evidence and communication, so when Harvard doesn’t care about promoting frauds, and the CDC doesn’t care about garbling the evidence, that should bother us. That it doesn’t, is an indication of the sad state we’ve come to, that decline in trust that has been seen for so many institutions in this country. You could say that the decline in trust is deserved, and I wouldn’t disagree with you—indeed, over the years I’ve done my part to decrease the trust in institutions such as the National Academy of Sciences and the Association for Psychological Science—; still, it seems like a sad state to be in, where these sorts of scandals don’t even bother people anymore.

Like many pieces of news, how one should react to this news depends on what one already knew and believed before the news.

What happened here wasn’t that Harvard and the CDC stopped being interested in truth. That ship sailed a while ago. What happened here was that Harvard and the CDC’s lack of interest in truth was revealed more explicitly and clearly, and became closer to common knowledge.

In response, the people responded that they already knew about that, and identified as Jack’s complete lack of surprise. The scandals didn’t bother people because they weren’t news. They were expected. No one was updated. Except, it seems, the author?

In the comments to that thread, someone pointed out a seriously misleading headline from the Centers for Disease Control and Prevention. This one was four weeks old and remains uncorrected and as misleading as ever. We posted on that one too.
To me, both these stories were shocking.

That, my friend, is a you problem. Most people had better models and made better predictions, and your shock is a sign you need to update. That shock is a mistake that needs to be fixed. Whereas the lack of trust is not a mistake, it is accurate. And if you think it would be better if people’s models were instead inaccurate, then who is the one who cares about truth? It’s a sad state indeed that the CDC is not worthy of our trust, but it is less sad, given that, that we no longer trust it. We’re less likely to make mistakes as a result, and more likely to do more sensible things, and perhaps more likely to fix the problem. I’m not fully in the ‘that which can be destroyed by the truth should be’ camp, but this does not seem like one of the worthwhile unprincipled exceptions.