The pandemic has become predictable, which is the world we much prefer to live in. Cases and deaths continue their slow but steady declines, vaccine approvals for boosters and children continue to slowly move forward. Mandates continue to make people angry but mostly work when used, while also not that often being used. Same old, same old.

The big news story was that one of the studies of Long Covid was revealed to be vastly overestimating frequency due to a methodological ‘error.’ It’s an important update.

Executive Summary

Cases and deaths declining as expected.
Approvals progressing slowly as expected.
Long Covid study had important error, see discussion later in post.

Let’s run the numbers.

The Numbers

Predictions

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

Results: 547k cases (-12%) and 11,051 deaths (-12%).

Prediction for next week: 481k cases (-12%) and 9,835 deaths (-11%).

We are still in a low-variance situation, with no reason to expect any big surprises for at least several more weeks.

Deaths

The exact rate of decline here was a pleasant surprise, but we’ve gotten to the point where this is a lagging indicator, so the times when it is surprising are mostly about data gathering issues, either holidays or changes in the ways in which we do testing. Expect this trend to continue, and continue to mirror cases with a lag.

Cases

This is pretty much exactly what we would have expected. The Northeast number is slightly disappointing, others were slightly better than expected, but no real surprises.

Vaccinations

The rate of vaccinations continues to not change much, and it’s clear that the positive bump wasn’t the start of a surge. That continues not to tell us much about how much work the mandates are doing here. My impression is that the mandates that have teeth work, but that few of them have teeth.

In his podcast interview this week with FiveThirtyEight, former FDA Commissioner Dr. Scott Gottlieb asks where the cost-benefit analyses are on the vaccine mandates, since there don’t seem to be any. He estimates that we could use mandates to go from something like 80% adult vaccination rates to 84%, and asks how much that really accomplishes.

My answer is that this change would be worth quite a lot, but how much depends heavily on how we would react to the two scenarios.

Cutting the number of unvaccinated adults by 20% wouldn’t cut transmission by 20%, since there is some spread by non-adults and some spread by the vaccinated. It’s still a major percent drop in transmission if behavior didn’t adjust, at least 10%. Cutting transmission by 10% means a 10% cut in cases every four days or so if behavior doesn’t adjust, which is a rather big game, cutting cases in half each month.

Behaviors would of course adjust, which is a big benefit. We’d get to increase our equilibrium amount of Covid-19 risk by 10%, which is a substantial percentage of the way back to regular life. If we used this to eliminate ‘stupid prevention’ selectively the win would be even bigger.

Alternatively, if we didn’t adjust our behaviors, then we get full suppression before too long, or damn close to it, at which point the adjustments happen no matter what any ‘public health experts’ or government officials might want. If we’re looking at under 10k cases per day, as we likely are within a few months, people outside of some particular institutions going to go back to normal, and even in those few places there’d be increasing pressure over time.

The intuition pump here is that putting us over the top is a huge deal, and that this is plausibly exactly what we need to get over the top, and if this doesn’t get us there it still gives us a bunch of extra slack to spend. Plus it creates new ‘safe spaces’ where everyone is vaccinated. And of course, it lowers average severity that much more, as well.

One big cost of all this is that Republicans are turning against vaccinations and vaccine mandates in general, which is a big problem, but the timing seems to correspond to the vaccine rollout rather than to the mandates. Not clear to what extent the mandates will contribute to this, but would be rather disastrous if red states stopped requiring childhood immunizations.

Looks like mix and matching vaccines is going to be shown once again to be effective, but this time the results come from America, so maybe they will count.

Vaccine Mandates

The mandate conflict this week is that Texas mandated a lack of vaccine mandates by any entity at all, to combat Biden’s mandate that there be mandates for large corporations, putting the two in direct conflict. There’s still a technical way out of that for corporations, which is that the Biden rule allows frequent testing as an alternative. Alternatively, one can take a side and say that the Texas rule is invalid, which is what the Biden administration is claiming, and the major airlines seem to have adopted this policy.

Mostly we didn’t hear about much in the way of new mandates this week. The mandates that are already in place or being put in place seem to be proceeding smoothly, but there isn’t much appetite to add new ones.

Meanwhile, given the lack of enthusiasm for surprise, ruthless efficiency or fanatical devotion to the Pope, some vaccine advertisements turn to fear.

In other places, some countries are actively halting or scaling back use of Moderna, despite it being clearly the most effective vaccine, due to relatively trivial concerns. I can’t even get angry about it anymore, but all the more reason to get your shots while you can to be safe on multiple fronts.

The FDA is moving forward with child vaccine approval (after which it will presumably become mandatory right away in many places) but isn’t comfortable yet that it has inserted enough delays to make everyone feel comfortable, so the delays continue for now.

Long Covid

Via an excellent comment, we have an important discovery about the Long Covid data.

A major source for the previous pessimistic LC estimates, like Scott Alexanders (the UK’s giant ONS survey) published an update of their previous report which looked at a follow-up over a longer time period. Basically they only counted an end to long Covid if there were two consecutive reports of no symptoms, and lots of their respondents had only one report of no symptoms before the study ended, not two, so got counted as persistent cases. When they went back and updated their numbers, the overall results were substantially lower. This graphic explains their original mistake:

This is why it’s important not to cut your dataset off early

The new headline result is 7.5% of Covid-19 patients had ‘some limitation’ of daily activities after 12 weeks if you ask them if they had long Covid-19. If you go by asking if there were any symptoms from a given list, the rate is lower (like 3%). The full reportis here. What’s notable is that a lot of participants reported LC symptoms with no Covid-19 positive test.

They break it down by age and sex in the full report, but you should treat these numbers as numbers for mostly double vaxxed AZ and some mixture of single/double vaxxed Pfizer/Moderna for younger groups, since that’s how it worked in the UK.

Specific symptom rates over time (corrected methodology)

Self-reported long covid rates over time (corrected methodology)

This is a pretty dumb error, a very dumb way to get a lot of people very scared and destroy a lot of value. Many thanks to the team for correcting the error, whether or not it was intentional and whether or not they should never have made the mistake. And whether or not the mistake was a reasonable one to be making, which it pretty much wasn’t. Error correction is a big deal. Basically what they did, as far as I can tell, was this:

If you report symptoms, that means for now you have Long Covid.
If you report no symptoms twice in a row, congratulations, you don’t have long Covid.
If you report no symptoms then symptoms, we still assume the symptoms are due to Covid, and you therefore still have Long Covid.
If your last report was no symptoms, you’re still considered to have Long Covid until you report in again with no symptoms.
A lot of people didn’t feel the second no-symptom report was a terribly urgent thing to be doing.
A lot of people simply hadn’t had the chance to report a second time once their symptoms had cleared up.
Yet they still counted the period that included their report of no symptoms, as a length of time that they had Long Covid.

To be blunt, they cheated (intentionally or otherwise), it was a massive effect, and we should have caught it, but to my knowledge none of us did. They have now fessed up.

If you ask people to pick from a list of common symptoms, only 3% report that they have one. The larger numbers are mostly or entirely what happens when people are asked if there is anything wrong with them at all, and would they like to blame it on Covid-19. Also the percentages declined a lot over time, so chances are few of the cases would be permanent or semi-permanent. Even if you buy one of the larger numbers, this is a substantial improvement.

Given how many people have already had Covid if you go by the antibodies present in various populations or what I would otherwise guess, this seems far more plausible, that Long Covid while real is relatively rare.

NPIs Including Mask and Testing Mandates

The other thing I wanted to highlight from Gottlieb’s podcast interview this week with FiveThirtyEight was that when cloth masks were first proposed as a solution, everyone involved (according to his account) agreed that cloth masks probably worked, and agreed they were widely available, but that they pushed back hard because if people were told they could use masks, they wouldn’t listen to demands that they stay inside. So that’s the type of thinking we are dealing with there. Scott Gottlieb is very much in the ‘level with the people and it will work out’ camp, and I continue to wonder about the alternative world where he had still been in charge at FDA in 2020.

Lateral Flow Tests looking more effective in practice than we previously thought.

Good thing we blocked them due to being insufficiently good, leaving many people without any access to testing when it mattered most.

In Other News

There were a bunch of flights cancelled in Florida, over some combination of a lack of pilots due to protests against vaccine mandates, a lack of air traffic controllers due to protests over vaccine mandates, and bad weather, depending on who you believe. In the mainstream media this has been treated with something that’s hard not to describe as a media blackout, where a big event happened with both practical short-term and potential long-term impact, and everyone somehow decided not to cover it. It seemed to reflect prioritizing something other than reporting newsworthy events or providing useful information to listeners and readers.

On the other side, this was seen as some glorious sign of revolt and things to come, which also seems mostly wrong to me. Such disruptions seem both rare and mostly not that impactful, with this being news exactly because it had any meaningful impact at all. Whereas supply chain issues caused by actual Covid-19 disruptions are increasingly dire.

Ivermectin studies looking more and more like outright fraud, as in the study never happened and they copied lines of data a lot levels of fraud.

Another reminder of how bad it’s been that we’ve groundlessly scared pregnant women to the point where they’re largely not getting vaccinated, and now they’re filling ICUs.

Dr. Sanjay Gupta appeared on the Joe Rogan Experience. Due to time limitations I haven’t yet had a chance to listen, I hope to be able to report back on this next week.