Archive for the ‘COVID-19’ Category.

Back When The ACLU Actually Stood Up For Civil Rights, Rather Than Shilling for Totalitarianism

This article by Glenn Greenwald on the ACLU's response to COVID is simply remarkable.  I won't even try to excerpt it.  Suffice it to say that barely a decade ago, the ACLU actually was concerned about individual rights being trashed by coercive government pandemic responses.  Their 2008 position paper can only be called "prescient."   They warned that with a state-sponsored coercive intervention program fanned by media fear porn, "People, rather than the disease, become the enemy."  No kidding.   But the ACLU has unfortunately become an operative of the progressive wing of the Democratic Party, and as such has reversed its position -- even from as recently as March of 2020 -- presumably because the part in power has changed.

One other thing on a related note -- the ACLU is a long-time strong supporter of abortion rights.  As such, this position in their recent NYT editorial supporting forced vaccination seems counter-productive to their cause in the extreme: "we all have the fundamental right to bodily integrity and to make our own health care decisions. But these rights are not absolute. They do not include the right to inflict harm on others."  In the past, the absolute sanctity of one's body has been the bulwark in protecting abortion rights.  Other people's opinion on whether the fetus is a human life or not were declared irrelevant because "my body is sacred, period."  But if the body is no longer sacred if and when the government declares another human being is being harmed, how is that any different from the typical abortion opponents argument?

A Couple of Thoughts on Medical Studies Given Recent Experience

  1.  Here is the iron law of medical -- in fact all scientific -- studies in the modern world: most do not replicate.  This has always been true of studies that supposedly find some link between doing [thing we enjoy] and cancer.  This of course does not stop the media from running with initial study results based on 37 study participants as "fact."  The same is true for studies of new drugs and treatments.  Most don't pan out or are not nearly as efficacious as early studies might indicate.  We have seen that over and over during COVID.
  2. The Feds insist that a drug that is know to be perfectly safe in humans still must be carefully tested in random controlled studies before it can be used for a new application.  Fine, I think they are overly cautious in application of this, but let's run with this standard for a moment.  Why, then, are NPI that have known astronomical human costs (eg lockdowns, business closures, and mask mandates) allowable without any sort of study -- allowable in fact when the existing science on their efficacy is at best ambivalent?

Update:  In case you wonder why they don't replicate

Australia and COVID Zero: What Was The Long-Term Plan?

Five years or so ago I remember it was a popular social media poll question in this country to ask where one would live if they could not live in the US.  I remember that Australia and New Zealand were often near the top of the lists.  Which leads me to ask today -- would anyone, after watching the extraordinarily totalitarian response of these two countries to COVID, answer the same way today?  I certainly would not.  The country of Crocodile Dundee has morphed before our eyes into the country of some weird fascist version of piglet in the 100 acre wood.

I have wondered for a while what Australia was thinking of -- long-term -- with its COVID zero policy.  Let's say they were successful in their country eliminating COVID cases.  Now what?  They would soon be a nation of non-immunes in a world that has largely come out the other side of the pandemic.  This is particularly true now that we have a better sense that existing vaccines are more of a before-the-fact treatment to reduce the severity of the disease than they are absolute immunity to catching the thing, at least in some mild way that triggers an overly-sensitive test.

Were the Australians going to permanently wall themselves off from the rest of the Earth?  Refuse to participate in the world economy?  Because the one thing that is absolutely certain is that reservoirs of the disease would still exist -- heck, there are still small whooping cough outbreaks in the US, and a couple hundreds polio cases around the world each year.  Perhaps they were hoping the disease would morph into something less deadly, as most viruses do (most all parasites will mutate over time to spread more easily but be less likely to kill their hosts).   If this is the case, it is sure strange given that the people most in favor of extreme government interventions are the exact same people who seem unable to recognize the Delta variant as being less rather than more deadly.

Well, the sort of good news is that the Australian government has announced that it is willing to release the citizenry from its hostage status once 80% are vaccinated.  I personally was vaccinated very early on (so early that I may soon not be counted as vaccinated) and would urge most adults without any unusual medical conditions get one as well.  It is not going to stop you from testing positive at some point, but it very likely will keep you off a ventilator if you do get COVID.   If you are in Australia, I certainly would recommend it as a small price to be released from captivity.

Crazy Government Responses to COVID Part 3: The Wrong Metrics

It should not be surprising that any roundup I do of problems with COVID response would include a chapter on metrics -- I am a very strong believer that metrics and incentives live at the very heart of most private and public organizational failures.  I already dealt with incentives in part I, though I will come back to them a bit in this piece.

For the metrics, I want to focus narrowly on the selection and quality of COVID-related tracking metrics.   Perhaps I will cover this in a later chapter, but I will not cover that absolutely awful performance of the media in reporting COVID data and COVID-related science.   Suffice it to say that the media has once again shown itself absolutely incapable of reading a scientific study and assessing the quality of the methodology, or parsing the true results of the study vs those ascribed to the study in the press release.  Inherent problems in the data, such as the time delay for death reporting, have been made an order of magnitude worse by the media's inability (unwillingness?) to explain shortcomings in the data.  Is it really so hard to explain how deaths reported yesterday in such and such state did not actually all occur yesterday and in fact represent data updates sometimes weeks old?  This simple bit of clarity has been a bridge too far for most of the media.

Poor Data Quality

For the last 18 months, we have had to work with absolutely awful data on COVID.  I am willing to believe that in March 2020 we had excuses for not knowing what we were doing.  But now?  Some examples:

  • We are testing for COVID using PCR tests that are far too sensitive.  These tests use a series of cycles to concentrate the virus being searched for.  Many tests are being conducted as high as 40 cycles, which pretty much everyone agrees is way too sensitive and is likely to give false positives.  Given the importance of this cycle number, it is astounding that in 18 months I have never seen -- not once -- a media article that has a statistic on positive COVID tests along with the cycle number at which these tests were conducted.
  • Hospitalization data is skewed by the fact that hospitals have strong financial incentives to report patients as COVID patients.   This means a dude in a car wreck who tests positive for COVID once brought in might be listed as a COVID patient, despite the fact that this person fits no definition any of us have for what should count as a COVID hospitalization.  Retrospective studies have consistently shown huge overcounts of COVID patients, confusing "patients with COVID" with the more important "patients who were hospitalized because of COVID."
  • Most retrospective audits have found that COVID death data suffers from the same over-reporting as hospitalization, as a person testing positive for COVID but dying of a stroke might still be listed as a COVID death
  • I have no idea what is going on in many states with COVID death reporting delays.  We still see COVID deaths being added to counts for dates months in the past.  Why the long long delay?  Is there some sort of reclassification going on, and if so why? If not, given that we literally have spent trillions of dollars on COVID response, why can't we fix these data issues?

Following the Wrong Metric

The metric we should really care about is deaths (or given the fact that COVID deaths skew so old, perhaps total life-years lost to COVID).  After all, if we are to be honest, it is the prospect of death and not getting really sick that has certain elements of our population nearly catatonic in fear.  The problem is that even without the death reporting problems outlined above, deaths are way too much of a lagging indicator to be useful in spotting early trends.

Unfortunately, though, because the vast vast majority of positive tests for COVID are for folks who will never display anything but mild symptoms (and due to the testing issues discussed above), this is not a very good metric either.  But there is another problem -- all positive tests are not created equal.  A positive test of a health 20-year-old is pretty much the occasion for a big yawn.  A positive test for an 86-year-old with heart problems and diabetes is a cause of immense concern.  But the metrics do not differentiate.  We just see case counts on the news.  And note the ratio between these two extremes has not been stable -- early on a lot of the cases were in older folks, while today most of the positive tests are in young and healthy people.  Add to this the fact that we now have positive tests in the vaccinated, who are highly unlikely to die of the disease, and I would argue that 1000 positive tests in August 2021 are FAR less worrisome than 1000 positive tests in March 2020.  But again we treat them the same.

So Coyote, is this just academic?  I don't think so.  Personally I think we have seen several decisions of late that are impossible to justify based on science.  For example:

  • Oregon governor orders that even the vaccinated must mask outdoors
  • Many, Many school districts are demanding that kids as young as 3 must mask in school

Neither of these are supported by any science, and to the extent that the former discourages people from getting out of crowded cities and into the outdoors, and the latter discourages children from getting educated, they likely have net negative consequences.  So why?

I would argue the problem is that we have gotten stuck on cases (from overly sensitive tests) being the key metric.  Kids going back to school will almost certainly increase case counts, but for a disease that is less threatening to them than the ordinary flu, so what?  We are stuck on a stupid metric that no longer reflects actual risk and we have politicians mindlessly (see part 1 on incentives) managing to that metric.

So what metric would be better?

First, a good metric needs to really measure what we care about.  At some level, if we really think about it, we shouldn't really give a sh*t about case counts -- we care about people who die or have serious health complications from the disease.

Second, a good metric needs to be easy to calculate and reach the same figure no matter who does the calculation

Third, a good metric needs to be timely.  It is not helpful to have a collision indicator in the cockpit that only lights up 30 seconds after the plane hits the mountain.

Through the middle part of last year, I tended to look at hospitalization data.  It had its flaws (discussed above) but it struck me as the best balance between being timely (more timely than deaths) and indicating true risk (vs just cases).

I can envision a better metric: risk adjusted cases.  This could be as simple or as complicated as one likes, but I would favor a simple version that did not look at too many metrics -- maybe just 5 or 6 age bands and maybe vaccination status.  How it would work in its simplest form is that each case in the summary statistics would be weighted with a factor based on that person's risk of death.  For a simple version with age bands, this means that a case in the 80+ band might have a multiplier of 10 or greater while a case in the 0-18 age band might have a multiplier of 0.1 or smaller.  This would have been impossible to do last March but certainly by the time of the winter peak last year it would have been very doable.  We could easily do this today and back calculate the 2020 data for comparability.  I think age adjustment would be enough, I wouldn't get more fancy than that because we tend to have the age in the case data but not a lot else.  Perhaps we could add a factor for vaccination status as we measure that too.

This approach give us a much clearer idea of how much we should be worried about rising case counts and would be a better leading indicator of potential stress on health care systems 1-2 weeks out.

Crazy Government Responses to COVID Part 2: Feelz Before Facts

Part one of this series was on government incentives.  Part two of this series was originally going to be "managing to the wrong metrics," and we will still get to that topic in part 3.  But as I wrote that piece, it occurred to me that perhaps an even larger issue is not just working from the wrong data, but working from no data at all.

While it would be easy to attribute the "feelz before facts" bias to things like post-modernist thought, in actuality it is older than civilization.    I am pretty sure that panicked, emotional stories about Native American attacks on 19th century settlers grossly exceeded actual such events had we had good statistics (just as panicked, emotional stores of barbarian attacks on 4th century Roman settlers probably similarly exceeded actual cases).

More recently, the global warming debate has been home to many good examples of this effect.  Rising global temperatures are fairly easy to show on a chart, and while the compilation of these statistics is fraught with problems, it is generally unassailable that the data trends up.  Where things really go downhill is in the supposed knock-on effects of rising global temperatures (eg hurricanes, tornadoes, droughts, floods, etc).

The media coverage of these issues is absolutely dominated with feelz over facts -- a good example being hurricanes.  Media coverage of every hurricane is full of panicked articles that this particular hurricane is a demonstration of climate change.  Beyond being a great example of how the media often tries to claim a trend from a single data point, the amazing part is that long data sets of hurricane frequency and, even better, total cyclonic energy in such storms, are readily available...  and NEVER published.  This data consistently shows no upward long-term trend in hurricane activity or strength, but such data is deprecated in comparison to fear of the individual hurricanes themselves.

We have seen this exact same kind of thing, with fear and anecdote trumping actual data, from the very beginning of COVID.  For example:

  • One single panicked tweet or interview of some random hospital nurse** will create a stampede of stories that hospitals are all full and that if you get sick you will likely get turned away and die.  What these stories never include is either a) real data on hospital bed occupancy in the area being reported on or b) any background how hospitals can and routinely do flex ICU bed capacity or c) any background on how this happens even in many flu seasons and is not a unique COVID marker (eg here, here, here, here).
  • Some person will claim so weird long-COVID reaction without any statistics or background on how a) many respiratory diseases have odd longer-lasting effects or b) at what rates these occur or c) how most of these are eventually debunked a few months later (remember the whole young athlete heart thing?).
  • A story will feature a person dying at 30 to try to scare people that this is not just killing old people without a) any context of pre-existing conditions in that person or b) without any data on the microscopic overall fatality rate for this age group and how unusual this case actually is.

My wife tends to be susceptible to this panic stuff because a) she actually still trusts the media and b) she tends to be one of those people who will always jump to the worst case scenario.   It is just incredibly frustrating to watch the media push her buttons and make her fearful when no rational basis exists to be scared.  And the hard part is that for rational people to bat this stuff down, it is like playing whack-a-mole.  At some point it just becomes tedious and exhausting to keep responding every day to a new batch of fact-free BS (irritatingly wrapped into a self-righteous mantle of "following the science.")

I remember a Teaching Company lecture course on German propaganda in the 1930's.  The professor Thomas Childers (I would recommend any of his courses) compared the messaging to a wheel.  They would try a message, and for those that this message did not work for they would turn the wheel a bit and get a new message.  And they would do this constantly until no opponent could reasonably knock them all down.

** Postscript.  This sort of gets back to the first post in this series on incentives, but one might wonder why some front-line healthcare worker would go to the media with dramatic stories that are untrue.  Various political sites that are skeptical of the stores have assumed these folks are political in some way with a political mission, but that does not have to be true.  Let me tell a story.

Back in the early 1990's I was on a jury in Dallas.  This was at the tail end of the incredible child molestation and day care panic, where Janet Reno and others using her "Miami Method" put scores of people in jail based on absurd, literally unbelievable stories generated by young children at the urging of prosecutors.    Our jury's case was a dad accused by the babysitter of molestation of his daughter.

The facts were absurd.  The molestation event supposedly occurred in a quasi-public place;  there was no physical or other evidence;  the "victim" recanted earlier stories told to aggressive prosecutors and testified for her dad;  no one actually witnessed anything.  We returned a not guilty verdict in barely an hour.

We can guess the prosecutors were motivated both by sincere belief that they were doing God's work as well as desire to emulate other prosecutors who had jump-started their career by recently making headline-grabbing molestation prosecutions (Janet Reno actually having jumped all the way to US AG, as an example).  But why the heck did the baby-sitter start all this?  It turns out that this was actually pretty clear from cross-examination by a very good defense lawyer.  She had seen another baby-sitter get on the Oprah TV show for accusing a father of molestation, and she wanted the same chance to meet Oprah and get her 15 minutes of fame.  Seriously, the whole family's life was shattered for years because she wanted to be on Oprah.  Never over-estimate anyone's motives, I guess.

Crazy Government Responses to COVID Part 1: Understanding Incentives

When I argue with folks about the irrationality of certain COVID NPI mandates, eg masks and lockdowns, their ultimate argument when their backs are up against the wall is this:  the government and/or the "experts" would not have mandated these interventions if they did not make sense.  The purpose of this and several following posts is to explain exactly why  they might, or more particularly, why certain government mandates might make sense for government officials even when they make sense for no one else.

Briefly, the case against masks

There are people I talk to that assume that the entire history of science consists of a march towards more and more certainly that public masking is essential to stopping respiratory disease spread and that the only people who oppose this NPI are doing so because Donald Trump or the Baptist Church told us to oppose them.  But there are actually really good reasons to be skeptical of masks as a mandated NPI for this respiratory disease:

  • The body of public health research prior to 2020, on balance, held that public masking (and large scale lockdowns, btw) were not effective and generally not recommended (at least once the outbreak is past a very small group).  A good roundup of the studies is here.
  • People usually respond to this by saying, well, you wouldn't want your surgeon to operate on you without a mask.  Of course, this use case comparison is absurd, since standing next to someone in line at Walmart for 60 seconds is not really anything like hovering over someone's open incision for 3 hours.   But it turns out that the scientific support for masks even in surgery to reduce post-op infection is surprisingly equivocal.
  • The weave of your mask looks to a COVID virus approximately what a chain link fence looks like to a mosquito.  It is not stopping the virus itself.  And this is even before discussing the total lack of sealing against the face I see on pretty much every mask.  And the fact that many people are reusing the same mask for days.
  • The argument is thus made that the mask is stopping saliva droplets.  But we have known pretty much since last March that droplets don't spread the disease.  Droplets end up on the floor, not floating around for hours.  The disease is spread best by aerosols, and masks are only marginally effective at blocking these aerosols
  • Everything I have said above is EXACTLY what the CDC has said for years.  Here is their info-graphic, still up on their web site.  (Here is a copy I have archived in case they ever take it down: understanddifferenceinfographic-508 )
  • A case can be made that masks can make spread worse.  Imagine being on a plane for 4 hours and you have COVID.  Before you ever even get on the plane, you mask is saturated with COVID virus and moisture.  You then spend the entire flight blowing COVID-laden aerosols out through the mask like bubbles from a bubble wand.

Incentives of Government Agencies

But within weeks of the start of the pandemic in 2020, government agencies like the CDC threw out all this history and decided to mandate masks.  Masks were mandated for people outdoors, even when we knew from the start that transmission risks outdoors were nil.   Officials are still mandating masks for children, who have lower death rates from COVID than the flu and despite a lot of clear research about the importance of facial expressions in childhood development and socialization.  Officials are even starting to mandate masks for the vaccinated who, if they are not effectively immune from the disease, are nearly perfectly immune to hospitalization and death from the disease.  So why?

One needs to remember that the officials of government agencies like the CDC are not active scientists, they are government bureaucrats.  They may have had a degree in science at one time and still receive some scientific journals, but so do I.  Dr. Fauci has seen about the same number of patients over the last 40 years as Dr. Biden.  These are government officials that think like government officials and have the incentives of government officials.

I will take the CDC as an example but the following could apply to any related agency.  Remember that the CDC has been around for decades, consuming billions of dollars of years of tax money.  And as far as the average American is concerned, the CDC has never done much (at least visibly) as we never have had any sort of public health emergency when the CDC had to roll into action.

If you think this unfair, consider that the CDC itself has recognized this problem.  For years they have been trying to expand their mandate to things like gun control and racism, trying to argue that these constitute public health emergencies and thus require their active participation.  The CDC has for years been actively looking for a publicly-visible role (as opposed to research coordination and planning and preparation and such) that would increase their recognition, prestige, and budget.

So that is the backdrop.  And boom - finally! - there is a public health emergency where they can roll into action.  They see this new and potentially scary respiratory virus, they check their plans on the shelf, and those plans basically say -- there is nothing much to be done, at least in the near term.  Ugh!  How are we going to justify our existence?  Tellingly, by the way, these agencies and folks like Fauci did follow a lot of the prior science in the opening weeks -- for example they discouraged mask wearing.  Later Fauci justified his flip flop by claiming he meant the statement as a way to protect mask supply for health care workers, but I actually think that was a lie.  His initial statements on masks were correct, but government agencies decided they did not like the signal of impotence this was sending.

There was actually plenty these agencies should have been doing, but none of those things looked like immediate things to make the public feel safer.  Agencies should have been:

  1. Trying to catalog COVID behavior and characteristics
  2. Developing tests
  3. Identifying and testing treatment protocols
  4. Slashing regulations vis a vis tests and other treatments so they could be approved faster
  5. Developing a vaccine

If we score these things, #1 was sort of done though with a lot of exaggerated messaging (ie they communicated a lot of stuff that was mostly BS, like long covid or heart risk to young athletes).  #2 the CDC and FDA totally screwed up.  #3 barely happened, with promising treatments politicized and ignored.  #4 totally did not happen, no one even tried.  #5 went fabulously, but was an executive project met with mostly skepticism from agencies like the CDC.

Instead, the CDC and other agencies decided they had to do something that seemed like it was immediately affecting safety, so it reversed both years of research and several weeks of their own messaging and came down hard for masks and lockdowns.   And, given the nature of government incentives, they had to stick with it right up to today, because an admission today that these NPI aren't needed risks having all their activity in 2020 questioned.

Incentives for Government Officials

Pretty much all of the above also applies to the incentives of government officials.  Our elected officials of both parties, but particularly the Democrats, have been working to have the average American think of them as super-dad.  Got a problem?  Don't spend too much time trying to solve it yourself because its the government's job to do so.  Against this background, the option to do nothing, at least nothing with immediate and dramatic apparent potency, did not exist.  We have to do "something."

It might have been possible for some officials to resist this temptation of action for action's sake, except for a second incentive.  Once one prominent official requires masks and lockdowns, the media began creating pressure on all other government officials.  New York has locked down, why haven't you?  Does New York care more than you?  We had a cascade, where each official who adopted these NPI added to the pressure on all the others to do so.  Further, as this NPI became the standard government intervention, the media began to blame deaths in states with fewer interventions on that state's leaders.  Florida had far fewer COVID deaths, particularly given their age demographics, than New York but for the media the NY leaders were angels and the Florida ones were butchers.  For a brief time terrible rushed "studies" were created to prove that these interventions were working, generally by the dishonest tactic of cherry-picking a state with NPI mandates that was not in its seasonal disease peak and comparing it to another state without NPI mandates that was in the heart of its seasonal peak.  (We are, by the way, starting to see a similar cascade around the most recent delta-driven mandates -- just today a random Arizona county with no uptick in COVID hospitalizations just required indoor masking for the vaccinated).

And then the whole thing got polarized around party affiliation and any last vestige of scientific thinking got thrown to the curb.   Take Chloroquine as a possible treatment protocol.  Personally, I have not seen much evidence in its favor but early last year we did not know yet one way or another and there were some reasons to think it might be promising.  And then Donald Trump mentioned it.  After that we had the spectacle of the Michigan Governor banning this treatment absolutely without evidence solely because Trump had touted it on pretty limited evidence.  What a freaking mess.  In addition to giving us all a really beautiful view of the hypocrisy of politicians, it also added another great lie to the standard list.  To "The check is in the mail" and "I will respect you in the morning" is now added "We are following the science."

Incentives for the Public

I won't dwell on this too long, but one thing COVID has made clear to me is that a LOT of people are looking for the world to provide them with drama and meaning.  The degree to which many folks (mostly all well-off white professionals and their families) seem to have enthusiastically embraced COVID restrictions and been reluctant to give them up has just been an amazing eye-opener for me.

Incentives for Businesses

Many businesses have been caught up in the politicized virtue-signaling, making a big deal of their support for or opposition to various NPI.  But even without this political element, businesses were always going to be conservative and mandate a lot of this stuff if for no reason than to avoid liability.  If politicians are worried about blame from the media for deaths if they did not mandate every intervention their neighbors required, just think what a corporation worries about.  Any tort lawyer worth their salt can get a jury to blame a customer or employee death, without evidence, on a company that somehow did not follow the CDC advice of the microsecond.

Next Episode

In our next episode, I will discuss the role of poor selection of metrics for crazy government interventions.  Spoiler alert -- focusing on cases via positive readings on an overly sensitive test has led to a LOT of the most recent wave of stupidity.

Your Defense Against Panic

The media and politicians are going to try to panic you over case counts.  Relax.  We have tamed COVID down to flu levels or below in terms of seriousness.  People can still test positive after being vaccinated, but they mostly don't die.  And while half the country has not been vaccinated, the half that has is mostly older folks who are most vulnerable.  Link to article

 

My Body My Rights

Variations of "my body my rights" have been a central theme for the Left for decades.  I am all for this (as long as we are applying it to adults wholeheartedly but more restrictively to minors).  But I have argued for years that this represents faux libertarianism -- the Left believes this absolutely when it comes to abortion (and more recently for gender transitions among minors) but not so much when it comes to any other issues.  You want to eat GMO foods?  Sorry, you can't do that.  Smoke?  Sorry, no dice.  Teenage tanning salon visits?  Sorry, not without more parental paperwork than is required for an abortion.

Here is your latest example, from the most progressive city in the country, San Francisco which is requiring vaccinations of all employees:

So these folks who don't think a couple of decades of testing of GMO foods is enough are requiring injection of a vaccine that has been tested for barely a year (I personally consider it safe and was vaccinated but I also consume GMO foods without reservation -- my body my choice).

By the way, this is from the ACLU website:

Being able to make our own decisions about our health, body and sexual life is a basic human right.

Whoever you are, wherever you live, you have the right to make these choices without fear, violence or discrimination.

Yet all over the world, people are bullied, discriminated against and arrested, simply for making choices about their bodies and their lives.

The ACLU, of course, has been completely missing in action throughout COVID, when we have experienced some of the greatest government intrusions of individual rights in our nation's history.  Lockdowns?  Silence.  Mask mandates?  Silence.   Bans on assembly?  Silence.  Censorship of heterodox opinions on the virus (that turn out to be right)? Silence.  Forced vaccinations?  Silence.  All of this is consistent with the ACLU's transition from being a true civil rights organization to yet another progressive political lobbyist.

 

Masks as Virtue Signaling

I want to thank David Hogg for this remarkably honest explanation for why he wears a mask when it is completely unneeded.

While others may not be doing it strictly to avoid looking Conservative, I do think that many young people wear them because they don't want to be mistaken as somehow anti-social or a Neanderthal.

When I am pressured to put a mask on despite having been fully vaccinated 8 weeks ago, I feel like I am signaling as well -- I am signaling that I am a rube who is meekly knuckling under to an irrational state.  It is certainly an eye-opener to see so many of the supposed members of the counter-culture marching in lockstep with state authority.

Our Personal Liberties Are Now Hostage to the Least Common Denominator of Mental Health

It is unbelievable we are allowing these people to rule us

Here are just some of the restrictions:

  • Everyone at the camp—including staff and every kid over the age of two—must wear masks at all times, unless they are eating or swimming. They should wear two layers of masks, especially when social distancing is difficult, regardless of "whether activities are indoors or outdoors."
  • Campers should be placed in "cohorts," and their interaction with people outside the cohort must be limited.
  • There should always be at least three feet between campers of the same cohort, and six feet between campers of different cohorts. Staff should keep six feet away from campers at all times, whether inside or outside. Distance should be maintained while eating, napping, or riding the bus: The CDC suggests seating kids in alternating rows.
  • The use of physical objects that might be shared among kids—toys, art supplies, electronics—should be limited wherever possible.
  • Camps should not permit close-contact sports and indoor sports, and should require masks regardless.

 

Why Must I Change My Behavior To Protect Those Who Choose Not To Vaccinate?

We are rapidly approaching the point where people who are unvaccinated are that way because they choose to eschew the vaccine.  Here in AZ, which has had a pretty solid vaccination program, tens of thousands of appointments for *free* vaccinations are going unused.  Vaccination rates are falling because people don't want them.

But states like Michigan still require that every citizen's freedoms be restricted until more people are vaccinated.  What if those folks choose never to get the shot?  Are we doomed to the same east-german-style regime forever?

And why should we?  People are making the individual choice that they perceive the risks and costs of vaccination to be higher than that from COVID.  OK, fine.  I disagree with them, but am happy to respect their right to make that decision.  But why do the rest of us still have to tiptoe around them?  They have made their risk choice, why don't we let them live with it and get on with our lives?

The answer is two-fold, and comes back to political incentives.  First, politicians fear they will be blamed for outbreaks of disease among the unvaccinated that raise their state's numbers -- we have lost the ability to talk in terms of individual responsibility and so somehow even when an individual explicitly makes a risk choice, we still want to blame politicians if this choice goes bad.  The other reason is that politicians really don't want to give up the power they have -- they have gained powers unprecedented in American history through declarations of health emergencies and fanning the flames of irrational fears, and they don't want to give those back.  Any excuse to extend the emergency will be grasped.

Why Most of the Pro-Mask Science Quoted in the Media is Absurd

I have been close to writing this post off and on for almost a full year.  Starting back in the early days of COVID when the media used graphics about droplet spray patterns with and without masks as "proof" that masks work to slow the spread of COVID.

I was going to write about how dumb this was, but I assumed that other scientific voices would soon skewer these studies and thus it would be a waste of my time.  But lo and behold, while many careful scientific minds did recognize the flaws in these studies, the large news and social media companies have been pretty diligent about preventing any heterodox opinions on masks from getting wide circulation.

And so it stood until the other day when someone once again threw these droplet studies at me as proof that masks reduce the spread of seasonal viruses like COVID.  OK, here is the problem:

It is best to think first in terms of an analogy.  You have a car and want to prove that at any time of day, you could drive 60 miles across Los Angeles in an hour.  So to "prove" that, you take the car our to a test track and show that yes indeed, your car can sustain 60 miles an hour for extended periods of time.

Hopefully the flaws with this are obvious.  Proving a car can go 60 miles an hour is not the same as proving a car can drive 60 miles in an hour in real world conditions, particularly in LA at, say, 5 in the afternoon.

In the same way, showing that a clean, new mask can stop the projection of droplets of liquid does not in any way demonstrate that they are effective in limiting the spread of a virus in real world conditions.  Others can probably add more to the logic problems here, but just a few are:

  • Are large droplets even primarily responsible for the spread of COVID  (remember, the COVID virus is WAY smaller than the holes in the weave of most masks)?
  • What happens when the mask is worn for a while and becomes saturated from the virus of an infected person.  Aren't they now just blowing out all day through a film of COVID, like a kid blowing bubbles with a bubble wand?
  • Are masks efficacious when almost none of them are sealed to the user's face?
  • Is there any evidence of transmission in certain environments, like outdoors on a sidewalk, with our without a mask?

The fact is that the sum of studies before 2020 on the efficacy of public mask wearing to limit the spread of seasonal viruses were equivocal as best.  No one thought they did much good.  People will respond, "well, you wouldn't want your doctor to do surgery on you without a mask" but in fact even the evidence on post-operative infection with and without surgeon's mask use is equivocal  (it is also an absurd analogy as I don't think anyone in Walmart will be hovering over an open incision in my body for 4 hours).   And certainly most (all?) of the quality studies since COVID on masks and virus spread have shown little or no mask effectiveness (there have been a few studies that have purported to show mask effectiveness but they had cherry-picked endpoints that compared one geography outside of its COVID season with another that was in it -- see more here).

Postscript:  I am in Knoxville for a day and had two different experiences.  Last night at the Lonesome Dove restaurant was the first time I have been in a restaurant where no one, not even the servers, wore masks.   A small return to sanity.  But then the next morning I went to an indie books store near market square that had a couple of people browsing and the proprietor would not let us in because they were over their COVID capacity limit (as I said to my wife, when your business model is heading for a cliff it is probably best not to stomp on the accelerator).

Postscript#2:  I know others have observed this but it is amazing how many of the people who do where masks when they are not required are under 25 -- and essentially immune from any major consequences.  Is this virtue-signaling?  A gesture of solidarity? Fear of authority?  Scientific cluelessness?  It is a very strange time when the young are mindlessly following authority and the older folks are skeptical.   The analogies I can think of is the German youth movement pre-WWI who were big supporters of war as a romantic endeavor and the young Chinese of the cultural revolution.

Update #3:  As a by the way, in case you every get to Knoxville and are looking for a nice place to stay in the downtown or university area, the Tennessean is the place to go.  Only slightly more expensive than other hotels nearby but has really top quality service and rooms  -- Four Seasons level IMO at a third the price.

Virological Calvinism

It is always dangerous when a non-religious person tries to make a statement about religious belief, especially when we get to complicated arguments about double predestination and supralapsarianism.  But for our limited purposes in this post, in Calvinism salvation and damnation are pre-ordained by God at the beginning of time --thus faith and good works have no bearing on being saved or damned.

I have come to believe that this is largely true of COVID-19, ie that the actions of man (at least as far as non-pharmaceutical interventions are concerned) have little or nothing to do with case rates and virus spread in any particular region.  Different geographies have different seasons for the virus, and trying to attribute low case rates or high case rates to the presence or lack of government interventions / restrictions is futile.  You can see that as location after location that was praised or damned at some point for its supposed good or bad handling of the virus have since seen opposite results.

There are a few exceptions to this, but very few.   On the positive side, the accelerated vaccine development programs were a near miracle, producing multiple viable vaccines WAY faster than I ever thought possible.  On the negative side, ordering infected people into long-term care facilities was a disaster.  But beyond these few exceptions, most of everything else didn't do squat.  The great regression analysis someone does someday on virus transmission rates across geographies is going to have seasonal variables, demographics, and urbanization with most of the explanatory power.

2020 Should Have Been The Year We Demanded Reform of the FDA and CDC, But We Didn't. Now It's Come Back to Bite Us.

Many of the early failings in COVID response can be laid right at the doorstep of the CDC and FDA.

Shortages of testing?  The FDA refused to approve an tests except those developed at the CDC, and then the CDC tests failed.  Later, the FDA was really slow and conservative in approving new test approaches (eg home testing).

Shortages of PPE?  We learned that PPE manufacturers were all heavily regulated by the FDA, and FDA rules prevented quick ramp-ups, while liability rules made folks like 3M reluctant to shift N95 masks from non-medical to medical markets.

Slow vaccine rollout?  The FDA was its usual conservative self in approving vaccines, and refused to give any credit to vaccines approved by other western nations.  THEY had to approve it too.

First doses first?  No way, the CDC and FDA would not even consider it.   The conservative approach was to insist the vaccines be used exactly as originally tested, despite testing on the Pfizer vaccine showing that 1 dose of it was over 80% effective.  Now we see the world leader in reducing cases is the UK, which is the one country that did first doses first.

In a sane world, the CDC and FDA would have gotten hammered for what could be described as following peacetime rules in during wartime.  Add to that their ever-shifting and contradictory guidance, and guidance on NPI's that went against the sum of scientific research that had been published pre-2020, and you should have expected a LOT of media scrutiny of them in 202o.   Instead there was virtually none, and if anything the media fetishized and hero-worshipped these agencies.  Why?

As usual, the answer is Trump.  By 2020 the media was in the habit of blaming everything on Trump.  If COVID tests were in short supply, it must be Trump's fault.  No further scrutiny was needed.  In fact, no further scrutiny was wanted, because no explanation excerpt for "Trump's fault" was wanted.  Granted Trump helped them to some extent by his usual habit of off-the-cuff stupid statements.  But the media went ever further -- they wanted an anti-pole to Trump, and these agencies and morons like Dr. Fauci were elevated to sainthood not because they did anything right but because they could be portrayed as not-Trump.

For the media, whatever the FDA or CDC said represented scientific consensus.  Which is a horrible bastardization of science.  The FDA and CDC are not "science" and scientific "consensus", if such a thing is even real, is based on a quasi-antagonistic process of challenge and response between differing hypotheses (a process by the way the media actually undermined by de-platforming one side of many of the COVID-related debates) and not dictats by government agencies.  The FDA and CDC are populated by politicians and government bureaucrats who happen to have scientific degrees.  They are subject to all the same influences and bad incentives as any other political organization.  For example, in the government there are very different risk profiles between action and inaction.  Essentially, bureaucrats are seldom held accountable for deaths and harm from inaction -- if people die because they are slow to approve a new drug or procedure, no one puts that on them.  But they try to avoid at all costs approving something that eventually hurts someone, even if that harm is far less than the benefits of what they approved.  But instead of making all this clear, the media granted them the secular form of Papal infallibility.

So now we arrive at April 2021, and the FDA shut down the use of the J&J vaccine because it has about a 1 in a million chance of causing blood clots and a one in 6 million chance of causing a fatality.  People seem suddenly surprised that the FDA would do such a thing that is obviously so irrational (the number of lives saved by the vaccine is  -- by everyone's estimate -- orders of magnitude larger that those who have died from this side effect that may not actually even be due to the vaccine).

What is surprising to me is that anyone is surprised.  The FDA has ALWAYS acted this way.  Libertarians have called them out of this for years (thus, for example, libertarian-sponsored right to try laws).  In particular, failure after failure of COVID response in 2020 can be laid right at the FDA's doorstep, but we were just having too much fun demonizing Trump to actually look for root causes.  Well, now our inattention has come back to bite us with this absurd FDA decision.  The only good thing that can come from it is the potential that we might finally consider some reforms.

Prediction: Feds Will Be About The Last Government Entity To Drop Their Mask Mandate

Joe Biden is kind of stuck on COVID.  He campaigned on all the things Trump did wrong in his COVID response, but the only policy step of note that I can see that Biden has done differently is to issue a mask mandate for all federal property where Trump eschewed making NPI mandates at the Federal level, preferring to leave it to state and local governments based on their local conditions.  If this is really the case, expect Biden to be about the last man standing on government mask mandates, at least in the US.  My guess is that he will use continued cases or low vaccine rates in some state as an excuse to say that he can't drop the mandate until everyone in the US is ready  (forgetting how insane this is particularly when a more logical Federalist solution exists for the problem).

Biden is trying to claim credit for vaccination rates but it is hard to think of anything he has actually done to boost these rates since most all vaccines are administered by local folks and the vaccines were developed and funded on Trump's watch.  The only major decision Biden has made, which I actually think was a setback, was to declare that the US would not take a first doses first strategy used so successfully in the UK.  Biden has declared a goal of 100 vaccines in 100 days, but this is pretty much meaningless, the equivalent of a random dude running to the front of a parade and claim to be leading it.  Someone in his shop merely took a chart and of vaccination rates and projected it forward and determined about 100 million looked like they would be done in 100 days and so adopted this as a goal, hoping to retroactively convince people they caused this rather than just predicted it.  I would love someone in the press to ask Biden to name three things his Administration did that measurably accelerated the vaccination pace.

Like many, I find Trump irritating and distasteful and I have trouble saying nice things about him but he got a range of vaccines funded and got the US first in line for doses by pre-paying.  Its hard to think of anyone else who did more to help the crisis.  This helps me forget things like the botched testing development, which was really the FDA's and the CDC's fault but a different leader might have kicked those agencies out of their obstinate blocking role and into a more productive mode.

UPDATE:  I will add that the recent CDC / FDA decision to stop the J&J vaccine due to a 1 in a million non-fatal side effect seems like a terrible decision.  Again, possibly not Biden's decision, but like my criticism of Trump and testing, Biden could exercise some leadership here.  This is the price for fetishizing the CDC and FDA as all-knowing consensus voices of "science" that are not to be doubted, even to the point of having heterodox youtube videos taken down.  Because 1) These guys like Fauci are not scientists per se, but government bureaucrats with science degrees.  And as I have written many many times, government employees have incentives that lead to high risk aversion for acts of commission and low risk aversion for acts of omission.  Which means they put much higher weight on a death from a very easy to count and identify side effect that they could have stopped by stopping the vaccine than they do on deaths that are impossible to count or to see that were caused by the vaccine delay.  And 2) the idea of "scientific consensus" is a chimera and a term only used by non-scientists and a small group of government scientists that want to wield their position as a club to exercise power.  Seriously, how does such a consensus even exist if one side never was allowed to debate?  This is consensus as defined by Stalin or Mao.

We Knew About the Disproportionate Danger of COVID to the Elderly From The Very Beginning

In some recent debates over the Great Barrington Declaration, critics of that proposal argued that we didn't know that COVID was only a relatively small threat to healthy people under 65.  But we did know, as early as April or at worst May.  I know I was writing about it.  Just think of all the articles you have read with the theme of "everyone, not just old people, need to be terrified of COVID" and then look at this:

People over 65 make up only 18% of the UK population but clearly accounted for 90+% of the deaths.

Here is the calculus as I see it:  I was 58 when this all started.  Let's assume I have 20 good years.  Hiding in my home and not doing the things I enjoy for a whole year, as preached by Fauci and company, would have wasted 5% of my remaining life.  Instead, by ignoring them and going about my business, I was taking perhaps a 1/2000 chance of dying to the disease or 0.05% (I actually think given my health and weight that this is exaggerated).  These two numbers are not even close.  They are not one but two full orders of magnitude apart.  When presented with these numbers, and given my preferences, it would have been wildly irrational (or demonstrated extreme risk aversion) for me to follow the advice and dictats of the coronabros.

Well, That Was Fast. UK COVID Strain Likely NOT More Deadly

In my post about the Sunday NY Times article on the B.1.1.7 COVID variant, I expressed skepticism that it really was substantially more deadly than other variants.  While this is possible, on average we expect viruses to mutate in a way that they are more communicable but less deadly (there are no rewards in the parasite world for killing the host).

Specifically I said:

My personal bet is that we will see a story buried on page 34 in August saying that original relative death studies for this [B.1.1.7] variant appear to have been exaggerated.  When the NY Times is hyping a scare story that increases the power of government, particularly in a Democratic administration, take the under.

Well, I was wrong.  Rather than in August, the predicted story was buried in the Wall Street Journal one day later

Clear evidence has emerged that B.1.1.7 transmits more easily than earlier variants, which helped enable its rapid spread. Whether the variant is associated with more severe disease and death has been less certain, however...

In the new study, the researchers took samples collected in early November from 341 Covid-19 patients admitted to University College London Hospitals or North Middlesex University Hospital. The researchers sequenced genetic material from the samples to determine the viral variant that caused the infection, used the test results to estimate how much virus the patients harbored and then compared the two groups.

Nearly 60% of the Covid-19 patients had an infection caused by the B.1.1.7 variant, and patients hospitalized with B.1.1.7 were younger, had fewer health conditions and more often received an oxygen mask than those admitted with other variants, the study found.

Yet the researchers didn’t find that those with a B.1.1.7 infection had more severe disease outcomes such as needing ventilation or dying, after accounting for other factors such as age, ethnicity and underlying conditions.

I will be more careful than the NY Times, who cherry-picked one study result on the far end of the scale of results to date, and acknowledge that the study results -- all based on small samples and uncontrolled population groups -- are mixed.  But evidence both of prior meta-studies as well as this new one give us little reason to believe that this variant is substantially more deadly.

Variant Terrorism and the New York Times

Update:  Just one day after this story, the Lancet published a study showing that B.1.1.7 not likely more deadly than other variants.  As predicted below.

The New York Times has scary red maps of Europe on its front page today (at least in the version we get in AZ) implying mass death from new COVID variants.  Given the prominence of COVID in the news and our lives, there is certainly a story here.  But as usual with American media coverage of COVID, there is absolutely no balance here.  The article highlights new developments in the virus, which is helpful, but does so in a largely data-free manager and simultaneously engages in the crudest of rhetorical tricks to make the situation seem far worse than it is.  Here are a few pointers to how to read through this mess.

  • The use of color on the front page maps is not accidental.  When the media wants you to be scared, it uses red on maps and scales it so that even small changes in variables result in a map going from green or white or blue to solid red and orange.    No exception here.  When one glances at the front page, one likely assumes that this is a map of spread of death or new case counts, but in fact it is merely a map of one new variant as a percentage of other new variants.  It says nothing about death or case counts.

  • The article attempts to use certain rhetorical framings to imply that increases in cases and/or deaths are due to this new variant.  For example:

The variant is now spreading in at least 114 countries. Nowhere, though, are its devastating effects as visible as in Europe, where thousands are dying each day and countries’ already-battered economies are once again being hit by new restrictions on daily life.

and this even more egregious example:

What happened this winter in the U.K. was mass death and deluged hospitals on a scale not seen earlier in the pandemic. Since B.1.1.7 was first sampled in late September, 85,000 people have died. Four million people — one out of every 17 Britons — have recorded infections.

So 85,000 people died from this variant?  Well, they want you to think that -- but they were careful that while implying that (which would not at all be true) they do not actually say that.  When you think about it - especially given that there are now dozens of COVID variants - this sentence means exactly nothing.  It's like saying that since Biden took office, thousands of people have died of cancer.  Here is the UK deaths chart (from Google, not in the NY Times article):

You would certainly never know from this article that deaths in the UK have basically gone to zero.  This chart shows exactly the same seasonal pattern we are seeing everywhere, including in places like Arizona where we have had few if any of this new variant.  This picture has become the great totalitarian Rorschach test of the 21st century, with everyone reading their own preferred causes into these seasonal humps (opened too soon! variants! spring break! evil Republican governor!)

By the way, I will save you clicking through the Times link above that says "mass death and delayed hospitals" in an attempt to see the data.  There is none. Just like with the overloaded hospital meme in the US, the article is quotes from a few harried doctors and funeral home managers and zero data.  The first "overloaded hospital" story I see with actual occupancy numbers compared to the same months in prior years will be the first.   In this case there really is no excuse for this, as the NHS apparently keeps pretty detailed daily hospital records and puts them all online here.  So I looked at the week including January 21, which looks like the peak of critical care at least in the death chart.  On 1/21/21, there were apparently 3 acute and emergency care diverts in the whole of England, and it is not even clear if these were due to capacity issues.  Other days that week were generally on 3 as well (I don't know how they count so I don't know if these are the same 3 people all week or different people each day).  Occupancy of acute and emergency beds was around 87%.  For comparison, the January 2019 report from the same site showed acute and critical care occupancy of 85%.  The site cautions that with the segregation of COVID and non-COVID patients, capacity is harder to manage (a basic tenant one learns in any operations course) but it is hard to gauge by how much.  But all this sort of discussion and outlining of facts that are so easy to find is missing from the article, as the whole point is to scare, not to inform.  After all, reciting statistical facts about vampire incidents is not the best way to tell a scary ghost story around the camp fire.

  • The article keeps saying that this variant is thought to be more transmissible and more deadly.  Towards the very end they get the most specific when they say:

The variant is believed to be about 60 percent more contagious and 67 percent deadlier than the original version of the virus. 

If you follow the link, you have to go through an Easter egg hunt of clicks, but eventually one gets to this metastudy looking at a number of results.   I am not even going to pretend to have expertise in reading and interpreting these results, but I would observe that a) the claimed 67% number seems at the high end of a lot of the results; b) 67% is awfully precise for studies who summarize their study results as this variant "may" and "probably" be more deadly; and c) the sample sizes here are really small and pretty skewed (most seem to be dealing with people already hospitalized or at least showing symptoms).    My personal bet is that we will see a story buried on page 34 in August saying that original relative death studies for this variant appear to have been exaggerated.  When the NY Times is hyping a scare story that increases the power of government, particularly in a Democratic administration, take the under.

  • My understanding is that most deadly viruses tend to mutate over time to be less rather than more deadly.   More transmissive but less deadly is the ideal for a virus trying to spam copies of itself across the globe.  I have yet to see any discussion in any article of this fact along with any hypothesis of why COVID might be behaving differently (since according to the media every damn variant is more scary than the last one).  There may be a reason, and it would be an interesting discussion -- as well as an obvious on of interest to readers -- but I have yet to see it.

I really should not get that worked up about all this -- after all, my blog certainly is not even-handed.  But my concern is

  1. The undercurrent of all these stories is essentially "so shut up and obey."
  2. No criticism or skepticism is being allowed by most of the major gatekeepers.  I can say this kind of stuff because I have a small audience, but once one gets any sort of prominence, such skepticism no matter how well-grounded in facts will be memory-holed.  Take this story.  The claim that children don't need masks is perfectly justifiable for a disease that is deadly for octogenarians but milder than the flu for kids.  We could have a discussion about this and people can disagree, but it is a totally reasonable topic for public discourse.  To ban this can't be due to science, it can only be a quasi-totalitarian deference to authority -- President Biden says we need masks so no one should publicly disagree with him.

Be warned -- totalitarians have not missed the significance of this nor that the government seems to be getting away with it.  You are going to see a spate of issues all reframed as public health issues -- guns, race, climate, immigration -- with folks claiming that newly established COVID-related dictatorial powers need to be applied to their pet issues as well,

I don't think in the history of this country the general populace** has been subjected to the sorts of limitations to individual freedoms that have been imposed over the last year, often by executive order without even involvement of the legislature.  Sometimes by public health officials who are not even elected.  Even in wartime I can't think of any affront to individual liberties that was as bad as the combination of lockdowns, school closures, and business closures.  To have all that happen is bad enough.  But to have the gatekeepers of the public discourse declare that not only are we going to do all these unprecedented authoritarian things, but we are not even going to allow public skepticism of them --that is really scary.  Historically, all the worst ideas have been accompanied by bans on public criticism.

** Clearly minority populations have been subjected to worse.  Enslavement of African-Americans, internment of Japanese-Americans, and near-genocidal actions taken against various native American groups come to mind.

No One In Power Has The Guts To Declare The Pandemic Over, So I Will: It's Over in Arizona

Half our politicians don't want to declare the pandemic over because they are wallowing in all their new power and having too much fun as petty dictators.  The other half are scared, living in fear that every death after they declare an end will be used as the basis for a Bush-esque "mission accomplished" critique.  Well, people will likely contract and perish from COVID forever.  Heck, people died last year in this country of the whooping cough.  My 25-year-old nephew died of regular old flu.

But if we define the pandemic as a time when a single disease drives excess mortality outside of normal bounds, then this pandemic is over, at least in AZ.   As of this morning, 27% of people in AZ had at least one dose of the Pfizer or similar vaccine, over half of those being in the vulnerable over-65 group.  We don't know how many have gotten the virus, but (non-random) anti-body tests were running over 50% positive last month.  If we assume a third of folks have antibodies from the virus itself, and that there is a 50% overlap between these folks and those vaccinated, this gets us to nearly 45% immunity, rising by several percentage points each week.  Immunity levels in the over-65 population may be over 80%.

As a result, cases have fallen sharply but due to the sensitivity of testing, I am not a fan of that metric.  We will probably always have people testing positive.  The question is whether people are getting seriously ill.  And here are the numbers for that, I use ICU bed occupancy as a proxy for serious illness (because case numbers are exaggerated and death numbers have a crazy lag to them):

I am not cherry-picking -- this is the most useful metric, I think, but all the others show the same thing.

My suspicion has always been that "COVID patients" means "Patients who test positive for COVID," so the number may be a bit exaggerated for true hospitalizations caused by COVID.  Also it is a lagging indicator -- 10 days to incubate and a week to end up in the hospital and perhaps a week stay in the hospital means these are likely folks exposed in early March.   But the result is clear.  Given the sensitivity of testing, these numbers will likely never go to zero.  What we see is a normal hospital load form a seasonal virus, in fact one currently far smaller than what we might get in a normal flu season.  In other words, we are back to normal.  AZ, by the way, last week opened vaccines to everyone over 18.

Postscript:  If you compare the ethnic data on COVID deaths vs. vaccines, it does appear Hispanic and native American groups are under-represented in the vaccine population vs. the population of COVID deaths, though the ethnic information on vaccine administration has a lot of gaps.  This is partly predictable for Hispanic groups as they skew much younger than whites in AZ so the prioritization to over-65 people first is going to skew the racial mix.

That fact may get reported on.  The fact that will not get reported on is the gender skew.  In AZ men were 58% of deaths but are only 43% of those who have been vaccinated.  I guess if I wanted to spend my life being aggrieved about my tribe I could be upset about this, but in fact it is entirely predictable from the vaccine priorities.  Vaccines first went to teachers, health care workers, and old people -- all three of which skew heavily female.

Postscript #2: One interesting thing that I have not seen reported -- I don't know any men, including myself, who had any substantial reactions from the vaccine.  My wife and daughter, however, were really knocked out for a day.  This is partly random, but also partly the inevitable result of having a singles-size dose for everyone.  The ladies in my family have much smaller body mass than I but got the same dose, which may explain why it hit them harder.

 

Credit Where It is Due -- Our County's Vaccination Effort is Pretty Impressive

Last week I volunteered, along with 100+ other people, for an 8-hour shift at the Phoenix area's largest vaccination station, located at State Farm Stadium (the oft-name-changing home of the Arizona Cardinals football team).  Someone really did it right.

I often criticize public efforts for their inefficiency and poor performance, but this one is certainly an exception.  Granted, it is being run as a public-private partnership and my gut feel is that the Blue Cross Blue Shield folks have a lot to do with the success, but partnering for expertise is a perfectly reasonable way to get a job done and the government seldom is willing to admit it needs help.

The entire operation uses one section of the stadium's massive flat parking lots.  They have created an assembly line for those being vaccinated to move through the process without ever leaving their car.  The whole setup has the feeling of a Disney ride or an assembly line.  Those being vaccinated are greeted at the first station and checked in against their reservation.  Their reservation number is written on grease pencil on their window.  They then proceed station by station to get their vaccine and to get checked for any negative reactions on the way out.  In between volunteers with ipads walk car to car in the queue for each station, asking screening questions, gathering data, or at the end making appointments for second vaccine.  The number on the windshield allows these volunteers (I was one) to quickly access the relevant portion of that visitor's records.  It is clear someone has load balanced the stations, because there might be 12 of one sort of station followed by 8 of another that cycle faster.  From front to back the process requires about 30 minutes, including the mandatory 15 minute wait for negative reactions.  Patients have an email waiting for them with their selected appointment time for a second shot before they even drive off the property.

The whole process never stops, running for 24 hours a day.  We volunteers get the training we need through a 15-30 minute overlap with the last person doing the job (most of us are on our feet with the iPads or with parking flags).  The biggest staffing bottleneck are the trained medical professionals needed at the vaccination station and at the end to monitor for negative reactions.  Thus all the rest of the process is designed to leverage these folks, to make sure they are doing only medical tasks -- a large force of volunteers without medical skills (eg me) do all the rest under the supervision of a surprisingly small permanent management team.  The medical folks for example at the actual vax station are not asking background questions or managing records -- this is all done with non-medical volunteers -- so they can focus on sticking needles in arms.  This is important because the medical professionals are the most limited resource and the hardest to keep deployed 24 hours a day.   I really have a lot of love for those folks because it is a long, long shift, rivaling any in a Chinese sweat shop.  Those of us non-medical volunteers just did it once or twice, these folks are doing it day after day.

The rest of the volunteers are frankly easy to get, despite it being a really long shift (especially the 10pm - 6am one), because folks who work a couple of shifts get the vaccine on the way out.  So soliciting volunteers mostly consists of running a sign up site and handling the deluge of traffic in the first 5 minutes after new spots open.  I will say it was a pretty amazing volunteering opportunity.  First, the number of well-organized volunteer efforts are, in my experience, really limited and these guys totally had their act together.   I worked at the end of the process, walking the line of cars waiting out their 15 minutes, scheduling appointments.  It was not unusual to have an older person crying and telling me they could finally go see their grandchildren after 12 months of isolation.

I thought a bit about whether to even bother, as I have never been very worried about COVID risk, but I have to travel a lot and I worry about whether the Biden Administration may put vaccine requirements on travel at some point.  Plus I work with about 800 folks over 60, so at the end of the day it made sense for me.  However, the second vaccine really has me in a quandy.  New reports have first dose effectiveness at 92+% vs two dose at 95%.  Are they really going to put this scarce resource in my arm for +03% effectiveness  (probably in the error bar of the studies)?  On the other hand, they have already scheduled me for x day and time for #2 and its part of the process that you agree to come back for the second.  I will think about it, but frankly I will be happy if the state decides to delay second doses for a while.

Every Service Organization Has Lost 20 Organizational IQ Points During COVID (Banks Have Lost 40)

Over the past year, I have spent a staggering amount of my time trying to get service providers who are supposed to be the leaders of their business to do their damn job.  I literally keep a list at my desk with a list of reminders I need to send out to service providers to do what they promised.  This list is never less than 30 names long.

More than the COVID life disruptions, more than the fear-mongering, more even than our merger, the most exhausting thing for me over the last year has been the utter inability to reliably delegate anything to a third party without constantly having to coach them through their job.

I see many reasons this is occurring.  These include:

  • Lack of employees due to either sickness or else difficulty in competing against high unemployment payments.
  • Closure and elimination of services that companies always wanted to eliminate but they can now blame on COVID.  For example
    • Hotels stopping maid services and room service
    • Banks closing tellers and branches
    • Airlines not serving meals or drinks
  • Unwillingness to adjust to the current reality.  Banks are high on this list, demanding things they have always demanded but that are impossible to do in the last year

But these do not encompass the whole problem.  There are a lot of companies in their core functionality that seem to have simply forgotten how to do what they do.  Even after 6 phone calls, Amerigas can't take and fulfill a simple order for bulk propane delivery;  Iron Mountain, who I like and invest in, can't reliably provide any of their core services accurately and on the first try; I don't think Intuit even picks up the phone anymore.

My hypothesis is that people are getting too far ahead of themselves in saying that COVID proves that the centralized workplace is dead.   I think we are going to find that this is not true at all, that there are networks in the office that spread both knowledge and accountability that are lost with all this home work.

I have run a company for 20 years where every employee works out of their home, or more accurately, where every employee moves their home (RV) to the workplace.  My employees work in over 400 spots.  And one thing I have learned vs. years of working in Fortune 50 offices is that you have to build a special process for this situation.   In particular, my constant focus is how how to centralize complexity.  I keep trying to take complexity out of field locations and managers and centralize it in a few office people where it is easier to train and build tools and create backups, etc.

My hypothesis is that companies did OK for the first month or two with work at home as well-trained employees carried the momentum of office work styles to their house.  But as time passes, and the staff turns over, the lack of traditional knowledge-sharing, support networks, and accountability systems are causing service functionality to degrade.

 

 

Media Fear-Mongering With Zero Education Value

For most of the past year I have been hammering on the media for their destructive COVID fear-mongering.  By always cherry-picking the most alarmist opinion on every topic, and filling articles with carefully calibrated fear-provoking language, they have made us all dumber.

Let me give you one example.  For literally months, day after day, our AZ papers have been screaming that emergency rooms are filling up and telling the public they may soon be lying untreated on some hallway floor or not allowed into a hospital at all.  The articles were in my email every morning -- maybe some day I need to piece together a supercut montage of them all but my guess is most of you have experienced something similar.

I know zero about hospital management but even I can look at ICU data and see that the narrative is substantially more complex than what is in the media.  Here is the AZ state tracking report on state ICU bed utilization -- dark gray is total and red is COVID-related in some way.

The implication in the media is always that a 80% full ICU plus the equivalent of 30% of the beds with new COVID patients = zero capacity and people dying with no treatment.  But that is clearly not what happens.  AZ ICU's have run at 80+% capacity utilization since June 1, while COVID bed use in that time has drifted from 10% to 60% but we were never out of capacity.

There is clearly some complex management process the goes on with the management of ICU capacity.  In fact, it seems like someone knows what they are doing here.  Why don't we ever, ever get to hear that story?   I can't think of one hospital administrator I have seen interviewed in our local papers discussing how this management process works.  The only people they ever interview seems to be that one nurse with PTSD screaming that her hospital is a dystopian nightmare.

Perhaps this capacity management is being done with little cost, deferring non-urgent cases.  Perhaps someone is missing out on care to defer to the COVID folks.  Perhaps this is entirely normal in every winter flu season.  We don't know because apparently the media has decided it is not interesting, or at least not as interesting as the reactions they get when they have everyone as scared as possible.

"Work From Home & Socialize via Zoom" Is the Height of Elite Priviledge

I have been pointing out since April that stay at home orders tend to be supported by folks who either a) are rich with lots of savings; b) have professional jobs and can work from home (eg journalists) or c) get paid even if they don't work (eg government workers and teachers).  A lot of folks on the Left that lecture the rest of us constantly on privilege have shown zero self-awareness in advocating for the most privilege-biased government order in my memory.

So it should not be shocking that the results of the COVID business lockdowns have disproportionately hit lower income and less educated workers.  From the WSJ:

A two-track recovery is emerging from the country’s pandemic-driven economic contraction. Some workers, companies and regions show signs of coming out fine or even stronger. The rest are mired in a deep decline with an uncertain path ahead.

Just months ago, economists were predicting a V-shaped recovery—a rapid rebound from a steep fall—or a U-shaped path—a prolonged downturn before healing began.

What has developed is more like a K. On the upper arm of the K are well-educated and well-off people, businesses tied to the digital economy or supplying domestic necessities, and regions such as tech-forward Western cities. By and large, they are prospering.

On the bottom arm are lower-wage workers with fewer credentials, old-line businesses and regions tied to tourism and public gatherings. They can expect to bear years-long scars from the crisis.

The divergence helps explain the striking disconnect of a stock market and household wealth near record highs, while lines stretch at food banks and applications for jobless benefits continue to grow.

These charts are telling:

     

One other observation -- I think the second part of the statement in the title to this post is important as well.  I am not an expert on ethnic and cultural variations and practices.  However, I have been lectured by the woke that cultural differences are important, including a memorable twitter argument about whether expecting workers to show up on time is racist.  It has been my observation that different cultures satisfy the human need for socialization differently.  In my world, you often see white families in parks gathered in small nuclear families, while other cultures might have 25-30 person extended multi-generational families with them.

I wish I had more background on this topic, but it is my hypothesis that the government's lockdown orders may well disproportionately harm ethnic minorities.  In general, we Westerners are more used to getting by individually or in small nuclear family groups (though remember that even for whites, solitary confinement is generally the ultimate societal punishment short of the death penalty).  I think there is a good chance other cultures more used to relying on larger networks and multi-generational extended families are having a particularly hard time with the order to limit social contact to zoom.

Why The Incentives Are Stacked to Overreact to COVID

Long-time readers will know that I am interested, to the point of obsession, in incentives.   One should always be suspicious of bad outcomes described as irrational or the nefarious actions of bad people.  In both cases, if one looks carefully, the outcomes usually turn out to be the perfectly rational outcomes of perfectly normal people responding to bad incentives, assumptions, and/or information.

I personally believe the COVID response in this country (and others) is exaggerated and counter-productive.  But for this post I am not going to ask you to agree or disagree with my skepticism.  Instead, I am going to focus on incentives, and show how media, academia, and government all have incentives, assumptions, and information asymmetries that push them towards exaggerated COVID responses.

The following list is not necessarily complete and the items here are not independent of each other.  Having completed this post, they now look a little random but this is sometimes the way I clarify my thinking on things -- to write and publish and get feedback and maybe be more structured the next time.

Incentives

  • Political incentives to "do something" about the issue of the moment.  We see this after every high-profile "bad thing" that happens.  There is immense pressure on politicians to do something -- pass some law (often with a person's name in it) or, if the legislative process is perceived as to slow, fire off some executive order.  In the heat of battle these actions are often taken without regard to efficacy, cost, or unintended consequences.  In the heat of these frenzies, a multi-dimensional decision is magically redefined as having only one dimension that matters.  Anyone who focuses on costs or unintended consequences or even efficacy problems of the proposed solution are cast as heartless and uncaring, potentially even evil and nefarious.
  • Politicians always legislate to first-order metrics, never second-order metrics.  Politicians know that the public and the media is looking at their country or state every day and publishing the number of COVID cases and deaths.  No one is publishing the number of additional suicides, or cancer deaths from people too scared to go to the hospital, or increased starvation and disease deaths in poorer countries as food prices rise and aid from rich countries dries up. These second order effects are real but hard to prove or measure.  They are what we call "unintended consequences" but should instead call "ignored but entirely predictable consequences."
  • Political incentives to expand power.  Every politician in every branch of government is always working to expand their own power (this is not unique to government, you can say the same thing of executives and functional departments in many large corporations).  When the public is scared and panicky, politicians are able to break through past limits and norms and establish new precedents.  The best example of this is that governments in Western democracies all expanded their power during the 20th century wars, expansions that largely stuck and were not reversed in peace time (except for a few fortunate examples like locking up whole ethnic groups in internment camps).  When the public is scared, power is to be had and it is the unusual politician that will say in such a situation that the right solution is to do nothing.
  • Political incentives not to admit error.  Politicians simply cannot admit error.  To some extent this is due to the personality and ego traits that the political process sorts for, and to some extent this is based on day to day political incentives.  But think about any President in your lifetime and try to think of even the smallest issue on which they said something like "I tried X, over time X has not worked and now I realize we should do something other than X."  We would actually hope this is the kind of person we have leading the country, but simultaneously our own behaviors don't allow it.  Presidents frequently admit past errors of others (eg, a current President saying the war in Afghanistan was a mistake) but they can never turn against any policy of their own.  So if, say, lockdowns were the response to wave 1 of the virus, lockdowns are damn well going to be the response in successive waves.  Because not doing so is essentially an admission that it was a mistake the first time.
  • If it bleeds, it leads.  This one takes little explanation, because I think most of us understand the strong incentives of news organizations to create and amplify emergencies to increase the attention and viewership they get.  Cable news had a huge spike in viewership after 9/11 and again in the early days of the Gulf War, and they are constantly jonesing for the same sort of hit.  Remember that the media has accurately called 11 of the last 2 pandemics, earlier predicting disaster from swine flu (dating myself here), bird flu, ebola, zika, mad cow, and probably several I can't remember.
  • Reference to personal circumstances when making national trade-offs.  I would say that the number 1 thing that drives me crazy about statists on the Left and Right and which makes me a libertarian is the tendency to impose solutions to tradeoffs on everyone in the country based on how you would personally make decisions for yourself.   If one-size-fits-all public policy decisions are going to be made, I want them to be made in a way that suits me.  For example, a politician in Chicago might say they would never feel comfortable letting thier kids walk to school on their own, so no parent should be allowed to let their kids walk to school alone.  Applying this to COVID, we know there is a large contingent in media, academia, and politics who will say that is is wrong to consider economic damage when evaluating COVID lockdowns.  What do all these folks have in common who tend to be advocating strongest for lockdowns?  They still have their jobs, are still getting paid, can still be productive over the Internet, and are comfortable getting their social interaction over zoom.  Note that these are the same folks that constantly tell us to check our privilege, but then tell us to ignore the economic hardships of lockdowns that they are too privileged to experience.  Only by the most extreme action do the voices of the less privileged who are suffering the most under lock-downs get heard (and even then, like the hair dresser in TX and later in SF, they get mocked by the elite).

Assumptions

  • Trump is so bad that no price is too high to get rid of him.  I have told folks for years that every generation thinks their current era is uniquely politically toxic.  I don't think we have yet risen even to 1968 levels of discord, but one exception is the hatred for Trump that exists in some quarters.  I personally have never seen anything like it.  The nadir was when Trump mentioned that HCQ looked like a promising COVID treatment and the governors of MI and NV immediately banned HCQ without evidence to make Trump look bad (a desire I assume stems from a perception that Tump is so dangerous and represents such an existential threat that any action to undermine him or make his re-election less likely should be pursued).  A prominent study was essentially made up out of whole cloth to prove HCQ was dangerous and thus Trump bad, a conclusion that should have made zero sense to everyone as HCQ is used by millions every day as a malaria prophylactic.   I find Trump distasteful but trust the American system to limit the damage of tyrants, but many are working from a very different assumption.
  • Humans have conquered nature.  I will confess to having an almost Victorian confidence in progress, but even I accept that sometimes nature throws things at us that are a) not our fault and b) we can't yet stop.  But throughout our COVID responses there seems to be, particularly in Western nations, an assumption that we should be able to prevent death from this thing -- ie that any death should be judged as a failure of our response.  But diseases still kill people.  Last year communicable diseases killed at least 15 million people in the world.  And many of our Western deaths have been among the very old in care facilities where the average life expectancy pre-COVID was numbered in months.

Information

  • Good cause skewing of data, or "fake but accurate."  Decades ago, there was a stat that there were a million homeless people in the US.  Everyone repeated it as gospel.  Someone tracked it down, and eventually discovered that it was just made up by a homeless advocate who just picked a round large number.  When this was presented to a well-respected reporter on NPR, that the "fact" she was quoting was no such thing, she just shrugged.  She said homelessness was clearly a problem and if the number she was quoting (as a reporter!) was exaggerated, then it was in the good cause of increasing attention to homelessness.  This was the first example I can remember of something that was considered fake but accurate, but there have been many more since.   During COVID, this has caused outlets like Goggle and Facebook to actually censor opinions the tend to be skeptical of the severity of the disease or efficacy of mitigation steps like lockdowns.  They claim to be doing so for a good cause, believing it is better to err on the side of having the public too cautious rather than insufficiently cautious.
  • Asymmetric public exposure to experts.  Throughout COVID we have been told that the experts all say X, that there is a consensus for X.  And sure enough, we mostly only hear X on the news.  But anyone in academia can tell you that this sort of homogeneity of opinion can't possibly be true.  As in other science, on issues such as mask or lockdown effectiveness or herd immunity thresholds, academics hold a wide range of opinions and there are a wide range of findings in the literature.  But this heterodoxy in opinions never really gets full public view due to media incentives, political incentives, and good cause skewing.  The most extreme voices on the end of the academic scale that support the media's and politicians' desire to create fear are selected for public exposure.  Then, these selected academics are retroactively crafted into leading experts.  Any of you folks every heard of Anthony Fauci before this started?  How about whatever expert your governor is using?  No, you had not -- these are prominent people in their field but just one of ten or twenty equally qualified persons who could have been selected and presented as experts.  They are then retroactively reinvented not as one of ten folks with a wide variety of opinions but as the one leading true unassailable expert.
  • Social media amplification of tail-of-the-distribution events.  One of the features of social media independent of these incentives is that it tends to spread and amplify tail of the distribution events/risks.  The problem is that there seems to be two personality types in people -- one, and I would include myself in this -- who are knee-jerk skeptical of such stories.  Did it really happen?  Did A really cause B?  Is this really anything more than one bizarre outlier?  But there is a second type of person, and I would say that they are WAY more prevalent than I would have believed a year ago, who sees a story that someone's gynecologist's hairdresser's uncle claimed to have had heart issues after getting COVID and suddenly "everyone who gets COVID has permanent heart damage!"  Even before the Internet, Americans were very bad at parsing relative risks and now they just seem terrible at it.

The COVID Rorschach Test and the Split in Thinking That Divides America (the Sweden tribe vs. the Whitmer tribe)

If you want to get right down to the core of the disagreement on responses to COVID, this post by Kevin Drum illustrates it perfectly.  Start with this:

My usual daily look at COVID-19 deaths was posted a few minutes ago, but I thought it might be worthwhile to also give you a quick look at COVID-19 cases. As you can see, they’re going up all over the place. Spain, France, and the Netherlands are skyrocketing. The United States skyrocketed back in July and looks like it’s now turning upward for a third time. The UK is going up, and so was Switzerland until a week ago, when it suddenly slammed the brakes on. Even Germany is rising a bit.

If we weed out exaggerated language like "skyrocketing" and ignore things like testing sensitivity and frequency, this statement is largely true.  The difference is how people interpret it, and the world splits into the Whitmer clan and the Sweden clan.  Drum speaks for the Whitmer tribe:

it sure looks as if even a modest re-opening quickly causes cases to boil over. ... Still, it’s obvious that we shouldn’t let up. The only way to keep cases and deaths down is to rigorously maintain social distancing precautions. If only we could get our president to agree.

For Drum and the Whitmer tribe, evidence that loosening of harsh lockdowns is followed by increasing COVID cases is proof that we should never stop lockdowns, at least until everyone is vaccinated with a vaccine that does not exist, may not exist, and will not exist for most of us until well into next year.

For those of us in the Sweden tribe, we come to exactly the opposite conclusion from the same evidence:  that lockdowns only pointlessly drag out the pandemic and artificially increase its costs, since no matter how long we hide, the disease is still there to infect us when we come out.  As I wrote last week:

All lockdowns do is delay the onset of the disease, not avoid it, and thus add severe economic dislocation, increased poverty, domestic violence, alcoholism, suicide and any number of other negative lockdown effects to the inevitable toll of the disease.  If we are doing anything at all to affect the course of the disease, we are stretching out the misery.

I go on to write that lockdowns make protection of the vulnerable harder.  I have two examples -- my 85+ year old mother-in-law and a bunch of immune compromised kids we support via Care Camps.  In both cases it's easy to keep them locked away for a few months.  But what happens when that stretches to 7 months?  Does my mother-in-law want to spend her all too precious remaining days locked inside?  Are we helping sick kids by essentially imprisoning them alone?

This may sound over-the-top, but I could argue that it is the duty of all of us who are under 60 and in good health to go out and risk exposure to the disease and get our society to herd immunity so the vulnerable can be safe and stop self-incarcerating.  I say this knowing the Mr. Drum may be among the immune compromised and particularly vulnerable.

My Now-Standard COVID Postscript:  I am not a fan of "check your privilege" retorts, but if one accepts that framework for a moment, one might notice just how privileged the exhortation to "Lock down, work from home, and stay in touch with friends over Zoom" really is.  Listen to the folks rooting for lockdowns and you will find that the vast majority

  • have professional jobs that can be done from home
  • continue to get paid even when they don't work at all (e.g. teachers and politicians)
  • have a lot of savings

A large number also tend to ignore the rules they foist on everyone else.

Update:  I am still working on data, but the declaration of second and third waves is often BS.  In most cases, these so-called second waves are the first waves in areas that were not affected earlier.  New York has had one wave.  Arizona has had one wave, just later.  Louisiana has had two waves, but it is a unique case due to the timing of Mardi Gras.