Tag Archives: Covid-19

Sweden’s Pandemic Policy: Arguably Best Practice

14 Monday Nov 2022

Posted by in Health Care, Pandemic

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When Covid-19 began its awful worldwide spread in early 2020, the Swedes made an early decision that ultimately proved to be as protective of human life as anything chosen from the policy menu elsewhere. Sweden decided to focus on approaches for which there was evidence of efficacy in containing respiratory pandemics, not mere assertions by public health authorities (or anyone else) that stringent non-pharmaceutical interventions (NPIs) were necessary or superior.

The Swedish Rationale

The following appeared in an article in Stuff in late April, 2020,

“Professor Johan Giesecke, who first recruited [Sweden’s State epidemiologist Anders] Tegnell during his own time as state epidemiologist, used a rare interview last week to argue that the Swedish people would respond better to more sensible measures. He blasted the sort of lockdowns imposed in Britain and Australia and warned a second wave would be inevitable once the measures are eased. ‘… when you start looking around at the measures being taken by different countries, you find very few of them have a shred of evidence-base,’ he said.

Giesecke, who has served as the first Chief Scientist of the European Centre for Disease Control and has been advising the Swedish Government during the pandemic, told the UnHerd website there was “almost no science” behind border closures and school closures and social distancing and said he looked forward to reviewing the course of the disease in a year’s time.”

Giesecke was of the opinion that there would ultimately be little difference in Covid mortality across countries with different pandemic policies. Therefore, the least disruptive approach was to be preferred. That meant allowing people to go about their business, disseminating information to the public regarding symptoms and hygiene, and attempting to protect the most vulnerable segments of the population. Giesecke said:

“I don’t think you can stop it. It’s spreading. It will roll over Europe no matter what you do.”

He was right. Sweden had a large number of early Covid deaths primarily due to its large elderly population as well as its difficulty in crafting effective health messages for foreign-speaking immigrants residing in crowded enclaves. Nevertheless, two years later, Sweden has posted extremely good results in terms of excess deaths during the pandemic.

Excess Deaths

Excess deaths, or deaths relative to projections based on historical averages, are a better metric than Covid deaths (per million) for cross-country or jurisdictional comparisons. Among other reasons, the latter are subject to significant variations in methods of determining cause of death. Moreover, there was a huge disparity between excess deaths and Covid deaths during the pandemic, and the gap is still growing:

Excess deaths varied widely across countries, as illustrated by the left-hand side of the following chart:

Interestingly, most of the lowest excess death percentages were in Nordic countries, but especially Sweden and Norway. That might be surprising in terms of high Nordic latitudes, which may have created something of a disadvantage in terms of sun exposure and potentially low vitamin D levels. Norway enacted more stringent public policies during the pandemic than Sweden. Globally, however, lockdown measures showed no systematic advantage in terms of excess deaths. Notably, the U.S. did quite poorly in terms of excess deaths at 8X the Swedish rate,

Covid Deaths

The right-hand side of the chart above shows that Sweden experienced a significant number of Covid deaths per million residents. The figure still compares reasonably well internationally, despite the country’s fairly advanced age demographics. Most Covid deaths occurred in the elderly and especially in care settings. Like other places, that is where the bulk of Sweden’s Covid deaths occurred. Note that U.S. Covid deaths per million were more than 50% higher than in Sweden.

NPIs Are Often Deadly

Perhaps a more important reason to emphasize excess deaths over Covid deaths is that public policy itself had disastrous consequences in many countries. In particular, strict NPIs like lockdowns, including school and business closures, can undermine public health in significant ways. That includes the inevitably poor consequences of deferred health care, the more rapid spread of Covid within home environments, the physical and psychological stress from loss of livelihood, and the toll of isolation, including increased use of alcohol and drugs, less exercise, and binge eating. Isolation is particularly hard on the elderly and led to an increase in “deaths of despair” during the pandemic. These were the kinds of maladjustments caused by lockdowns that led to greater excess deaths. Sweden avoided much of that by eschewing stringent NPIs, and Iceland is sometimes cited as a similar case.

Oxford Stringency Index

I should note here, and this is a digression, that the most commonly used summary measure of policy “stringency” is not especially trustworthy. That measure is an index produced by Oxford University that is available on the Our World In Data web site. Joakim Book documented troubling issues with this index in late 2020, after changes in the index’s weightings dramatically altered its levels for Nordic countries. As Book said at that time:

“Until sometime recently, Sweden, which most media coverage couldn’t get enough of reporting, was the least stringent of all the Nordics. Life was freer, pandemic restrictions were less invasive, and policy responses less strong; this aligned with Nordic people’s experience on the ground.”

Again, Sweden relied on voluntary action to limit the spread of the virus, including encouragement of hygiene, social distancing, and avoiding public transportation when possible. Book was careful to note that “Sweden did not ‘do nothing’”, but it’s policies were less stringent than its Nordic neighbors in several ways. While Sweden had the same restrictions on arrivals from outside the European Economic Area as the rest of the EU, it did not impose quarantines, testing requirements, or other restrictions on travelers or on internal movements. Sweden’s school closures were short-lived, and its masking policies were liberal. The late-2020 changes in the Oxford Stringency Index, Book said, simply did not “pass the most rudimentary sniff test”.

Economic Stability

Sweden’s economy performed relatively well during the pandemic. The growth path of real GDP was smoother than most countries that succumbed to the excessive precautions of lockdowns. However, Norway’s economy appears to have been the most stable of those shown on the chart, at least in terms of real output, though it did suffer a spike in unemployment.

The Bottom Line

The big lesson is that Sweden’s “light touch” during the pandemic proved to be at least as effective, if not more so, than comparatively stringent policies imposed elsewhere. Covid deaths were sure to occur, but widespread non-Covid excess deaths were unanticipated by many countries practicing stringent intervention. That lack of foresight is best understood as a consequence of blind panic among public health “experts” and other policymakers, who too often are rewarded for misguided demonstrations that they have “done something”. Those actions failed to stop the spread in any systematic sense, but they managed to do great damage to other aspects of public health. Furthermore, they undermined economic well being and the cause of freedom. Johan Giesecke was right to be skeptical of those claiming they could contain the virus through NPIs, though he never anticipated the full extent to which aggressive interventions would prove deadly.

Collectivism Is Not the “Natural” State

03 Tuesday May 2022

Posted by in Collectivism, Property Rights

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There is a great myth that primitive man was some sort of “noble savage”, perfectly attuned to the natural environment and disposed to an egalitarian principle. All that, of course, is balderdash. A related myth is that primitive societies were essentially collectivist and that private property was largely an unrecognized institution. This is something I’ve heard too often from individuals wishing to characterize leftist ideals as natural and wholesome. So I welcomed a recent piece in Aeon called “Primitive Communism”, by Manvir Singh, which reviews evidence on a number of hunter-gatherer societies and cites several scholars on the subject of ownership and the distribution of goods among those peoples. A preponderance of the evidence suggests that private property and private rewards were (and are) quite common in primitive societies, and those practices predated agriculture.

The assertion that the advent of private property and trade was somehow unnatural for mankind, or even unjust, might owe its widespread acceptance to Friedrich Engels’ “The Origin of the Family, Private Property and the State”. Singh summarizes one of the book’s primary arguments thusly:

“Once upon a time, private property was unknown. Food went to those in need. Everyone was cared for. Then agriculture arose and, with it, ownership over land, labour and wild resources. The organic community splintered under the weight of competition.”

While there were a few primitive societies in which economic output was shared, it is not clear whether any central authority was relied upon for determining the distribution of output. Instead, in those cases, sharing seems to have been a matter of social convention. Singh posits that interdependence played a major role in motivating output sharing, but mechanisms for dealing with interdependence differed in societies with stronger property rights, including voluntary sharing, which was often but not always based on reciprocity. Volunteerism still has a strong role in modern, developed economies, but for better or worse, social insurance is increasingly viewed as a function of the state, with its monopoly on legal coercion.

And how “natural” is social insurance? Not very in a world of extreme scarcity. One of the more interesting passages in Singh’s article has to do with the brutality of subsistence-level societies. The weak were often abandoned or killed, which Singh discusses in the context of the collectivist Aché people of Paraguay. This “culling” applied variously to orphans, the disabled, the unsightly, and the aged. It’s unclear whether these decisions were collective or left up to individual families. Noble savages indeed!

It’s astonishing how often Engels’ faulty premise is accepted as historical fact. The argument, however, often serves as a subtext for collectivist rationales in the modern era. As Singh says:

“For anyone hoping to critique existing institutions, primitive communism conveniently casts modern society as a perversion of a more prosocial human nature.”

I’m not sure whether it’s possible to marshall evidence that primitive societies with strong property rights were more successful than their collectivist counterparts. That would be a good topic of further research, but it would be tough to control for the difficulties posed by varying natural conditions faced by these societies.

On the other hand, suppose we stipulate that property rights developed as a consequence of, or in tandem with, organized production, as Engels would have had it. We’d have to categorize that development as a kind of technological breakthrough in its own right. By aligning incentives with production, property rights were critical to the phenomenal growth in prosperity the world has enjoyed over the past several centuries. Nevertheless, the evidence on primitive societies suggests that the alignment came more “naturally”.

It’s about time to put the fiction of “primitive communism” to rest. Private property was sensible for the denizens of most primitive societies. Even the most collectivist of the those societies made certain concessions to that reality. These facts comport with a view of property ownership as a natural right.

Excess Deaths and Avoidable Deaths

07 Monday Mar 2022

Posted by in Public Health

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Understanding the severity of the coronavirus pandemic is more straightforward when measured in terms of excess deaths, rather than total Covid deaths. We’ve had a large number of excess deaths in the U.S., but not all of them can be attributed to Covid. It’s also worth asking whether some of the deaths were avoidable, because that reflects even more profoundly on the success or failure of public policy and the health care system in dealing with the challenge. Unfortunately, while the precise number of avoidable deaths the nation has suffered is speculative, it is nevertheless significant.

Bad Metrics

A huge problem with using total Covid deaths as a measure of pandemic severity is that no one is confident in the accuracy of official statistics. There are reasons to suspect over-counting in the U.S. due to financial incentives created for hospital systems by the CARES Act. These were exacerbated by the CDC’s absurd 2020 recommendations for the completion of death certificates. Essentially, any non-primary Covid entry on a death certificate was sufficient to count the death as from Covid. No other disease is or has ever been tallied like that.

There is an important distinction between deaths “with Covid” and deaths “from Covid” that has been acknowledged only recently by health authorities. A death “with Covid” can occur when a patient tests positive for Covid after being admitted to a hospital for another primary ailment. Thus, deaths from other causes like heart failure have been improperly coded as Covid deaths under the CDC’s guidelines. Even tragedies like auto fatalities have been coded as Covid deaths.

At the same time, some public health “elites” insist that many Covid deaths in the community have gone unreported. That might have been true in the early weeks of the pandemic. However, post-mortem testing by medical examiners began to spread by April 2020, though there was a shortage of tests, and the CDC issued guidelines to encourage it late in the year.

Counting excess deaths from all causes avoids these controversies, including differences across countries in the way they record Covid deaths. It’s also possible to break down excess death into broad categories of causes, though the task is complex.

How Many?

First some simple accounting. Let’s define all-cause mortality during a period (Mort) as Covid deaths (C) plus plus all other mortality (M), or Mort = C + M. Expected mortality in the absence of a pandemic would be Exp(Mort) = Exp(M). Usually this expected value is taken as an average of deaths over several previous years. Therefore, excess mortality during the pandemic is:

EM = C + M – Exp(M)

How many excess deaths have we actually seen during the pandemic? According to Our World In Data, the figure was 950,000 as of Jan 9th. USMortality.com puts the excess at about 965,000 through the end of 2021. So these two sources are in close agreement, which says a lot given the usual difficulty of getting pandemic numbers to tie-out across sources

Through 2021, cumulative Covid deaths (by date of death) were almost 850,000. That’s less than excess deaths, so it’s obvious that other factors have contributed to the excess. Interestingly, 2021 was worse for excess deaths than 2020 for all age groups except 85+. Some have suggested the most vulnerable in this highly vulnerable age group had already succumbed to Covid in 2020, but there may have been other reasons for the difference.

Non-Covid Excesses

As noted above, some of the Covid deaths were misattributions. If we understand C to include only deaths “from Covid”, then we must acknowledge that M includes deaths from other causes but “with Covid”, as well as all deaths without Covid diagnoses. For example, because of the confounded way in which Covid deaths have been counted, a death from heart disease could end up in the official count of C, but it should be included in M instead.

The figures above imply 100,000+ excess deaths during the pandemic not associated with Covid diagnoses. If we add to those the “with Covid”, incidental total, then perhaps 300,000 – 400,000 excess deaths during the pandemic were from non-Covid primary causes!

Lockdown effects are a prime suspect in these non-Covid deaths. For example, if health care was deferred because hospitals cancelled or delayed elective procedures, or because patients feared the hospital environment, that would certainly manifest in premature deaths. Deaths of despair or neglect were also in excess, as one should expect when populations are subjected to prolonged periods of isolation.

These kinds of deaths are so-called “lockdown” deaths because they could have been avoided without such stringent policy measures and the propagation of fear by public health authorities. Those who might protest this nomenclature should note that lockdowns have been unsuccessful in mitigating the pandemic (and see here). After all, in terms of excess deaths, the Swiss approach was quite successful!

Avoidable Deaths

Many of the excess pandemic deaths were avoidable. Prolonged lockdown policies were driven by politics rather than sound public health reasoning. However, within the Covid death totals there is another category of avoidable deaths, and it is every bit as controversial. This post from The Ethical Skeptic (TES) goes into great detail on the matter. He takes a strong position, and some of his assertions and his accounting are subject to challenge. I sometimes find that TES’s posts contain ambiguities, and the graphical evidence he presents is often poorly labeled. Still, he has proven correct on other controversial issues, such as the ancestry and surprisingly early “vintage” of the Omicron variant.

Most of the “avoidable” Covid deaths (again, as distinct from the non-Covid lockdown deaths) occurred well after the primary symptoms of the infection (fever, cough, and cytokine storm) had passed. In the end, the real killers were follow-on problems induced by Covid, primarily related to blood clotting and compromised vascular integrity from endothelial dysfunction. These deadly complications were known very early in the pandemic. The following schematic from TES shows a Covid “death timeline”. The figures listed under the schematic show the large share of clotting and vascular problems involved in these deaths.

Over the past two years, not all of these patients were placed on anticoagulants or blood thinners early in the course of their infections. Indeed, many of them were told to “go home and sleep it off”. This is what happened to TES as well as a number of commenters on his Twitter account. I know several individuals who received the same advice from medical professionals. Even among the hospitalized, many were not placed on these drugs in a timely fashion, or until it was too late. TES adds the wrinkle that his physician indicated he should have been vaccinated! Short of that, tough luck, said the healer.

TES blames this medical “malfeasance” on the CDC’s Emergency Use Authorizations (EUA) for the Covid vaccines. In fact, he calls these deaths “EUA Shadow Deaths”, citing legal requirements associated with EUAs that would appear to prohibit alternatives such as therapies and even tests or studies of alternatives. That contention seems questionable given the CDC’s issuance of other EUAs for certain treatments, and there was no shortage of published experiments conducted during 2020-21.

The vaccine EUAs were not issued until late 2020, but TES claims that forces leading up to those EUAs were responsible for the failure to put patients on anticoagulants/blood thinners even earlier in 2020. The schematic says more than half of Covid deaths through the end of 2021 involved blood coagulation issues, and I have no reason to doubt those figures, which TES sources from the CDC. But He uses a value of 50% of Covid deaths to estimate that 421,000 Covid deaths were avoidable.

I’m not sure about that total, or rather, the use of the term “avoidable” in all those cases. I am sure, however, that we’ve seen a remarkable under-emphasis on therapeutics (and see here and here) relative to the emphasis on vaccines. The news media contributed to the dysfunction by condemning certain promising therapies for political reasons.

I’m also sure that there have been a meaningful number of patients who should have received anticoagulants/thinning agents but did not. Why did they not? Plausibly, the restrictions imposed by the vaccine EUAs made a difference, but clearly the medical community was not tuned into what should have been an obvious treatment regimen.

How many Covid deaths were truly avoidable? TES’s estimate of 421,000 seems too high if only because we can’t expect the dissemination of information through the medical community to be perfect. Moreover, some of these patients were undoubtedly on blood thinners already, or there might have been contraindications preventing the use of anticoagulants/thinners.

Nevertheless, a substantial number of deaths could have been avoided by more timely use of therapeutics and less stringent lockdown measures. Here is a chart from a tweet by TES showing another accounting for excess deaths:

Here, TES uses a slightly longer time frame, through about February 5, 2022, so the “EUA Shadow Death” total is somewhat larger, about 437,000, than shown in the earlier schematic. He attributes about 800,000 excess deaths, or 77%, to Covid, most of which he believes were avoidable deaths.

Lockdown deaths account for some of the additional 236,000 excess deaths reported in the chart, and probably a large share of the roughly 90,000 non-natural deaths labeled #3 (SAAAAD = “Suicide Addiction Abandonment Abuse Accident & Despair”; the two other categories in #3 relate to non-Covid illnesses acquired in-hospital or adverse reactions to medications). The Unknown/Abnormal category may include some lockdown deaths, but more on that category below.

If TES is correct about shadow deaths, the “avoidable” pandemic death total might account for well over half of all excess deaths. I suspect it might account for half, but even if less, it’s clear that avoidable deaths have been a huge part of the pandemic’s toll.

Vaccine Adverse Events

There’s been much speculation about the large number of Unknown/Abnormal deaths that have been coded during the pandemic: more than 65,000 in the chart above. One caveat is that an “unknown” cause of death usually means the cause is ambiguous: there might have been several factors contributing to the death such that the medical examiner was unable to assign a definitive cause. That status can be temporary as well. Still, the surge is noteworthy.

Unfortunately, there were an unusual number of excess deaths in younger age brackets in 2021, especially in the second half of the year after vaccinations had reached a fairly large share of the population. The pace of those deaths hasn’t yet abated in 2022. The next chart, from USMortality.com, shows excess mortality in the 25 – 44 age bracket in 2020 – early 2022.

Many of these prime age deaths could be a continuing hangover from deferred medical care and depression. There are claims, however, that the vaccines themselves killed a significant number of individuals. The upsurge in excess deaths suggests to some that the vaccines have had a much greater number of “adverse events” than we’ve seen reported by the CDC and the news media.

Here is how TES presents the data on excess deaths and vaccinations. The chart title is his somewhat confusing attempt to summarize the meaning of the lines plotted. The left axis measures the pace of vaccinations by week and the right access measures weekly excess non-Covid natural-cause deaths.

I have no doubt as to the efficacy of the vaccines against serious Covid outcomes in high-risk groups, though vaccine efficacy has been drastically overstated by the Biden Administration. The balance of risks for older individuals is clearly in favor of vaccination. Still, I’ve long felt that vaccination is less compelling for people in younger age brackets, and it’s possibly a bad idea. That’s both because Covid is a much smaller risk to them and because of possible vaccine risks, such as myocarditis.

To the extent that natural-cause, non-Covid excess deaths among younger age cohorts have been driven by unnecessary vaccinations, those deaths were avoidable. I’m not convinced of the significance, and it’s clear that among hospitalized Covid patients, outcomes have been better among the vaccinated. The following chart is from the link in the previous paragraph:

That sort of pattern might mean more deaths among the unvaccinated could have been avoided, on balance, had they opted for the jab. In almost all things, however, I believe we should eschew blanket mandates and instead offer protection to those seeking it in the high-risk population.

Conclusion

As many as 30% of Covid deaths to date are likely misattributions in which Covid was not really the primary cause of death. Nevertheless, excess Covid deaths “from Covid” as the primary cause are probably approaching 700,000 today.

The pandemic was certainly bad enough without a slew of bad calls by the public health and medical establishments. Of the 950,000+ excess deaths that occurred through the end of 2021, over 100,000 were not attributed to Covid. If we include deaths mis-attributed to Covid, the non-Covid total is likely in excess of 300,000 and could be as high as 400,000. It’s time to acknowledge that lockdowns and fear-mongering led to a large number of those deaths, and most of those deaths were avoidable. However, while I am skeptical, the number of deadly adverse effects from vaccines in the prime age population is an open question.

Another class of avoidable deaths was a product of the underemphasis on Covid therapies by the medical establishment. There were many cases of promising, repurposed drugs that were shouted down after so-called experts insisted that their use must be withheld until adequate randomized control trials (RCTs) had confirmed their efficacy. Not only did this ignore the long history of clinical evidence as a guide to medical practice. It also ignored the frequent real-world inadequacies that plague RCTs.

At the same time, obvious complications of the vascular system, primarily blood clotting, were not treated in a timely way or as a precautionary treatment’s, at least prior to hospitalization. Adding a conservative allowance for these deaths to the other avoidable deaths probably means that at least half of the excess deaths during the pandemic were avoidable. As of March 2022, that’s over half a million deaths! We can chalk it up to mismanagement and miscommunication by the public health establishment with a dash of ignorance, and perhaps some malfeasance, by health care practitioners. The death of expertise, indeed!

Chill-Out Advisory: Pandemic to Endemic Means Live Again

13 Sunday Feb 2022

Posted by in Pandemic, Public Health, Uncategorized

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We might be just be done with the coronavirus pandemic. That is, it appears to be transitioning to a more permanent endemic phase. What follows are a few details about the Omicron wave and its current status, an attempt to put the risks of Covid in perspective, and a few public policy lessons that are now gaining broad currency but should have been obvious long ago.

What’s The Status?

The Omicron variant became the dominant U.S. strain of the coronavirus in December. Omicron outcompeted Delta, which was very good news because Omicron is far less severe. The chart below (from the CDC Data Tracker site) shows Omicron’s rapid ascendance and displacement of the Delta variant. The orange bar segments represent the proportion of cases of the Delta strain, while the purple and pink segments are Omicron sub-variants known as BA.1 and BA.2, respectively. BA.2 is even more transmissible than BA.1 and is likely to become dominant over the next month or so. However, the BA.2 sub-variant appears to be far less virulent than Delta, like BA.1.

Despite a record number of infections over a period of a month or so, the Omicron wave is tapering just as rapidly as it ramped up, as the next chart demonstrates. In fact, covidestim.org shows that cases are now receding in all states, DC, and Puerto Rico. Here are new cases per million people from Our World in Data:

Whether BA.2 causes cases to plateau for a while, or even a secondary Omicron “wavelet”, is yet to be seen. That would be consistent with the normal Hope-Simpson seasonal pattern of viral prevalence in the northern hemisphere (hat tip: HOLD2):

Data problems make the Omicron wave difficult to assess, however. We don’t know the share of incidental infections for the U.S. as a whole, but more than half of hospitalized Covid patients in Massachusetts and Rhode Island are classified with incidental infections. The proportion in the UK is estimated to be rising and approaching 30% of total cases, with much higher percentages in many regions of England, as shown below.

As I’ve emphasized in the past, case numbers should not be the primary gauge of the state of the pandemic, especially with a more highly contagious but relatively mild variant like Omicron. Hospitalizations are a better measure, but only if “incidental” infections are removed from the counts. That’s been acknowledged only recently by the public health establishment, and even the Biden Administration is emphasizing it as a matter of sheer political expediency. Another measure that might be more reliable for assessing the pandemic in the community as a whole is the number of emergency room patients presenting Covid-like symptoms. From the CDC Data Tracker:

There is no doubt that incidental infections create complications in caring for patients with other ailments. That has a bearing on the utilization of hospital capacity. Generally, however, strains on hospital capacity during the pandemic have been greatly exaggerated. This is not to diminish the hard work and risks faced by health care workers, and there have been spot shortages of capacity in certain localities. However, in general, staffed beds have been more than adequate to meet needs. This chart, like a few others below, is courtesy of Phil Kerpen:

With the more highly transmissible variants we have now, it’s not at all surprising to see a high proportion of incidental cases among inpatients. Incidental infections are likely to inflate counts of Covid deaths as well, given the exceptional and odd way in which Covid deaths are being recorded. It will be some time until we see full U.S. data on cases and deaths net of incidental infections. Moreover, many of the Covid deaths in December and January were from lingering Delta infections, which might still be a factor in the February counts.

How Are Your Odds?

The mild or asymptomatic nature of most Omicron cases, the large proportion of incidental hospitalizations, and the knowledge that Omicron is not a deep respiratory threat should offer strong reassurance to healthy individuals that the variant does not pose a great risk. According to a recent CDC report, in a sample of almost 700,000 vaccinated individuals aged 65 or less without co-morbidities, there were no Covid fatalities or ICU admissions during the 10 months from December 2020 through October 2021. There was only one fatality in the sample of healthy individuals older than 65. There were just 36 fatalities across the full sample of over 1.2 million vaccinated individuals, so COVID’s fatality risk was only about 0.3%. Of those deaths, 28 were among those with four or more risk factors (including co-morbidities and > 65 years). And this was before the advent of Omicron!

I have a few doubts about the CDC’s sample selection and vagaries around certain definitions used. Nevertheless, the results are striking. However, the study did not address risks to unvaccinated adults. Another more limited CDC study found that vaccinated patients were still less likely than the unvaccinated to require critical care during the Omicron wave.

A separate CDC study found a 91% reduction in the likelihood of death for Omicron relative to Delta. A study from the UK (see summary here) found that Omicron cases were 59% less likely than Delta cases to require hospitalization and 69% less likely to result in death within 28 days of a positive test. Omicron was far less deadly among both the vaccinated and the unvaccinated, and the latter had a larger reduction in the likelihood of death. The study was stratified by age as well, with less severe outcomes for Omicron among older cohorts except in the case of death, for which there was no apparent age gradient.

Another unnecessarily contentious issue has been the risk to children during the pandemic. Based on the data, there should never have been much doubt that these risks are quite low. Apparently, however, it was advantageous for teachers’ unions to insist otherwise. Phil Kerpen soundly debunks that claim with the following chart:

Covid has been less deadly to children from infancy through 17 years than the pre-pandemic flu going back to 2012! Oh yes, but teachers FEAR transmission from the children! That claim is just as silly, since children are known to be inefficient transmitters of the virus (and see here).

Now that Omicron has relegated the Delta variant to the history books, the risks going forward seem much more manageable. Omicron is less severe, especially for the vaccinated. Levels of acquired (natural) immunity from earlier infections are now much higher against older strains, and Omicron infections seem to be protective against Delta.

In commentary about the first CDC study discussed above, John Tierney lends perspective to the odds of death from pre-Omicron Covid:

“Those are roughly the same odds that in the course of a year you will die in a fire, or that you’ll perish by falling down stairs. Going anywhere near automobiles is a bigger risk: you’re three times more likely during a given year to be killed while riding in a car, and also three times more likely to be a pedestrian casualty. The 150,000-to-1 odds of a Covid death are even longer than the odds over your lifetime of dying in an earthquake or being killed by lightning.”

Yet with all this research confirming the low odds of death induced by Omicron, why have we seen recent deaths at levels approaching previous waves? First, many of those deaths are carried over from Delta infections. That means deaths should begin to taper rapidly as February reports roll in. And remember that daily reports do not show deaths by date of death. Deaths usually occur weeks or even months before they are reported. That also means some of the deaths reported might be “harvested” from much earlier fatalities. Second, given the high levels of incidental Omicron infections, some of those deaths are misattributed to Covid, an issue that is not new by any means. Finally, while Omicron is relatively mild for most people, the high rate of transmission means that a high number of especially vulnerable individuals may be infected with severe outcomes. We have seen much more severe consequences for the unvaccinated, of course, and for those with co-morbidities.

Things We Should Have Known

I’ll try to keep this last section brief, but as an introduction I’ll just say that it’s almost as if we’ve been allowing the lunatics to run the asylum. To paraphrase one comment I saw recently, if you wonder why there is so much dissent, you ought to consider the fact the much of what our governments have done (along with many private organizations) was to prohibit things that were demonstrably safe (e.g., going outside, using swing sets, or attending schools) and to encourage things that were demonstrably harmful (e.g., deferring medical care, or masking small children).

The following facts are only now coming into focus among those who’ve been “following the politics” rather than “the science”, despite pretensions to the latter.

Grow Up and Chill Out!

Life is full of risks, and nothing has changed to alter wisdom gained in earlier pandemics. For example, this pearl from a 2006 publication on disease mitigation measures should be heeded (hat tip: Phil Kerpen):

If there is one simple message everyone needs to hear, it is to stop allowing the virus bogeyman to rule your life. It will never go away completely, and it is likely to present risks that is are comparable to the flu going forward. In fact, it might well compete with the flu, which means we won’t be dealing with endemic Covid plus historical flu averages, but some smaller union of the two case loads.

So get out, go back to work, or go have some fun! Get back truckin’ on!

Vagaries of Vaccine Efficacy

23 Sunday Jan 2022

Posted by in Coronavirus, Vaccinations

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There should never have been any doubt that vaccines would not stop you from “catching” the coronavirus. Vaccines cannot stop virus particles from lodging in your nose or your eyeballs. The vaccines act to prime the immune system against the virus, but no immune response is instantaneous. In other words, if you aren’t first “infected”, antibodies don’t do anything! A virus may replicate for at least a brief time, and it is therefore possible for a vaccinated individual to carry the virus and even pass it along to others. The Omicron variant has proven that beyond a shadow of a doubt, though the wave appears to be peaking in most of the U.S. and has peaked already in a few states, mostly in the northeast.

I grant that the confusion over “catching” the virus stems from an imprecision in our way of speaking about contracting “bugs”. Usually we don’t say we “caught” one unless it actually makes us feel a bit off. We come into intimate contact with many more bugs than that. The effects are often so mild that we either don’t notice or brush it off without mention. But when it comes to pathogens like Covid and discussions of vaccine efficacy (VE), it’s obviously useful to remember the distinction between infections, on the one hand, and symptomatic infections on the other.

Cases Are the Wrong Focus

Unless calibrated by seroprevalence data, these studies are not based on proper estimates of infections in the population. Asymptomatic people are much less likely to get tested, and vaccinated individuals who are infected are either much more likely to be asymptomatic or the test might not detect the weak presence of a virus at all. VE based on detected infections is essentially meaningless unless testing is universal.

We are bombarded by studies (and analyses like the one here) alleging that VE should be judged on the reduction in infections among the vaccinated. The likelihood of a detected infection by vaccination status is simply the wrong way to measure of VE. It’s not so much the direction of bias in measured VE, however. The mere presence of cases among the vaccinated has been sufficient to inflame anti-vax sentiment, especially cases detected in mandatory tests at hospitals, where the infections are often incidental to the primary cause of admission.

The typical evolution of a novel virus is further reason to dismiss case numbers as a basis for measuring VE. Mutations create new variants in ways that usually promote the continuing survival of the lineage. Subsequent variants tend to be more transmissible and less deadly to their hosts. Thus, given a certain “true” degree of VE, so-called breakthrough infections among the vaccinated are even more likely to be asymptomatic and less likely to be tested and/or detected.

There is the matter of immune escape or evasion, however, which means that sometimes a virus mutates in ways that get around natural or vaccine-induced immune responses. While such a variant is likely to be less dangerous to unvaccinated hosts, more cases among the vaccinated will turn up. That should not be interpreted as a deterioration in VE, however, because detected infections are still the wrong measure. Instead, the fundamental meaning of VE is a lower virulence or severity of a variant in vaccinated individuals than in unvaccinated individuals.

Interestingly, to digress briefly, while immune escape has been discussed in connection with Omicron, that variant’s viral ancestors may have predated even the original Covid strain released from the Wuhan lab! It is a fascinating mystery.

Virulence

In fact, vaccines have reduced the virulence of Covid infections, and the evidence is overwhelming. See here for a CDC report. The chart below is Swiss data, followed by a “handy” report from Wisconsin:

From the standpoint of virulence, there are other kinds of misguided comparisons to watch out for: these involve vaxed and unvaxed patients with specific outcomes, like the left side of the graphic at the top of this post (credit to Twitter poster aparachick). This thread has an excellent discussion of the misconception inherent in the claim that vaccines haven’t reduced severity: the focus is on the wrong conditional probability (again, like the left side of the graphic). Getting that wrong can lead to highly inaccurate conclusions when the sizes of the two key groups, hospitalizations and vaccinated individuals in this case, are greatly different.

Bumbled Messaging

The misunderstandings about VE are just one of many terrible failures of public health authorities over the course of the pandemic. There seems to have been fundamental miscommunication by the vaccine manufacturers and many others in the epidemiological community about what vaccines can and cannot do.

Another example is the apparent effort to downplay the importance of natural immunity, which is far more protective than vaccines. This looks suspiciously like a willful effort to push the narrative that universal vaccination as the only valid course for ending the pandemic. Even worse, the omission was helpful to those attempting to justify the tyranny of vaccine mandates.

Waning Efficacy

It should be noted that the efficacy of vaccines will wane over time. This phenomenon has been measured by the presence of antibodies, which is a valid measure of one aspect of VE over time. However, immune responses are more deeply embedded in the human body: so-called T-cells carry messages alerting so-called B-cells to the presence of viral “invaders”. The B-cells then produce new antibodies specific to characteristics of the interloping pathogen. Thus, these cells can function as a kind of “memory” allowing the immune system to mount a fresh antibody defense to a repeat or similar infection. The reports on waning antibodies primarily in vaccinated but uninfected individuals do not and cannot account for this deeper process.

Conclusion

Vaccines don’t necessarily reduce the likelihood of infection or even the spread of the virus, but they absolutely limit virulence. That’s why Jay Bhattacharya, one of the authors of The Great Barrington Declaration, says the vaccines provide a private benefit, but only a limited public benefit. Yet too often we see VE measured by the number of infections detected, and vaccine mandates are still motivated in part by the idea that vaccines offer protection to others. They might do that only to the extent that infections are less severe and clear-up more quickly.

Three Justices Reveal Astonishing Covid Ignorance

10 Monday Jan 2022

Posted by in Coronavirus, Supreme Court, Vaccinations

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Good God! What a remarkable display of ignorance we witnessed on Friday from three different Supreme Court justices. This trio dumped buckets-full of erroneous information about the current state of the COVID pandemic, all points that are easily falsifiable. The three are Sonia Satamayor, Stephen Breyer, and Elena Kagan. The flub-fest occurred during a proceeding on challenges to OSHA’s attempt to impose a nationwide vaccine mandate on private employers having more than 100 employees. I’m sorely tempted to say these jurists must know better, but perhaps they were simply parroting what they’ve heard from “reliable” media sources.

Here’s a list of the false assertions made by the three justices at the hearing, as compiled by Michael P. Sanger, along with my own brief comments:

  • 100,000 children in critical care and on ventilators (Sotomayor) — Not even close!
  • Vaccine mandate would prevent 100% of US cases (Breyer) — Lol!
  • 750 million people tested positive last Thursday (Breyer) — That’s more than twice the U.S. population… in one day! Haha! See here.
  • COVID deaths are at an all-time high (Sotomayor) — No, they are well under half of the all-time high, and many of those “announced” deaths are Delta deaths and deaths that occurred weeks to months ago.
  • It’s “beyond settled” that vaccines and masks are the best way to stop the spread (Kagan) — Say what?
  • COVID vaccines stop transmission (Kagan) — Is that why two fully vaccinated attorneys arguing the government’s case just tested positive?
  • Federal agencies can mandate vaccines using the police powers of the federal government (Sotomayor) — Incorrect, not at their fancy. Police powers with respect to health, safety and morals are generally reserved to the states by the Tenth Amendment. The Commerce Clause allows Congress to regulate these powers through federal agencies on “major questions”. Congress, however, has never acted on the question of vaccine mandates.
  • Hospitals are nearing capacity (Sotomayor) — Again, no! And see here.
  • Omicron is deadlier than Delta (Sotomayor) — Omicron may be more severe than the common cold in some cases, but all indications are that it has much lower severity than the Delta variant.
  • Hospitals are full of unvaccinated people (Breyer) — No, on two counts: 1) hospitals are not full, and 2) there are COVID hospitalizations among the vaccinated as well. Also see here.

I’ve covered most of these points on this blog at various times in the past, a few links to which are provided in the bullets above. As one wag said, it’s almost as if these justices read nothing but the New York Times, the paper that once assured the world that Joseph Stalin was actually a pretty decent fellow. With tongue firmly in cheek, Ed Morrissey asked whether Twitter would suspend Justice Sotomayor for spreading COVID misinformation.

There also followed a desperate attempt by left-wing journalists to convince themselves and their followers that Justice Neil Gorsuch had incorrectly claimed hundreds of thousands of people die from the flu every year. The actual Gorsuch quote in the transcript reads:

“Flu kills—I believe—hundreds, thousands of people every year.”

And that indeed is what can be heard clearly on the audio (short clip here). But in the fertile imaginations of the lefty commentariat, Gorsuch uttered an extra “of”. Gorsuch was clearly correcting himself mid-sentence. As noted by Phil Kerpen, the line of questioning had to do with the establishment of a limiting principle under which OSHA could conceivably have authority to impose a vaccine mandate. Naturally, Gorsuch intended to quote a number smaller than the count of COVID deaths.

Most of the justices appeared to lean against the OSHA mandate. We’ll probably get a ruling this week. However, the episode vividly illustrates the power of the leftist mainstream media and social media to manipulate beliefs, even beliefs held by individuals of formidable intellect. It also shows how fiercely people cling to falsehoods supporting their ideological mood affiliations.

Reformed Covid Reporting Might Quell the Omicron Panic

31 Friday Dec 2021

Posted by in Coronavirus, Data Integrity

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That’s our Commander and Chief this week, posing in a mask on the beach in what is a phenomenal display of stupidity. More importantly, that kind of messaging contributes to the wholly unwarranted panic surrounding the Omicron variant of Covid-19. Panic, you say? Take a look at this admission from a New York health official. She says a recent alert on pediatric hospitalizations was driven by a desire to “motivate” parents to vaccinate their children. Yet Covid has never posed a significant risk to children. And take a look at what this insane physician posted. It’s fair to say he’s “catastrophizing”, an all too common psychological coping mechanism for alarmists.

The Omicrommon Cold

Given Omicron’s low apparent severity, it might be the variant that allows a return to normalcy. It’s perhaps the forefront of a more benign but endemic Covid, as it seems to be out-competing and displacing the far more dangerous Delta variant. In fact, Omicron infections are protective against Delta, probably for much longer than vaccines. The mild severity we’ve seen thus far is due in part to protection from vaccines and acquired immunity against breakthrough infections, but there’s more: there are plenty of non-breakthrough cases of Omicron, and most hospitalizations are among the unvaccinated. Yet we see this drastic decline in Florida’s ratio of ICU to hospital admissions (as well as a reduction in length of stay — not shown on chart). Similar patterns appear elsewhere. Omicron’s more rapid onset and course make it less likely that these patterns are caused by lags in the data.

Panic Begets Lockdowns

The frantic Omicron lunacy is driven partly by data on the number of new cases, which can be highly misleading as a guide to the real state of affairs. Testing is obviously necessary for diagnosis, but case totals as an emphasis of reporting have a way of feeding back to panic and destructive public policy: every wave brings surges in cases and the positivity rate prompting authoritarian measures with dubious benefits and significant harms (see here and here).

Flawed Case Data

In many respects, the data on Covid case totals have been flawed from the beginning, owing largely to regulators. At the outset in early 2020, there was a severe shortage in testing capacity due to the CDC’s delays in approving tests, as well as restrictions on testing by private labs. Many cases went undiagnosed, including a great many asymptomatic cases. The undercount of cases inflated the early case fatality rate (CFR). Subsequently, the FDA dithered in its reviews of low-cost, rapid, at-home tests. The latest revelation was the Administration’s decision in October to nix a large rollout of at-home tests. While the results of those tests are often unreported, they would have been helpful to individual decisions about seeking care and quarantining.

The PCR test finally distributed in March 2020 was often too sensitive, which the CDC has finally acknowledged, This is a flaw I’ve noted several times in the past. It led to false positives. Hospitals began testing all admitted patients, which was practical, and the hospitals were happy to do so given the financial rewards attendant to treating Covid patients under the CARES Act. However, it resulted in the counting of “incidental” Covid-positives: patients admitted with Covid, but not for Covid. That inflates apparent severity gleaned through measures like hospitalized cases, and it can distort counts of Covid fatalities and the CFR.

On balance, the bias caused by the test shortage at the start of the pandemic likely constrained total case counts, but the subsequent impact of testing practices is uncertain except for incidental hospitalized cases and the impact on counts of deaths.

Omicron Enlightenment

Omicron spreads rapidly, so the clamoring for tests by panicked consumers has resulted in another testing shortage, both for PCR tests and at-home tests at pharmacies. The shortage might not be relieved until the Omicron wave has crested, which could occur within a matter of a few weeks if the experience of South Africa and London are guides. In the meantime, another deleterious effect of the “case panic” is the crush of nervous individuals at emergency rooms presenting with relatively minor symptoms. Now more than ever, many of the cases identified at hospitals are incidental, particularly pediatric cases.

A thread by Monica Gandhi, and her recent article in the New York Times, makes the case that hospitalizations should be the primary focus of Covid reporting, rather than new cases. Quite apart from the inaccuracies of case counting and the mild symptoms experienced by most of those infected, Gandhi reasons that breakthrough infections so common with Omicron render case counts less relevant. That’s because high rates of vaccination (not to mention natural immunity from prior infections) reduce severity. Even Jennifer Rubin has taken this position, a complete reversal of her earlier case-count sanctimony.

Incidental Infections

Phil Kerpen’s reaction to Gandhi’s article was on point, however:

“Unless HHS Protect adds a primary [diagnosis] column, hospital census isn’t much more useful than cases.”

HHS Protect refers to the Health and Human Services public data hub. Without knowing whether Covid is the primary diagnosis at admission, we have no way of knowing whether the case is incidental. If Covid is the primary reason for admission, the infection is likely to be fairly severe. It is more useful to know both the number of patients hospitalized for Covid and tge number hospitalized for other conditions (incidentally with Covid). The distinction has been extremely important to those interpreting data from South Africa, where a high proportion of incidental admissions was a tip-off that Omicron is less severe than earlier variants.

The absence of such coding is similar to the confusion caused by the CDC’s decision early in pandemic to issue new guidance on the completion of death certificates when Covid is present or even suspected. A special exception was created at that time requiring all deaths involving primary or incidental Covid infections to be ruled as Covid deaths. This represented another terrible corruption of the data.

Summary

Earlier variants of Covid were extremely dangerous to the elderly, obese, and the immune-compromised. Yet public health authorities seemed to take every opportunity to mismanage the pandemic, including contradictory messaging and decisions that compromised the usefulness of data on the pandemic. But here we are with Omicron, which might well be the variant that spells the end of the deadly Covid waves, and the focus is still squarely on case counts, vaccine mandates, useless masking requirements, and President Brandon wearing a mask on the beach!

Case counts should certainly be available, as Gandhi goes to great lengths to emphasize. However, other metrics like hospitalizations are more reliable indicators of the current wave’s severity, especially if paired with information on primary diagnoses. Fortunately, there has been a very recent shift of interest to that kind of focus because the superior information content of reports from countries like South Africa and Denmark is too obvious. As Don Wolt marvels:

“Behold the sudden interest by the public health establishment in the “With/From” COVID distinction. While long an important & troubling issue for many who sought to understand the true impact of the virus, it was, until very recently, actively ignored by Fauci & crew.”

That change in emphasis would reduce the current sense of panic, partly by making it more difficult for the media to purvey scare stories and for authorities to justify draconian non-pharmaceutical interventions. It’s no exaggeration to say that anything that might keep the authoritarians at bay should be a public health priority.

Scary New Variant or Omicrommon Cold?

08 Wednesday Dec 2021

Posted by in Coronavirus, Pandemic, Uncategorized

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The political motives behind the naming of the Covid Omicron variant might prove to be a huge irony. The Greek letter Xi was skipped by the World Health Organization (WHO), undoubtedly to avoid any symbolic association between Covid and the Chinese dictator Xi Jinping. After all, he’s probably determined to bury discussion of the leak at the Wuhan lab that was the probable cause of this whole mess. The WHO was happy to provide cover. The irony is that the Omicron variant might well bring on a more gentle phase of the pandemic if early indications can be trusted. But in that case, my guess is Chairman Xi wouldn’t have appreciated the twist even if WHO had called it the Xi variant.

The Omicron variant was identified in the Gauteng Province of South Africa and announced by national health authorities on November 24th. The earliest known sample was taken on November 9th. The variant was subsequently diagnosed in a number of other countries, including the U.S. It has a large number of mutations, and initial reports indicated that the variant was spreading extremely fast, having suddenly outcompeted other variants to account for the majority of new cases in South Africa. It is apparently highly contagious. Moreover, Omicron has been diagnosed among the vaccinated as well as those having immunity from prior infections, which is usually more effective and durable than vaccination. Thus, it is said to have “immune escape” properties. Scary indeed!

However, Omicron seems to have been around much longer than suggested by its initial diagnosis in late November (and see this link for an extreme view). Cases in a number of countries show that it is already global; the lags involved in diagnosis as well as earlier contacts with spreaders suggest that Omicron’s origin could have been as early as late September. That means the spread has not been quite as fast as the first alarming reports suggested.

The reported symptoms of the Omicron variant have been quite mild, with fatigue being the most noteworthy. Omicron appears to have taken one mutation from the common cold, which, like Covid-19, is a type of coronavirus. And while there has been a surge in hospitalized cases in South Africa, most of these are said to be “incidental”. That is, these patients were admitted for other problems but happened to test positive for the Omicron variant. As we’ve seen throughout the pandemic, the data is not always reliable.

It’s too early to draw definite conclusions, and this variant might prove to be more dangerous with time. In fact, some say that South Africa’s experience might not be representative because of its young population and high natural immunity. It also happens to be early summer there, when higher vitamin D levels help to boost immunity. So, there is a great deal of uncertainty about Omicron (and see here). Nevertheless, I’ll risk a jinx by momentarily contemplating an outcome that’s not terribly far-fetched.

Viruses mutate in ways that help ensure their survival: they must not kill too many of their hosts, which means the usual progression is toward less lethal variants. They may become more contagious, and new variants must be contagious enough to outcompete their ancestors. Viral interference can sometimes prevent multiple viruses from having a broad coexistence. That’s the likely phenomenon we witnessed when the Covid pandemic coincided with the virtual disappearance of the flu and other respiratory viruses. More to the point, it’s the same phenomenon that occurred when the Spanish Flu was eventually outcompeted by less deadly variants.

So it’s possible that a mild Omicron will put the pandemic behind us. If it proves to be as contagious and as mild as it appears thus far, it would likely displace Delta and other variants as the first phase of a new, endemic malady. That might even cut into the severity of the current seasonal wave. The Ethical Skeptic tweets thusly:

“So was Omicron an ultra fast-mutating magic terminator variant? A gift from God, or aliens…? … Or natural virility/genetic profile derived from a previous variant conferring immunity …”

That would be a wonderful outcome, but Omicron’s arrival in the northern hemisphere just as winter gets underway contributes to the uncertainty. It’s severity during the northern winter could be far worse than what we’ve seen in South Africa. We can hope this variant isn’t one truly deserving of Chairman Xi’s name.

Failed Health Education, In One Anecdote

28 Thursday Oct 2021

Posted by in Coronavirus, Public Health

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I’d just posted an article about the idiocy of masking outdoors, which included a call for an end to the confused public health messaging we’ve heard during the pandemic, when I witnessed something that made my eyes roll:

A fiftyish guy just ahead of me is wearing a mask, walking from the beach toward a public pavilion where there are restrooms. He is barefoot…. and he enters the men’s room and steps right up to the row of urinals. He leaves the restroom without washing his hands.

Perhaps he’s not quite Darwin Award material, but I ask: do you think this guy’s precautions against potential pathogens and disease vectors were well balanced? It’s not terribly uncommon to see “moisture” or even shallow puddles around public urinals. Don’t go barefoot! Wear flip-flops to the john, at the very least. And wash your hands when you’re done!

Amazingly, the only message related to health and hygiene that our friend has absorbed is to wear a useless mask. And he wears it at the beach! I’m sure he got around to adjusting his mask with unwashed hands at some point. I’ll cut him some slack for wearing a mask inside the restroom, but as my last post noted, that precaution is almost surely wasted effort.

Mask Truths and Signals

26 Tuesday Oct 2021

Posted by in Coronavirus, Public Health

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It’s been clear since the beginning of the pandemic that your chance of getting infected with COVID outside is close to zero. (Also see here). Yet I still see a few masked people on the beach, in the park, on balconies, and walking in the neighborhood. Given the negligible risk of contracting COVID outdoors, the marginal benefit of masking outdoors is infinitesimal. Likewise, the benefit of a mask to the sole occupant of a vehicle is about zilch. Okay, some individuals might forget to remove their masks after leaving a “high-risk” environment. Sure, maybe, but cloth masks really don’t stop the dispersion of fine aerosols anywhere, indoors or outdoors. Of course, the immune-compromised have a reasonable excuse to apply the precautionary principle, but generally not outside with good air quality.

The following link provides a list of mask studies, and meta-studies. Several describe randomized control trials (RCTs). They vary in context, but all of them reject the hypothesis that masks are protective. Positive evidence on mask efficacy is lacking in health care settings, in community settings, and in school settings, and the evidence shows that masks create “pronounced difficulties” for young children and “emotional interference” for school children of all ages. Here’s another article containing links to more studies demonstrating the inefficacy of masks. Also see here. And this article is not only an excellent summary of the research, but it also highlights the hypocrisy of the “follow the science” public health establishment with respect to RCTs. Compliance is not even at issue in many of these studies, though if you think masks matter, it is always an issue in practice. Even studies claiming that cloth masks of the type normally worn by the public are “effective” usually concede that a large percentage of fine aerosols get through the masks… containing millions of tiny particles. In indoor environments with poor ventilation, those aerosols remain suspended in the air for periods long enough to be inhaled by others. That, in fact, is why masks are ineffective at preventing transmission.

Another dubious claim is that masks are responsible for virtually eliminating cases of influenza in 2020 and 2021. Again, to be charitable, masks are of very limited effectiveness in stopping viral transmission. Moreover, compliance has been weak at best, and areas without mask mandates have experienced the same plunge in flu cases as areas with mandates. A far more compelling explanation is that viral interference caused the steep reduction in flu incidence. The chance of being infected with more than one virus at a time is almost nil. Simply put, COVID outcompeted the flu.

Again, I grant that there are studies (though only a single randomized control trial out of India of which I’m aware) that have demonstrated significant protective effects. Even then, however, the mixed nature of this body of research does not support intrusive masking requirements.

Nevertheless, masks are still mandated in some jurisdictions. Those mandates usually don’t apply outdoors, however, and not in your own damn car! Mask mandates contribute to the general climate of fear surrounding COVID, which is wholly unjustified for most children and healthy working-age people. Public health messaging should focus on high-risk individuals: the elderly, the obese, and those having so-called comorbidities and compromised immune systems. Those groups have obvious reasons to be concerned about the virus. They have excuses to be germaphobic! Still, they are at little risk outdoors, the value of masks is doubtful, and breathing deep of fresh air is good for you in any case!

The incidence of COVID has declined substantially in many areas since early September, but the virus is now almost certainly endemic and is likely to return in seasonal waves. However, the Delta wave was far less deadly than earlier variants, a favorable trend many believe will continue. These charts from the UK posted by Michael Levitt demonstrate the improvement vividly. Perhaps the mask craze will fade away as the evidence accumulates.

The pandemic has been a moment of redemption for germaphobes, but no reasonable assessment of risk mitigation relative to the cost, inconvenience, discomfort, and psychological debasement of face jackets can prove their worth outdoors. Their value indoors is nearly as questionable. Yet there remains a stubborn reluctance by public health authorities to lift mask mandates. There are far too many individuals masking outdoors, and to be nice, perhaps it’s mere ignorance. But there are still a few would-be tyrants on Twitter presuming to shame others into joining this pathetic bit of theatre. I believe Anne Wheeler nailed it with this recent tweet:

“This is one of the first things you learn in OCD therapy – you don’t get to make people participate in your compulsions in order to lesson your own anxiety. It’s bizarre that it’s been turned into a virtue.”

There’s also no question that masks are still in vogue as a virtue signal in some circles, but a mask outdoors, especially, is increasingly viewed as a stupid-signal, and for good reason. I’ll continue to marvel at the irrationality of these masked alarmists, who just don’t understand how foolish they look. Give yourself permission to get some fresh air!