Tag Archives: Delta Variant

Chill-Out Advisory: Pandemic to Endemic Means Live Again

13 Sunday Feb 2022

Posted by in Pandemic, Public Health, Uncategorized

≈ Leave a comment

Tags

, , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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!

Three Justices Reveal Astonishing Covid Ignorance

10 Monday Jan 2022

Posted by in Coronavirus, Supreme Court, Vaccinations

≈ Leave a comment

Tags

, , , , , , , , , , , , , , , , , ,

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

≈ Leave a comment

Tags

, , , , , , , , , , , , ,

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

≈ Leave a comment

Tags

, , , , , , , , , , , , , ,

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.

Mask Truths and Signals

26 Tuesday Oct 2021

Posted by in Coronavirus, Public Health

≈ 6 Comments

Tags

, , , , , , , , , , , , , , , , , , , ,

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!

In Praise of Voluntary Vaccination

31 Tuesday Aug 2021

Posted by in Coronavirus, Vaccinations

≈ Leave a comment

Tags

, , , , , , , , , , , , , , , , ,

I was vaccinated in March and early April and I’m damn glad to have done it. I have certain co-morbidities, and I’m of an age at which contracting COVID seems like a very bad idea, I felt a little run-down on the day after my second jab, but that was my only side effect, notwithstanding the unending litany of antivax hysterics to which we’ve all been subjected (even on certain sites to which I contribute).

Freedom Without Misinformation

In the context of the pandemic, it’s important to take a stand for liberty. In that spirit, I oppose the imposition of mandates requiring face masks and vaccinations against COVID. Furthermore, vaccination is at best unnecessary for those having acquired immunity from infection and for those at low risk, especially children. In fact, the younger, healthier, and fitter you are, the less important it is to be vaccinated.

It’s disappointing, however, to see completely innumerate people cite statistics purporting to show that COVID-19 vaccines are deadly or even particularly dangerous to those lacking contra-indications. Far worse, and far more idiotic, is to suggest that a conspiracy is afoot to kill large numbers of people via vaccination! I’m truly embarrassed to hear individuals who otherwise share my libertarian ideals say such irresponsible bullshit.

While the COVID vaccines seem to have more frequent side effects than earlier vaccines, they are not particularly risky. I’ll discuss the safety of the COVID vaccines in what follows. Even minuscule risks are unacceptable to some individuals, which of course is their right. However, others find these risks acceptable considering the far greater dangers posed by the early strains of COVID and even the more recent but less deadly Delta variant.

Unverified Adverse Events

The vaccine scaremongers often quote statistics from the CDC’s Vaccine Adverse Reporting Events System (VAERS). Here’s a disclaimer about the system from the CDC’s web site:

“Healthcare providers, vaccine manufacturers, and the public can submit reports to VAERS. While very important in monitoring vaccine safety, VAERS reports alone cannot be used to determine if a vaccine caused or contributed to an adverse event or illness. The reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable.”

All kinds of reports are submitted alleging adverse events. For example, one observer cites the following reports from the system:

The link above refers to the following report as “Hulk Syndrome”, which was alleged to have been a side effect of the MMR vaccine:

Finally, we have this report related to the Pfizer COVID vaccine:

In case that’s hard to read, it claims that a COVID vaccine caused a third arm to grow from the reporting individual’s forehead, which constantly slaps him or her while trying to sleep. This report is a case of wonderful sarcasm, but it was submitted to VAERS! The real lesson is that the VAERS system collects many unverified accounts of side effects, so the aggregate counts of adverse events are not reliable, even by the CDC’s admission.

A More Sober Risk Assessment

Therefore, the VAERS system has obvious limitations. But even stipulating the use of VAERS reports, the risks of the COVID vaccines are vanishingly low. For example, roughly 198 million people in the U.S. have received at least one dose of a vaccine. As of last week, there had been about 13,600 reports of post-vaccination death in VAERS. The raw number is very high, and I don’t wish to minimize the seriousness of those losses. Nevertheless, if those deaths were all attributable to vaccination, and that is a BIG “if”, the risk of death from vaccination to-date is just 0.007%. That is seven thousandth of 1%. 

To put those VAERS deaths into perspective, I should first add the caveat that I am highly skeptical of the COVID case and death statistics. Nevertheless, let’s take the official U.S. COVID death toll of 646,000 at face value. I’m also treating reported vaccine deaths from VAERS at face value, which is a huge stretch. So, we have COVID mortality of 0.2% of the U.S. population, which is more than 28 times the risk of death from vaccination. I grant you the risk posed by COVID is lower going forward than in the past, which is due both to vaccinations and the declining virulence of the virus itself.

There are a range of vaccine side effects reported in VAERS, from pain near the injection site to such alarming conditions as anaphylaxis, Bell’s Palsy, and myocarditis/pericarditis. VAERS would attribute over 54,000 hospitalizations to the vaccines, a rate of 3 hundredths of one percent of those receiving at least one dose. Like COVID deaths, the number of COVID hospitalizations is likely inflated. Still, at 1.9% of the U.S. population, the risk of hospitalization from COVID is 68 times that of hospitalization from vaccine side effects reported in VAERS.

A large share of VAERS reports, covering all adverse events, are from middle aged individuals. It’s unclear how concentrated that reporting is among those with co-morbidities, including obesity, but I suspect they are heavily represented.

Coincidental Events

Perhaps less obvious is that many sincere reports to VAERS from both the public and health care providers represent coincidental events. A number of states have given heavy vaccine priority to the elderly and those with co-morbidities, and demand from those groups has been disproportionate in any case. Most of the VAERS-reported deaths also happen to be among the elderly and co-morbids.

For example, more than 38% of VAERS death reports come from the 80+ age cohort, accounting for roughly 5,200 deaths. That’s four hundredths of one percent of the 12.9 million people of ages 80+ in the U.S., most of whom have been vaccinated. Well over 1.2 million 80+ year-olds can be expected to die each year under normal circumstances. That a few would occur within days, weeks, or months of a vaccination should be expected. Furthermore, it would not be surprising, given the controversy surrounding vaccines and the suggestive power of antivax propaganda, for families or some caregivers to imagine a connection between vaccination and subsequent death. File a report! Who knows? Perhaps a class action award might be in it someday.

This is not to deny that a small number of individuals could be in such weakened states, or perhaps have unknown vulnerabilities, that the vaccines have catastrophic consequences. No doubt there are a few deaths precipitated by COVID vaccines in combination with other conditions. However, a large share of the deaths reported to VAERS are likely to have been coincidental. Likewise, people develop conditions all the time… sore joints, rashes, coughs, and headaches. It runs the gamut. Some of the VAERS reports of a less serious nature are undoubtedly coincidental, and perhaps some are due to the vivid imaginations of a subset of those having consented to the vaccine with great reluctance.

What Kills and What Doesn’t

Everything comes with a risk, and tradeoffs between risks must be balanced. The COVID pandemic was deadly, and I’ll be the first to admit that I underestimated its potential to kill. However, its deadliness was magnified by the non-pharmaceutical interventions imposed in many jurisdictions. Lockdowns and closures took a massive toll on the health of the population, cutting short many lives due to economic and personal despair as well as deferred and cancelled health care. While those interventions were deadly, I do not believe that kind of harm was intended. I do suspect the concomitant assault on liberty was welcomed in certain circles.

There are certainly downsides to the COVID vaccines. There have been more side effects and deaths than have ever been reported relative to earlier vaccines. It’s also a shame that public health authorities refuse to recognize the superior effects of natural immunity and the heightened risk of vaccinations to those with prior infections. And it’s a travesty that “vaccine passports” are now being demanded for various forms of travel, entertainment, and entry to some places of business. Despite these issues, it’s blatantly false to assert that the vaccines are generally harmful. Many more of the remaining vaccine-hesitant can benefit from vaccination. Let’s advocate for better assessments of risk by age and co-morbidity, and simply avoid the vaccines if that is your preference.

Addendum: I just came across this nice piece entitled “A Statistical Analysis of COVID-19 Breakthrough Infections and Deaths“. I thought I should share the link in case anyone supposes that so-called breakthrough infections somehow invalidate some of the comparisons I made above. This chart is particularly revealing:

Vax Results, Biden Boosters, Delta, and the Mask Charade

19 Thursday Aug 2021

Posted by in Coronavirus, Public Health, Uncategorized, Vaccinations

≈ Leave a comment

Tags

, , , , , , , , , , , , , , , , , , , , , ,

If this post has an overarching theme, it might be “just relax”! That goes especially for those inclined to prescribe behavioral rules for others. People can assess risks for themselves, though it helps when empirical information is presented without bias. With that brief diatribe, here are a few follow-ups on COVID vaccines, the Delta wave, and the ongoing “mask charade”.

Israeli Vax Protection

Here is Jeffrey Morris’ very good exposition as to why the Israeli reports of COVID vaccine inefficacy are false. First, he shows the kind of raw data we’ve been hearing about for weeks: almost 60% of the country’s severe cases are in vaccinated individuals. This is the origin of the claim that the vaccines don’t work. 

Next, Morris notes that 80% of the Israeli population 12 years and older are vaccinated (predominantly if not exclusively with the Pfizer vaccine). This causes a distortion that can be controlled by normalizing the case counts relative to the total populations of the vaccinated and unvaccinated subgroups. Doing so shows that the unvaccinated are 3.1 times more likely to have contracted a severe case than the vaccinated. Said a different way, this shows that the vaccines are 67.5% effective in preventing severe disease. But that’s not the full story!

Morris goes on to show case rates in different age strata. For those older than 50 (over 90% of whom are vaccinated and who have more co-morbidities), there are 23.6 times more severe cases among the unvaccinated than the vaccinated. That yields an efficacy rate of 85.2%. Vaccine efficacy is even better in the younger age group: 91.8%. 

These statistics pertain to the Delta variant. However, it’s true they are lower than the 95% efficacy rate achieved in the Pfizer trials. Is Pfizer’s efficacy beginning to fade? That’s possible, but this is just one set of results and declining efficacy has not been proven. Israel’s vaccination program got off to a fast start, so the vaccinated population has had more time for efficacy to decay than in most countries. And as I discussed in an earlier post, there are reasons to think that the vaccines are still highly protective after a minimum of seven months.

Biden Boosters

IIn the meantime, the Biden Administration has recommended that booster shots be delivered eight months after original vaccinations. There is empirical evidence that boosters of similar mRNA vaccine (Pfizer and Moderna) might not be a sound approach, both due to side effects and because additional doses might reduce the “breadth” of the antibody response. We’ll soon know whether the first two jabs are effective after eight months, and my bet is that will be the case.

Is Delta Cresting?

Meanwhile, the course of this summer’s Delta wave appears to be turning a corner. The surge in cases has a seasonal component, mimicking the summer 2020 wave as well as the typical Hope-Simpson pattern, in which large viral waves peak in mid-winter but more muted waves occur in low- to mid-latitudes during the summer months.

Therefore, we might expect to see a late-summer decline in new cases. There are now 21 states with COVID estimated reproduction rates less than one (this might change by the time you see the charts at the link). In other words, each new infected person transmits to an average of less than one other person, which shows that case growth may be near or beyond a peak. Another 16 states have reproduction rates approaching or very close to one. This is promising.

Maskholes

Finally, I’m frustrated as a resident of a county where certain government officials are bound and determined to impose a mask mandate, though they have been slowed by a court challenge. The “science” does NOT support such a measure: masks have not been shown to mitigate the spread of the virus, and they cannot stop penetration of aerosols in either direction. This recent article in City Journal by Jeffrey H. Anderson is perhaps the most thorough treatment I’ve seen on the effectiveness of masks. Anderson makes this remark about the scientific case made by mask proponents:

“Mask supporters often claim that we have no choice but to rely on observational studies instead of RCTs [randomized control trials], because RCTs cannot tell us whether masks work or not. But what they really mean is that they don’t like what the RCTs show.”

Oh, how well I remember the “follow-the-science” crowd insisting last year that only RCTs could be trusted when it came to evaluating certain COVID treatments. In any case, the observational studies on masks are quite mixed and by no means offer unequivocal support for masking. 

A further consideration is that masks can act to convert droplets to aerosols, which are highly efficient vehicles of transmission. The mask debate is even more absurd when it comes to school children, who are at almost zero risk of severe COVID infection (also see here), and for whom masks are highly prone to cause developmental complications.

Closing Thoughts

The vaccines are still effective. Data purporting to show otherwise fails to account for the most obvious of confounding influences: vaccination rates and age effects. In fact, the Biden Administration has made a rather arbitrary decision about the durability of vaccine effects by recommending booster shots after eight months. The highly transmissible Delta variant has struck quickly but the wave now shows signs of cresting, though that is no guarantee for the fall and winter season. However, Delta cases have been much less severe on average than earlier variants. Masks did nothing to protect us from those waves, and they won’t protect us now. I, for one, won’t wear one if I can avoid it.

Herd Immunity To Public Health Bullshitters and To COVID

16 Monday Aug 2021

Posted by in Coronavirus, Herd Immunity, Uncategorized

≈ Leave a comment

Tags

, , , , , , , , , , , , , , , , , , , , , , , ,

My last post had a simple message about the meaning of immunity: you won’t get very sick or die from an infection to which you are immune, including COVID-19. Like any other airborne virus, that does NOT mean you won’t get it lodged in your eyeballs, sinuses, throat, or lungs. If you do, you are likely to test positive, though your immunity means the “case” is likely to be inconsequential.

As noted in that last post, we’ve seen increasing COVID case counts with the so-called Delta variant, which is more highly transmissible than earlier variants. (This has been abetted by an uncontrolled southern border as well.) However, as we’d expect with a higher level of immunity in the population, the average severity of these cases is low relative to last year’s COVID waves. But then I saw this article in ScienceAlert quoting Sir Andrew Pollard, a scientist affiliated AstraZeneca and the University of Oxford. He says with Delta, herd immunity “is not a possibility” — everyone will get it.

Maybe everyone will, but that doesn’t mean everyone will get sick. His statement raises an obvious question about the meaning of herd immunity. If our working definition of the term is that the virus simply disappears, then Pollard is correct: we know that COVID is endemic. But the only virus that we’ve ever completely eradicated is polio. Would Pollard say we’ve failed to achieve herd immunity against all other viruses? I doubt it. Endemicity and herd immunity are not mutually exclusive. The key to herd immunity is whether a virus does or does not remain a threat to the health of the population generally.

Active COVID infections will be relatively short-lived in individuals with “immunity”. Moreover, viral loads tend to be lower in immune individuals who happen to get infected. Therefore, the “infected immune” have less time and less virus with which to infect others. That creates resistance to further contagion and contributes to what we know as herd immunity. While immune individuals can “catch” the virus, they won’t get sick. Likewise, a large proportion of the herd can be immune and still catch the virus without getting sick. That is herd immunity.

One open and controversial question is whether uninfected individuals will require frequent revaccination to maintain their immunity. A further qualification has to do with asymptomatic breakthrough infections. Those individuals won’t see any reason to quarantine, and they may unwittingly transmit the virus.

I also acknowledge that the concept of herd immunity is often discussed strictly in terms of transmission, or rather its failure. The more contagious a new virus, like the Delta variant, the more difficult it is to achieve herd immunity. Models predicting low herd immunity thresholds due to heterogeneity in the population are predicated on a given level of transmissibility. Those thresholds would be correspondingly higher given greater transmissibility.

A prominent scientist quoted in this article is Paul Hunter of the University of East Anglia. After backing-up Pollard’s dubious take on herd immunity, Hunter drops this bit of real wisdom:

“We need to move away from reporting infections to actually reporting the number of people who are ill. Otherwise we are going to be frightening ourselves with very high numbers that don’t translate into disease burden.”

Here, here! Ultimately, immunity has to do with the ability of our immune systems to fight infections. Vaccinations, acquired immunity from infections, and pre-existing immunity all reduce the severity of later infections. They are associated with reductions in transmission, but those immune responses are more basic to herd immunity than transmissability alone. Herd immunity does not mean that severe cases will never occur. In fact, more muted seasonal waves will come and go, inflicting illness on a limited number of vulnerables, but most people can live their lives normally while viral reproduction is contained. Herd immunity!

Sadly, we’re getting accustomed to hearing misstatements and bad information from public health officials on everything from mask mandates, lockdowns, and school closings to hospital capacity and vaccine hesitancy. Dr. Pollard’s latest musing is not unique in that respect. It’s almost as if these “experts” have become victims of their own flawed risk assessments insofar as their waning appeal to “the herd” is concerned. Professor Hunter’s follow-up is refreshing, however. Public health agencies should quit reporting case counts and instead report only patients who present serious symptoms, COVID ER visits, or hospitalizations.

Effective Immunity Means IF YOU CATCH IT, You Won’t Get Sick

12 Thursday Aug 2021

Posted by in Coronavirus, Uncategorized, Vaccinations

≈ 3 Comments

Tags

, , , , , , , , , , , , , , , , , , , ,

Listen very carefully: immunity does NOT mean you won’t get COVID, though an infection is less likely. Immunity simply means your immune system will be capable of dealing with an infection successfully. This is true whether the immunity is a product of vaccination or a prior infection. Immunity means you are unlikely to have worse than mild symptoms, and you are very unlikely to be hospitalized. (My disclaimer: I am opposed to vaccine mandates, but vaccination is a good idea if you’ve never been infected.)

I emphasize this because the recent growth in case numbers has prompted all sorts of nonsensical reactions. People say, “See? The vaccines don’t work!” That is a brazenly stupid response to the facts. Even more dimwitted are claims that the vaccines are killing everyone! Yes, there are usually side effects, and the jabs carry a risk of serious complications, but it is minuscule.

Vaccine Efficacy

Right out of the gate, we must recognize that our PCR testing protocol is far too sensitive to viral remnants, so the current surge in cases is probably exaggerated by false positives, as was true last year. Second, if a large share of the population is vaccinated, then vaccinated individuals will almost certainly account for a large share of infected individuals even if they have a lower likelihood of being infected. It’s simple math, as this explanation of base rate bias shows. In fact, according to the article at the link:

“… vaccination confers an eightfold reduction in the risk of getting infected in the first place; a 25-fold reduction in risk of getting hospitalized; and a 25-fold reduction in the risk for death.”

The upshot is that if you are vaccinated, or if you have acquired immunity from previous exposure, or if you have pre-existing immunity from contact with an earlier COVID strain, you can still “catch” the virus AND you can still spread it. Both are less likely, and you don’t have as much to worry about for your own health as those having no immunity.

As for overall vaccine efficacy in preventing death, here are numbers from the UK, courtesy of Phil Kerpen:

The vertical axis is a log scale, so each successive gridline is a fatality rate 100x as large as the one below it. Obviously, as the chart title asserts, the “vaccines have made COVID-19 far less lethal.” Also, at the bottom, see the information on fatality among children under age 18: it is almost zero! This reveals the absurdity of claims that children must be masked for schools to reopen! In any case, masks offer little protection to anyone against a virus that spreads via fine aerosols. Nevertheless, many school officials are pushing unnecessary but politically expedient masking policies

Delta

Ah, but we have the so-called Delta variant, which is now dominant and said to be far more transmissible than earlier variants. Yet the Delta variant is not as dangerous as earlier strains, as this UK report demonstrates. Delta had a case fatality rate among unvaccinated individuals that was at least 40% less than the so-called Alpha variant. This is a typical pattern of virus mutation: the virus becomes less dangerous because it wants to survive, and it can only survive in the long run by NOT killing its hosts! The decline in lethality is roughly demonstrated by Kelly Brown with data on in-hospital fatality rates from Toronto, Canada:

The case numbers in the U.S. have been climbing over the past few weeks, but as epidemiologist Larry Brilliant of WHO said recently, Delta spreads so fast it essentially “runs out of candidates.” In other words, the current surge is likely to end quickly. This article in Issues & Insights shows the more benign nature of recent infections. I think a few of their charts contain biases, but the one below on all-cause mortality by age group is convincing:

The next chart from Our World In Data shows the infection fatality rate continuing its decline in the U.S. The great majority of recent infections have been of the Delta variant, which also was much less virulent in the UK than earlier variants.

Furthermore, it turns out that the vaccines are roughly as effective against Delta and other new variants as against earlier strains. And the newest “scary” variants, Kappa and Lambda, do not appear to be making strong inroads in the U.S. 

Fading Efficacy?

There have been questions about whether the effectiveness of the vaccines is waning, which is behind much of the hand-wringing about booster shots. For example, Israeli health officials are insisting that the effectiveness of vaccines is “fading”, though I’ll be surprised if there isn’t some sort of confounding influence on the data they’ve cited, such as age and co-morbidities. 

Here is a new Mayo Clinic study of so-called “breakthrough” cases in the vaccinated population in Minnesota. It essentially shows that the rate of case diagnosis among the vaccinated rose between February and July of this year (first table below, courtesy of Phil Kerpen). However, the vaccines appear only marginally less effective against hospitalization than in March (second table below).

The bulk of the vaccinated population in the U.S. received their jabs three to six months ago, and according to this report, evidence of antibodies remains strong after seven months. In addition, T-cell immunity may continue for years, as it does for those having acquired immunity from an earlier infection. 

Breakthroughs

It’s common to hear misleading reports of high numbers of “breakthrough” cases. Not only will these cases be less menacing, but the reports often exaggerate their prevalence by taking the numbers out of context. Relative to the size of the vaccinated population, breakthrough cases are about where we’d expect based on the original estimates of vaccine efficacy. This report on Massachusetts breakthrough hospitalizations and deaths confirms that the most vulnerable among the vaxed population are the same as those most vulnerable in the unvaxed population: elderly individuals with comorbidities. But even that subset is at lower risk post-vaccination. It just so happens that the elderly are more likely to have been vaccinated in the first place, which implies that the vaccinated should be over-represented in the case population.

Conclusion

The COVID-19 vaccines do what they are supposed to do: reduce the dangers associated with infection. The vaccines remain very effective in reducing the severity of infection. However, they cannot and were not engineered to prevent infection. They also pose risks, but individuals should be able to rationally assess the tradeoffs without coercion. Poor messaging from public health authorities and the crazy distortions promoted in some circles does nothing to promote public health. Furthermore, there is every reason to believe that the current case surge in Delta infections will be short-lived and have less deadly consequences than earlier variants.