I'm open to the case that NPIs simply *cannot* work in 2020s USA. Indeed, if I were the American King for a Day when the next one hit, I'd probably just issue advice, and leave it at that. But still...NPIs seemed to work pretty well in Japan and Denmark and Australia.
Either your public is 40% comprised of low trust whack-jobs hunting online for horse medicine, or not.
"Masks don't work" always reminded me of "abstinence doesn't work." In both cases, I think the phrase was a shortened version of what the speaker MEANT to say. "Mask MANDATES don't work" is a coherent sentence. "Abstinence only EDUCATION" doesn't work. But not having sex is a pretty good way to not get pregnant, and wearing a mask has a >0 effect on reducing the spread of infectious disease (albeit varying by type).
Abstinence is 100% effective in preventing pregnancy. As you note, masks are variable but they are never 100%.
I think one problem is that people treated masks like some kind of force field where they thought wearing one made them safe, when the reality was a lot more complicated- especially for cloth and non-certified masks.
My favorite were the football coaches being forced to wear masks outdoors, dumb enough as is, but they'd still muscle memory their way into covering their faces further with their playsheets, still paranoid that someone might lip read them.
Two specific funny moments in this regard were Andy Reid wearing a fogged up face shield, and Bill Belichick putting an N95 *over* a neck warmer.
I don't think I've ever been angrier at policy than I was at that. I was a mushroom cloud laying motherfucker, Superfly TNT, Guns Of The Navarone at that, and also at the antivaxxers.
The real abstinence is shelter-in-place. If you never leave your home and only get things via delivery, you won’t get sick from a respiratory virus. Just like if you don’t have sex with anyone ever other than your equally lifelong monogamous partner (and also don’t get blood transfusions) you won’t get any diseases that are spread only through sex and blood.
Masks are like condoms, but less effective. (Maybe like how condoms are for herpes or whatever.)
I don't think there's any evidence that cloth masks have much of an effect in terms of preventing disease spread. A .02% effect is yes literally larger than 0, but it doesn't reach the level of statistical 'significance'.
I think properly worn and fitted N95 masks have a much larger effect, but that's not what most people were wearing
One of the problems with the fight over whether or not universal masking works is that we have a lot of really low quality data and a small amount of high quality data, and even those higher quality studies aren't great. Organizations like the CDC and NIH really dropped the ball in making sure that these studies did get done. Interestingly, some of the high quality studies were done by researchers from the Nordic countries. I don't know how much this had to do with the nordics having a less politicized response vs institutional characteristics, but this is one of those situations where we should be more like the Nordics.
The high quality data (RCTs, the occasional well-matched prospective observational study) tend to find either a null effect or a small effect. There is an abundance of low to terrible quality data showing that they are effective. Many people in (US) public health have concluded that RCTs are the wrong way to study them, and instead we should look at laboratory studies, ecological studies or the case control studies, but it's not clear what other interventions they would apply that standard of evidence to. We didn't do a lot of good quality science around it so we don't know why these RCTs aren't showing an effect. When it comes to cloth masks, it is entirely plausible that they have an extremely small effect on transmission and this is because the virus is transmitted primarily via aerosols and the cloth masks are not very good at blocking them. But we don't know that because we didn't have much high quality science investigating this.
Then there's the problem of whether a study is generalizable. If a study finds that an infectious person wearing an 95 is 99% less likely to infect the other people in the room, it does not follow that having people wear 95s everywhere they go will have a large effect. They need to seal properly and if people are doing things that are likely to break that seal and not notice that they've broken the seal, we would expect them to be less effective. SO if something works in a hospital, it's a good idea to run another study in the general population to see if it holds up in that population as well.
There’s also an important fight about whether a “high quality study” is an RCT on telling people to mask, or a lab study where we expose people to known-infected individuals and watch them wearing or not wearing the masks, or an aerosol study that sees how the mechanisms work, or what. Much of public health is based around the idea that the RCT is somehow most ecologically valid and statistically sound and is therefore the highest quality, but it doesn’t always test what you want to test (and in the case of masks you can’t do blinding).
Totally agree about the question of what is a high quality study. The fact that we did not do those kinds of studies is really disappointing. I think we should have done all of the above. At least then we'd have had better data to make decisions/
In my memory cloth masks had ~40% efficacy against the original strain (which is certainly not nothing, if everyone is wearing one you save a lot of lives vs. no one wearing one), but then it went to virtually zero vs. the much more contagious follow up strains.
Isn't funny that we once were so steeped in this debate (literally constantly debating effectiveness of NPIs), and now it feels like a bit of a distant memory. That's my experience at least.
Definitely not *everybody*! I know many people who got COVID for the first time between mid December 2021 and mid January 2022, including some people who got it apparently the day after we had Christmas dinner with them. But my partner and I somehow didn’t get it until May 2022 (and we were paying close attention to every cough for several years, and would have identified a minor viral cough as distinct from an allergic one).
Yep. I've found that some people literally think human bodies violate thermodynamics, but usually people mean "calories in, calories out is extremely difficult to adhere to because it relies on continuous long-term exertion of willpower and constant monitoring of calories eaten and expended."
Ehhhh… I’m not convinced that a bomb calorimeter is especially similar to human digestion. You don’t have to violate thermodynamics to suspect that some people’s bodies start to use fewer calories while they’re dieting.
Given the amount of calories expended in baseline metabolic processes that can speed up or slow down without you noticing, “constant monitoring” is basically impossible.
No, the admiral who said masks don't work in Feb was lying, with support from doctors who didn't understand basics of disease transmission due to innumeracy. Of course masks do work, as he said in March.
Right - I read “Intervention “ in NPI as meaning a mandated or strongly suggested public health program. That doesn’t stop me from trolling through CDC NPI literature to find ways to personally survive a pandemic. However, since I don’t work, let alone in healthcare or in an essential function, I have freedom that others may not have. Maybe we went on too long with the strict, legally and peer-enforced NPIs, but with anything new we should pull out all the stops to protect employees. Probably not possible in this political climate, alas.
And also showed that NPIs can be enforced well past any reasonable timeframe of when they should be enforced. Oh and also showed that NPI enforcement can be used as excuse to extend authoritarian tendency.
Yes on both those things. I’m certainly not lauding how they handled it, but it was nice of them to do the experiment for us. I do find it hard to understand how people continue to argue NPI’s don’t work to stop the spread of disease when China’s zero covid heyday’s just sitting there for all to see.
Fair, but it was hard to hide the deaths when they lifted the restrictions (tho the government lied like crazy about it). Just as it was hard to hide the fact that Chinese people were living life pretty much as normal while we were locked down, due to mass testing, manic-level contract tracing, and their extreme restrictions on exposed and infected people’s movements. A lot of Chinese people were happy about it.
As we saw in China, NPIs do work for awhile when vigorously enforced. But, it's only possible to keep that up for so long, and when the measures lift, the population doesn't have immunity, and everyone gets sick anyway.
In the long run, unless NPI is able to completely eradicate the virus quickly, it accomplishes very little.
Yes, authoritarian governments are good at enforcement. But ultimately much of it was just a time-shift. China eventually had to stop its attempt at a zero-Covid policy and immediately lots of people got sick and died - how many we don’t know because the government isn’t honest.
They were arguably the gold standard in 2020 and early 2021. Even then they weren't flawless: they prioritized vaccinating working aged people, but, as that effort ramped up, made little/no effort to pivot back to the elderly. So the seeds of their far less successful approach after the midpoint in 2021 were sewn early. And needless to say, living in a dictatorship, millions of Chinese suffered horribly from policy overreach throughout this period, with no recourse.
Also don’t think a lot of people have really made the connection between openly flouting mask mandates and a lot of subsequent disorder.
People are very quick to blame the Floyd protests but really don’t want to talk about the downstream effects of “40% of the country is willing to get fired rather than comply with a vaccine mandate.”
Agreed. Also, whether to do NPI's really depends on the severity of the disease. What if instead of the 1% fatality rate of COVID we had the 10% fatality rate of SARS, or God forbid the 33% fatality rate of MERS???
I would submit that with something like MERS the only proper response is absolutely everyone stays inside until transmission literally stop with pretty draconian enforcement.
Not to be Clintonian but claims like "NPIs worked in [x] country" seem to hinge a lot on the definition of "worked". It's true that when people obeyed them, the disease spread more slowly. But importantly, Covid spread much too easily to ever be defeated by NPIs, which meant that for it to "go away" in the sense it has now, it basically required the vast majority of people's immune systems encountered it.
Which is to say, pretty much everyone has to get it eventually. Those low numbers don't seem like much of a victory if you pull the timeframe out and you end up in the same place.
Now I think there's an argument to be made here in favor, but I don't buy general claims that "they worked" without unpacking more specificity:
- They can be used to temporarily tamp down the infection rate at a time when hospitals are overwhelmed. This happened for a few moments in a few places but generally was not a common circumstance during the pandemic. (Hilariously this was the plan during the first couple of weeks which everyone forgot once everything got politicized)
- They can be used to minimize the number of infections that occur before vaccines are available. But remember that vaccines arriving in a year was a huge surprise, an amazing best case scenario. So unless you were willing to restrict long and aggressively enough to tamp down cases for a *year* or more, this is also pointless.
Ultimately I think a retrospective case can easily be made for limited, strategic NPIs for particular time frames or populations. And a lot of people made these arguments correctly in real time - including the leadership of Sweden, and Trump's national health pick.
A lot of this is right. But we now know that the 12 month time frame for the vaccine involved a lot of last-minute making an mRNA vaccine supply chain for the first time ever, and then waiting several months for tests of effectiveness.
But updating an mRNA vaccine should only take a few weeks, and if we come up with plans for more expedited testing (and maybe not worry about the details of effectiveness testing before beginning some of the rollout) it could be brought down quite a bit.
They already had the mRNA sequence and the first synthesized mRNA in January 2020 within a week and a half of isolation in patients.
Sure, I can imagine a future scenario where all of the parameters line up in such a way to justify NPIs. But I don't trust our public health establishment (ugh that sounds Trumpy) to make that call, nor would have the population listen to it, wolf having already been cried.
I really hope there is some way to draw useful conclusions from this. For example, what's the best way to encourage people to wear masks or get vaccinated without prompting backlash that makes the net situation worse? I feel that just saying "hey, please wear masks and get vaccinated but there are zero consequences if you don't" doesn't get very far, but workplace vaccine mandates and many mandatory NPIs prompted a level of backlash that made things worse. Even the military had to back off from COVID vaccine mandates.
I really wish the US had tried just paying people to get vaccinated.
I worry that with Dale Gribbles sorting into the Republican Party there's no good answer. If we have another pandemic, it's either with RFK Jr. making important decisions or with 40% of the population primed to do the opposite of good medical advice out of spite.
If Covid had happened under Bush or Obama, the politics would likely have been a bit different. Under Bush, the anti-vax movement was clearly left wing. Under Obama, the stupidity of the anti-vax movement was helping to snuff it out on the left. (That's why outbreaks tended to be in small social groups specifically targeted by anti-vaxers, like the Amish or Somalis in Minnesota.) If Rubio had become president in 2016 instead of Trump, it's very likely conservatives wouldn't have had the social pressure to turn antivax the way they did.
I will never got over the fact that the pandemic started in March 2020 and began to wind down in December of 2020 when the first shots were administered. Most of what everyone recalls from the pandemic - locks downs, etc. occurred during the Trump administration. And yet he gets zero blame even though he was the guy in charge.
I would probably repeat what Deadpan Troglodytes already said- NPIs were virtually all run at the state level, and Democratic states (or Dem cities in red states) were much much harsher on the NPIs than red states were. Voters are in general not what I would call 'bright', but they're not stupid, and they do recall the NPI-Democrat connection. They remember who was closing playgrounds, mandating masks in restaurants, closing schools, etc. I think that mental connection is now pretty permanently fixed in voters' psyches
It didn’t help that a non-zero number of progressives were openly trying to use COVID as a pretext for a lot of unrelated radical transformational changes.
Aside from using NPIs well past the point they were necessary, they also wanted to make a lot of targeted pandemic relief permanent — remember the whole “Biden promised us $2000” discourse from early 2021?
It will also never cease to amaze me that there are hundreds of thousands of extra people unnecessarily dead because DJT got jealous that Andrew Cuomo was getting such fawning coverage* in the press and overshadowed him.
I continue to maintain that his “liberate Michigan” tweet is one of the deadliest tweets in history. It gave the signal to his followers that Covid was “fake news” and not to be taken seriously.
To tie it back to Matt’s post. One huge danger clearly signaled by RFK jr’s nomination is that it’s basically Trump indulging in anti-vaccine insanity about everything. RFK jr could be completely ineffective at HHS, a real viable H1N1 vaccine could be developed and one Truth Social post could mean half the country refuses the vaccine.
*I’ve noted before that my wife used to work extensively in NY politics. Which she means she’s known longer than most what POS Cuomo is. Upshot is we own a “Cuomosexual” mug as an ironic reminder of that moment when Cuomo was quasi celebrity
NPIs were administered at the state and local levels: what is a president's responsibility there, leadership?
He could have fired Fauci, whose public equivocations damaged institutional trust, but there's no universe in which blue locales would have followed his successor's lead. We already know what they thought of Bhattacharya!
If you listened to what Fauci actually said he was quite moderate as far as public health people go. The rupture with Trump occurred when Donald went into mad King at a press conference and Fauci had to correct him.
The red blue divergence happened when Trump decided covid would end by Easter and decided everything needed to open to boost the economy. Red states opened up and blue states extended/increased the intensity of the early lockdowns that made sense in March/April.
I'd also say that Jay Bhattarachia wrote a bunch of op ads early on claiming covid was milder than the flu. Dude's a hack who happened to be correct a few times.
Take a look at Europe. Those countries all had very different public reactions as far as polarization around NPI's went. The country that saw a schism like us is Brazil and the chief executives explain that.
Matt's contention that low uptake vaccine vis a vis our peer countries is because people don't like needles is one of his worst takes. There are people who hate needles literally in every country. There's no way that explain why a much higher percentage of people are vaccinated in Germany than America.
But more to your point. The low levels of vaccination in American and Brazil are amazing examples to me that the "great men of history" thesis of how history unfolds has merit. As usual with these things, it's never one thing (hard not to cite UK's unique geographic position as to why industrialization took off there first as an important example). But the huge delta in per capita death rates is a morbid example that your leaders really do matter.
I do think needles are an important factor in vaccine hesitancy, though I don’t think it explains US exceptionalism. Unfortunately, everyone in public health learned to get over needles in their first year of graduate education, so they underestimate how valuable it would be to get non-needle-based vaccines.
I'm not a Fauci hater. I think he did a lot of great work through his career, through multiple public heath crises. But he screwed up COVID and it wasn't just changing his mind as the evidence changed.
First, there's the story everyone knows: his early dismissal and then subsequent support of masks. The story is complicated, but it is clearly not simply a matter of evolving science. As Slate's writers put it in "The Noble Lies of COVID-19":
> One thing is beyond a doubt, however: One of those two statements [on masks] did not accurately reflect the evidence as Fauci saw it. Such high-profile mixed messages in a short time frame, without substantive new data to justify the change, generated confusion and a backlash from politicians, other experts, and the general public.
But that's not all. He also made knowingly false estimates of the herd immunity threshold, by his own words! Some part of these revisions were related to new data, but as Donald McNeil wrote in the New York Times, Fauci had been deliberately withholding his real analysis:
> Dr. Fauci acknowledged that he had slowly but deliberately been moving the goal posts. He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks.(https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html)
Other times, Fauci just admits to being concerned with the consequences of communicating the truth, rather than disseminating knowledge. For example, in early 2021, he said of switching to a "first shots first" strategy:
I mean ... he's right, but if you're paying attention and reading that in March 2021, it's becoming increasingly harder to take anything he says at face value anymore.
His people would follow him over a cliff. If Trump had decided "A strong response to the pandemic is my ticket to a second term" we would have looked a lot more like Canada or Australia in terms of excess mortality.
Now, no doubt a lot of MAGA enthusiasts would in principle reject saving a few hundred thousands lives if that meant a motorcycle rally got cancelled one year, or they had to get take out instead of dining in at a crowded Chick-fil-A. Freedom isn't free, after all.
But still, given Trump's utterly messianic hold over tens of millions of American conservatives, it seems obvious we could have had a very different 2020. Hell, Trump could have couched the effort in terms of "fighting the CCP's efforts to harm us."
But Trump thought his ticket to reelection wasn't saving American lives, but rather, opening up the economy as rapidly as possible—public health consequences be damned.
Well trodden ground here at Slow Boring. Something that's been chewed over, what, three hundred times? I get it: the partial and irritating NPIs were history's greatest crime.
That’s true, but they were following, perhaps overzealously, the official federal guidance from the CDC. That guidance had a tremendous impact on policy, at least for blue states.
I suspect that any non-Trump president would have at least explored some coordination of NPIs. It is obvious that states with open borders running completely autonomous semi-lockdowns is a recipe for failure. It really was a situation that required the one thing most lacking in the Trump presidency, strong leadership.
Be that as it may, it would only be a positive from the perspective of NPI supporters. BZC is saying that Trump is responsible for blue state mask mandates and school closures, which is what I'm responding to.
That claim is obviously silly and I am not attempting to make it sound less-so. I am making a very narrow and specific claim. I am not certain that someone could have successfully organized the states to act in concert but it absolutely should have been seriously attempted.
Not acting like a crazy person early on. People forget, the country was relatively unified and he had the highest approval of his presidency pre press conference meltdown.
How many people were actually tracking what Fauci said from day-to-day, rather than absorbing vibes second-hand from their ideological fellow travelers? This critique always seemed to me to assume that everyone has the same media diet.
I think we just gotta attribute this to some fundamental differences in the electorate. The way this stood out to me egregiously was that during the campaign, Harris would talk about what her plans were and get pilloried with comments such as, "You're in power NOW, why aren't you doing any of this???", completely ignoring the historically pretty well-known fact that VPs are, uh, cartoonishly powerless.
(I'm not cutting her slack here, it cuts both ways, running as a sitting VP when times are good also affords one credit they also most likely do not deserve.)
But Trump was still somehow running as an outsider despite having already had the chance to do the things he is proposing. The comedian Theo Von, who interviewed Trump prior to the election, had on fellow comedian Stavros Halkios (who is disdainful of ALL politicians, but is certainly of the left) the other day, and was saying that he voted for Trump because he represented something different, someone who might change things, and Halkios was laughing at him and said something to the effect of, "what are you talking about?!? He was already President before!"
Clip here, should start at the timestamp. He also stomps on Vance, which is fun.
Some of it is attributable to differences in the electorate, yes, but Trump really did literally go hard against much of his own government's (that is, the United States Government's) efforts to battle a public health crisis. And I strongly suspect it helped him in 2020 and in 2024 with at least some cohorts (if not on net in 2020), by increasing his support among working class Americans for whom forced unemployment (yes, even with fat checks) was highly stressful and unpleasant. And those memories were still fresh for many two weeks ago. It's not hard for me to believe the GOP's inroads among young Hispanic men, for instance, were given a nice boost by Trump's seizure of the "Let's get America back to work" brand. Many working class Americans saw Trump as championing their right to earn a paycheck and resume their lives. Which, of course, in a large sense he was.
We might be talking to different people then, because I know people who voted for him specifically because they got big checks and *didn't* have to work.
I will never get over the fact that for us in Illinois the pandemic stretched on into 2022 and for our friend's and family living in Georgia it ended in like Sept. 2020. It was such a stark difference in response and it's definitely radicalized my wife against Democrats.
Georgia had the 5th worst COVID death rate (191/100k people) in the U.S. during 2021. You do have to give them credit for always striving to be the worst. \S
Isn't one conclusion from the inflation backlash that voters don't accept being asked to sacrifice "for the greater good" (high inflation vs. less unemployment; lockdowns vs. fewer elderly deaths)?
Problems while Trump was President -> initial response, early testing debacle, early anti-mask recommendations, extended lockdowns in blue states
Every one of those either didn’t matter in the end, wasn’t really Trump’s fault, or Trump was right on the merits. Trump absolutely fucked up early response stuff, but I doubt any President could have stopped COVID from becoming an epidemic in the US, and once it’s loose, long-term government-imposed lockdowns are a needless and polarizing restriction of liberty, since people naturally hit a self-isolation equilibrium based on their personal risk tolerance and local case rates.
On the plus side, he actually did meaningfully accelerate vaccine development, which actually matters.
Problems while Biden was President -> Mask mandates on airplanes lasted until spring 2022, when the administration only dropped them because they lost in court. CDC being so slow to accept importance of ventilation vs. handwashing and surfaces. Concerns about “equity” messing with vaccine approval and distribution.
This is stuff where I think Biden was wrong on the merits and it was actually plausibly within his control.
Messaging directly against his own government is a pretty big problem in terms of public trust right? I get that we always grade trump on a curve but a normal president (even a Republican) would have been meeting with blue state governors and the CDC to at least give some appearance of a united front.
See my response to your other comment, but the TL:DR is that I actually don't think he deserves much credit. The mRNA vaccines were "novel" in the sense that the market hadn't supported their adoption, but it was tech literally sitting on the shelf in January 2020, which is why Pfizer was willing to pass on a lot of Warp Speed money (they wanted to retain more of the IP rights). And spending that summer dumping gasoline on the riots was just a straight-up disaster, even if (like me), you think Defund was stupid and counterproductive in all sorts of ways.
Like, if you look at 2020 and think, "That guy deserves a lot more credit for his great leadership and executive management as President and for all the great stuff that happened in the US as a result," I just find that to be a pretty risible claim.
I doubt it; think about the complexity of the set of factors that I laid out to you--it was enough that David responded with the suggestion that I was some kind of industry insider (not actually the case, but I was an academic doing work on pandemics, so also weirdly deep in the weeds for that reason*).
But this is where I come back to one of my hobby horses, which is that people tend to fundamentally misunderstand the nature of expertise. We tend to use "expertise" as a shorthand for "smartness," like so-and-so is an expert in X because they are somehow so "smart" about it. This is why during the pandemic you had so many pundit / columnist types who were suddenly acting like Covid experts--they all thought, correctly, "I'm pretty smart," but then took that to mean, "so I can figure this out as well as anybody with some internet research."
Obviously smartness is great. I like people to be smart.
But good expertise is really about having a large, useful body of specialist knowledge and training, combined with a highly developed social network in some particular area of interest that helps you develop thinking or delivers special insights. It's a deeply imperfect system--groupthink is 100% a thing, as we saw in Covid. But the only reason that I know about mRNA vaccines and their history is because of some connection I had to a researcher at Baylor College of Medicine who was involved with that stuff, plus I happened to be doing this pandemic project, plus I happened to have spent a lot time thinking and reading about infrastructure and logistics and clinical trials for a completely different bioethics project that had nothing to do with pandemics, and so on.
I can't have been the only one who knew this stuff or thought about the problem in these ways. But by the same token, I doubt the pool of such people is that large. To get that kind of input, you would have needed to seek it out because you desperately wanted it. And for the Trump administration, in particular, it would have meant seeking it out in precisely the pool of pointy-heads that they despised. It was never going to happen. But this was definitely not the insight that the smart columnists in the NYT were going to deliver, because you can't be smart enough to act on information that you simply don't possess because it is diffusely spread through a network that you don't have.
I think, too, that better pandemic response would have required the administration, and particularly Trump himself, to understand the shape of the problem differently than he did, or maybe could. People treat the pandemic as a black swan event, and in some ways it obviously is, but recall that Trump actually campaigned on his opposition to the Obama administration's response to the ebola outbreak. I think that with hindsight you can see a lot of the seeds of what he would do well or badly looking at that episode. It's useful to remind yourself that even though Covid was unique, we've had pandemic scares and even actual pandemics with clockwork regularity throughout the twentieth and twenty-first century, and people's ways of thinking about disease events are framed by all of those prior experiences in ways both good and bad. Part of expertise is being able to actually tease apart thinking, manipulate your own perspective, and rigorously examine your own ideas on issues where none of us are actually a blank slate.
I'll leave you with the same thing I said before: all of this stuff is very hard. It would be very easy to have tried and failed with Covid. A lot of people DID try and fail at various stuff with Covid. But the particular pathologies of the Trump administration were relevant to how they failed and what they did or didn't do, and it's silly to pretend otherwise. The nature of doing a hard job is that people die when you screw up--I say this in the most personal way, as a critical care nurse--and that you absolutely will be judged, harshly, after the fact. I see no reason to exempt Trump from that just because liberals dislike him.
*In part I was working on a museum project that opened, hilariously, in Nov 2019; in hindsight, it held up quite well until the museum closed, three months later. When the museum reopened, they quietly pulled the whole thing down--it had been scheduled to stay up for three years--because, "No one wants to talk about pandemics any more." Which, fair enough.
Your initial objection is to the idea of Trump getting credit for Operation Warp Speed, because it could theoretically have been better and faster than it was? I’ll take as given that you’re correct, but I’m not sure if that’s the right standard to use. I think we probably should give him credit if he was better on vaccine development than his political opponents.
In the summer of 2020, Democrats in Congress were objecting to Operation Warp Speed, not because it was too slow, but on the grounds that it was insufficiently transparent and that there were conflicts of interest in how it was run. There were objections about abrogating normal government procurement processes. You had Democrats saying that you shouldn’t trust the federal government on which vaccines were safe, because approvals were being rushed for political purposes. Biden campaigned on how he was going to set up a COVID-19 Racial and Ethnic Disparities Task Force and implement price controls to keep the costs of COVID vaccines down.
I really can’t say that I wish Democrats had had more control over COVID vaccine development in 2020.
Apologies for not replying to this; I was working night shift this week and too tired to keep up with comments.
I think this final comment takes you straight back to the core problem with your analysis: you keep wanting to get somewhere, to your take on how Trump was actually good on pandemic stuff, and so you look for ways to get there that involve hypotheticals or logical shortcuts, because a hardnosed analysis of actual circumstances runs straight into the actual Trump administration. I'm speaking, here, of the guy who said the pandemic would be over by Easter. That China did a great response. That we didn't really need the vaccines because Ivermectin and hydroxychloroquine were great treatments.
Interestingly, for purposes of your analysis, that guy also concluded that the vaccines weren't actually so great and that people shouldn't really be pushed to use them. In fact, that concluded that vaccines are bit overrated, full stop, and has added RFK to his cabinet in order to boost the signal on that view.
So no. I do not trust that guy's instincts. I agree with President Trump that his work on vaccines and vaccine policy was not something to be incredibly proud of. And I think it is telling that you have to 1) disagree with him--and ignore so much of what he said and did in the actual world--and 2) imagine some set of hypotheticals to get to a gauzy view of his administration's pandemic response.
You will notice that when I trafficked in hypotheticals, I always wrote that this stuff is very, very hard and that it is entirely possible that other administrations would have failed. And you will note that what I expressed anger over was the lack of effort combined with the actual things the Trump administration did and the attitudes that governed it. I'm not mad that Trump didn't deliver; I'm mad that he didn't try. And I think that the lack of effort is downstream of the basic pathologies of his administration.
Here's what I believe about a hypothetical Clinton adminstration response to Covid: it happens in a world where so many things are different--politics of the moment, personnel in jobs, policies enacted in prior years, economic and geopolitical circumstances--that we have no f-ing idea what would have happened.
With regard to the actual Biden administration, I have a laundry list of complaints; I was an "open up" guy in fall of 2020, when I pitched that very idea to the sensei at my martial arts dojo (you can find my excessively detailed written proposal online). But you wanted to talk Trump and how his instincts on pandemic stuff were right, so we talked Trump. If you want to open up a different line of conversation, we should do that. But that's a different line of conversation. It doesn't solve any of the problems with Trump Covid policy.
Do you think Trump was following an actual plan to deal with the pandemic in the most responsible manner possible or was just doing what he felt would serve his reelection and ego the most?
What I find frustrating about this debate is how much it leaves out.
Operation Warp Speed achieved some great stuff in terms of funding / incentivizing vaccine development. But it could have achieved so much more if the rollout had been well managed with a lot of federal government logistics muscle on the development and deployment side. I genuinely believe that Trump would have won the election in 2020 if thousands of people had been able to show up to national-guard-run vaccine centers and get needles in arms on the day the thing was approved. Here in Philly, that DID eventually happen--but not until months into the Biden administration. The delay and disorder literally killed thousands of people.
But logistics is hard, and the Trump people were too incompetent to make it happen, even though it was clearly in both their and the public's best interest. And that's what I fear about the next four years: the malice is bad, but the incompetence is worse.
I thought the first emergency use authorization in the US didn't come in until after election day? Do you mean Trump should have pushed the FDA harder on faster approvals?
I think this plays out in a lot of ways, actually, so let me just offer two examples:
1) The EUA was dependent on the outcome of clinical trials. Clinical trials are basically a massive logistics problem with multiple pieces, i.e. you have to organize participation, you have to produce enough of the vaccine to use it, you have to decide on structural questions like dose size. BUT...
You can absolutely drown a lot of those problems in money and logistics muscle, if you want to. Just to take one example, you actually DON'T have to make as many hard decisions on dosing if you just literally run multiple simultaneous trials at different dose strengths. The dosing thing actually came up specifically during the Covid trials, which is why I am thinking about it.
But this kind of thing is legitimately hard. The players in private industry want to keep control of their process and are going to resent the government's involvement; you may recall that Pfizer actually rejected significant parts of Operation Warp Speed because they wanted to keep more control of their product. Clinical trials are a huge pain in the ass. The production bottlenecks on Covid vaccines were real, particularly for the novel ones. These are all solveable problems, but they are difficult problems. BUT...
2) A thing I think that people still do not realize is that although we keep talking about "novel mRNA vaccines," the novelty was in the rollout, NOT the technology. The Covid vaccines were essentially off-the-shelf tech that had been developed by researchers in response to PRIOR CORONAVIRUS THREATS, especially SARS. The tech never made it to market because the SARS and MERS pandemics were the dog that didn't bark, for epidemiological reasons--those two never made it to general transmissibility (SARS basically makes you too sick too fast to actually be good at moving through the population). So researchers developed the mRNA vaccine tech, but then it got shelved because vaccines are, frustratingly, a lousy, low-profit-margin business with a lot of associated corporate PR risk owing to the anti-vax movement.
So it is possible that the mRNA vaccines would have failed; a lot of promising stuff in medicine fails in unexpected ways. But the reason it could roll out so incredibly fast is that the truth is we already had it--the core research had been done. We just weren't using it. That's also why Pfizer was willing to abstain from parts of Warp Speed; they were pretty sure it would work because it wasn't actually novel, and they wanted to maintain control of as much of the IP as possible.
But all of this highlights just how much low hanging fruit was left on the tree. Operation Warp Speed backed up a dump truck of money to some private companies and then asked them to manage a massive public health campaign. And they did an okay job in many respects! But that kind of thing--massive production of goods for managed delivery to literally the entire general public as quickly as possible--isn't actually what those companies are structured to do.
If you want to see how this failure works, look at the attempted Operation Warp Speed for ventilators, where the administration was going to incentivize GE to crank out vents for hospitals. It was a big nothing burger. The private sector simply did not--could not--deliver the needed vents when they were needed, and then as we learned to manage the disease at the hospital level, the vents were no longer as critical, so everybody just kind of muddled through and forgot about whatever Operation Vent was, except, hilariously, for Trump, who still brings it up publicly from time to time as something he should be praised for.
3) Rinse and repeat this story for testing, plus add in some screw-ups at CDC, which the Trump administration COMPLAINED ABOUT BUT DIDN'T FIX. Which is basically all you need to know about competence. Competent people fix things. But the Trump people had know idea HOW to fix things, because they had not cultivated that kind of internal expertise at managing a technocracy.
4) Rinse and repeat for PPE, plus add in the bit about how the administration had deep-sixed the automated factory project intended to solve precisely this problem.
Look: I want to be clear, here. These are very, very hard problems. Like, way harder than they sound when I describe them. I was a public health academic before I was a nurse, and I studied pandemics and infectious disease response (among other things), so I want to be clear that a competent administration might still have fumbled the ball on this. It requires an enormous level of money and muscle--note that other countries didn't step in and do this stuff. But the US has, at least on paper, the resources and expertise for even so Herculean a task, and I think given the will and competence, we could have worked that miracle.
But instead our leaders spent the summer fanning the flames of race riots in our cities, and instead of using our national guard and military logistics muscle to set up vaccination centers, we argued about whether to deploy them against protestors. And I think that was the real disaster that most people can't even see, because they lack the knowledge and imagination to understand what was possible.
You seem like you're deep in the industry so what am I mis-remember on 2)? I thought the big story pre-COVID about Moderna and mRNA in general was how the technology was struggling with safety and they kept over-promising and under-delivering.
"Despite the promising trials with mRNA based therapeutics in laboratory settings, the facts remained that mRNA is highly unstable inside the body and prone to degradation by immune agents and nucleases, possesses a high potential for adverse immunogenicity, and initially generates weaker protective immunity than conventional vaccines [37]."
So the question to ask yourself, here, is, "How far, precisely, were we from developing functional versions of mRNA vaccines in January 2020?" And you have an actual, precise, real-world answer to that question: three months. They started the first safety testing in humans in March.
Three months is just nothing, in "scientific breakthrough" terms. If two different companies could arrive at a solution within three months, then the solution was not very hard to find. Does that make sense?
So the obvious secondary question is, "So why didn't they roll this tech out earlier if it was so easy?" And the answer, as I wrote in my prior post, is that the market did not support it, for a variety of deeper structural reasons that are why we have certain other kinds of persistent problems in public health. Public health is just, in general, bad as a profit-making business for Econ 101 reasons. This is why I come back to that Operation Warp Speed's money was absolutely a helpful thing to do. I am a big fan of throwing money at certain kinds of problems.
But then ask yourself: do you think Pfizer would have taken its shot on vaccine development absent the Warp Speed money that it, in fact, chose not to take? And I think the answer is probably yes. I still think that promising the government bulk purchases of vaccine was good, and I also think that assurances given shielding the companies from certain kinds of product liability were also good. Like, I think that Warp Speed achieved some stuff.
But I think what it achieved was way, way under the threshold of what was possible and way, way oversold in terms what it actually delivered versus what the private sector, acting in its own interest, would have developed. It's like government was a power screwdriver, and we used it to bang in some nails and felt very clever. You can absolutely hammer nails in with the battery pack of a heavy screwdriver. That doesn't make it the best use of the tool.
“ versus what the private sector, acting in its own interest, would have developed”
Ah, I was trying to figure out your counterfactual! So you think that a more hands off federal government could have done better? I guess, like, no FDA approvals required for vaccines? But also pharmaceutical companies can charge as much as they want for vaccine doses? But, presumably, you’d still have government enforcement of intellectual property in pharmaceuticals, and probably also you have to shield them from liability.
Is that right more or less?
I will 100% agree that this hypothetical semi-Libertarian World could have completely crushed us on vaccine development and rollout. I bet CVS would have been selling vaccine shots for $1000 a pop in like, May 2020.
Yeah. This is why I come back to, "these problems (logistics, distribution, organization, etc.) are very, very, very hard, and even if people had tried to solve them, they definitely might have failed." As I pointed out, it's not like any other country picked up that challenge.
In gift stores in primarily metropolitan, but also liberal small towns, there are always little bobbleheads or candles that have certain cultural icons on them. People like Obama, Ginsburg, Jane Fonda, etc. Basically, to be put on one of those is a sign that you're above criticism in polite liberal society.
I think a lot of the criticism fauci got from conservaties was B.S, but his face got slapped on those bobbleheads and candles too. And I think that's indicative of his complete saint like status in certain liberal circles. People were just completely shut off from criticizing him. And in retrospect, it was needlessly divisive and stupid.
He got into the saint role because Teump acted like a crazy person and Fauci stood his ground on some basic facts about the virus.
If Trump says yes Fauci is correct, we're asking the CDC to find a middle ground that keeps schools open and helps the economy you wouldn't see the rupture. Fauci worked with every president from Reagan to Trump and didn't split with the other guys through multiple health scares.
True! But he also treated some concerns about NPI's that many people had as right wing talking points. This was a broader problem in public health discourse and sowed distrust in the institution.
Do you really think he sowed the distrust? I was never confused by anything Tony said. Seems to me it was Trump first, contradicting what his own experts were saying, then a whole host of opportunistic self-appointed experts - mostly but not exclusively on conservative media - who skewed the hell out of the story. In any case, Fauci was doing what the top public official in the country should do in the face of a pandemic caused by a novel and wily pathogen: giving the administration and the populace advice for how to keep the greatest number of people alive based on the information they had at the time - information and therefore advice that changed as scientists across the globe raced to learn more about the virus. It was up to the administration decide how to balance the implementation of that advice.
Oh, the disconnect between the feds and the thousands of local health departments and school districts was a big contributor to the confusion as well. Then the whole thing became partisan (one of most regrettable turns in American history) and we were off to the races.
He’s still seen that way too. I went to the recording of the Wait Wait Don’t Tell Me ep he was on at Wolf Trap. The crowd gave him three full standing ovations. A woman in front of me kept pumping her hand in the air like she was at a revival meeting. It was weird.
Yeah i understand this is annoying but it's crazy to me the extent to which people like Nate Silver and other centristish folks who I normally respect basically thought annoyance with suburban liberal culture was sufficient reason to vote for trump.
"It is likely that I’ll vote Democrat for president again in 2024. I would certainly not vote for Trump, DeSantis or Vivek Ramaswamy, though I do see Trump as being much more of a threat to democracy than the other two and I think there has been too much equivocation about that."
Yes this is true. However if you listen to his Ezra Klein show appearance there's a whole section where he talks about how homebody liberals are annoying. But where's the disdain for dumbass antivaxxers?
Fauci is a really interesting case. In early 2020, I was happy that he was there, because he had been famously wrong on HIV but been willing to learn lessons. The deeply fraught relationship between Fauci and Larry Kramer is part of what I respected about Fauci. (Kramer was a relatively early Covid death, but famous for his aids activism where he called Fauci a killer for not legalizing experimental treatments.)
He was Director of the National Institute of Allergy and Infectious Diseases, a part of the White House Task Force on Coronavirus and de facto spokesman for the federal government on COVID.
Sadly, I think most people made up their mind about Trump many years ago and will never change it. Orange Man Bad or Orange Man Good, which is why his popularity was hardly affected by his disastrous leadership during COVID, or by leading an insurrection, or by his many other crimes.
Experience has told us that when Trump said he could shoot a man on Fifth Avenue and not change anyone's mind about him, this was not hyperbole.
I am not optimistic that his supporters will desert him even when his policies hurt them personally. They just won't blame him for it.
One thing I've told friends is that I'd find the election results meaningfully less depressing if Trump bragged about the vaccine. Obviously he wasn't in the labs but it's the kind of thing it's totally normal for politicians to take credit for and it makes the Trumpstalgia narrative way more coherent (economy was great first three years, COVID crashed it but Trump signed a bill creating a big, beautiful vaccine). Instead, he basically never talked about it and got booed the one time at a rally he did bring it up.
It will never cease to amaze me that he didn't brag about the vaccine. This is the guy who went to twitter to brag about the fact that there were zero *global* airplane traffic deaths in 2017 or 18 or whatever, as if he made it happen. He used to troll twitter looking for virtually any positive news, then construct a brag tweet taking credit for it.
And so, of course, I mean, obviously, he distances himself from his administration's greatest achievement. I mean, that's right there, in the middle of my 2019 bingo card. Totally saw that coming.
It's amazing. Trump doesn't even want credit for the few good things he did, and he gets no blame for the bad things except from people who were against him all along. Nothing sticks to this guy. How does he do it?
(The first things that come to my mind are the common accusations that his supporters are idiots, and that their diet of legacy and social media consists of nonsense and propaganda -- but I personally know lukewarm Trump supporters who are generally quite smart, and just think that Trump is bad but the left is even worse. Also, Trump personally attracts more intense and more committed love and hate than most political figures. The left has become more radical since the mid-2010s, sure, and there is something about Trump's personality that is polarizing -- but is there a structural reason for these things to pick that point in time rather than another? Maybe the spread of social media, with a few years lag? Or the destabilizing effects of rising inequality? Or backlash to the changing ethnic composition of America?)
Ok, you think Trump is responsible for blue state mask mandates and school closures, lol.
Unfair?
It's not as bad as "lol who was president during all that stuff you're complaining about?"
80% of human-generated internet content over the last two months has been "The president isn't responsible for inflation"* If you want to hang NPIs on Trump, you've got to do better than that.
This is stage four rhetorical cancer. Nuclear-grade self-delusion. Every upvote for your comment is vote to stop thinking and just fling shit at your opponents.
* Except on the rare occasion when someone's giving them _credit_ for "favoring employment over inflation"
If this is a serious response and not just trolling, please tell me what you think Trump could have done that would have actually made blue America adopt different mask mandate and school closure policies.
The CDC guidelines related to what a safe indoor space looked like. They didn't say just keep schools closed.
All early pandemic playboys say close the schools early on because not knowing anything, kids are likely to be a large spreader of a new virus.
Trump could have said, we're investing $$$ into air filtration for schools and we will ensure they're all able to open in the fall. A competent executive makes that happen.
I mean, we'll never know, but he could have tried having the CDC give better advice. If the idea for NPIs hadn't come from the federal government, where would it have come from?
And yet blame for inflation did stick to Biden and Harris like glue. And that's with inflation's huge drop by 2024! It's like "we'll blame you for what happened about two years ago but not credit you for fixing the problem."
The contrast with Trump's CDC and NPIs couldn't be starker.
The post-vaccine Biden era restrictions would’ve made sense if Long Covid really led to almost permanent disabilities for a significant number of people. Despite some series cases the initial double digit % numbers were fortunately completely wrong and never retracted and the topic seems to have been completely memory holed. If Covid really led to permanent damage to a large percentage of the working population things would’ve looked quite different.
It’s not totally obvious that the early numbers were wrong - it wouldn’t be totally surprising that somehow people got incidental exposure to bits of Covid strands once most people had been infected and vaccinated multiple times and copies of the virus were everywhere, but that for people who got infected with literally zero prior exposure to the virus, it had different effects. Theres so much we just don’t understand about viruses or the immune system.
I think it was about expectations. You mention it began to wind down in December 2020, but it didn’t fully wind down. 2021 had several nasty variants, the vaccines did not work as well or as initially advertised, and there were still school closures and disruptions into 2022. There was lots of general angst and strong policy disagreements in 2021 about continued mandated use of NPI’s, Biden’s attempt to mandate vaccines via OSHA in late 2021, etc.
Guys, it was so authoritarian, I remember. Literally I was radicalized by the Biden administration (and blue states) COVID policies. The government was suddenly very intrusive in my personal life.
Remember how after 2008 people joked we should stop giving out Nobel prizes in economics? I feel like after COVID we should just shut the federal public health establishment down.
I've fully admitted here that vaccines are my most authoritarian position, so I'm willing to own the label if you must, but a mandate through OSHA always made the most practical sense to me. I probably would have had more leeway for jobs with lower transmission risk, primarily ones that overwhelmingly work outdoors, but I just don't see a couple jabs as some huge personal intrusion in the face of impeding the intrusion of disease in others.
What am I missing? I thought the consensus is now "the impact of vaccination on community transmission of circulating variants of SARS-CoV-2 appeared to be not significantly different from the impact among unvaccinated people."
Like I said in another subthread, suppressing transmission isn't the point, it's damn near impossible. Blunting adverse health impacts while transmission occurs is what the goal is.
This is some dude's letter to the editor interpreting another study. There were other letters, e.g., this one, saying the original study's results may be confounded by age (the authors try to rebut this though): https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00763-5/fulltext (note that the authors of this letter wrote their own study based on data in the Netherlands showing there was an effect on transmissibility)
I would be more open to this authoritarianism if there was much more certainty about the safety and effectiveness of the vaccines, particularly on transmission. The OSHA mandate would be primarily mandating low risk people (prime age workers) get vaccinated to hypothetical benefit of other people (the very elderly). To me it also matters that this formulation had young healthy people sacrificing for old sick people.
There's no adult mandate for the pertussis vaccine even though there ARE babies who die of pertussis before they are old enough to be vaccinated.
Seems like a really low value moment for Democrats to have taken their shot for authoritarianism.
"sacrificing" is doing a lot of work there. Let's not overstate the case: any risks from the vaccine are miniscule. It may not pencil out for some cohorts, especially children, but we're still talking about incredibly small numbers here. Now as it turns out, mandates probably didn't/wouldn't have mattered in aggregate (I think?), but they weren't poorly conceived at the time.
I have never had a good experience with the covid vaccine and I have gotten every booster. Lots of people reasonably say "that was not fun" after the first jab. I understand why people need the vaccine but also am empathetic to folks who don't want it.
I really wish they would run some studies on smaller doses of vaccine. I’ve heard rumors that they all proposed bigger doses in their trial just to be sure it would work on the first trial, and then once it was approved, there’s little motivation from either side to run a new trial with smaller doses. But Moderna has more awful next-day effects and has twice the dose of Pfizer, while being only moderately more effective, so there are likely other points on the curve where people would get better tradeoffs.
I flew the day before and the day after it was lifted. It was amazing how people's spirits seemed lifted afterwards. IIRC, ~75% of the passengers dropped the masks, not to mention the whole flight crew.
It's true, but it's also perfectly consistent with hardcore Trumpist political philosophy, whose proponents believe that Trump (or whoever the leader of their movement is in the future) merely being "the guy in charge" isn't sufficient to fix the country. If political opponents are allowed to oppose him in Congress and act independently of him in states and cities, then that ruins everything. If anything bad happened on Trump's watch, then all of the blame should go to the political opposition, and the solution should be to neutralize all competing sources of political power.
I agree broadly with the thrust of this piece but think you badly misread the role Bhattacharya played in the last pandemic.
A strident critic of NPIs, even to the point of controversy, with conventional views on the deadliness of covid, would maybe cause similar controversy but would not be as alarming to me.
But Bhattacharya’s M.O. during the pandemic was to stake out a contrarian position on the deadliness of covid, produce poor science to support that position, and misinform people of their personal risk of morbidity and mortality in appearances on conservative media. This began as far back as April of 2020, when he co-authored and pre-released a study with serious flaws suggesting an IFR about a tenth of the consensus (and the consensus was right). I do not have time before work to cite all this in full, but I suggest this piece from Andrew Gelman of Columbia on the quality of the work that shot Bhattacharya to fame in conservative circles: http://www.stat.columbia.edu/~gelman/research/published/AssessingEvidence.pdf .
Bhattacharya is the opposite of someone who could credibly approach trump about the deadliness of a new pandemic - not because he wouldn’t be credible, but because he would almost certainly conclude again that the deadliness of any virus is overblown, especially in the earliest stages when interventions can actually be effective, and would use his credibility to prevent an appropriate response.
People should read the piece by Andrew Gelman linked in the comment: it is short, well-written, and makes several very good points about the weakness of the study.
It does not, however, support this level of hostility to Bhattacharya.
As Gelman himself wrote, Bhattacharya's team's inferences were consistent with the data, just overconfident. Recall that the Santa Clara County study was *published* in April 2020. That team was hardly the only one getting over their skis.
Your comment is fair minded, and you are right to suggest that the article is not sufficient to justify my view that he did not correctly assess the severity of the last pandemic, and persisted in error to the point of misleading people about their risk levels - the IFR controversy probably requires a book, and I’m not the one to write it. In lieu of that, I think a short summary (with which I agree) that addresses the points you raised can be found here: https://www.econlib.org/the-pessimists-were-correct-about-covid/ . In it, you’ll find a quote from Bhattacharya from November of 2020 in which he makes demonstrably false claims about the deadliness of covid for under-70s (much later than April, which as you note was early enough that many people got things wrong).
The study I linked to at the National Institutes of Health says: "For 29 countries (24 high-income, 5 others), publicly available age-stratified COVID-19 death data and age-stratified seroprevalence information were available and were included in the primary analysis. The IFRs had a median of 0.034% (interquartile range (IQR) 0.013–0.056%) for the 0–59 years old population"
In the one you quote, Bhattacharya is criticized for saying it was 0.05% for those under 70, which actually OVERSTATES the IFR. Seems Bhattacharya is more correct than the author of that page.
I would like to engage on the substance of the paper (with which I am familiar), but do not have time this morning. I will point out:
1) the paper you link was written by a group of authors who dedicated their pandemic research output to producing work that suggested a contrarian IFR for COVID, including at least one who was a co author on the April 2020 study I mentioned.
I agree that it's fair to hold Bhattacharya responsible for his November 2020 statements, but he may well have been more accurate than his opponents at that time!
In the article you linked, Sumner is taking him to task for estimating an 0.05% IFR for under-70s. Per Sumner, that was ridiculous because, 14 months later (when Sumner was writing) 0.10% of Americans under 70 had died of COVID. Indeed, the best information I can find now estimates that cohort's IFR was roughly 0.10%* If true, Bhattacharya was off by a factor of two, which sound really bad at first blush! But well into 2021, I recall many epidemiologists arguing that the IFR would be significantly higher, often approaching 1%, which would have been off by a factor of twenty! (Those estimates probably weren't apples-to-apples, which complicates things.)
I agree about the IFR controversy, and I'd love to read a solid retrospective that incorporates everything we know, including seroprevalence studies, wastewater monitoring, antigen test regimes (at colleges), etc..
Agree with you on the rest of your comment, but I don’t think 1% was ever an IFR estimate for under-70s; it was the first-wave consensus IFR overall for places with age distributions like the western world. The early UK IFR estimate from Ferguson which Ioannidis, Bhattacharya, and co criticized relentlessly was 0.9% overall, not among under 70s.
Indeed - it's not apples to apples, and it's difficult to find age-stratified estimates from that time.
It feels a lot like an isolated demand for rigor, though, where Bhattacharya's errors aren't compared to any real-world baseline. (That's one of my problems with Sumner's article: Ferguson and Bhattacharya's projections were different along several dimensions.)
For all of human history up until the 19th century half of all kids didn’t reach their 5th birthday. And that was almost entirely due to communicable disease. If you managed to hit 5 you could fairly often, like Ben Franklin or Louis XIV, live into your 80s.
The idea that kids don’t get sick and die is a very new development historically. There is very little evidence that kids are less susceptible to communicable disease than adults. As anyone who’s has kids at daycare can attest.
As a perhaps dated pop culture reference remember the Seinfeld episode about how vomit streak? It’s funny because people remember being a kid and getting sick and throwing up fairly regularly but that’s something that happens very rarely if at all as an adult.
TLDR - for many of you your mental model of disease is a modern one and it’s about non-communicable disease processes - cancer, stroke, heart attack, etc. Disease processes of the old. For most of human history half of us were dying at 2 of scarlet fever or whatever.
Not to mention malnutrition, vitamin deficiencies, drowning, car accidents, poisoning, etc.
It should be obvious to anyone who has kids that they are incredibly fragile up to around five or six, at which point you've likely watched them have every symptom of every weird infection that babies and toddlers get and watched any number of close calls where you thought "if it weren't for <common safety measure> my kid might have died!"
Now that we fortify foods and vaccinate kids, a bunch of idiots have come to the conclusion that the problems these things solved never existed and, actually, that it's a huge conspiracy and these things are really bad for kids so they should all be drinking raw milk or whatever. And, you know, it's just a huge coincidence that a bunch of kids get the measles when kids at their school aren't vaccinated.
I don't "get" the raw milk thing at all. Best I can tell *all* the supposed benefits to raw milk (e.g., lactase / probiotic bacteria) are actual benefits for fermented milk (i.e., kefir) but they're not actually in raw milk. It's so dumb. Like ... just drink kefir?!
People like to push it in terms of “benefits” but I think the real thing is the actual taste and mouthfeel and all that. Pasteurized and homogenized milk has its charms, but it’s different from real raw milk, just as orange candy is different from a real orange, and Hershey’s chocolate is different from a single origin bar, and so on.
Kefir and all the other traditional cultured milk products have their own taste and place but they can’t substitute for each other if you care about the sensation.
Now is it worth caring about the sensation enough to be worth the small risk of getting contaminated milk? Most people don’t think so, but should government decide for us? Maybe it’s reasonable for them to ban commercialization, the way they ban commercialized BASE jumping. But I can see how people get to the idea that they shouldn’t.
I find it frustrating that the same people who think the DSM-5 is a bunch of woke nonsense are totally convinced that autism spectrum disorder is a greater threat to public health than communicable diseases.
I mean it’s obvious to anyone with a functioning brain that autism diagnoses have increased because they’ve expanded the definition to include a lot of kids that past generations would have just called nerds.
Oh but the rise in autism diagnoses is also correlated with a rise in vaccination rates and, as we all know, correlation = causality. Except for the correlation between guns and gun-deaths, that one remains a huge unsolved mystery.
That’s certainly part of it. But there has also been a rise in childhood myopia and childhood obesity in recent decades, that aren’t just changes in diagnostic criteria. It’s not out of the question that there’s some real change (though being convinced that it’s vaccines, and *also* making the *further* step to thinking that this would make vaccines net negative, are both unwarranted).
"Now that we've solved this problem, people can be easily led to believe it was never a problem" is a curse of modernity I never would have imagined when I was younger. It really sucks for society.
“ Jerry and Elaine stop at Royal Bakery to purchase a chocolate babka while Kramer and George go to buy wine. Jerry and Elaine forget to take a number at the counter. As a result, David and Barbara Benedict, a couple on their way to the same dinner party, get ahead of them in line and purchase the last chocolate babka. Jerry and Elaine resort to purchasing a cinnamon babka, which Elaine considers a "lesser babka". They find that the babka has a hair on it, and are forced to wait in line again to exchange it. While they wait, Jerry eats a black and white cookie, which he extols as a metaphor for racial harmony. Once they are called again, Elaine and Jerry exchange the babka for a new one, only for the seller to violently cough on the new one. Afterward, they have to wait for Kramer and George to pick them up. The cookie causes Jerry to end the non-vomit streak he has held since June 29, 1980.”
Ah, thank you, I do know that episode (Jerry concludes that his B&W cookie must have consisted of Farrakhan and David Duke), I was confused by "episode about how vomit streak," which I'm guessing is a typo for "non-vomit streak."
I think that episode is the whole reason as a kid I learned about babka, black-and-white cookies, and that there was a baked good named after Napoleon.
Allow me to vent...as a the child of a public school teacher (and union rep!) I will never forgive the Seattle Education Association (teacher's union) for keeping my first-grader at home until April 2021, and then going back half-time. And requiring masks for kids in fall 2021, despite everyone having been vaccinated. And then going on strike to delay the start of school for a week in 2022.
They lost all credibility and SPS attendance has dropped to the point that school closures are necessary.
This makes me feel especially grateful we were in Rhode Island - a blue state - but our governor (who is now Secretary of Commerce) was paying attention to the data and really pushed hard for schools to reopen quickly. She got a ton of parent pushback. But she was on TV every week early in the pandemic trying to persuade people to send their kids back. My son started in-person preK in June 2020 and my daughter in-person 2nd grade in fall 2020. I was so nervous about it then, but so grateful for it now.
I'm pretty worried about a public school death spiral out here - seems like a lot of chatter I'm hearing is from folks who want their kids in public school in theory, but don't want to be "holding the bag" by being the last ones to pull out. Really bad situation, especially with a simultaneous budget crunch. It feels like some prominent elected official (mayor? governor?) will need to come out and say "we're done with social engineering attempts, the only metric we care about is academic performance" to reverse the trend.
Same here in IL. Except our stupid and selfish Chicago Teacher's Union went even further and walked out in January of 2022. These actions created a huge outflow from the city back to the suburbs. I don't see this reversing for an entire generation until we have another city collapse like in the late 90s.
Fall 2020-winter 2021 I might have had a little grace, especially if too many people were getting sick to even be able to run a school, and also with knowledge of vaccines around the corner. But post-vaccine, yes, let 'er rip, proceed normally, and get to work.
There is a question about what “proceed normally” means. What are the conditions under which a school should mandate that a sick student stays home? The 2021 version where any symptom means staying home is too strict, but the Florida version of “come in even if you have measles” is surely not right either, and I don’t think it’s clear we had the best balance in 2019.
That was very bad, and I'm genuinely sorry to hear that.
I teach in higher ed in the UK, where (like in most of Europe) school closures were much shorter than in lots of US urban districts, and the effect of even relatively short closures on students were devastating - even for affluent students. We're still seeing students who are functionally illiterate and innumerate (and we're pressured to allow them to get undergraduate degrees, which is a whole other thing I could rant at length about) as a result of those closures. Remote schooling doesn't work for any but the most high-performing students (who'd probably thrive academically pretty much no matter what).
>"Conservative rage against the public health establishment led them to hypercorrect against claims of vaccine effectiveness and downplay the virtues of vaccines that were genuinely quite virtuous."
I think many people even now underestimate just how large this effect is. I spent most of this last year in the south and midwest, and multiple strangers I talked to randomly brought up that this is what they believe (though they didn't think of it as a belief). In the more extreme instances, I was told that the covid vaccine killed or injured (and is still killing or injuring) absolutely massive numbers of people,. In two cases, that they personally knew multiple people in their small town that died because of it. In one case, they were convinced there were two versions of the vaccine, neither of them effective, a placebo given to liberals and a "death shot" given to conservatives.
I listened to the Politix podcast on my train to work this morning and both Matt and Brian agreed there is a real danger to RFK Jr's nomination even if he is completely ineffective changing anything substantive at HHS for the reasons you cite. This nomination is a giant signal flare to Trump's biggest fans to indulge in anti-vax crankery full stop. Not just covid but vaccines in general.
Really one of the top areas where not listening to experts is actually deadly. I suspect that most regular people don't realize that the pure anti-Vaxers are still small enough that they are "free riding" on the fact that 90% of us are vaccinated against all sorts of diseases. I think we are rapidly getting to the point where vaccination will dip below the proverbial "Mendoza line" and we can have serious outbreaks of diseases like measles.
RFK shouldn't be anywhere near the HHS organization and nominating him to that role is irresponsible. I'm hoping the Senate will fail to confirm him (and Gaetz) in a couple of months.
Him, RFK jr and Tulsi. My friend has convinced me that Tulsi is probably most dangerous given we have serious doubts about her actual loyalties (we clearly have a source somewhere close to Putin. Whoever that is I would seriously consider trying to find a way to flee).
Pete Hesgeth is also a terrible pick. Besides the assault allegations, just not qualified. But I’m trying to be realistic about how many cabinet positions can be blocked. So Ill grudgingly take it if the other three are denied
Even if Gabbard isn't a traitor, the fact that there's enough question marks around her would mean our allies would be reluctant to share intelligence as freely as they traditionally have done.
Honest to god. If it becomes clear that she will get confirmed I really hope Biden raises alarm bells to our allies to withhold sensitive intelligence.
Being a nurse doesn't necessarily mean that you know a ton about medical science.
Like, don't get me wrong: some nurses DO know a lot about medical science, and found that that flowed naturally from their training. But others learned a lot of basically specific trade skills to do with medical procedures, and maybe a few isolated principles relating to a few areas, and never put it into much of a framework.
Among other crankery. Since the announcement of RFK Jr. I’ve noticed a lot more raging about seed oils and GMOs. The sort of things we used to associate with cranks on the *left.*
Again, right-wing cranks getting into hippie-coded crankdom isn’t new (the homeschool movement is an older example) but this is going to end badly.
Unlike other kinds of crankery though, this one in particular has a sort of self-correcting effect: unvaccinated folks have a higher risk of dying, which over the long term, uh, "adjusts" the prevalence of that belief in the population. And people aren't total morons - they'll eventually pick up on the fact that folks with this theory of the case are having worse outcomes, and quietly start getting vaccinated. Like, as long as vaccines aren't banned, I'm happy to continue getting my shots and just seeing this contagion of stupidity work it's way through the population.
The selection effects here aren’t nearly strong enough. Even if every unvaccinated child gets measles, most of them survive just fine, and the fact that a few vaccinated people will get breakthrough cases too will muddy the waters about the effectiveness of the vaccine (which we’ve seen plenty of with Covid).
The other issue is if there is enough unvaccinated people to create outbreaks you substantially increase the possibility of mutation which means even vaccinated people may not be protected
I think you underestimate the danger to children. Anti-Vax people are likely vaccinated against all sorts of diseases in childhood. Anti-Vax crusade is more likely to lead to outcomes like polio coming back and afflicting innocent kids who had no choice in the matter to not be vaccinated
A common thing on college sports forums in the SEC is trying to make a connection between an increase in cardiac events involving healthy young athletes (think Bronny James or Christian Eriksen) and COVID vaccines. These people are genuinely very stupid and deranged.
In my shittier and more intolerant moments, whenever someone goes on at length about the side effect risks from the Covid vaccines, I reflect on my zero side effects across four shots (across three different countries, as it turns out) and think, trollishly, "I guess I must just have superior genes."
So that there's no confusion, I'll reiterate the "shitty" and "intolerant" aspects of the above. Not my brain's finest work, to say the least.
Searching for the positive in what could happen in the next four years, one thing that would be great is a tota ban on gain-of-function research by virologists. Regardless of where you stand on lab-leak vs natural origin it’s still shocking to me that the pandemic didn’t spur massive change in this area. Even if one doesn’t believe in a lab-leak, it’s clear that having done all the dangerous research didn’t lead to any actionable information to prevent the pandemic, so what could possibly justify the risk.
I can’t understand why this isn’t a bigger deal for the Covid-phobic. I find myself rooting for Rand Paul, and it just doesn’t feel right. Why aren’t more people motivated to pursue this?
It’s not just the risky research, it’s doing it in labs that aren’t safe enough, that plenty of people *knew* weren’t safe enough. Stopping it seems like an obvious political win for anyone who wants to step up (beyond Rand Paul).
Yeah, it would be one thing if they were doing this research in top secret bases in the desert guarded by military with few interactions with the outside world.
Sure, but what will they gain by that? Besides it's utility in designing biological weapons, which, as far as WMDs go, seem like the stupidest kind (see: Covid). The reason to ban it is because the risks out weight the benefits both locally (you are much more likely to have a lab leak than develop a successful, hyper targeted biological weapon) and globally (you are much more likely to have a lab leak than to develop counter measures to some future, unknown virus). Unlike AI or missile technology, where banning it could theoretically give a bad actor a leg up in the arms race, pursuing this research just never seems to meet the cost/benefit threshold, regardless of what your opponents are doing.
I'm still somewhat amazed at the worldwide reaction to a disease with such a low infection fatality rate (IFR). For those under 70 years old, COVID (across all its variants) was just not that much of a risk. And yet officials and the media exaggerated the risks and implemented extreme measures in cases all across the developed world.
I recently saw this scientific paper analyzing IFR by age group for the pre-vaccination period. It is eye-opening. I know the "fog of war" applies to more than just military engagements, but I do wonder how much of this was known at the time and why it didn't inform the communication strategy and NPI measures more directly.
20/20 hindsight. The hospitals were full at one point and few of those people survived initially. There were tremendous advances in treatment in the first few weeks/months.
What would your ideal policy have been in March of 2020?
Some (not many) were full, but as the study notes, "However, in depth analysis of population data of health utilization show that for the non-elderly (and even more so for children) the number of hospitalizations was shaped initially in many countries by the precautionary principle, admitting many people to the hospital, especially early in the pandemic, while hospitalization rates declined over time."
The hospitalizations were due to the panic, not just the pandemic. And the idea that "few of those people survived" isn't true.
My understanding from people who were there is the main issue was with the severely obese more so than the elderly. Although the obese elderly were really fucked.
The article seems to suggest the 28 year old's double lung transplant was "due to covid", but if you read it more closely it was covid -> "low oxygen levels" -> ventilator -> bad reaction to ventilator -> double lung transplant.
Putting otherwise healthy people on ventilators because of low oxygen levels was a failure of the "first, do no harm" principle. It was good that we stopped doing that, but not very excusable that we were doing it in the first place.
Sure, but a ventilator was an extremely intensive and risky response to what was not a serious problem.
If they were putting people on ventilators as part of a "medical panic" during covid, that should be a scandal. If they were putting anyone who was 28 and had low oxygen on ventilators as a normal course of action prior to the pandemic, then that should be a scandal, as well.
One of the things that was shocking in early COVID was that people had much lower blood oxygen levels than doctors were used to seeing in anything other than extreme pneumonia. If you were always trained that blood oxygen below 90 means severe risk of death, then the ventilator seems like a worthwhile risk. But surprisingly, COVID often seemed to produce low blood oxygen levels in ways that didn’t obviously cause other harms.
I don’t know if it’s because past measurements were just missing cases where low blood oxygen arrived in less dangerous ways, or if there’s something about how COVID distorts blood oxygen measurements or what.
I mean, over a million people died in the US alone. Think of how American policy changed for about a decade when 9/11 happened and killed a fraction of that.
Beat me to it. The IFR might be low compared to greater pandemics past, but that's still a ridiculous amount of people dead, to say nothing of the many more who suffered, plenty of which needed hospitalization.
But these numbers are due to the fact that there are vastly more really old people than there used to be. Now that we are up to 330 million people, everything is "worse" in the sense that there are more people to be impacted.
I guess the question is "matter for what"? I'm not sure if you are suggesting that the population size of a country should impact how seriously it take a pandemic, but that seems a bit illogical to me.
If it's not about total numbers, but instead about the impact of 1 million from covid vs deaths from other causes, then the usual public health technique has been to convert deaths to years-of-life-lost, or sometimes years-of-healthy-life-lost, in which case each death from, say, the Vietnam war (50 or 60 years lost) counts for much more than each death from covid (on average 5-10 much less healthy years lost, maybe?)
By this weighting, our current overdose crises begins to look a lot worse than covid, probably equalling it in years-of-life-lost every two years.
But these things can't be reduced to pure math equations. 9/11 was bad for many, many reasons beyond the number of people killed. The pentagon was partially destroyed, for example.
Whatever we say about the difference between pre-9/11 life and post-9/11 life, it pales in comparison to the difference between December 2019 or December 2024 and April 2020.
I think you’re forgetting how scary the fact that Covid was new really was. Are there researchers who maybe knew in February how seriously dangerous Covid was? I mean maybe. But reality is there was probably no way to know. I mean how do you measure medium/long term impact without enough time to elapse.
As an example. Remember “Cytokine storms”? People supposedly breathing normally and then suddenly they are dead in their hospital bed. There was a real “WTF?!” going on. Or remember how supposedly people were getting “reinfected” like a week later? Turns out it wasn’t true but it turned out to be true that your symptoms can come back in like a week.
In other posts I’ve noted I’m at least sympathetic to your position especially post vaccine. Once vaccines were widely available trying to keep enforcing NPIs was dumb and (sigh) someone like RDS might have been right (at least on NPI).
But February though April 2020? I think we need to give a lot of consideration to remembering how scary this time was. The answer that most of us don’t want to admit is when something is brand new there is way too many unknowns. In that environment, being overly cautious is completely defensible to me.
I give a lot of grace to officials during the Feb-Apr 2020 timeframe, for the reasons you cite. After that, though, the response should have adjusted for the data and it did not.
For people not clicking the link, it's showing the mortality rate from all causes in 2020, compared to other years. NYC, most notably, was more than 30% increased.
I understand the presence of extreme measures. I cannot understand the application of those measures to the population at large rather than having them targeted by age.
We were too lax with the NPIs for those over 75 years old and too strict for those under 65.
It's not hindsight. It isn't like health officials in 2020 just looked at "number of deaths" without knowing whether it was someone who was 89 years old or 18 months old. They had the age data right there all the time.
John, with respect, this is just pure retconning. The scientific process works over periods of years, not periods of weeks and frankly it wasn't/isn't set up to provide the kind of data we needed fast enough.
For at least the first 9 months, for every study that said kids were fine, there was another one saying kids faced high rates of permanent heart and lung damage that would scar them forever.
History is filled with diseases that didn't reveal their true cost until years or even decades later (scarlet fever -> heart damage, HPV -> cervical cancer, Epstein Barr -> MS). We were dealing with a brand new disease that we barely understood The correct response to this is to carefully apply the precautionary principle, which was roughly what policy-makers did (obviously excepting the downright stupid stuff like BLM protests, etc).
Just because the worst case scenario didn't pan out in the end doesn't mean the response wasn't roughly correct, at least for those initial months, probably until the vax and maybe antivirals were widely available.
Death rates and hospitalizations by age would have been available from the point that deaths were being counted, though, would they not? I remember reading analysis of the Diamond Princess Cruise ship very early on, and working them out myself, for example. It's a failure of the scientific or public health response if simple facts around age can't be communicated in a timely manner
As far as it being a new disease that we were unfamiliar with, this is only partially true. We have plenty of experience with other coronaviruses, and "long term effects of minor/moderate/severe covid infection will be similar to minor/moderate/severe other coronavirus infections" should have been the default.
The problem with transmissible diseases (especially ones that transmit prior to symptoms) is that they don't just stay among low-risk populations.
Restrictions were placed on low-risk people because they could easily transmit to high-risk people. A huge portion of transmission was within a household, and those are commonly multi-generational.
And it's not like the olds are going to be properly wearing N95s all the time, especially at home.
That was the biggest problem. I give everyone a mulligan for Spring 2020. No one knew what this was yet and extreme caution was warranted. But by summer it was clear that the risk was to the 65+ population and there needed to be a policy change reflecting that knowledge.
I kind of agree with this, but I’m also conscious that a policy that in effect says “everyone can go out and do what they want, but people 70+ need to stay home” isn’t particularly workable and in actual fact would likely provide little benefit to those 70+.
The risk wasn't/isn't limited to the 65+ population, it extends to a very large portion of the over 40 population in the US that's overweight or has other preexisting conditions. A quick search says around 40% of 50 year olds in the US are obese.
The excess deaths for people under 75 were also significant, it's just that such deaths are quite rare in general so a smaller increase is a big change. Furthermore, it's not like there was a discontinuity at retirement age, 60 year old people, many of whom work, were significantly more vulnerable.
Furthermore, it wasn't and isn't really possible to just protect the vulnerable from an airborne disease. Older people need to go to the store and then doctor, they need to see other people, and even in the places they live they interact with lots of younger people.
Was it also more severe for all populations at the beginning? I live near one of the early extreme hot points. I know several people who died of COVID in the early months, including two people in their 30s. One had asthma, but a lot of people had asthma. If this is more than an anomaly of people I know, that could affect response as well.
The idea was to reduce the rate of transmission and, thus, the risk of infection among the vulnerable. Some of that may have turned into exaggerating the risk in other populations
The cutoff is not at 70 or 75. The dramatically lower losses for people under 40 are just making the losses between 60 and 75 look much rosier than reality.
The same kinds of decisions they make about flu season. The same decisions those of us with newborns have to make. Our society isn't structured around the immunocompromised and the COVID vaccine never offered that great of protection anyways.
Which, as a percentage of all 70 and 80 year olds, is pretty small, right? In the US 5% of people over 65 die every year and a google search tells me there are around 750 million 65+ globally, so the senior death burden may have doubled for one year?
My hottest take with COVID is the vast majority of the deaths were just pulled forward by some small number of years. If it wasn't COVID their next bout with flu or pneumonia was going to do it. For example, one of our employee's Father's passed away but was like 88 and on oxygen because he smoked his entire life. It never felt right to count this as a "COVID death".
Yeah. I had two older relatives pass, both in their 90s and the one had fairly bad dementia. Normally almost a quarter of people in their 90s die every year.
But to be fair, attributing a single cause of death to a very old person is fundamentally very challenging. When I've compared excess deaths to reported "covid deaths" the numbers line up fairly well. Even in the midst of the pandemic, some percentage of people who died while having covid were listed as dying of other reasons, while others maybe shouldn't have been counted as covid but were.
At the end of the day, the various judgement calls seemed to have averaged out, and we ended up with a covid death count that comes fairly close to matching excess disease deaths.
It’s true that was a large majority. But let’s say we discount those deaths completely, and look only at the people under 50 who died and weren’t otherwise ill. It’s a much, much smaller number, but still 15,000 deaths of 40-49 year olds per year, which is more than traffic fatalities or homicides (probably even put together). For 30-39 year olds, probably similar to homicide. If homicide didn’t exist, and then started one year at modern levels, that would be a huge shock to the system, and a deep, dark tragedy.
Even at the time I interpreted that as 4D chess to get us all to work together to not spread the virus so that we didn't infect those who WERE vulnerable.
I'd prefer the government be truthful and just say "this isn't THAT deadly to those under age X, but it is very contagious, so for the sake of grandpa, we're asking you to stay inside too."
But even at the time I was reading through the lines.
Yes, but for people over 70, it was *really* dangerous.
At the height of the pandemic, in the USA, about 1,000 people were dying per day. That is a lot of death. This was not the freaking flu, or even pneumonia. It's weird to me to ask that we do not take that seriously.
And I agree with you that a lot of NPI was unnecessary and taken too far. But to dismiss Covid as "no big deal" the way you are here just feels callous and gross to me.
If a lot of children and healthy prime age adults were dying, it would be immediately obvious. Everyone would personally know dead young people. As far as I could tell, the only place where this happened was NYC, and even there it was overwhelmingly a pandemic of the elderly.
My mental model for COVID was that we basically had a rare but deadly disease wrapped inside a common not deadly disease, and the results totally baked our brains. If we only had the rare but deadly version and everyone else was fine, I think we would have FTFO more.
(That's my mental model from the first waves, April, summer, xmas, before we got vaxed.)
Vaccines are a good way to turn me in to a #resist lib. The sudden spread of anti-vax attitudes on the right has been like that of... a disease which we have no vaccine against. And the reason for this is that this is an example of something that's actually getting worse. Most of the time, doomer takes of "everything is getting worse" are wrong, but on vaccines, it's actually true.
My background going on to the pandemic was the PNW Measles outbreak of January 2019. The threshold for herd immunity for measles is somewhere around ~90%. It looks like somebody brought measles over from somewhere in Eastern Europe over Christmas break and then it came to our attention that there was a large pocket of unvaccinated people in Clark County, in our case, a combination of conservative Eastern European immigrants and liberal hippy dippy types. Our vax rate for kids was somewhere around ~78%. My wife and I were both working in schools at the time. Pretty quickly, schools implemented rules that kids weren't allowed to attend until they could produce proof of vaccination. And this was to continue until we hit the threshold of 90%. I don't remember talking to ANYBODY who had a problem with this. In fact, the conservatives I knew were less forgiving, because a lot of the unvaxxed were crunchy Portlandia types. Outside of a handful of genuine religious exemptions, most unvaccinated kids got the measles vaccine, and life returned to normal. The reaction to the COVID vax gave me whiplash because it was so different than our reaction just two years prior. Maybe this says something about a double standard around the behavior of hippies and foreigners. I have no idea. Either way, I was surprised at the reception.
It genuinely makes me wonder if what we need is some sort of larger scale resurgence of a major childhood illness (like measles) due to sub-threshold vaccination to remind everyone why we vaccinate. Sort of like an…inoculation against anti-vax movements?
Apparently we need to keep bashing ourselves in the face with a frying pan, because had one just two years before the COVID vaccine and everybody forgot apparently.
Yeah to clarify, I am not jazzed about the prospect. It's not like 4 month olds are out there choosing whether or not they get vaccinated. I just fear that that's what it would take to snap us out of this decline. I am happy to keep the good fight going in every other way (online, in doctor's offices, the public school requirements, etc.).
>> "The result is that long-term NPIs ended up having no discernible impact on mortality..."
Has this actually been conclusively determined? The data I've seen on this is decidedly mixed and the confounds make it a really tough one to untangle.
Frankly, I think there's a lot of retconning going on around our pandemic response that ignores the fact that NPIs are what kept us from overwhelming the hospital system. Sure, voluntary responses were a big part of what saved us, but imo the idea that we could have adopted a full on "let it rip" mentality throughout 2020 is deeply mistaken.
You can probably study official stated NPIs more easily and I would guess that's that Matt is referring to. If you compare various NPI orders in Illinois vs Indiana, for example, you'd probably find little difference in eventual outcomes. It seems like outcomes in the end were mostly a function of demographics.
So if "let it rip" meant something like Sweden or Japan's response, which was more about informing the public and less about imposing official restriction, then I think it would have worked out just as well on the health side and we might have avoided a large dose of this inflation, as well.
Another tricky factor is the correlation between obesity and covid mortality. Relatively lax intervention in countries with lower rates of obesity than the US might generate the same rate of excess deaths as relatively stricter restrictions in the US. However, the causal explanation might not be that "interventions are ineffective" and, instead, that even stricter interventions in the US would have further lowered the rate of excess deaths.
I agree with that, and I think that hypothetically, stricture interventions could have prevented deaths.
The problem is actually enforcing or implementing the restrictions. It's one thing to publicly close libraries and schools and to require masks, it's another thing to shutdown parties and events and actually enforce rules around mask.
That's why I think Sweden and Japan got it right, because it seems like there was more guidance and trust and information provided to the public, and less attempts at compulsion, especially compulsion that was often not even enforced.
Sweden and Japan probably had a lot more compliance with NPI suggestions than the United States did with mandates (even if the US mandates were weaker than the European places that established curfews and things like that).
Well..I don't know about that. It might depend if you're looking in the public or private sphere. Certainly when schools or libraries were ordered closed, they were actually closed in the US. Some people might have flouted nonsensical beach and park closures here, but the fact that they never tried that stuff in Japan or Sweden suggests as much about their public health officials as it does about their public at large.
Which other sorts of NPI mandates do you believe the US didn't comply with? Mask mandates on public transport? Sweden didn't even begin recommend masking in most situations until Dec 2020, so it's hard to compare. It's not like Europeans never flout rules.
As I recall, the gap between demographically adjusted COVID death rates for Democrats and Republicans didn’t really open up until after the vaccine became widely available. That’s consistent with the idea that the long-term poorly-enforced and poorly-targeted NPI mandates in blue localities weren’t accomplishing much.
I don't recall a clear left/right divide on NPIs during the initial response, especially while Trump was President. Sure, their were the Jay Bhattacharya types, but initially at least, they didn't get much traction with the broader right and most of the pushback was confined to libertarian circles.
In terms of personality and disposition, people on the right were probably more inclined toward adopting behaviors to guarantee higher personal safety initially, especially before the controversy and political sorting really got going strong.
I think long-term NPIs are impossible to enforce and if you do a reactive model where NPIs go up and down in response to case numbers, people get confused and are essentially calibrating their behavior to control spread as well as a mandated NPI would anyways.
NPI’s and inflation have a lot in common in terms of the policy debate. Do we inconvenience everyone to help a few percent of the population or do we leave the few percent to their terrible fate but avoid inconveniencing the +90%.
Or maybe split the difference a bit better. If unemployment had been 0.7% higher for a couple years but inflation had peaked at 5%, that would be better. That being said, our economic response to covid was closer to optimal than most big stakes policy decisions. The soft landing with disinflation is one of the greatest technocratic accomplishments in American history.
Your point is taken, but I think with covid, we really couldn't be very confident the danger applied to "only a few percent of the population" in the early days. That first wave hit very, very hard indeed in such diverse locations as Wuhan, Lombardy, Britain, and the Northeastern United States.
But sure, a clearer picture had emerged by late summer, 2020. My own take is that, ideally, we should have had a fairly strict national NPI program starting in March 2020 that was communicated clearly to the public in detail and eased in phases (say, June, September, December of 2020); and basically lifted completely relatively expeditiously in early 2021, as vaccines became available. In retrospect (to me, anyway) that would have been the plan that best combined strong action to keep people safe with the need to normalize as rapidly as feasible. The open-ended nature of the crisis—When is this damn thing going to be over? When can I get a haircut?—was bad. A pre-determined schedule the public could look at to know relief was on the way would have done wonders.
Instead we more or less had: (1) strict NPI programs in some locations; (2) less strict NPI locations in other locations; (3) no NPI programs at all in a few red states; (4) the administration actually beginning to fight and undermine NPI programs by the time the first wave of deaths peaked (April); (5) confusion and a non-uniform national approach increasingly dominant as we moved through the summer; (6) most of the leadership of the governing party openly contemptuous of anti-pandemic efforts in general, along with a terrible coddling and promotion of medical quackery (Ivermectin, etc); (7) the successful rollout of MRNA vaccines at the end of 2020 and first quarter of 2021 (queues were eliminated by April, 2021); (8) a new administration basically semi-oblivious to the political realities of pandemic management that had crystallized by 2021; (9) a period of fumbling overreach by them, that was mercifully largely over after their first year in office.
And of course this is a problem for a party that spends a lot of time centering the tiny portion of the population that identifies as trans/non-binary.
The vaccine mandates did a lot of damage. Scott Gottlieb (former FDA commissioner and Pfizer board member) spoke against mandates almost daily, because he was worried that they would undermine confidence in other vaccines. And he was right.
The FDA's 10-day suspension of the J&J vaccine, over a statistically trivial risk, also did a lot of damage. Daily vaccinations peaked literally the day of the suspension, and then fell off a cliff. It was different technology than the MRNA vaccines, but there was no way the public was going to understand that, and, anyway, it stands to reason that if FDA is going to suspend a vaccine during a lethal pandemic it must have a good reason, right? Turns out, not. It was a terrible moment to turn to the "precautionary principle."
I think the Biden administration went for vaccine mandates because it was in a trap. The "red" states (and red people in blue states) had effectively opened up and were back to work, but a lot of "blue" people remained extremely Covid-phobic into 2021. For them, the goal post had moved from "flatten the curve" to "reduce mortality to the level of ordinary flu." Biden was therefore at great risk that the economy would remain in a funk for years. The Covid-phobic folks needed a step-function justification to change their attitude and get back to work and rejoin real life, and the vaccines provided that justification. To such people, mandating vaccines would "ensure" that it was "safe" to restart normal life. To "red" people who had already gone back to work and otherwise restarted normal life, this looked like rank authoritarianism. (Which, in turn, had the perverse effect of discrediting claims by Democrats that it was Trump who was the authoritarian. However much he had screwed up the pandemic response, he never mandated vaccines.)
Totally with Gottlieb on this. The other big factor was pre-COVID vaccine all the prior mRNA vaccine's failed. Moderna was teetering on the brink for years trying to get something to market. This quote captures the risk quite well "Despite the promising trials with mRNA based therapeutics in laboratory settings, the facts remained that mRNA is highly unstable inside the body and prone to degradation by immune agents and nucleases, possesses a high potential for adverse immunogenicity, and initially generates weaker protective immunity than conventional vaccines [37]."
One of the things that was smart about Operation Warp Speed is that it spread its bets among four different vaccine technologies, with two companies for each. That maximized the chances for success, and positioned the United States as the leader of the world in the field.
Unfortunately, the weird intersection of Trump's personality and the chattering class's hatred of him made it much harder to gain the full recognition for that triumph.
It’s a shame it took so long for Novavax to get approved, and that the public health people didn’t see an advantage to having at least one vaccine that doesn’t put any mRNA in your body. (Also, there seems to be a lot of evidence that the malaise the next day is much less bad with Novavax than with the mRNA or viral vector vaccines.)
... yeah I just think that a political coalition that cheerfully embraced a guy who said that the coronavirus was generally engineered not to target Jews is not going to be fertile ground for any of this
"Beyond that, the genetic difference between a chicken and a pig is much smaller than the difference between a pig and a human."
Where did this come from? This is almost certainly very false: the genetic difference between members of two different classes is smaller than the difference between members of the same class?
I’m not sure what MY was getting at with that line but this is the issue with pigs:
“Pigs are the ideal genetic mixing vessel to generate a human pandemic influenza strain, because they have receptors in their respiratory tracts which both avian and human flu viruses can bind to.”
"It’s kind of fun to speculate about a crunchy-pilled Republican Party, but it’s just not real."
Eh....do I think it's already happened, or will happened overnight? Of course not. But it's amazing to see just how much inversion has already taken place, so I don't think it's impossible. This tweet by Anna Paulina Luna [https://x.com/RepLuna/status/1857516047458595123] is something that would have expected from a raving Green Party candidate if there was no name attached to it. There are a few things that the pro-business wing of the Republican Party feels it has to grin and bear in order to get votes. Anti-immigration is a real obvious one. We have a long way to go to see if this will be one of them, but I wouldn't rule it out.
I kind of want to see how the rubber hits the road on this one. The MAHA movement seems so underbaked in all but the vibes. I’m sure they’ll agree on vaccines, but the food part of it is just a jumbled mess for most of them.
It's not just that it's scientifically unsound, I'm not sure they believe the juice is worth the squeeze on banning all the things they supposedly hate. Even the things we all agree are bad (lead) they'll defend–if it shows up in a product they like, such as Redmond salt.
It perhaps smacks of grasping at straws or reading too much into the tea leaves, but if you really want to, you can draw a line from the MAGA embrace of RFK Jr/Vermont crunchy ideas on pure food/pure environment and pastoral aesthetic to Giorgia Meloni Tolkienesque/Shire interest, to the Voelkisch movement and its romantic agrarianism, organicism and ideas of pure Land/pure Volk, and so on from there….
So it isn’t necessarily that surprising to see variants of that general strain of romanticism represented in the Trump entourage but probably only as one faction among many.
But I think this kind of thing is cheap to post until they come up against a large entrenched business interest. If they go after HFCS or food dyes that'll be crossing the rubicon.
How disruptive would a ban on all artificial food dyes be? Does it just mean all skittles are now brown M&Ms? Do we still get fairly colorful food with annatto and turmeric and kale extract or whatever? Does all colorful junk food suddenly look more wholesome and boring, but in a way that leaves them competitively equal to where they were before?
One of the things we did learn throughout the pandemic was that NPIs associated with clean air do, in fact, work: ventilation, HEPA filtration, and N95 masks. We learned that the infectious disease community had outdated ideas about the fluid dynamics of respiratory aerosols, that transmission is primarily (perhaps entirely) via virus-laden aerosol particles that are mostly water and which are generated at several stages of the respiratory tract, and virus-laden aerosol particles can remain aloft for hours. We learned that HEPA or MERV-13+ filters can remove these virus-laden particles from the air and N95 masks can capture them, in large part because of electrostatic attraction from the electret fibers of such masks.
There's an overt conspiracy element to this too, although how it plays in the current political landscape is confusing. The WHO knew about airborne spread of other diseases, China early on said COVID was airborne, even Trump says so. But WHO kept insisting it was droplets that fall to the ground: there's the famous early press conference where WHO secretary general Tedros Ghebreyesus at first says COVID is airborne, then the person next to him scribbles something on a paper, then instead of answering a question, Ghebreyesus clarifies that he "misspoke" about aerosols and really it was droplets. And there are endless clips of Maria Van Kerkhove insisting that COVID spread through droplets that fall to the ground.
There's evidence that at least some in the Biden administration have internalized the airborne nature of COVID, with a few White House events. Plus there's all the air filtration gear that would accompany his early (maskless) speaking engagements, which was generally kept of sight.
But overall it seems the conspiracy is that even left-leaning folks don't want to deal with measures that can't be reduced to individual choice. Truly fixing ventilation and air filtering would be an enormous expense, especially following decades of HVAC design for energy efficiency.
I don’t get the opposition to energy efficiency. The specific mandates that required recirculating of indoor air were bad, but other energy mandates were good.
I just want a shower head that gives me a good drenching. Water is (mostly) a closed loop system -- we clean it, pump it, use it, and return for cleaning. Having to "save" water is a misnomer for the vast majority of consumer uses.
Especially in Florida. We have plenty of water. Hell, it rains every day during the summer. Let me take my shower with a 5 gpm shower head.
Yeah I think the mandates for low flow shower heads and kitchen sinks are badly chosen regulations. Behavioral changes are likely to undo a lot of the advantage those were supposed to have (unlike low flow toilets and washing machines).
There's a difference between:
(1) NPIs don't work....and:
(2) NPIs that aren't enforced don't work.
I'm open to the case that NPIs simply *cannot* work in 2020s USA. Indeed, if I were the American King for a Day when the next one hit, I'd probably just issue advice, and leave it at that. But still...NPIs seemed to work pretty well in Japan and Denmark and Australia.
Either your public is 40% comprised of low trust whack-jobs hunting online for horse medicine, or not.
"Masks don't work" always reminded me of "abstinence doesn't work." In both cases, I think the phrase was a shortened version of what the speaker MEANT to say. "Mask MANDATES don't work" is a coherent sentence. "Abstinence only EDUCATION" doesn't work. But not having sex is a pretty good way to not get pregnant, and wearing a mask has a >0 effect on reducing the spread of infectious disease (albeit varying by type).
That's a good analogy!
Abstinence is 100% effective in preventing pregnancy. As you note, masks are variable but they are never 100%.
I think one problem is that people treated masks like some kind of force field where they thought wearing one made them safe, when the reality was a lot more complicated- especially for cloth and non-certified masks.
Sure, but not 100% effective =! doesn't work.
But yes, the masks were less effective against subsequent variants.
Where I really lost it on masks is when I was told we still had to wear them after we were vaccinated. That makes zero sense.
See also morons wearing masks, but not helmets, while riding bikes. What a world.
My favorite were the football coaches being forced to wear masks outdoors, dumb enough as is, but they'd still muscle memory their way into covering their faces further with their playsheets, still paranoid that someone might lip read them.
Two specific funny moments in this regard were Andy Reid wearing a fogged up face shield, and Bill Belichick putting an N95 *over* a neck warmer.
https://youtu.be/ZtJM8J_qfPk?si=ezLkVlpsaAvTRLeA
I don't think I've ever been angrier at policy than I was at that. I was a mushroom cloud laying motherfucker, Superfly TNT, Guns Of The Navarone at that, and also at the antivaxxers.
I had to wear a mask while delivering Amazon packages in spring 2021 because of paranoid people with Ring doorbells.
Ridiculous.
Very true! But people aren’t good with probabilities and the advice boiled down to a binary: masks=safe, not wearing masks=unsafe.
It wasn't clear what the chance of Long COVID was after a breakthrough infection. In practice it turned out to be (AFAIK) extremely small.
The real abstinence is shelter-in-place. If you never leave your home and only get things via delivery, you won’t get sick from a respiratory virus. Just like if you don’t have sex with anyone ever other than your equally lifelong monogamous partner (and also don’t get blood transfusions) you won’t get any diseases that are spread only through sex and blood.
Masks are like condoms, but less effective. (Maybe like how condoms are for herpes or whatever.)
Probably depends on the type of mask. I imagine the masks we had in the army where pretty close to 100%
They were also rated against chemical attacks
I don't think there's any evidence that cloth masks have much of an effect in terms of preventing disease spread. A .02% effect is yes literally larger than 0, but it doesn't reach the level of statistical 'significance'.
I think properly worn and fitted N95 masks have a much larger effect, but that's not what most people were wearing
One of the problems with the fight over whether or not universal masking works is that we have a lot of really low quality data and a small amount of high quality data, and even those higher quality studies aren't great. Organizations like the CDC and NIH really dropped the ball in making sure that these studies did get done. Interestingly, some of the high quality studies were done by researchers from the Nordic countries. I don't know how much this had to do with the nordics having a less politicized response vs institutional characteristics, but this is one of those situations where we should be more like the Nordics.
The high quality data (RCTs, the occasional well-matched prospective observational study) tend to find either a null effect or a small effect. There is an abundance of low to terrible quality data showing that they are effective. Many people in (US) public health have concluded that RCTs are the wrong way to study them, and instead we should look at laboratory studies, ecological studies or the case control studies, but it's not clear what other interventions they would apply that standard of evidence to. We didn't do a lot of good quality science around it so we don't know why these RCTs aren't showing an effect. When it comes to cloth masks, it is entirely plausible that they have an extremely small effect on transmission and this is because the virus is transmitted primarily via aerosols and the cloth masks are not very good at blocking them. But we don't know that because we didn't have much high quality science investigating this.
Then there's the problem of whether a study is generalizable. If a study finds that an infectious person wearing an 95 is 99% less likely to infect the other people in the room, it does not follow that having people wear 95s everywhere they go will have a large effect. They need to seal properly and if people are doing things that are likely to break that seal and not notice that they've broken the seal, we would expect them to be less effective. SO if something works in a hospital, it's a good idea to run another study in the general population to see if it holds up in that population as well.
There’s also an important fight about whether a “high quality study” is an RCT on telling people to mask, or a lab study where we expose people to known-infected individuals and watch them wearing or not wearing the masks, or an aerosol study that sees how the mechanisms work, or what. Much of public health is based around the idea that the RCT is somehow most ecologically valid and statistically sound and is therefore the highest quality, but it doesn’t always test what you want to test (and in the case of masks you can’t do blinding).
Totally agree about the question of what is a high quality study. The fact that we did not do those kinds of studies is really disappointing. I think we should have done all of the above. At least then we'd have had better data to make decisions/
Really? I think the data I saw showed that cloth masks were more effective than .02%, but now I'd have to go find that data again...
In my memory cloth masks had ~40% efficacy against the original strain (which is certainly not nothing, if everyone is wearing one you save a lot of lives vs. no one wearing one), but then it went to virtually zero vs. the much more contagious follow up strains.
Isn't funny that we once were so steeped in this debate (literally constantly debating effectiveness of NPIs), and now it feels like a bit of a distant memory. That's my experience at least.
Like most of the pandemic experience.
~40% efficacy vs the OG strain is close to the figure I remember. I do remember it dropping off for subsequent variants. I don't know how much though.
https://www.mwra.com/biobot/biobotdata.htm
Per wastewater data from Boston, EVERYBODY got COVID around 1/1/22, so Omicron was ferocious.
Definitely not *everybody*! I know many people who got COVID for the first time between mid December 2021 and mid January 2022, including some people who got it apparently the day after we had Christmas dinner with them. But my partner and I somehow didn’t get it until May 2022 (and we were paying close attention to every cough for several years, and would have identified a minor viral cough as distinct from an allergic one).
My first (and so far only) confirmed case was October 2022.
What LF said is how I remembered. The properly worn and fitted part is also what makes it just a piss poor policy to implement.
See also: "calories in, calories out doesn't work."
It doesn't work IF YOU DON'T DO IT
Yep. I've found that some people literally think human bodies violate thermodynamics, but usually people mean "calories in, calories out is extremely difficult to adhere to because it relies on continuous long-term exertion of willpower and constant monitoring of calories eaten and expended."
Ehhhh… I’m not convinced that a bomb calorimeter is especially similar to human digestion. You don’t have to violate thermodynamics to suspect that some people’s bodies start to use fewer calories while they’re dieting.
Well we KNOW that people’s bodies start to use fewer calories as they age (hence, “dad bods.”)
I do find it intriguing how much slimmer my grandparents were compared to my parents at similar ages.
Given the amount of calories expended in baseline metabolic processes that can speed up or slow down without you noticing, “constant monitoring” is basically impossible.
The people who think this are very obviously lying about their calories in.
No, the admiral who said masks don't work in Feb was lying, with support from doctors who didn't understand basics of disease transmission due to innumeracy. Of course masks do work, as he said in March.
Right - I read “Intervention “ in NPI as meaning a mandated or strongly suggested public health program. That doesn’t stop me from trolling through CDC NPI literature to find ways to personally survive a pandemic. However, since I don’t work, let alone in healthcare or in an essential function, I have freedom that others may not have. Maybe we went on too long with the strict, legally and peer-enforced NPIs, but with anything new we should pull out all the stops to protect employees. Probably not possible in this political climate, alas.
Yep. If you have to MANDATE mask-wearing, you're dealing with a population that's not cooperative to begin with.
China especially managed to prove the efficacy of enforced NPI’s.
And also showed that NPIs can be enforced well past any reasonable timeframe of when they should be enforced. Oh and also showed that NPI enforcement can be used as excuse to extend authoritarian tendency.
Yes on both those things. I’m certainly not lauding how they handled it, but it was nice of them to do the experiment for us. I do find it hard to understand how people continue to argue NPI’s don’t work to stop the spread of disease when China’s zero covid heyday’s just sitting there for all to see.
Unsurprisingly, people don't trust the data coming out of China.
Fair, but it was hard to hide the deaths when they lifted the restrictions (tho the government lied like crazy about it). Just as it was hard to hide the fact that Chinese people were living life pretty much as normal while we were locked down, due to mass testing, manic-level contract tracing, and their extreme restrictions on exposed and infected people’s movements. A lot of Chinese people were happy about it.
As we saw in China, NPIs do work for awhile when vigorously enforced. But, it's only possible to keep that up for so long, and when the measures lift, the population doesn't have immunity, and everyone gets sick anyway.
In the long run, unless NPI is able to completely eradicate the virus quickly, it accomplishes very little.
If it delays mass infection until everyone is vaccinated, it saves a lot of deaths. See Australia and New Zealand.
Yes, authoritarian governments are good at enforcement. But ultimately much of it was just a time-shift. China eventually had to stop its attempt at a zero-Covid policy and immediately lots of people got sick and died - how many we don’t know because the government isn’t honest.
Australia and New Zealand did it with effective vaccination, so there wasn’t just a time shift in deaths.
They were arguably the gold standard in 2020 and early 2021. Even then they weren't flawless: they prioritized vaccinating working aged people, but, as that effort ramped up, made little/no effort to pivot back to the elderly. So the seeds of their far less successful approach after the midpoint in 2021 were sewn early. And needless to say, living in a dictatorship, millions of Chinese suffered horribly from policy overreach throughout this period, with no recourse.
The Chinese vaccine also wasn't that good (but at least better than the Russian one), which undermined elderly trust in it.
Also don’t think a lot of people have really made the connection between openly flouting mask mandates and a lot of subsequent disorder.
People are very quick to blame the Floyd protests but really don’t want to talk about the downstream effects of “40% of the country is willing to get fired rather than comply with a vaccine mandate.”
This was surely connected to the rise in air rage and traffic deaths.
Agreed. Also, whether to do NPI's really depends on the severity of the disease. What if instead of the 1% fatality rate of COVID we had the 10% fatality rate of SARS, or God forbid the 33% fatality rate of MERS???
I would submit that with something like MERS the only proper response is absolutely everyone stays inside until transmission literally stop with pretty draconian enforcement.
Not to be Clintonian but claims like "NPIs worked in [x] country" seem to hinge a lot on the definition of "worked". It's true that when people obeyed them, the disease spread more slowly. But importantly, Covid spread much too easily to ever be defeated by NPIs, which meant that for it to "go away" in the sense it has now, it basically required the vast majority of people's immune systems encountered it.
Which is to say, pretty much everyone has to get it eventually. Those low numbers don't seem like much of a victory if you pull the timeframe out and you end up in the same place.
Now I think there's an argument to be made here in favor, but I don't buy general claims that "they worked" without unpacking more specificity:
- They can be used to temporarily tamp down the infection rate at a time when hospitals are overwhelmed. This happened for a few moments in a few places but generally was not a common circumstance during the pandemic. (Hilariously this was the plan during the first couple of weeks which everyone forgot once everything got politicized)
- They can be used to minimize the number of infections that occur before vaccines are available. But remember that vaccines arriving in a year was a huge surprise, an amazing best case scenario. So unless you were willing to restrict long and aggressively enough to tamp down cases for a *year* or more, this is also pointless.
Ultimately I think a retrospective case can easily be made for limited, strategic NPIs for particular time frames or populations. And a lot of people made these arguments correctly in real time - including the leadership of Sweden, and Trump's national health pick.
A lot of this is right. But we now know that the 12 month time frame for the vaccine involved a lot of last-minute making an mRNA vaccine supply chain for the first time ever, and then waiting several months for tests of effectiveness.
But updating an mRNA vaccine should only take a few weeks, and if we come up with plans for more expedited testing (and maybe not worry about the details of effectiveness testing before beginning some of the rollout) it could be brought down quite a bit.
They already had the mRNA sequence and the first synthesized mRNA in January 2020 within a week and a half of isolation in patients.
Sure, I can imagine a future scenario where all of the parameters line up in such a way to justify NPIs. But I don't trust our public health establishment (ugh that sounds Trumpy) to make that call, nor would have the population listen to it, wolf having already been cried.
I really hope there is some way to draw useful conclusions from this. For example, what's the best way to encourage people to wear masks or get vaccinated without prompting backlash that makes the net situation worse? I feel that just saying "hey, please wear masks and get vaccinated but there are zero consequences if you don't" doesn't get very far, but workplace vaccine mandates and many mandatory NPIs prompted a level of backlash that made things worse. Even the military had to back off from COVID vaccine mandates.
I really wish the US had tried just paying people to get vaccinated.
I worry that with Dale Gribbles sorting into the Republican Party there's no good answer. If we have another pandemic, it's either with RFK Jr. making important decisions or with 40% of the population primed to do the opposite of good medical advice out of spite.
If Covid had happened under Bush or Obama, the politics would likely have been a bit different. Under Bush, the anti-vax movement was clearly left wing. Under Obama, the stupidity of the anti-vax movement was helping to snuff it out on the left. (That's why outbreaks tended to be in small social groups specifically targeted by anti-vaxers, like the Amish or Somalis in Minnesota.) If Rubio had become president in 2016 instead of Trump, it's very likely conservatives wouldn't have had the social pressure to turn antivax the way they did.
Eh, the stupid was very clearly being unleashed on the right during the Obama years.
I will never got over the fact that the pandemic started in March 2020 and began to wind down in December of 2020 when the first shots were administered. Most of what everyone recalls from the pandemic - locks downs, etc. occurred during the Trump administration. And yet he gets zero blame even though he was the guy in charge.
I would probably repeat what Deadpan Troglodytes already said- NPIs were virtually all run at the state level, and Democratic states (or Dem cities in red states) were much much harsher on the NPIs than red states were. Voters are in general not what I would call 'bright', but they're not stupid, and they do recall the NPI-Democrat connection. They remember who was closing playgrounds, mandating masks in restaurants, closing schools, etc. I think that mental connection is now pretty permanently fixed in voters' psyches
Trump also coded himself as anti-lockdown at a time when anti-lockdown sentiment was becoming most salient to people.
Which is ironic because wasn't he fighting with Governor Kemp in Georgia about opening up *too early*?
It didn’t help that a non-zero number of progressives were openly trying to use COVID as a pretext for a lot of unrelated radical transformational changes.
Aside from using NPIs well past the point they were necessary, they also wanted to make a lot of targeted pandemic relief permanent — remember the whole “Biden promised us $2000” discourse from early 2021?
It also didn't help that several notable Dem pols seemed hypocritical in violating NPI measures or creating exemptions for cronies.
It will also never cease to amaze me that there are hundreds of thousands of extra people unnecessarily dead because DJT got jealous that Andrew Cuomo was getting such fawning coverage* in the press and overshadowed him.
I continue to maintain that his “liberate Michigan” tweet is one of the deadliest tweets in history. It gave the signal to his followers that Covid was “fake news” and not to be taken seriously.
To tie it back to Matt’s post. One huge danger clearly signaled by RFK jr’s nomination is that it’s basically Trump indulging in anti-vaccine insanity about everything. RFK jr could be completely ineffective at HHS, a real viable H1N1 vaccine could be developed and one Truth Social post could mean half the country refuses the vaccine.
*I’ve noted before that my wife used to work extensively in NY politics. Which she means she’s known longer than most what POS Cuomo is. Upshot is we own a “Cuomosexual” mug as an ironic reminder of that moment when Cuomo was quasi celebrity
NPIs were administered at the state and local levels: what is a president's responsibility there, leadership?
He could have fired Fauci, whose public equivocations damaged institutional trust, but there's no universe in which blue locales would have followed his successor's lead. We already know what they thought of Bhattacharya!
If you listened to what Fauci actually said he was quite moderate as far as public health people go. The rupture with Trump occurred when Donald went into mad King at a press conference and Fauci had to correct him.
The red blue divergence happened when Trump decided covid would end by Easter and decided everything needed to open to boost the economy. Red states opened up and blue states extended/increased the intensity of the early lockdowns that made sense in March/April.
I'd also say that Jay Bhattarachia wrote a bunch of op ads early on claiming covid was milder than the flu. Dude's a hack who happened to be correct a few times.
The mask mandates on airplanes, airports, and public transit were issued at the federal level.
Good point - I would say it's fair to blame him for those.
This is why I've always felt that the reactions among the public were going to be broadly similar regardless of who was president.
Take a look at Europe. Those countries all had very different public reactions as far as polarization around NPI's went. The country that saw a schism like us is Brazil and the chief executives explain that.
Matt's contention that low uptake vaccine vis a vis our peer countries is because people don't like needles is one of his worst takes. There are people who hate needles literally in every country. There's no way that explain why a much higher percentage of people are vaccinated in Germany than America.
But more to your point. The low levels of vaccination in American and Brazil are amazing examples to me that the "great men of history" thesis of how history unfolds has merit. As usual with these things, it's never one thing (hard not to cite UK's unique geographic position as to why industrialization took off there first as an important example). But the huge delta in per capita death rates is a morbid example that your leaders really do matter.
I do think needles are an important factor in vaccine hesitancy, though I don’t think it explains US exceptionalism. Unfortunately, everyone in public health learned to get over needles in their first year of graduate education, so they underestimate how valuable it would be to get non-needle-based vaccines.
“ leadership”
Um…yeh?
>He could have fired Fauci, whose public equivocations damaged institutional trust<
Are "public equivocations" similar to "changing his mind as the evidence changes"?
[Edited to add details]
I'm not a Fauci hater. I think he did a lot of great work through his career, through multiple public heath crises. But he screwed up COVID and it wasn't just changing his mind as the evidence changed.
First, there's the story everyone knows: his early dismissal and then subsequent support of masks. The story is complicated, but it is clearly not simply a matter of evolving science. As Slate's writers put it in "The Noble Lies of COVID-19":
> One thing is beyond a doubt, however: One of those two statements [on masks] did not accurately reflect the evidence as Fauci saw it. Such high-profile mixed messages in a short time frame, without substantive new data to justify the change, generated confusion and a backlash from politicians, other experts, and the general public.
(https://slate.com/technology/2021/07/noble-lies-covid-fauci-cdc-masks.html)
But that's not all. He also made knowingly false estimates of the herd immunity threshold, by his own words! Some part of these revisions were related to new data, but as Donald McNeil wrote in the New York Times, Fauci had been deliberately withholding his real analysis:
> Dr. Fauci acknowledged that he had slowly but deliberately been moving the goal posts. He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks.(https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html)
Other times, Fauci just admits to being concerned with the consequences of communicating the truth, rather than disseminating knowledge. For example, in early 2021, he said of switching to a "first shots first" strategy:
> We’re telling people [two shots] is what you should do … and then we say, ‘Oops, we changed our mind’?” Fauci said. “I think that would be a messaging challenge, to say the least.” (https://www.washingtonpost.com/health/2021/03/01/fauci-defends-two-shot-strategy/)
I mean ... he's right, but if you're paying attention and reading that in March 2021, it's becoming increasingly harder to take anything he says at face value anymore.
Please spell out what that would have looked like, accounting for Trump's uniquely polarizing effect on the population.
His people would follow him over a cliff. If Trump had decided "A strong response to the pandemic is my ticket to a second term" we would have looked a lot more like Canada or Australia in terms of excess mortality.
Now, no doubt a lot of MAGA enthusiasts would in principle reject saving a few hundred thousands lives if that meant a motorcycle rally got cancelled one year, or they had to get take out instead of dining in at a crowded Chick-fil-A. Freedom isn't free, after all.
But still, given Trump's utterly messianic hold over tens of millions of American conservatives, it seems obvious we could have had a very different 2020. Hell, Trump could have couched the effort in terms of "fighting the CCP's efforts to harm us."
But Trump thought his ticket to reelection wasn't saving American lives, but rather, opening up the economy as rapidly as possible—public health consequences be damned.
This branch of the discussion is about changing blue state policies, like mask mandates and school closures, not vaccine uptake.
Well trodden ground here at Slow Boring. Something that's been chewed over, what, three hundred times? I get it: the partial and irritating NPIs were history's greatest crime.
People hold Biden responsible for global inflation - it’s not fair but there it is.
That’s true, but they were following, perhaps overzealously, the official federal guidance from the CDC. That guidance had a tremendous impact on policy, at least for blue states.
There's something to that, but I can't think of a plausible action Trump could have taken that would have changed blue state policies.
I suspect that any non-Trump president would have at least explored some coordination of NPIs. It is obvious that states with open borders running completely autonomous semi-lockdowns is a recipe for failure. It really was a situation that required the one thing most lacking in the Trump presidency, strong leadership.
Be that as it may, it would only be a positive from the perspective of NPI supporters. BZC is saying that Trump is responsible for blue state mask mandates and school closures, which is what I'm responding to.
That claim is obviously silly and I am not attempting to make it sound less-so. I am making a very narrow and specific claim. I am not certain that someone could have successfully organized the states to act in concert but it absolutely should have been seriously attempted.
Not acting like a crazy person early on. People forget, the country was relatively unified and he had the highest approval of his presidency pre press conference meltdown.
How many people were actually tracking what Fauci said from day-to-day, rather than absorbing vibes second-hand from their ideological fellow travelers? This critique always seemed to me to assume that everyone has the same media diet.
It coud have helped in blue states, too, but at least we coud have avoided a lot of economic harm in red states.
>And yet he gets zero blame even though he was the guy in charge.<
He pulled off the neat trick of going to war with his own government—he somehow managed to make himself look like the (not so) Loyal Opposition.
I think we just gotta attribute this to some fundamental differences in the electorate. The way this stood out to me egregiously was that during the campaign, Harris would talk about what her plans were and get pilloried with comments such as, "You're in power NOW, why aren't you doing any of this???", completely ignoring the historically pretty well-known fact that VPs are, uh, cartoonishly powerless.
(I'm not cutting her slack here, it cuts both ways, running as a sitting VP when times are good also affords one credit they also most likely do not deserve.)
But Trump was still somehow running as an outsider despite having already had the chance to do the things he is proposing. The comedian Theo Von, who interviewed Trump prior to the election, had on fellow comedian Stavros Halkios (who is disdainful of ALL politicians, but is certainly of the left) the other day, and was saying that he voted for Trump because he represented something different, someone who might change things, and Halkios was laughing at him and said something to the effect of, "what are you talking about?!? He was already President before!"
Clip here, should start at the timestamp. He also stomps on Vance, which is fun.
https://youtu.be/4KBQaT_DYzg?si=IDFTfRrIEbQZ5wF2&t=6813
Some of it is attributable to differences in the electorate, yes, but Trump really did literally go hard against much of his own government's (that is, the United States Government's) efforts to battle a public health crisis. And I strongly suspect it helped him in 2020 and in 2024 with at least some cohorts (if not on net in 2020), by increasing his support among working class Americans for whom forced unemployment (yes, even with fat checks) was highly stressful and unpleasant. And those memories were still fresh for many two weeks ago. It's not hard for me to believe the GOP's inroads among young Hispanic men, for instance, were given a nice boost by Trump's seizure of the "Let's get America back to work" brand. Many working class Americans saw Trump as championing their right to earn a paycheck and resume their lives. Which, of course, in a large sense he was.
We might be talking to different people then, because I know people who voted for him specifically because they got big checks and *didn't* have to work.
I will never get over the fact that for us in Illinois the pandemic stretched on into 2022 and for our friend's and family living in Georgia it ended in like Sept. 2020. It was such a stark difference in response and it's definitely radicalized my wife against Democrats.
https://www.reuters.com/world/us/chicago-teachers-backs-deal-reopen-schools-after-covid-walkout-report-2022-01-11/
Georgia had the 5th worst COVID death rate (191/100k people) in the U.S. during 2021. You do have to give them credit for always striving to be the worst. \S
CDC has them at 13th in 2021 but also just 26th in 2020 - which is the immediate re-opening period I'm highlighting: https://www.cdc.gov/nchs/pressroom/sosmap/covid19_mortality_final/COVID19.htm
"in Georgia [the pandemic] ended in like Sept. 2020."
So just now I learned that no one in Georgia died from COVID after Sept. 2020.
Did no one die in Illinois after Sept. 2020?
The highest mortality period of the pandemic occurred in January 2021.
We could have decided to let the thing run it's course and do nothing early, but then America's gripe would be all the dead and disabled people.
Isn't one conclusion from the inflation backlash that voters don't accept being asked to sacrifice "for the greater good" (high inflation vs. less unemployment; lockdowns vs. fewer elderly deaths)?
Problems while Trump was President -> initial response, early testing debacle, early anti-mask recommendations, extended lockdowns in blue states
Every one of those either didn’t matter in the end, wasn’t really Trump’s fault, or Trump was right on the merits. Trump absolutely fucked up early response stuff, but I doubt any President could have stopped COVID from becoming an epidemic in the US, and once it’s loose, long-term government-imposed lockdowns are a needless and polarizing restriction of liberty, since people naturally hit a self-isolation equilibrium based on their personal risk tolerance and local case rates.
On the plus side, he actually did meaningfully accelerate vaccine development, which actually matters.
Problems while Biden was President -> Mask mandates on airplanes lasted until spring 2022, when the administration only dropped them because they lost in court. CDC being so slow to accept importance of ventilation vs. handwashing and surfaces. Concerns about “equity” messing with vaccine approval and distribution.
This is stuff where I think Biden was wrong on the merits and it was actually plausibly within his control.
Messaging directly against his own government is a pretty big problem in terms of public trust right? I get that we always grade trump on a curve but a normal president (even a Republican) would have been meeting with blue state governors and the CDC to at least give some appearance of a united front.
See my response to your other comment, but the TL:DR is that I actually don't think he deserves much credit. The mRNA vaccines were "novel" in the sense that the market hadn't supported their adoption, but it was tech literally sitting on the shelf in January 2020, which is why Pfizer was willing to pass on a lot of Warp Speed money (they wanted to retain more of the IP rights). And spending that summer dumping gasoline on the riots was just a straight-up disaster, even if (like me), you think Defund was stupid and counterproductive in all sorts of ways.
Like, if you look at 2020 and think, "That guy deserves a lot more credit for his great leadership and executive management as President and for all the great stuff that happened in the US as a result," I just find that to be a pretty risible claim.
Were there a lot of people in April 2020 saying that Operation Warp Speed was insufficiently ambitious in terms of the timeline?
This NYT article is critical, but not on those grounds I don't think:
https://www.nytimes.com/2020/04/29/us/politics/trump-coronavirus-vaccine-operation-warp-speed.html
I doubt it; think about the complexity of the set of factors that I laid out to you--it was enough that David responded with the suggestion that I was some kind of industry insider (not actually the case, but I was an academic doing work on pandemics, so also weirdly deep in the weeds for that reason*).
But this is where I come back to one of my hobby horses, which is that people tend to fundamentally misunderstand the nature of expertise. We tend to use "expertise" as a shorthand for "smartness," like so-and-so is an expert in X because they are somehow so "smart" about it. This is why during the pandemic you had so many pundit / columnist types who were suddenly acting like Covid experts--they all thought, correctly, "I'm pretty smart," but then took that to mean, "so I can figure this out as well as anybody with some internet research."
Obviously smartness is great. I like people to be smart.
But good expertise is really about having a large, useful body of specialist knowledge and training, combined with a highly developed social network in some particular area of interest that helps you develop thinking or delivers special insights. It's a deeply imperfect system--groupthink is 100% a thing, as we saw in Covid. But the only reason that I know about mRNA vaccines and their history is because of some connection I had to a researcher at Baylor College of Medicine who was involved with that stuff, plus I happened to be doing this pandemic project, plus I happened to have spent a lot time thinking and reading about infrastructure and logistics and clinical trials for a completely different bioethics project that had nothing to do with pandemics, and so on.
I can't have been the only one who knew this stuff or thought about the problem in these ways. But by the same token, I doubt the pool of such people is that large. To get that kind of input, you would have needed to seek it out because you desperately wanted it. And for the Trump administration, in particular, it would have meant seeking it out in precisely the pool of pointy-heads that they despised. It was never going to happen. But this was definitely not the insight that the smart columnists in the NYT were going to deliver, because you can't be smart enough to act on information that you simply don't possess because it is diffusely spread through a network that you don't have.
I think, too, that better pandemic response would have required the administration, and particularly Trump himself, to understand the shape of the problem differently than he did, or maybe could. People treat the pandemic as a black swan event, and in some ways it obviously is, but recall that Trump actually campaigned on his opposition to the Obama administration's response to the ebola outbreak. I think that with hindsight you can see a lot of the seeds of what he would do well or badly looking at that episode. It's useful to remind yourself that even though Covid was unique, we've had pandemic scares and even actual pandemics with clockwork regularity throughout the twentieth and twenty-first century, and people's ways of thinking about disease events are framed by all of those prior experiences in ways both good and bad. Part of expertise is being able to actually tease apart thinking, manipulate your own perspective, and rigorously examine your own ideas on issues where none of us are actually a blank slate.
I'll leave you with the same thing I said before: all of this stuff is very hard. It would be very easy to have tried and failed with Covid. A lot of people DID try and fail at various stuff with Covid. But the particular pathologies of the Trump administration were relevant to how they failed and what they did or didn't do, and it's silly to pretend otherwise. The nature of doing a hard job is that people die when you screw up--I say this in the most personal way, as a critical care nurse--and that you absolutely will be judged, harshly, after the fact. I see no reason to exempt Trump from that just because liberals dislike him.
*In part I was working on a museum project that opened, hilariously, in Nov 2019; in hindsight, it held up quite well until the museum closed, three months later. When the museum reopened, they quietly pulled the whole thing down--it had been scheduled to stay up for three years--because, "No one wants to talk about pandemics any more." Which, fair enough.
Your initial objection is to the idea of Trump getting credit for Operation Warp Speed, because it could theoretically have been better and faster than it was? I’ll take as given that you’re correct, but I’m not sure if that’s the right standard to use. I think we probably should give him credit if he was better on vaccine development than his political opponents.
In the summer of 2020, Democrats in Congress were objecting to Operation Warp Speed, not because it was too slow, but on the grounds that it was insufficiently transparent and that there were conflicts of interest in how it was run. There were objections about abrogating normal government procurement processes. You had Democrats saying that you shouldn’t trust the federal government on which vaccines were safe, because approvals were being rushed for political purposes. Biden campaigned on how he was going to set up a COVID-19 Racial and Ethnic Disparities Task Force and implement price controls to keep the costs of COVID vaccines down.
I really can’t say that I wish Democrats had had more control over COVID vaccine development in 2020.
Apologies for not replying to this; I was working night shift this week and too tired to keep up with comments.
I think this final comment takes you straight back to the core problem with your analysis: you keep wanting to get somewhere, to your take on how Trump was actually good on pandemic stuff, and so you look for ways to get there that involve hypotheticals or logical shortcuts, because a hardnosed analysis of actual circumstances runs straight into the actual Trump administration. I'm speaking, here, of the guy who said the pandemic would be over by Easter. That China did a great response. That we didn't really need the vaccines because Ivermectin and hydroxychloroquine were great treatments.
Interestingly, for purposes of your analysis, that guy also concluded that the vaccines weren't actually so great and that people shouldn't really be pushed to use them. In fact, that concluded that vaccines are bit overrated, full stop, and has added RFK to his cabinet in order to boost the signal on that view.
So no. I do not trust that guy's instincts. I agree with President Trump that his work on vaccines and vaccine policy was not something to be incredibly proud of. And I think it is telling that you have to 1) disagree with him--and ignore so much of what he said and did in the actual world--and 2) imagine some set of hypotheticals to get to a gauzy view of his administration's pandemic response.
You will notice that when I trafficked in hypotheticals, I always wrote that this stuff is very, very hard and that it is entirely possible that other administrations would have failed. And you will note that what I expressed anger over was the lack of effort combined with the actual things the Trump administration did and the attitudes that governed it. I'm not mad that Trump didn't deliver; I'm mad that he didn't try. And I think that the lack of effort is downstream of the basic pathologies of his administration.
Here's what I believe about a hypothetical Clinton adminstration response to Covid: it happens in a world where so many things are different--politics of the moment, personnel in jobs, policies enacted in prior years, economic and geopolitical circumstances--that we have no f-ing idea what would have happened.
With regard to the actual Biden administration, I have a laundry list of complaints; I was an "open up" guy in fall of 2020, when I pitched that very idea to the sensei at my martial arts dojo (you can find my excessively detailed written proposal online). But you wanted to talk Trump and how his instincts on pandemic stuff were right, so we talked Trump. If you want to open up a different line of conversation, we should do that. But that's a different line of conversation. It doesn't solve any of the problems with Trump Covid policy.
Do you think Trump was following an actual plan to deal with the pandemic in the most responsible manner possible or was just doing what he felt would serve his reelection and ego the most?
What I find frustrating about this debate is how much it leaves out.
Operation Warp Speed achieved some great stuff in terms of funding / incentivizing vaccine development. But it could have achieved so much more if the rollout had been well managed with a lot of federal government logistics muscle on the development and deployment side. I genuinely believe that Trump would have won the election in 2020 if thousands of people had been able to show up to national-guard-run vaccine centers and get needles in arms on the day the thing was approved. Here in Philly, that DID eventually happen--but not until months into the Biden administration. The delay and disorder literally killed thousands of people.
But logistics is hard, and the Trump people were too incompetent to make it happen, even though it was clearly in both their and the public's best interest. And that's what I fear about the next four years: the malice is bad, but the incompetence is worse.
I thought the first emergency use authorization in the US didn't come in until after election day? Do you mean Trump should have pushed the FDA harder on faster approvals?
I think this plays out in a lot of ways, actually, so let me just offer two examples:
1) The EUA was dependent on the outcome of clinical trials. Clinical trials are basically a massive logistics problem with multiple pieces, i.e. you have to organize participation, you have to produce enough of the vaccine to use it, you have to decide on structural questions like dose size. BUT...
You can absolutely drown a lot of those problems in money and logistics muscle, if you want to. Just to take one example, you actually DON'T have to make as many hard decisions on dosing if you just literally run multiple simultaneous trials at different dose strengths. The dosing thing actually came up specifically during the Covid trials, which is why I am thinking about it.
But this kind of thing is legitimately hard. The players in private industry want to keep control of their process and are going to resent the government's involvement; you may recall that Pfizer actually rejected significant parts of Operation Warp Speed because they wanted to keep more control of their product. Clinical trials are a huge pain in the ass. The production bottlenecks on Covid vaccines were real, particularly for the novel ones. These are all solveable problems, but they are difficult problems. BUT...
2) A thing I think that people still do not realize is that although we keep talking about "novel mRNA vaccines," the novelty was in the rollout, NOT the technology. The Covid vaccines were essentially off-the-shelf tech that had been developed by researchers in response to PRIOR CORONAVIRUS THREATS, especially SARS. The tech never made it to market because the SARS and MERS pandemics were the dog that didn't bark, for epidemiological reasons--those two never made it to general transmissibility (SARS basically makes you too sick too fast to actually be good at moving through the population). So researchers developed the mRNA vaccine tech, but then it got shelved because vaccines are, frustratingly, a lousy, low-profit-margin business with a lot of associated corporate PR risk owing to the anti-vax movement.
So it is possible that the mRNA vaccines would have failed; a lot of promising stuff in medicine fails in unexpected ways. But the reason it could roll out so incredibly fast is that the truth is we already had it--the core research had been done. We just weren't using it. That's also why Pfizer was willing to abstain from parts of Warp Speed; they were pretty sure it would work because it wasn't actually novel, and they wanted to maintain control of as much of the IP as possible.
But all of this highlights just how much low hanging fruit was left on the tree. Operation Warp Speed backed up a dump truck of money to some private companies and then asked them to manage a massive public health campaign. And they did an okay job in many respects! But that kind of thing--massive production of goods for managed delivery to literally the entire general public as quickly as possible--isn't actually what those companies are structured to do.
If you want to see how this failure works, look at the attempted Operation Warp Speed for ventilators, where the administration was going to incentivize GE to crank out vents for hospitals. It was a big nothing burger. The private sector simply did not--could not--deliver the needed vents when they were needed, and then as we learned to manage the disease at the hospital level, the vents were no longer as critical, so everybody just kind of muddled through and forgot about whatever Operation Vent was, except, hilariously, for Trump, who still brings it up publicly from time to time as something he should be praised for.
3) Rinse and repeat this story for testing, plus add in some screw-ups at CDC, which the Trump administration COMPLAINED ABOUT BUT DIDN'T FIX. Which is basically all you need to know about competence. Competent people fix things. But the Trump people had know idea HOW to fix things, because they had not cultivated that kind of internal expertise at managing a technocracy.
4) Rinse and repeat for PPE, plus add in the bit about how the administration had deep-sixed the automated factory project intended to solve precisely this problem.
Look: I want to be clear, here. These are very, very hard problems. Like, way harder than they sound when I describe them. I was a public health academic before I was a nurse, and I studied pandemics and infectious disease response (among other things), so I want to be clear that a competent administration might still have fumbled the ball on this. It requires an enormous level of money and muscle--note that other countries didn't step in and do this stuff. But the US has, at least on paper, the resources and expertise for even so Herculean a task, and I think given the will and competence, we could have worked that miracle.
But instead our leaders spent the summer fanning the flames of race riots in our cities, and instead of using our national guard and military logistics muscle to set up vaccination centers, we argued about whether to deploy them against protestors. And I think that was the real disaster that most people can't even see, because they lack the knowledge and imagination to understand what was possible.
You seem like you're deep in the industry so what am I mis-remember on 2)? I thought the big story pre-COVID about Moderna and mRNA in general was how the technology was struggling with safety and they kept over-promising and under-delivering.
https://www.statnews.com/2017/01/10/moderna-trouble-mrna/
https://www.nature.com/articles/nbt.3488
EDIT and to combine down-thread comments:
"Despite the promising trials with mRNA based therapeutics in laboratory settings, the facts remained that mRNA is highly unstable inside the body and prone to degradation by immune agents and nucleases, possesses a high potential for adverse immunogenicity, and initially generates weaker protective immunity than conventional vaccines [37]."
https://pmc.ncbi.nlm.nih.gov/articles/PMC8502079/
So the question to ask yourself, here, is, "How far, precisely, were we from developing functional versions of mRNA vaccines in January 2020?" And you have an actual, precise, real-world answer to that question: three months. They started the first safety testing in humans in March.
Three months is just nothing, in "scientific breakthrough" terms. If two different companies could arrive at a solution within three months, then the solution was not very hard to find. Does that make sense?
So the obvious secondary question is, "So why didn't they roll this tech out earlier if it was so easy?" And the answer, as I wrote in my prior post, is that the market did not support it, for a variety of deeper structural reasons that are why we have certain other kinds of persistent problems in public health. Public health is just, in general, bad as a profit-making business for Econ 101 reasons. This is why I come back to that Operation Warp Speed's money was absolutely a helpful thing to do. I am a big fan of throwing money at certain kinds of problems.
But then ask yourself: do you think Pfizer would have taken its shot on vaccine development absent the Warp Speed money that it, in fact, chose not to take? And I think the answer is probably yes. I still think that promising the government bulk purchases of vaccine was good, and I also think that assurances given shielding the companies from certain kinds of product liability were also good. Like, I think that Warp Speed achieved some stuff.
But I think what it achieved was way, way under the threshold of what was possible and way, way oversold in terms what it actually delivered versus what the private sector, acting in its own interest, would have developed. It's like government was a power screwdriver, and we used it to bang in some nails and felt very clever. You can absolutely hammer nails in with the battery pack of a heavy screwdriver. That doesn't make it the best use of the tool.
“ versus what the private sector, acting in its own interest, would have developed”
Ah, I was trying to figure out your counterfactual! So you think that a more hands off federal government could have done better? I guess, like, no FDA approvals required for vaccines? But also pharmaceutical companies can charge as much as they want for vaccine doses? But, presumably, you’d still have government enforcement of intellectual property in pharmaceuticals, and probably also you have to shield them from liability.
Is that right more or less?
I will 100% agree that this hypothetical semi-Libertarian World could have completely crushed us on vaccine development and rollout. I bet CVS would have been selling vaccine shots for $1000 a pop in like, May 2020.
I had dealings with the general put in charge of distribution when he was an Army one-star. Basically competent but far from blowing me away.
Yeah. This is why I come back to, "these problems (logistics, distribution, organization, etc.) are very, very, very hard, and even if people had tried to solve them, they definitely might have failed." As I pointed out, it's not like any other country picked up that challenge.
But it still makes me angry that they didn't try.
I agree with you. He should have fired Anthony* Fauci and Rochelle Walensky early on.
(edited to correct first name)
In gift stores in primarily metropolitan, but also liberal small towns, there are always little bobbleheads or candles that have certain cultural icons on them. People like Obama, Ginsburg, Jane Fonda, etc. Basically, to be put on one of those is a sign that you're above criticism in polite liberal society.
I think a lot of the criticism fauci got from conservaties was B.S, but his face got slapped on those bobbleheads and candles too. And I think that's indicative of his complete saint like status in certain liberal circles. People were just completely shut off from criticizing him. And in retrospect, it was needlessly divisive and stupid.
He got into the saint role because Teump acted like a crazy person and Fauci stood his ground on some basic facts about the virus.
If Trump says yes Fauci is correct, we're asking the CDC to find a middle ground that keeps schools open and helps the economy you wouldn't see the rupture. Fauci worked with every president from Reagan to Trump and didn't split with the other guys through multiple health scares.
True! But he also treated some concerns about NPI's that many people had as right wing talking points. This was a broader problem in public health discourse and sowed distrust in the institution.
Do you really think he sowed the distrust? I was never confused by anything Tony said. Seems to me it was Trump first, contradicting what his own experts were saying, then a whole host of opportunistic self-appointed experts - mostly but not exclusively on conservative media - who skewed the hell out of the story. In any case, Fauci was doing what the top public official in the country should do in the face of a pandemic caused by a novel and wily pathogen: giving the administration and the populace advice for how to keep the greatest number of people alive based on the information they had at the time - information and therefore advice that changed as scientists across the globe raced to learn more about the virus. It was up to the administration decide how to balance the implementation of that advice.
Oh, the disconnect between the feds and the thousands of local health departments and school districts was a big contributor to the confusion as well. Then the whole thing became partisan (one of most regrettable turns in American history) and we were off to the races.
He’s still seen that way too. I went to the recording of the Wait Wait Don’t Tell Me ep he was on at Wolf Trap. The crowd gave him three full standing ovations. A woman in front of me kept pumping her hand in the air like she was at a revival meeting. It was weird.
Yeah i understand this is annoying but it's crazy to me the extent to which people like Nate Silver and other centristish folks who I normally respect basically thought annoyance with suburban liberal culture was sufficient reason to vote for trump.
"people like Nate Silver…thought annoyance with suburban liberal culture was sufficient reason to vote for Trump."
Nate has said he's anti-Trump on record, although I can't find a page in his archives to cite.
https://www.natesilver.net/p/not-everyone-who-disagrees-with-you
"It is likely that I’ll vote Democrat for president again in 2024. I would certainly not vote for Trump, DeSantis or Vivek Ramaswamy, though I do see Trump as being much more of a threat to democracy than the other two and I think there has been too much equivocation about that."
Yes this is true. However if you listen to his Ezra Klein show appearance there's a whole section where he talks about how homebody liberals are annoying. But where's the disdain for dumbass antivaxxers?
Fauci is a really interesting case. In early 2020, I was happy that he was there, because he had been famously wrong on HIV but been willing to learn lessons. The deeply fraught relationship between Fauci and Larry Kramer is part of what I respected about Fauci. (Kramer was a relatively early Covid death, but famous for his aids activism where he called Fauci a killer for not legalizing experimental treatments.)
https://www.nytimes.com/2020/05/27/us/larry-kramer-dead.html
Can you remind me what Andrew Fauci's role was?
He was Director of the National Institute of Allergy and Infectious Diseases, a part of the White House Task Force on Coronavirus and de facto spokesman for the federal government on COVID.
I think David is trying to tell you that his name is Anthony Fauci
oops. my bad.
But he didn’t. So why doesn’t he get blamed for it?
For his followers, he is covered in teflon. For his detractors, he is covered in velcro.
Sadly, I think most people made up their mind about Trump many years ago and will never change it. Orange Man Bad or Orange Man Good, which is why his popularity was hardly affected by his disastrous leadership during COVID, or by leading an insurrection, or by his many other crimes.
Experience has told us that when Trump said he could shoot a man on Fifth Avenue and not change anyone's mind about him, this was not hyperbole.
I am not optimistic that his supporters will desert him even when his policies hurt them personally. They just won't blame him for it.
i mean there was a 6 point popular vote swing so clearly some people were changing their mind
>>But he didn’t. So why doesn’t he get blamed for it?<<
More basically, Trump failed to protects us from the depredations of the CCP. He doesn't seem to get much blame for that, either.
One thing I've told friends is that I'd find the election results meaningfully less depressing if Trump bragged about the vaccine. Obviously he wasn't in the labs but it's the kind of thing it's totally normal for politicians to take credit for and it makes the Trumpstalgia narrative way more coherent (economy was great first three years, COVID crashed it but Trump signed a bill creating a big, beautiful vaccine). Instead, he basically never talked about it and got booed the one time at a rally he did bring it up.
It will never cease to amaze me that he didn't brag about the vaccine. This is the guy who went to twitter to brag about the fact that there were zero *global* airplane traffic deaths in 2017 or 18 or whatever, as if he made it happen. He used to troll twitter looking for virtually any positive news, then construct a brag tweet taking credit for it.
And so, of course, I mean, obviously, he distances himself from his administration's greatest achievement. I mean, that's right there, in the middle of my 2019 bingo card. Totally saw that coming.
It's amazing. Trump doesn't even want credit for the few good things he did, and he gets no blame for the bad things except from people who were against him all along. Nothing sticks to this guy. How does he do it?
(The first things that come to my mind are the common accusations that his supporters are idiots, and that their diet of legacy and social media consists of nonsense and propaganda -- but I personally know lukewarm Trump supporters who are generally quite smart, and just think that Trump is bad but the left is even worse. Also, Trump personally attracts more intense and more committed love and hate than most political figures. The left has become more radical since the mid-2010s, sure, and there is something about Trump's personality that is polarizing -- but is there a structural reason for these things to pick that point in time rather than another? Maybe the spread of social media, with a few years lag? Or the destabilizing effects of rising inequality? Or backlash to the changing ethnic composition of America?)
Ok, you think Trump is responsible for blue state mask mandates and school closures, lol.
Unfair?
It's not as bad as "lol who was president during all that stuff you're complaining about?"
80% of human-generated internet content over the last two months has been "The president isn't responsible for inflation"* If you want to hang NPIs on Trump, you've got to do better than that.
This is stage four rhetorical cancer. Nuclear-grade self-delusion. Every upvote for your comment is vote to stop thinking and just fling shit at your opponents.
* Except on the rare occasion when someone's giving them _credit_ for "favoring employment over inflation"
The blue states didn't come up with this stuff out of the, uh, blue. They were following the CDC's guidelines.
If this is a serious response and not just trolling, please tell me what you think Trump could have done that would have actually made blue America adopt different mask mandate and school closure policies.
The CDC guidelines related to what a safe indoor space looked like. They didn't say just keep schools closed.
All early pandemic playboys say close the schools early on because not knowing anything, kids are likely to be a large spreader of a new virus.
Trump could have said, we're investing $$$ into air filtration for schools and we will ensure they're all able to open in the fall. A competent executive makes that happen.
I mean, we'll never know, but he could have tried having the CDC give better advice. If the idea for NPIs hadn't come from the federal government, where would it have come from?
And yet blame for inflation did stick to Biden and Harris like glue. And that's with inflation's huge drop by 2024! It's like "we'll blame you for what happened about two years ago but not credit you for fixing the problem."
The contrast with Trump's CDC and NPIs couldn't be starker.
The problem is that even if inflation has a huge drop, that box of cereal still has a much higher number on its sticker than it did two years ago.
This is kindergarten-level reasoning.
I went to a very highly ranked kindergarten.
“ Ok, you think Trump is responsible for blue state mask mandates and school closures, lol.”
When did Truman say the buck stops?
Ok, so not unfair then.
The post-vaccine Biden era restrictions would’ve made sense if Long Covid really led to almost permanent disabilities for a significant number of people. Despite some series cases the initial double digit % numbers were fortunately completely wrong and never retracted and the topic seems to have been completely memory holed. If Covid really led to permanent damage to a large percentage of the working population things would’ve looked quite different.
It’s not totally obvious that the early numbers were wrong - it wouldn’t be totally surprising that somehow people got incidental exposure to bits of Covid strands once most people had been infected and vaccinated multiple times and copies of the virus were everywhere, but that for people who got infected with literally zero prior exposure to the virus, it had different effects. Theres so much we just don’t understand about viruses or the immune system.
I think it was about expectations. You mention it began to wind down in December 2020, but it didn’t fully wind down. 2021 had several nasty variants, the vaccines did not work as well or as initially advertised, and there were still school closures and disruptions into 2022. There was lots of general angst and strong policy disagreements in 2021 about continued mandated use of NPI’s, Biden’s attempt to mandate vaccines via OSHA in late 2021, etc.
Yes, but that's mainly becasue Biden did not criticize and pivot away from his policies.
Biden was forced to end the masking mandate on planes and the eviction moratorium due to court orders. Lots of things in retrospect were silly.
AND THE OSHA COVID VACCINE MANDATE.
Guys, it was so authoritarian, I remember. Literally I was radicalized by the Biden administration (and blue states) COVID policies. The government was suddenly very intrusive in my personal life.
Remember how after 2008 people joked we should stop giving out Nobel prizes in economics? I feel like after COVID we should just shut the federal public health establishment down.
I've fully admitted here that vaccines are my most authoritarian position, so I'm willing to own the label if you must, but a mandate through OSHA always made the most practical sense to me. I probably would have had more leeway for jobs with lower transmission risk, primarily ones that overwhelmingly work outdoors, but I just don't see a couple jabs as some huge personal intrusion in the face of impeding the intrusion of disease in others.
What am I missing? I thought the consensus is now "the impact of vaccination on community transmission of circulating variants of SARS-CoV-2 appeared to be not significantly different from the impact among unvaccinated people."
https://www.thelancet.com/journals/laninf/article/PIIS1473-30992100768-4/fulltext
Like I said in another subthread, suppressing transmission isn't the point, it's damn near impossible. Blunting adverse health impacts while transmission occurs is what the goal is.
This is some dude's letter to the editor interpreting another study. There were other letters, e.g., this one, saying the original study's results may be confounded by age (the authors try to rebut this though): https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00763-5/fulltext (note that the authors of this letter wrote their own study based on data in the Netherlands showing there was an effect on transmissibility)
Original study: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00648-4/fulltext
Author's reply to the various letters: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00761-1/fulltext
I would be more open to this authoritarianism if there was much more certainty about the safety and effectiveness of the vaccines, particularly on transmission. The OSHA mandate would be primarily mandating low risk people (prime age workers) get vaccinated to hypothetical benefit of other people (the very elderly). To me it also matters that this formulation had young healthy people sacrificing for old sick people.
There's no adult mandate for the pertussis vaccine even though there ARE babies who die of pertussis before they are old enough to be vaccinated.
Seems like a really low value moment for Democrats to have taken their shot for authoritarianism.
"sacrificing" is doing a lot of work there. Let's not overstate the case: any risks from the vaccine are miniscule. It may not pencil out for some cohorts, especially children, but we're still talking about incredibly small numbers here. Now as it turns out, mandates probably didn't/wouldn't have mattered in aggregate (I think?), but they weren't poorly conceived at the time.
I have never had a good experience with the covid vaccine and I have gotten every booster. Lots of people reasonably say "that was not fun" after the first jab. I understand why people need the vaccine but also am empathetic to folks who don't want it.
I really wish they would run some studies on smaller doses of vaccine. I’ve heard rumors that they all proposed bigger doses in their trial just to be sure it would work on the first trial, and then once it was approved, there’s little motivation from either side to run a new trial with smaller doses. But Moderna has more awful next-day effects and has twice the dose of Pfizer, while being only moderately more effective, so there are likely other points on the curve where people would get better tradeoffs.
Not just in retrospect but also in real time.
The airplane bullshit pissed me off so much in real time.
I flew the day before and the day after it was lifted. It was amazing how people's spirits seemed lifted afterwards. IIRC, ~75% of the passengers dropped the masks, not to mention the whole flight crew.
Omicron/Delta erasure. Most of the deaths occurred after December 2020.
But otherwise, yeah I agree.
It's true, but it's also perfectly consistent with hardcore Trumpist political philosophy, whose proponents believe that Trump (or whoever the leader of their movement is in the future) merely being "the guy in charge" isn't sufficient to fix the country. If political opponents are allowed to oppose him in Congress and act independently of him in states and cities, then that ruins everything. If anything bad happened on Trump's watch, then all of the blame should go to the political opposition, and the solution should be to neutralize all competing sources of political power.
It is absolutely true that if you hire incompetent leaders, they will accomplish little when faced with challenges. \S
I agree broadly with the thrust of this piece but think you badly misread the role Bhattacharya played in the last pandemic.
A strident critic of NPIs, even to the point of controversy, with conventional views on the deadliness of covid, would maybe cause similar controversy but would not be as alarming to me.
But Bhattacharya’s M.O. during the pandemic was to stake out a contrarian position on the deadliness of covid, produce poor science to support that position, and misinform people of their personal risk of morbidity and mortality in appearances on conservative media. This began as far back as April of 2020, when he co-authored and pre-released a study with serious flaws suggesting an IFR about a tenth of the consensus (and the consensus was right). I do not have time before work to cite all this in full, but I suggest this piece from Andrew Gelman of Columbia on the quality of the work that shot Bhattacharya to fame in conservative circles: http://www.stat.columbia.edu/~gelman/research/published/AssessingEvidence.pdf .
Bhattacharya is the opposite of someone who could credibly approach trump about the deadliness of a new pandemic - not because he wouldn’t be credible, but because he would almost certainly conclude again that the deadliness of any virus is overblown, especially in the earliest stages when interventions can actually be effective, and would use his credibility to prevent an appropriate response.
People should read the piece by Andrew Gelman linked in the comment: it is short, well-written, and makes several very good points about the weakness of the study.
It does not, however, support this level of hostility to Bhattacharya.
As Gelman himself wrote, Bhattacharya's team's inferences were consistent with the data, just overconfident. Recall that the Santa Clara County study was *published* in April 2020. That team was hardly the only one getting over their skis.
Your comment is fair minded, and you are right to suggest that the article is not sufficient to justify my view that he did not correctly assess the severity of the last pandemic, and persisted in error to the point of misleading people about their risk levels - the IFR controversy probably requires a book, and I’m not the one to write it. In lieu of that, I think a short summary (with which I agree) that addresses the points you raised can be found here: https://www.econlib.org/the-pessimists-were-correct-about-covid/ . In it, you’ll find a quote from Bhattacharya from November of 2020 in which he makes demonstrably false claims about the deadliness of covid for under-70s (much later than April, which as you note was early enough that many people got things wrong).
The study I linked to at the National Institutes of Health says: "For 29 countries (24 high-income, 5 others), publicly available age-stratified COVID-19 death data and age-stratified seroprevalence information were available and were included in the primary analysis. The IFRs had a median of 0.034% (interquartile range (IQR) 0.013–0.056%) for the 0–59 years old population"
In the one you quote, Bhattacharya is criticized for saying it was 0.05% for those under 70, which actually OVERSTATES the IFR. Seems Bhattacharya is more correct than the author of that page.
I would like to engage on the substance of the paper (with which I am familiar), but do not have time this morning. I will point out:
1) the paper you link was written by a group of authors who dedicated their pandemic research output to producing work that suggested a contrarian IFR for COVID, including at least one who was a co author on the April 2020 study I mentioned.
2) More than 0.1% of US under-70s died of COVID.
I agree that it's fair to hold Bhattacharya responsible for his November 2020 statements, but he may well have been more accurate than his opponents at that time!
In the article you linked, Sumner is taking him to task for estimating an 0.05% IFR for under-70s. Per Sumner, that was ridiculous because, 14 months later (when Sumner was writing) 0.10% of Americans under 70 had died of COVID. Indeed, the best information I can find now estimates that cohort's IFR was roughly 0.10%* If true, Bhattacharya was off by a factor of two, which sound really bad at first blush! But well into 2021, I recall many epidemiologists arguing that the IFR would be significantly higher, often approaching 1%, which would have been off by a factor of twenty! (Those estimates probably weren't apples-to-apples, which complicates things.)
I agree about the IFR controversy, and I'd love to read a solid retrospective that incorporates everything we know, including seroprevalence studies, wastewater monitoring, antigen test regimes (at colleges), etc..
* Ioannidis was on the papers, which you've suggested might be discrediting. I'm open to better ones, but can't find them. https://www.medrxiv.org/content/10.1101/2022.10.11.22280963v1, https://pmc.ncbi.nlm.nih.gov/articles/PMC9613797/
Agree with you on the rest of your comment, but I don’t think 1% was ever an IFR estimate for under-70s; it was the first-wave consensus IFR overall for places with age distributions like the western world. The early UK IFR estimate from Ferguson which Ioannidis, Bhattacharya, and co criticized relentlessly was 0.9% overall, not among under 70s.
Indeed - it's not apples to apples, and it's difficult to find age-stratified estimates from that time.
It feels a lot like an isolated demand for rigor, though, where Bhattacharya's errors aren't compared to any real-world baseline. (That's one of my problems with Sumner's article: Ferguson and Bhattacharya's projections were different along several dimensions.)
Just one data point that is driving me nuts.
For all of human history up until the 19th century half of all kids didn’t reach their 5th birthday. And that was almost entirely due to communicable disease. If you managed to hit 5 you could fairly often, like Ben Franklin or Louis XIV, live into your 80s.
The idea that kids don’t get sick and die is a very new development historically. There is very little evidence that kids are less susceptible to communicable disease than adults. As anyone who’s has kids at daycare can attest.
As a perhaps dated pop culture reference remember the Seinfeld episode about how vomit streak? It’s funny because people remember being a kid and getting sick and throwing up fairly regularly but that’s something that happens very rarely if at all as an adult.
TLDR - for many of you your mental model of disease is a modern one and it’s about non-communicable disease processes - cancer, stroke, heart attack, etc. Disease processes of the old. For most of human history half of us were dying at 2 of scarlet fever or whatever.
Not to mention malnutrition, vitamin deficiencies, drowning, car accidents, poisoning, etc.
It should be obvious to anyone who has kids that they are incredibly fragile up to around five or six, at which point you've likely watched them have every symptom of every weird infection that babies and toddlers get and watched any number of close calls where you thought "if it weren't for <common safety measure> my kid might have died!"
Now that we fortify foods and vaccinate kids, a bunch of idiots have come to the conclusion that the problems these things solved never existed and, actually, that it's a huge conspiracy and these things are really bad for kids so they should all be drinking raw milk or whatever. And, you know, it's just a huge coincidence that a bunch of kids get the measles when kids at their school aren't vaccinated.
I don't "get" the raw milk thing at all. Best I can tell *all* the supposed benefits to raw milk (e.g., lactase / probiotic bacteria) are actual benefits for fermented milk (i.e., kefir) but they're not actually in raw milk. It's so dumb. Like ... just drink kefir?!
It's truly bizarre to me that adults would even *want* to drink milk. I get using it as an ingredient in things, but *drinking* it? What?
People like to push it in terms of “benefits” but I think the real thing is the actual taste and mouthfeel and all that. Pasteurized and homogenized milk has its charms, but it’s different from real raw milk, just as orange candy is different from a real orange, and Hershey’s chocolate is different from a single origin bar, and so on.
Kefir and all the other traditional cultured milk products have their own taste and place but they can’t substitute for each other if you care about the sensation.
Now is it worth caring about the sensation enough to be worth the small risk of getting contaminated milk? Most people don’t think so, but should government decide for us? Maybe it’s reasonable for them to ban commercialization, the way they ban commercialized BASE jumping. But I can see how people get to the idea that they shouldn’t.
Worse, a lot of them have concluded that your child dying of a communicable disease is a better outcome than autism.
I find it frustrating that the same people who think the DSM-5 is a bunch of woke nonsense are totally convinced that autism spectrum disorder is a greater threat to public health than communicable diseases.
I mean it’s obvious to anyone with a functioning brain that autism diagnoses have increased because they’ve expanded the definition to include a lot of kids that past generations would have just called nerds.
Oh but the rise in autism diagnoses is also correlated with a rise in vaccination rates and, as we all know, correlation = causality. Except for the correlation between guns and gun-deaths, that one remains a huge unsolved mystery.
Right, couple that with "risk factors for autism are smart parents", and it's really obvious what is going on.
In many ways it’s similar to what ADHD was in the 1990s.
That’s certainly part of it. But there has also been a rise in childhood myopia and childhood obesity in recent decades, that aren’t just changes in diagnostic criteria. It’s not out of the question that there’s some real change (though being convinced that it’s vaccines, and *also* making the *further* step to thinking that this would make vaccines net negative, are both unwarranted).
I think childhood obesity is where the seed oil nonsense comes in.
"Now that we've solved this problem, people can be easily led to believe it was never a problem" is a curse of modernity I never would have imagined when I was younger. It really sucks for society.
Basically, you are saying that kids used to get the live virus version of the vaccine which had substantially more severe side effects. \S
agreed vaccines were great.
But don't forget modern sanitation and antibiotics
"the Seinfeld episode about how vomit streak"
Despite being pretty sure I've seen every Seinfeld episode, "vomit streak" is escaping my recollection.
“ Jerry and Elaine stop at Royal Bakery to purchase a chocolate babka while Kramer and George go to buy wine. Jerry and Elaine forget to take a number at the counter. As a result, David and Barbara Benedict, a couple on their way to the same dinner party, get ahead of them in line and purchase the last chocolate babka. Jerry and Elaine resort to purchasing a cinnamon babka, which Elaine considers a "lesser babka". They find that the babka has a hair on it, and are forced to wait in line again to exchange it. While they wait, Jerry eats a black and white cookie, which he extols as a metaphor for racial harmony. Once they are called again, Elaine and Jerry exchange the babka for a new one, only for the seller to violently cough on the new one. Afterward, they have to wait for Kramer and George to pick them up. The cookie causes Jerry to end the non-vomit streak he has held since June 29, 1980.”
Ah, thank you, I do know that episode (Jerry concludes that his B&W cookie must have consisted of Farrakhan and David Duke), I was confused by "episode about how vomit streak," which I'm guessing is a typo for "non-vomit streak."
I think that episode is the whole reason as a kid I learned about babka, black-and-white cookies, and that there was a baked good named after Napoleon.
Allow me to vent...as a the child of a public school teacher (and union rep!) I will never forgive the Seattle Education Association (teacher's union) for keeping my first-grader at home until April 2021, and then going back half-time. And requiring masks for kids in fall 2021, despite everyone having been vaccinated. And then going on strike to delay the start of school for a week in 2022.
They lost all credibility and SPS attendance has dropped to the point that school closures are necessary.
Good job, guys.
This makes me feel especially grateful we were in Rhode Island - a blue state - but our governor (who is now Secretary of Commerce) was paying attention to the data and really pushed hard for schools to reopen quickly. She got a ton of parent pushback. But she was on TV every week early in the pandemic trying to persuade people to send their kids back. My son started in-person preK in June 2020 and my daughter in-person 2nd grade in fall 2020. I was so nervous about it then, but so grateful for it now.
I'm pretty worried about a public school death spiral out here - seems like a lot of chatter I'm hearing is from folks who want their kids in public school in theory, but don't want to be "holding the bag" by being the last ones to pull out. Really bad situation, especially with a simultaneous budget crunch. It feels like some prominent elected official (mayor? governor?) will need to come out and say "we're done with social engineering attempts, the only metric we care about is academic performance" to reverse the trend.
Same here in IL. Except our stupid and selfish Chicago Teacher's Union went even further and walked out in January of 2022. These actions created a huge outflow from the city back to the suburbs. I don't see this reversing for an entire generation until we have another city collapse like in the late 90s.
https://www.illinoispolicy.org/chicago-teachers-union-uses-covid-19-to-walk-out-on-students-again/
The CTU has a faculty lounge in the 5th circle of hell.
Fall 2020-winter 2021 I might have had a little grace, especially if too many people were getting sick to even be able to run a school, and also with knowledge of vaccines around the corner. But post-vaccine, yes, let 'er rip, proceed normally, and get to work.
There is a question about what “proceed normally” means. What are the conditions under which a school should mandate that a sick student stays home? The 2021 version where any symptom means staying home is too strict, but the Florida version of “come in even if you have measles” is surely not right either, and I don’t think it’s clear we had the best balance in 2019.
That was very bad, and I'm genuinely sorry to hear that.
I teach in higher ed in the UK, where (like in most of Europe) school closures were much shorter than in lots of US urban districts, and the effect of even relatively short closures on students were devastating - even for affluent students. We're still seeing students who are functionally illiterate and innumerate (and we're pressured to allow them to get undergraduate degrees, which is a whole other thing I could rant at length about) as a result of those closures. Remote schooling doesn't work for any but the most high-performing students (who'd probably thrive academically pretty much no matter what).
>"Conservative rage against the public health establishment led them to hypercorrect against claims of vaccine effectiveness and downplay the virtues of vaccines that were genuinely quite virtuous."
I think many people even now underestimate just how large this effect is. I spent most of this last year in the south and midwest, and multiple strangers I talked to randomly brought up that this is what they believe (though they didn't think of it as a belief). In the more extreme instances, I was told that the covid vaccine killed or injured (and is still killing or injuring) absolutely massive numbers of people,. In two cases, that they personally knew multiple people in their small town that died because of it. In one case, they were convinced there were two versions of the vaccine, neither of them effective, a placebo given to liberals and a "death shot" given to conservatives.
I listened to the Politix podcast on my train to work this morning and both Matt and Brian agreed there is a real danger to RFK Jr's nomination even if he is completely ineffective changing anything substantive at HHS for the reasons you cite. This nomination is a giant signal flare to Trump's biggest fans to indulge in anti-vax crankery full stop. Not just covid but vaccines in general.
There's already a growing movement to loosen restrictions on childhood vaccination. https://floridaphoenix.com/2024/05/17/as-states-loosen-childhood-vaccine-requirements-health-experts-worries-grow/
Really one of the top areas where not listening to experts is actually deadly. I suspect that most regular people don't realize that the pure anti-Vaxers are still small enough that they are "free riding" on the fact that 90% of us are vaccinated against all sorts of diseases. I think we are rapidly getting to the point where vaccination will dip below the proverbial "Mendoza line" and we can have serious outbreaks of diseases like measles.
RFK shouldn't be anywhere near the HHS organization and nominating him to that role is irresponsible. I'm hoping the Senate will fail to confirm him (and Gaetz) in a couple of months.
Him, RFK jr and Tulsi. My friend has convinced me that Tulsi is probably most dangerous given we have serious doubts about her actual loyalties (we clearly have a source somewhere close to Putin. Whoever that is I would seriously consider trying to find a way to flee).
Pete Hesgeth is also a terrible pick. Besides the assault allegations, just not qualified. But I’m trying to be realistic about how many cabinet positions can be blocked. So Ill grudgingly take it if the other three are denied
Even if Gabbard isn't a traitor, the fact that there's enough question marks around her would mean our allies would be reluctant to share intelligence as freely as they traditionally have done.
Honest to god. If it becomes clear that she will get confirmed I really hope Biden raises alarm bells to our allies to withhold sensitive intelligence.
An actual comment from a NURSE in our friend circle in Florida: "My step kids just had the measles and they were fine lol."
Imagine writing this as a health professional. I'm embarrassed for her.
Being a nurse doesn't necessarily mean that you know a ton about medical science.
Like, don't get me wrong: some nurses DO know a lot about medical science, and found that that flowed naturally from their training. But others learned a lot of basically specific trade skills to do with medical procedures, and maybe a few isolated principles relating to a few areas, and never put it into much of a framework.
You don't have to know a lot about medical science to know you should probably vaccinate your kids against measles.
You don't. But the whole "but it was a NURSE" thing is just overestimating how much particular knowledge nurses as a class have.
Among other crankery. Since the announcement of RFK Jr. I’ve noticed a lot more raging about seed oils and GMOs. The sort of things we used to associate with cranks on the *left.*
Again, right-wing cranks getting into hippie-coded crankdom isn’t new (the homeschool movement is an older example) but this is going to end badly.
Unlike other kinds of crankery though, this one in particular has a sort of self-correcting effect: unvaccinated folks have a higher risk of dying, which over the long term, uh, "adjusts" the prevalence of that belief in the population. And people aren't total morons - they'll eventually pick up on the fact that folks with this theory of the case are having worse outcomes, and quietly start getting vaccinated. Like, as long as vaccines aren't banned, I'm happy to continue getting my shots and just seeing this contagion of stupidity work it's way through the population.
The selection effects here aren’t nearly strong enough. Even if every unvaccinated child gets measles, most of them survive just fine, and the fact that a few vaccinated people will get breakthrough cases too will muddy the waters about the effectiveness of the vaccine (which we’ve seen plenty of with Covid).
The other issue is if there is enough unvaccinated people to create outbreaks you substantially increase the possibility of mutation which means even vaccinated people may not be protected
I think you underestimate the danger to children. Anti-Vax people are likely vaccinated against all sorts of diseases in childhood. Anti-Vax crusade is more likely to lead to outcomes like polio coming back and afflicting innocent kids who had no choice in the matter to not be vaccinated
So little in life is unambiguously good, but vaccines are just about the closest thing to it. Being against vaccines is like being against toilets.
A common thing on college sports forums in the SEC is trying to make a connection between an increase in cardiac events involving healthy young athletes (think Bronny James or Christian Eriksen) and COVID vaccines. These people are genuinely very stupid and deranged.
In my shittier and more intolerant moments, whenever someone goes on at length about the side effect risks from the Covid vaccines, I reflect on my zero side effects across four shots (across three different countries, as it turns out) and think, trollishly, "I guess I must just have superior genes."
So that there's no confusion, I'll reiterate the "shitty" and "intolerant" aspects of the above. Not my brain's finest work, to say the least.
If the financial crisis was a nail in the coffin of "establishment credibility", so was the pandemic. :-(
Searching for the positive in what could happen in the next four years, one thing that would be great is a tota ban on gain-of-function research by virologists. Regardless of where you stand on lab-leak vs natural origin it’s still shocking to me that the pandemic didn’t spur massive change in this area. Even if one doesn’t believe in a lab-leak, it’s clear that having done all the dangerous research didn’t lead to any actionable information to prevent the pandemic, so what could possibly justify the risk.
I can’t understand why this isn’t a bigger deal for the Covid-phobic. I find myself rooting for Rand Paul, and it just doesn’t feel right. Why aren’t more people motivated to pursue this?
It’s not just the risky research, it’s doing it in labs that aren’t safe enough, that plenty of people *knew* weren’t safe enough. Stopping it seems like an obvious political win for anyone who wants to step up (beyond Rand Paul).
Yeah, it would be one thing if they were doing this research in top secret bases in the desert guarded by military with few interactions with the outside world.
instead they are doing it inside major cities
China will still be doing it
Sure, but what will they gain by that? Besides it's utility in designing biological weapons, which, as far as WMDs go, seem like the stupidest kind (see: Covid). The reason to ban it is because the risks out weight the benefits both locally (you are much more likely to have a lab leak than develop a successful, hyper targeted biological weapon) and globally (you are much more likely to have a lab leak than to develop counter measures to some future, unknown virus). Unlike AI or missile technology, where banning it could theoretically give a bad actor a leg up in the arms race, pursuing this research just never seems to meet the cost/benefit threshold, regardless of what your opponents are doing.
I dunno, then why do they still do it?
Still worth banning, so they do less of it.
I'm still somewhat amazed at the worldwide reaction to a disease with such a low infection fatality rate (IFR). For those under 70 years old, COVID (across all its variants) was just not that much of a risk. And yet officials and the media exaggerated the risks and implemented extreme measures in cases all across the developed world.
I recently saw this scientific paper analyzing IFR by age group for the pre-vaccination period. It is eye-opening. I know the "fog of war" applies to more than just military engagements, but I do wonder how much of this was known at the time and why it didn't inform the communication strategy and NPI measures more directly.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9613797/
20/20 hindsight. The hospitals were full at one point and few of those people survived initially. There were tremendous advances in treatment in the first few weeks/months.
What would your ideal policy have been in March of 2020?
Some (not many) were full, but as the study notes, "However, in depth analysis of population data of health utilization show that for the non-elderly (and even more so for children) the number of hospitalizations was shaped initially in many countries by the precautionary principle, admitting many people to the hospital, especially early in the pandemic, while hospitalization rates declined over time."
The hospitalizations were due to the panic, not just the pandemic. And the idea that "few of those people survived" isn't true.
My understanding from people who were there is the main issue was with the severely obese more so than the elderly. Although the obese elderly were really fucked.
My scariest early COVID moment was when a 30-something guy in my city died in like early March. He was obese, but not severely so.
I wonder what "John from NYC" would have to say about this retrospective view.
Depends on whether it is "John From Staten Island" or "John from the Upper West Side"
This is a good example of why the hospitals were full:
https://www.npr.org/sections/health-shots/2020/08/17/902690217/back-to-life-covid-lung-transplant-survivor-tells-her-story
The article seems to suggest the 28 year old's double lung transplant was "due to covid", but if you read it more closely it was covid -> "low oxygen levels" -> ventilator -> bad reaction to ventilator -> double lung transplant.
Putting otherwise healthy people on ventilators because of low oxygen levels was a failure of the "first, do no harm" principle. It was good that we stopped doing that, but not very excusable that we were doing it in the first place.
They weren’t “otherwise” healthy if they weren’t oxygenating their blood - that’s kinda the key definition of healthy.
Sure, but a ventilator was an extremely intensive and risky response to what was not a serious problem.
If they were putting people on ventilators as part of a "medical panic" during covid, that should be a scandal. If they were putting anyone who was 28 and had low oxygen on ventilators as a normal course of action prior to the pandemic, then that should be a scandal, as well.
Not being able to oxygenate you blood is the very definition of a serious problem.
But they wouldn't have put that girl on a ventilator if she showed up at the ER today.
One of the things that was shocking in early COVID was that people had much lower blood oxygen levels than doctors were used to seeing in anything other than extreme pneumonia. If you were always trained that blood oxygen below 90 means severe risk of death, then the ventilator seems like a worthwhile risk. But surprisingly, COVID often seemed to produce low blood oxygen levels in ways that didn’t obviously cause other harms.
I don’t know if it’s because past measurements were just missing cases where low blood oxygen arrived in less dangerous ways, or if there’s something about how COVID distorts blood oxygen measurements or what.
I mean, over a million people died in the US alone. Think of how American policy changed for about a decade when 9/11 happened and killed a fraction of that.
Beat me to it. The IFR might be low compared to greater pandemics past, but that's still a ridiculous amount of people dead, to say nothing of the many more who suffered, plenty of which needed hospitalization.
But these numbers are due to the fact that there are vastly more really old people than there used to be. Now that we are up to 330 million people, everything is "worse" in the sense that there are more people to be impacted.
Should that really matter much? Seven digits of people dead is still a lot of dead people, even if we're now at nine digits of total population.
I guess the question is "matter for what"? I'm not sure if you are suggesting that the population size of a country should impact how seriously it take a pandemic, but that seems a bit illogical to me.
If it's not about total numbers, but instead about the impact of 1 million from covid vs deaths from other causes, then the usual public health technique has been to convert deaths to years-of-life-lost, or sometimes years-of-healthy-life-lost, in which case each death from, say, the Vietnam war (50 or 60 years lost) counts for much more than each death from covid (on average 5-10 much less healthy years lost, maybe?)
By this weighting, our current overdose crises begins to look a lot worse than covid, probably equalling it in years-of-life-lost every two years.
But these things can't be reduced to pure math equations. 9/11 was bad for many, many reasons beyond the number of people killed. The pentagon was partially destroyed, for example.
Whatever we say about the difference between pre-9/11 life and post-9/11 life, it pales in comparison to the difference between December 2019 or December 2024 and April 2020.
I think you’re forgetting how scary the fact that Covid was new really was. Are there researchers who maybe knew in February how seriously dangerous Covid was? I mean maybe. But reality is there was probably no way to know. I mean how do you measure medium/long term impact without enough time to elapse.
As an example. Remember “Cytokine storms”? People supposedly breathing normally and then suddenly they are dead in their hospital bed. There was a real “WTF?!” going on. Or remember how supposedly people were getting “reinfected” like a week later? Turns out it wasn’t true but it turned out to be true that your symptoms can come back in like a week.
In other posts I’ve noted I’m at least sympathetic to your position especially post vaccine. Once vaccines were widely available trying to keep enforcing NPIs was dumb and (sigh) someone like RDS might have been right (at least on NPI).
But February though April 2020? I think we need to give a lot of consideration to remembering how scary this time was. The answer that most of us don’t want to admit is when something is brand new there is way too many unknowns. In that environment, being overly cautious is completely defensible to me.
I give a lot of grace to officials during the Feb-Apr 2020 timeframe, for the reasons you cite. After that, though, the response should have adjusted for the data and it did not.
I think the visualization here captures why extreme measures were taken: https://kieranhealy.org/blog/archives/2021/10/21/excess-deaths-in-2020/
For people not clicking the link, it's showing the mortality rate from all causes in 2020, compared to other years. NYC, most notably, was more than 30% increased.
I understand the presence of extreme measures. I cannot understand the application of those measures to the population at large rather than having them targeted by age.
We were too lax with the NPIs for those over 75 years old and too strict for those under 65.
20/20 hindsight.
Most of human history has taught us that the very young are most vulnerable to communicable diseases.
It's not hindsight. It isn't like health officials in 2020 just looked at "number of deaths" without knowing whether it was someone who was 89 years old or 18 months old. They had the age data right there all the time.
John, with respect, this is just pure retconning. The scientific process works over periods of years, not periods of weeks and frankly it wasn't/isn't set up to provide the kind of data we needed fast enough.
For at least the first 9 months, for every study that said kids were fine, there was another one saying kids faced high rates of permanent heart and lung damage that would scar them forever.
History is filled with diseases that didn't reveal their true cost until years or even decades later (scarlet fever -> heart damage, HPV -> cervical cancer, Epstein Barr -> MS). We were dealing with a brand new disease that we barely understood The correct response to this is to carefully apply the precautionary principle, which was roughly what policy-makers did (obviously excepting the downright stupid stuff like BLM protests, etc).
Just because the worst case scenario didn't pan out in the end doesn't mean the response wasn't roughly correct, at least for those initial months, probably until the vax and maybe antivirals were widely available.
Death rates and hospitalizations by age would have been available from the point that deaths were being counted, though, would they not? I remember reading analysis of the Diamond Princess Cruise ship very early on, and working them out myself, for example. It's a failure of the scientific or public health response if simple facts around age can't be communicated in a timely manner
As far as it being a new disease that we were unfamiliar with, this is only partially true. We have plenty of experience with other coronaviruses, and "long term effects of minor/moderate/severe covid infection will be similar to minor/moderate/severe other coronavirus infections" should have been the default.
They had the data and they were also responsible if they were wrong. What if they were wrong?
What they could be wrong about, in terms of simply reporting deaths by age rather than just deaths?
The problem with transmissible diseases (especially ones that transmit prior to symptoms) is that they don't just stay among low-risk populations.
Restrictions were placed on low-risk people because they could easily transmit to high-risk people. A huge portion of transmission was within a household, and those are commonly multi-generational.
And it's not like the olds are going to be properly wearing N95s all the time, especially at home.
Absolutely, but we knew the truth four-to-six months in, at which point policy did not update
That was the biggest problem. I give everyone a mulligan for Spring 2020. No one knew what this was yet and extreme caution was warranted. But by summer it was clear that the risk was to the 65+ population and there needed to be a policy change reflecting that knowledge.
I kind of agree with this, but I’m also conscious that a policy that in effect says “everyone can go out and do what they want, but people 70+ need to stay home” isn’t particularly workable and in actual fact would likely provide little benefit to those 70+.
The risk wasn't/isn't limited to the 65+ population, it extends to a very large portion of the over 40 population in the US that's overweight or has other preexisting conditions. A quick search says around 40% of 50 year olds in the US are obese.
The excess deaths for people under 75 were also significant, it's just that such deaths are quite rare in general so a smaller increase is a big change. Furthermore, it's not like there was a discontinuity at retirement age, 60 year old people, many of whom work, were significantly more vulnerable.
Furthermore, it wasn't and isn't really possible to just protect the vulnerable from an airborne disease. Older people need to go to the store and then doctor, they need to see other people, and even in the places they live they interact with lots of younger people.
Was it also more severe for all populations at the beginning? I live near one of the early extreme hot points. I know several people who died of COVID in the early months, including two people in their 30s. One had asthma, but a lot of people had asthma. If this is more than an anomaly of people I know, that could affect response as well.
I think this is a possibility but we really don't know. We definitely got a lot better at treatment though, which reduced the death rate
The idea was to reduce the rate of transmission and, thus, the risk of infection among the vulnerable. Some of that may have turned into exaggerating the risk in other populations
The cutoff is not at 70 or 75. The dramatically lower losses for people under 40 are just making the losses between 60 and 75 look much rosier than reality.
How do you envision this policy operating? For example, what are we to do with people under 65 who want to visit people over 75?
Communicate information about risk and then let those people MAKE THEIR OWN DECISIONS.
For (relatively common) multi-generational households, what decisions are there to be made? Find an apartment for grandma?
The same kinds of decisions they make about flu season. The same decisions those of us with newborns have to make. Our society isn't structured around the immunocompromised and the COVID vaccine never offered that great of protection anyways.
No. Shan't. 🙂
Leading to a total excess mortality globally between 19 and 36 million according to sourced information in Wikipedia.
Which, as a percentage of all 70 and 80 year olds, is pretty small, right? In the US 5% of people over 65 die every year and a google search tells me there are around 750 million 65+ globally, so the senior death burden may have doubled for one year?
My hottest take with COVID is the vast majority of the deaths were just pulled forward by some small number of years. If it wasn't COVID their next bout with flu or pneumonia was going to do it. For example, one of our employee's Father's passed away but was like 88 and on oxygen because he smoked his entire life. It never felt right to count this as a "COVID death".
Yeah. I had two older relatives pass, both in their 90s and the one had fairly bad dementia. Normally almost a quarter of people in their 90s die every year.
But to be fair, attributing a single cause of death to a very old person is fundamentally very challenging. When I've compared excess deaths to reported "covid deaths" the numbers line up fairly well. Even in the midst of the pandemic, some percentage of people who died while having covid were listed as dying of other reasons, while others maybe shouldn't have been counted as covid but were.
At the end of the day, the various judgement calls seemed to have averaged out, and we ended up with a covid death count that comes fairly close to matching excess disease deaths.
"My hottest take with COVID is the vast majority of the deaths were just pulled forward by some small number of years." Oh yeah, sort of like SIDS. \S
It’s true that was a large majority. But let’s say we discount those deaths completely, and look only at the people under 50 who died and weren’t otherwise ill. It’s a much, much smaller number, but still 15,000 deaths of 40-49 year olds per year, which is more than traffic fatalities or homicides (probably even put together). For 30-39 year olds, probably similar to homicide. If homicide didn’t exist, and then started one year at modern levels, that would be a huge shock to the system, and a deep, dark tragedy.
https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/
Even at the time I interpreted that as 4D chess to get us all to work together to not spread the virus so that we didn't infect those who WERE vulnerable.
I'd prefer the government be truthful and just say "this isn't THAT deadly to those under age X, but it is very contagious, so for the sake of grandpa, we're asking you to stay inside too."
But even at the time I was reading through the lines.
Yes, but for people over 70, it was *really* dangerous.
At the height of the pandemic, in the USA, about 1,000 people were dying per day. That is a lot of death. This was not the freaking flu, or even pneumonia. It's weird to me to ask that we do not take that seriously.
And I agree with you that a lot of NPI was unnecessary and taken too far. But to dismiss Covid as "no big deal" the way you are here just feels callous and gross to me.
If a lot of children and healthy prime age adults were dying, it would be immediately obvious. Everyone would personally know dead young people. As far as I could tell, the only place where this happened was NYC, and even there it was overwhelmingly a pandemic of the elderly.
My mental model for COVID was that we basically had a rare but deadly disease wrapped inside a common not deadly disease, and the results totally baked our brains. If we only had the rare but deadly version and everyone else was fine, I think we would have FTFO more.
(That's my mental model from the first waves, April, summer, xmas, before we got vaxed.)
Vaccines are a good way to turn me in to a #resist lib. The sudden spread of anti-vax attitudes on the right has been like that of... a disease which we have no vaccine against. And the reason for this is that this is an example of something that's actually getting worse. Most of the time, doomer takes of "everything is getting worse" are wrong, but on vaccines, it's actually true.
My background going on to the pandemic was the PNW Measles outbreak of January 2019. The threshold for herd immunity for measles is somewhere around ~90%. It looks like somebody brought measles over from somewhere in Eastern Europe over Christmas break and then it came to our attention that there was a large pocket of unvaccinated people in Clark County, in our case, a combination of conservative Eastern European immigrants and liberal hippy dippy types. Our vax rate for kids was somewhere around ~78%. My wife and I were both working in schools at the time. Pretty quickly, schools implemented rules that kids weren't allowed to attend until they could produce proof of vaccination. And this was to continue until we hit the threshold of 90%. I don't remember talking to ANYBODY who had a problem with this. In fact, the conservatives I knew were less forgiving, because a lot of the unvaxxed were crunchy Portlandia types. Outside of a handful of genuine religious exemptions, most unvaccinated kids got the measles vaccine, and life returned to normal. The reaction to the COVID vax gave me whiplash because it was so different than our reaction just two years prior. Maybe this says something about a double standard around the behavior of hippies and foreigners. I have no idea. Either way, I was surprised at the reception.
https://en.wikipedia.org/wiki/2019_Pacific_Northwest_measles_outbreak
It genuinely makes me wonder if what we need is some sort of larger scale resurgence of a major childhood illness (like measles) due to sub-threshold vaccination to remind everyone why we vaccinate. Sort of like an…inoculation against anti-vax movements?
Apparently we need to keep bashing ourselves in the face with a frying pan, because had one just two years before the COVID vaccine and everybody forgot apparently.
of course the obvious downside to that would be a lot of dead kids. I would rather argue online...
Yeah to clarify, I am not jazzed about the prospect. It's not like 4 month olds are out there choosing whether or not they get vaccinated. I just fear that that's what it would take to snap us out of this decline. I am happy to keep the good fight going in every other way (online, in doctor's offices, the public school requirements, etc.).
Sadly agreed.
It's like the old quote “Hard times create strong men, strong men create good times, good times create weak men, and weak men create hard times.”
Sadly it seems people often have to keep relearning things the hard way
Sadly, probably...
Exactly. Antivaxxers are very loud, but they're in a minority and can be rolled over if there's enough fortitude. https://x.com/sam_d_1995/status/1857431628877820106
Still above water with Republicans! Don't roll over!
>> "The result is that long-term NPIs ended up having no discernible impact on mortality..."
Has this actually been conclusively determined? The data I've seen on this is decidedly mixed and the confounds make it a really tough one to untangle.
Frankly, I think there's a lot of retconning going on around our pandemic response that ignores the fact that NPIs are what kept us from overwhelming the hospital system. Sure, voluntary responses were a big part of what saved us, but imo the idea that we could have adopted a full on "let it rip" mentality throughout 2020 is deeply mistaken.
You can probably study official stated NPIs more easily and I would guess that's that Matt is referring to. If you compare various NPI orders in Illinois vs Indiana, for example, you'd probably find little difference in eventual outcomes. It seems like outcomes in the end were mostly a function of demographics.
So if "let it rip" meant something like Sweden or Japan's response, which was more about informing the public and less about imposing official restriction, then I think it would have worked out just as well on the health side and we might have avoided a large dose of this inflation, as well.
You may be right, but imo Japan data isn't very relevant here because voluntary mask use and other NPIs are so built-in to their culture.
Notice the mask use in this Oct 2024 video in a mall in Tokyo
https://youtu.be/FxBAjK_OsWI?t=33
I watched a Japanese film from 2018 where a character has a cold and wears a mask and no one even comments
Another tricky factor is the correlation between obesity and covid mortality. Relatively lax intervention in countries with lower rates of obesity than the US might generate the same rate of excess deaths as relatively stricter restrictions in the US. However, the causal explanation might not be that "interventions are ineffective" and, instead, that even stricter interventions in the US would have further lowered the rate of excess deaths.
I agree with that, and I think that hypothetically, stricture interventions could have prevented deaths.
The problem is actually enforcing or implementing the restrictions. It's one thing to publicly close libraries and schools and to require masks, it's another thing to shutdown parties and events and actually enforce rules around mask.
That's why I think Sweden and Japan got it right, because it seems like there was more guidance and trust and information provided to the public, and less attempts at compulsion, especially compulsion that was often not even enforced.
Sweden and Japan probably had a lot more compliance with NPI suggestions than the United States did with mandates (even if the US mandates were weaker than the European places that established curfews and things like that).
Well..I don't know about that. It might depend if you're looking in the public or private sphere. Certainly when schools or libraries were ordered closed, they were actually closed in the US. Some people might have flouted nonsensical beach and park closures here, but the fact that they never tried that stuff in Japan or Sweden suggests as much about their public health officials as it does about their public at large.
Which other sorts of NPI mandates do you believe the US didn't comply with? Mask mandates on public transport? Sweden didn't even begin recommend masking in most situations until Dec 2020, so it's hard to compare. It's not like Europeans never flout rules.
As I recall, the gap between demographically adjusted COVID death rates for Democrats and Republicans didn’t really open up until after the vaccine became widely available. That’s consistent with the idea that the long-term poorly-enforced and poorly-targeted NPI mandates in blue localities weren’t accomplishing much.
I don't recall a clear left/right divide on NPIs during the initial response, especially while Trump was President. Sure, their were the Jay Bhattacharya types, but initially at least, they didn't get much traction with the broader right and most of the pushback was confined to libertarian circles.
In terms of personality and disposition, people on the right were probably more inclined toward adopting behaviors to guarantee higher personal safety initially, especially before the controversy and political sorting really got going strong.
I think long-term NPIs are impossible to enforce and if you do a reactive model where NPIs go up and down in response to case numbers, people get confused and are essentially calibrating their behavior to control spread as well as a mandated NPI would anyways.
NPI’s and inflation have a lot in common in terms of the policy debate. Do we inconvenience everyone to help a few percent of the population or do we leave the few percent to their terrible fate but avoid inconveniencing the +90%.
Or maybe split the difference a bit better. If unemployment had been 0.7% higher for a couple years but inflation had peaked at 5%, that would be better. That being said, our economic response to covid was closer to optimal than most big stakes policy decisions. The soft landing with disinflation is one of the greatest technocratic accomplishments in American history.
Your point is taken, but I think with covid, we really couldn't be very confident the danger applied to "only a few percent of the population" in the early days. That first wave hit very, very hard indeed in such diverse locations as Wuhan, Lombardy, Britain, and the Northeastern United States.
But sure, a clearer picture had emerged by late summer, 2020. My own take is that, ideally, we should have had a fairly strict national NPI program starting in March 2020 that was communicated clearly to the public in detail and eased in phases (say, June, September, December of 2020); and basically lifted completely relatively expeditiously in early 2021, as vaccines became available. In retrospect (to me, anyway) that would have been the plan that best combined strong action to keep people safe with the need to normalize as rapidly as feasible. The open-ended nature of the crisis—When is this damn thing going to be over? When can I get a haircut?—was bad. A pre-determined schedule the public could look at to know relief was on the way would have done wonders.
Instead we more or less had: (1) strict NPI programs in some locations; (2) less strict NPI locations in other locations; (3) no NPI programs at all in a few red states; (4) the administration actually beginning to fight and undermine NPI programs by the time the first wave of deaths peaked (April); (5) confusion and a non-uniform national approach increasingly dominant as we moved through the summer; (6) most of the leadership of the governing party openly contemptuous of anti-pandemic efforts in general, along with a terrible coddling and promotion of medical quackery (Ivermectin, etc); (7) the successful rollout of MRNA vaccines at the end of 2020 and first quarter of 2021 (queues were eliminated by April, 2021); (8) a new administration basically semi-oblivious to the political realities of pandemic management that had crystallized by 2021; (9) a period of fumbling overreach by them, that was mercifully largely over after their first year in office.
And of course this is a problem for a party that spends a lot of time centering the tiny portion of the population that identifies as trans/non-binary.
You mean the Republican Party?
The vaccine mandates did a lot of damage. Scott Gottlieb (former FDA commissioner and Pfizer board member) spoke against mandates almost daily, because he was worried that they would undermine confidence in other vaccines. And he was right.
The FDA's 10-day suspension of the J&J vaccine, over a statistically trivial risk, also did a lot of damage. Daily vaccinations peaked literally the day of the suspension, and then fell off a cliff. It was different technology than the MRNA vaccines, but there was no way the public was going to understand that, and, anyway, it stands to reason that if FDA is going to suspend a vaccine during a lethal pandemic it must have a good reason, right? Turns out, not. It was a terrible moment to turn to the "precautionary principle."
I think the Biden administration went for vaccine mandates because it was in a trap. The "red" states (and red people in blue states) had effectively opened up and were back to work, but a lot of "blue" people remained extremely Covid-phobic into 2021. For them, the goal post had moved from "flatten the curve" to "reduce mortality to the level of ordinary flu." Biden was therefore at great risk that the economy would remain in a funk for years. The Covid-phobic folks needed a step-function justification to change their attitude and get back to work and rejoin real life, and the vaccines provided that justification. To such people, mandating vaccines would "ensure" that it was "safe" to restart normal life. To "red" people who had already gone back to work and otherwise restarted normal life, this looked like rank authoritarianism. (Which, in turn, had the perverse effect of discrediting claims by Democrats that it was Trump who was the authoritarian. However much he had screwed up the pandemic response, he never mandated vaccines.)
Of course, I could be wrong.
Totally with Gottlieb on this. The other big factor was pre-COVID vaccine all the prior mRNA vaccine's failed. Moderna was teetering on the brink for years trying to get something to market. This quote captures the risk quite well "Despite the promising trials with mRNA based therapeutics in laboratory settings, the facts remained that mRNA is highly unstable inside the body and prone to degradation by immune agents and nucleases, possesses a high potential for adverse immunogenicity, and initially generates weaker protective immunity than conventional vaccines [37]."
https://pmc.ncbi.nlm.nih.gov/articles/PMC8502079/
One of the things that was smart about Operation Warp Speed is that it spread its bets among four different vaccine technologies, with two companies for each. That maximized the chances for success, and positioned the United States as the leader of the world in the field.
Unfortunately, the weird intersection of Trump's personality and the chattering class's hatred of him made it much harder to gain the full recognition for that triumph.
It’s a shame it took so long for Novavax to get approved, and that the public health people didn’t see an advantage to having at least one vaccine that doesn’t put any mRNA in your body. (Also, there seems to be a lot of evidence that the malaise the next day is much less bad with Novavax than with the mRNA or viral vector vaccines.)
... yeah I just think that a political coalition that cheerfully embraced a guy who said that the coronavirus was generally engineered not to target Jews is not going to be fertile ground for any of this
Well, the title of the article is "How Trump *can* lead on vaccine development", not "How Trump *would* lead on vaccine development, again."
And it does address how RFK, Jr. is a big obstacle.
If he had read the article I’m sure he would have said something differently.
I'd like to speak to the manager of COVID because whatever they put in it to avoid Jews did NOT work. >:(
"Beyond that, the genetic difference between a chicken and a pig is much smaller than the difference between a pig and a human."
Where did this come from? This is almost certainly very false: the genetic difference between members of two different classes is smaller than the difference between members of the same class?
I assumed that was a mistake.
I’m not sure what MY was getting at with that line but this is the issue with pigs:
“Pigs are the ideal genetic mixing vessel to generate a human pandemic influenza strain, because they have receptors in their respiratory tracts which both avian and human flu viruses can bind to.”
https://theconversation.com/bird-flu-has-been-detected-in-a-pig-in-the-us-why-does-that-matter-242688
I think he meant larger
He got it backwards. The paragraph reads exactly right if you replace “smaller” with “larger” in that one sentence.
"It’s kind of fun to speculate about a crunchy-pilled Republican Party, but it’s just not real."
Eh....do I think it's already happened, or will happened overnight? Of course not. But it's amazing to see just how much inversion has already taken place, so I don't think it's impossible. This tweet by Anna Paulina Luna [https://x.com/RepLuna/status/1857516047458595123] is something that would have expected from a raving Green Party candidate if there was no name attached to it. There are a few things that the pro-business wing of the Republican Party feels it has to grin and bear in order to get votes. Anti-immigration is a real obvious one. We have a long way to go to see if this will be one of them, but I wouldn't rule it out.
Parties are made up of their members! Trump picking these appointees sends a strong single to the crunchy people that their issues matter.
I kind of want to see how the rubber hits the road on this one. The MAHA movement seems so underbaked in all but the vibes. I’m sure they’ll agree on vaccines, but the food part of it is just a jumbled mess for most of them.
Because the food part of it is as scientifically sound as the vaccine part of it.
It's not just that it's scientifically unsound, I'm not sure they believe the juice is worth the squeeze on banning all the things they supposedly hate. Even the things we all agree are bad (lead) they'll defend–if it shows up in a product they like, such as Redmond salt.
It’s not “underbaked”, it’s “raw and natural”.
It perhaps smacks of grasping at straws or reading too much into the tea leaves, but if you really want to, you can draw a line from the MAGA embrace of RFK Jr/Vermont crunchy ideas on pure food/pure environment and pastoral aesthetic to Giorgia Meloni Tolkienesque/Shire interest, to the Voelkisch movement and its romantic agrarianism, organicism and ideas of pure Land/pure Volk, and so on from there….
So it isn’t necessarily that surprising to see variants of that general strain of romanticism represented in the Trump entourage but probably only as one faction among many.
That's an amazing tweet.
But I think this kind of thing is cheap to post until they come up against a large entrenched business interest. If they go after HFCS or food dyes that'll be crossing the rubicon.
HFCS definitely, not sure where the food dye lobby would be strongly connected to.
My assumption is that banning a bunch of dyes would be disruptive to the companies using them and those companies would have lobbying juice.
Sure, I just question how much--certainly much less than the corn lobby.
How disruptive would a ban on all artificial food dyes be? Does it just mean all skittles are now brown M&Ms? Do we still get fairly colorful food with annatto and turmeric and kale extract or whatever? Does all colorful junk food suddenly look more wholesome and boring, but in a way that leaves them competitively equal to where they were before?
One of the things we did learn throughout the pandemic was that NPIs associated with clean air do, in fact, work: ventilation, HEPA filtration, and N95 masks. We learned that the infectious disease community had outdated ideas about the fluid dynamics of respiratory aerosols, that transmission is primarily (perhaps entirely) via virus-laden aerosol particles that are mostly water and which are generated at several stages of the respiratory tract, and virus-laden aerosol particles can remain aloft for hours. We learned that HEPA or MERV-13+ filters can remove these virus-laden particles from the air and N95 masks can capture them, in large part because of electrostatic attraction from the electret fibers of such masks.
There's an overt conspiracy element to this too, although how it plays in the current political landscape is confusing. The WHO knew about airborne spread of other diseases, China early on said COVID was airborne, even Trump says so. But WHO kept insisting it was droplets that fall to the ground: there's the famous early press conference where WHO secretary general Tedros Ghebreyesus at first says COVID is airborne, then the person next to him scribbles something on a paper, then instead of answering a question, Ghebreyesus clarifies that he "misspoke" about aerosols and really it was droplets. And there are endless clips of Maria Van Kerkhove insisting that COVID spread through droplets that fall to the ground.
There's evidence that at least some in the Biden administration have internalized the airborne nature of COVID, with a few White House events. Plus there's all the air filtration gear that would accompany his early (maskless) speaking engagements, which was generally kept of sight.
But overall it seems the conspiracy is that even left-leaning folks don't want to deal with measures that can't be reduced to individual choice. Truly fixing ventilation and air filtering would be an enormous expense, especially following decades of HVAC design for energy efficiency.
The best general publication about the airborne nature of COVID is in WIRED: https://www.wired.com/story/the-teeny-tiny-scientific-screwup-that-helped-covid-kill/
But a peer-reviews overview: https://doi.org/10.1098/rsfs.2021.0049
And a more technical article in Science: https://doi.org/10.1126/science.abd9149
Good point about energy efficiency. Personally, I would support a ban on all government energy efficiency mandates.
They've wrecked all of our household appliances.
I don’t get the opposition to energy efficiency. The specific mandates that required recirculating of indoor air were bad, but other energy mandates were good.
I just want a shower head that gives me a good drenching. Water is (mostly) a closed loop system -- we clean it, pump it, use it, and return for cleaning. Having to "save" water is a misnomer for the vast majority of consumer uses.
Especially in Florida. We have plenty of water. Hell, it rains every day during the summer. Let me take my shower with a 5 gpm shower head.
Yeah I think the mandates for low flow shower heads and kitchen sinks are badly chosen regulations. Behavioral changes are likely to undo a lot of the advantage those were supposed to have (unlike low flow toilets and washing machines).