Patterico's Pontifications


Governor Hair-Gel Is, Like, Totally Sorry

Filed under: General — JVW @ 10:41 pm

[guest post by JVW]

It’s hardly an earth-shattering story (and that’s why I am posting it late in the evening), but California Governor Gavin Newsom, fresh from his embarrassing dining outing which violated the COVID protocols he’s been flogging, wants his subjects — sorry, fellow citizens — to know that he’s, like, really really sorry:

Credibility is hard to accumulate yet pretty easy to throw away. Good luck getting Californians to cheerfully follow any further shutdowns you might order, chief.


Prioritizing A Potential COVID-19 Vaccine

Filed under: General — Dana @ 12:17 pm

[guest post by Dana]

Terrific news:

It feels like it’s been a long time since Anthony Fauci has delivered good news—but here it is. U.S. biotech firm Moderna announced Monday that preliminary analysis shows that its COVID-19 vaccine is nearly 95 percent effective at preventing the disease. It appears to be particularly effective at stopping people from falling severely ill, according to The Washington Post. “It’s extremely good news. If you look at the data, the numbers speak for themselves,” said Fauci, the director of the National Institute of Allergy and Infectious Diseases. Moderna’s vaccine was co-developed with Fauci’s institute and is being tested in 30,000 people. While Pfizer’s recently announced vaccine needs ultra-cold storage at around minus 75C, Moderna said its vaccine would be easier to store as it remains stable at minus 20 degrees Celsius for up to six months, and can be kept in a standard fridge for up to 30 days.

Now that we have a glimpse of an eventual end to the pandemic in our near future, Dr. Fauci cautioned this weekend that getting back to normal “won’t be like the flick of a switch.”

“If we get the overwhelming majority of people taking the vaccine and you have on the one hand, an effective vaccine, on the other hand, a high degree of uptake of the vaccine, we could start getting things back to relative normal as we get into the second and third quarter of the year”—meaning 2021—”where people can start thinking about doing things that were too dangerous just months ago, but we’ve got to put all those things together—we can’t just wish it happening. We’ve got to get the vaccine, it’s gotta be deployed and we can’t abandon fundamental public health measures. You can approach a degree of normality while still doing some fundamental public health things that synergize with the vaccine to get us back to normal.”

Fauci reiterated that normality wouldn’t come at the flick of a switch. “If we get most of the country vaccinated in the second, third quarter of the year and the vaccine continues to prove its efficacy and people adhere to those fundamental measures, I think we can start approaching the degree—[but it] is not going to be a light switch, we’re not going to turn it on and off going from where we are to completely normal. It’s going to be a gradual accrual of more normality as the weeks and the months go by as we get well into 2021.”

Of course, not everyone will want to take the vaccine: anti-vaxxers, young people who don’t see the need for it, the elderly who figure there is little reason for it at their advanced age, etc. And certainly, questions about any potential side effects (of both Moderna and Pfizer’s vaccines) will give Americans pause. Here is look at what scientists have seen thus far:

So far, both vaccines appear to be generally tolerable — but by no means painless. In its announcement Monday, Moderna said it observed a few short-lived severe side effects in volunteers, including fatigue, muscle pain, and headache. None required hospitalization. For its part, Pfizer said last week that its independent data monitors reported no serious safety concerns. In an earlier update from its Phase 1 clinical trial, Pfizer’s vaccine led to mild or moderate fever and pain at the site of injection, side effects that resolved over time, the company said.

But the most important safety data won’t come until patients have been followed for months and even years. Pfizer and Moderna have promised to collect and disclose that information in time.

I’m also interested in learning how the distribution of the vaccines will be prioritized. Clearly, frontline workers receiving the vaccines first makes sense. But what about after that?

Both Moderna and Pfizer have promised to file for emergency use authorizations in the coming weeks. If the FDA grants them, as it’s widely expected to do before the end of the year, the companies will ship doses to the federal government, which is in charge of allocating the limited supply to front-line workers and people at an elevated risk of severe Covid-19.

For everyone else, neither vaccine is likely to be available until spring at the earliest, in large part because of logistics. (By that time, Pfizer and Moderna are also likely to have generated enough supporting data to justify full FDA approvals.) Pfizer and Moderna expect to produce just 70 million doses of their vaccines by the end of 2020, enough for only 35 million people around the globe. In 2021, the companies could have as many as 2.3 billion doses between them, but in a pandemic-ravaged world of 7.5 billion people, that’s not going to be enough to satisfy demand. Unless more Covid-19 vaccines prove to work in the coming months, the world will be rationing doses well into next year.

One of President-elect Joe Biden’s coronavirus task force health advisors, Dr. Zeke Emanuel, has previously written about the path he would like to see taken with regard to vaccine distribution:

The model allows the country that produces the vaccine to hold onto enough of a supply to reach a threshold for herd immunity (“Rt below 1″). Beyond that, the model supports distributing the vaccine internationally, which means giving away or selling doses of the vaccine before it’s available to every citizen in that country, Emanuel explained to Scientific American.

“Reasonable national partiality does not permit retaining more vaccine than the amount needed to keep the rate of transmission (Rt) below 1, when that vaccine could instead mitigate substantial COVID-19–related harms in other countries that have been unable to keep Rt below 1 through ongoing public-health efforts,” the Science magazine article titled “An ethical framework for global vaccine allocation” argues.

“Associative ties only justify a government’s giving some priority to its own citizens, not absolute priority,” Emanuel wrote with his co-authors.

Contra to Emanuel’s ideas, the Trump administration’s stated plan differed considerably:

The Trump administration had said that the U.S. will share any coronavirus vaccine it develops with other countries after American needs are met and that the U.S. will not coordinate with the World Health Organization (WHO) on distribution.

“Our first priority of course is to develop and produce enough quantity of safe and effective FDA-approved vaccines and therapeutics for use in the United States,” Health and Human Services Secretary Alex Azar said during an August visit to Taiwan.

“But we anticipate having capacity that, once those needs are satisfied, those products would be available in the world community according to fair and equitable distributions that we would consult in the international community on,” Azar said.

Here is the Mayo Clinic’s estimate for herd immunity in the U.S.:

Even if infection with the COVID-19 virus creates long-lasting immunity, a large number of people would have to become infected to reach the herd immunity threshold. Experts estimate that in the U.S., 70% of the population — more than 200 million people — would have to recover from COVID-19 to halt the epidemic.

As the vaccines get ready for mass production, the debate about distribution and prioritizing who gets it first is bound to increase.

Here is how the President and the President-elect reacted to today’s great news about the vaccine:


Why “If the Left Gets to Have Their Dangerous Gatherings, We Get to Have Ours!” Is the Wrong Conclusion

Filed under: General — Patterico @ 8:29 am

It’s happened so often it’s a running joke with conservatives: public health experts decried mass public gatherings . . . until those gatherings were motivated by George Floyd’s death and calls for racial justice — and all of a sudden the gatherings were OK. But there was never really a clear explanation as to why.

Catherine Troisi, an infectious-disease epidemiologist at the University of Texas Health Science Center at Houston, studies Covid-19. When, wearing a mask and standing at the edge of a great swell of people, she attended a recent protest in Houston supporting Mr. Floyd, a sense of contradiction tugged at her.

“I certainly condemned the anti-lockdown protests at the time, and I’m not condemning the protests now, and I struggle with that,” Dr. Troisi said. “I have a hard time articulating why that is OK.”

Mark Lurie, a professor of epidemiology at Brown University, described a similar struggle.

“Instinctively, many of us in public health feel a strong desire to act against accumulated generations of racial injustice,” Dr. Lurie said. “But we have to be honest: A few weeks before, we were criticizing protesters for arguing to open up the economy and saying that was dangerous behavior.

“I am still grappling with that.”

This is old news, and the linked New York Times story is an old story, from July 6. I am thinking about it now because I am reading Nicholas Christakis’s book Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live (affiliate link). I was reminded how bizarre it was to see some conservatives’ reaction to the verdict of public health experts like those just quoted: OK, then, if they get to have their gatherings then we get to have ours!

It was as if, as long as you could find hypocrisy among some public health experts, that meant that all public health advice was suddenly worthless.

As Christakis makes clear, it is not. Social distancing, mask wearing, hand washing, and similar common sense practices have been around forever. And despite what you might see in the fever swamps — Alex Berenson, Scott Atlas, and the people who quote them — these measures work. They do not make a virus disappear. But they do reduce transmission significantly.

And yet too many people want to deny that, citing the hypocrisy of the above-mentioned public health experts as evidence.

I see this all too often in any discussion about science where politics enters the picture. If you can find one scientist with whom you politically disagree who is caught saying something contradictory, or silly, it means their point of view is wrong. That’s actually a perfect description of the ad hominem fallacy, but people still use that sort of reasoning every day.

Radical thought here: maybe the best idea is not to cast aside all public health advice, but to find better and more reliable people on whom to rely. Was Dr. Fauci saying “go ahead and protest because racism is a more important public health issue than COVID-19”? No. He was saying he was “very concerned.” And what was Christakis himself saying when the above-linked New York Times article was published? Well, he happens to have been extensively quoted in it. So let’s look!

Others take a more cautious view of the moral stakes. Nicholas A. Christakis, professor of social and natural science at Yale, noted that public health is guided by twin imperatives: to comfort the afflicted and to speak truth about risks to public health, no matter how unpleasant.

These often-complementary values are now in conflict. To take to the street to protest injustice is to risk casting open doors and letting the virus endanger tens of thousands, he said. There is a danger, he said, in asserting that one moral imperative overshadows another.

“The left and the right want to wish the virus away,” Dr. Christakis said. “We can’t wish away climate change, or the epidemic, or other inconvenient scientific truths.”

He said that framing the anti-lockdown protests as white supremacist and dangerous and the George Floyd protests as anti-racist and essential obscures a messier reality.

When he was a hospice doctor in Chicago and Boston, he said, he saw up close how isolation deepened the despair of the dying — a fate now suffered by many in the pandemic, with hospital visits severely restricted. For epidemiologists to turn around and argue for loosening the ground rules for the George Floyd marches risks sounding hypocritical.

“We allowed thousands of people to die alone,” he said. “We buried people by Zoom. Now all of a sudden we are saying, never mind?”

If public health experts turn on a dime, and suddenly minimize the importance of public health measures they advocated until yesterday, it doesn’t mean public health measures are unnecessary. It means those particular “experts” are unreliable and you should not listen to them. But there are plenty of experts who didn’t take the wokeness bait.

Yes, it’s an old discussion, but as we head back into a nasty COVID season, it’s an important one. Find the good experts, and listen to those folks.

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