COVID-19 Megathread 6: Return of the Omicron

[Fmr. Gov. NickG]

It seems like if we just decide to give a half, single dose, we could vaccinate everyone who wants it within about month.  Given that we are racing against a much more contagious strain now, I am reasonably convinced that this is the way to go.

This is actually a situation where we should trust the social scientists more than we trust the doctors.  Doctors are given very limited statistically training; it is very committed to orthodoxy and giving a binary yes/no result.  Whereas social scientists, because they have to be able to intepret a much wider range of quantitative methodolgies, are more adept at thinking probabilistically about these issues.

[Fmr. Gov. NickG]

It seems like if we just decide to give a half, single dose, we could vaccinate everyone who wants it within about month.  Given that we are racing against a much more contagious strain now, I am reasonably convinced that this is the way to go.

This is actually a situation where we should trust the social scientists more than we trust the doctors.  Doctors are given very limited statistically training; it is very committed to orthodoxy and giving a binary yes/no result.  Whereas social scientists, because they have to be able to intepret a much wider range of quantitative methodolgies, are more adept at thinking probabilistically about these issues.

The vaccines weren't tested to work at quarter doses. Stop your buffoonery. See the post above you as to why. No more needs to be said.

The post above is exactly what I’m talking about with respect to methodological orthodoxy.  It’s just not suited to a unprecedented global pandemic.  From the very start, we should have been throwing everything we could think of against the wall as fast as we could just to see what sticks.  It’s likely that a lot of these ideas would have actively killed people.  But for every person we killed, we may have saved thousands.

[Fmr. Gov. NickG]

It seems like if we just decide to give a half, single dose, we could vaccinate everyone who wants it within about month.  Given that we are racing against a much more contagious strain now, I am reasonably convinced that this is the way to go.

This is actually a situation where we should trust the social scientists more than we trust the doctors.  Doctors are given very limited statistically training; it is very committed to orthodoxy and giving a binary yes/no result.  Whereas social scientists, because they have to be able to intepret a much wider range of quantitative methodolgies, are more adept at thinking probabilistically about these issues.

The vaccines weren't tested to work at quarter doses. Stop your buffoonery. See the post above you as to why. No more needs to be said.

The post above is exactly what I’m talking about with respect to methodological orthodoxy.  It’s just not suited to a unprecedented global pandemic.  From the very start, we should have been throwing everything we could think of against the wall as fast as we could just to see what sticks.  It’s likely that a lot of these ideas would have actively killed people.  But for every person we killed, we may have saved thousands.

I am a social scientist, and your point makes no sense. We haven't spent nearly a year in isolation and restraint waiting for a vaccine so that foolish decisions makes the whole thing worthless.

This is not a case of gradience or interpretation. It's been tested to work at two full doses, and that's what people need to take to be innoculated.

How do you know that’s what people need to take to be in innoculated?
How many dosages was it tested at?
Presumably there is a trade-off between dosage and effectiveness.  How do we know we have chosen the right trade-off?

This is what I’m also what I’m talking about with respect to binary statistical orthodox.  i.e. it’s only been tested at x dosage and it’s proven effect at y statistical confidence, so therefore it is safe and effective to give at x dosage and no other dosage.

I agree we don’t have the same certainty about a half dosage as we do about a full dosage.  But the data seems to suggest that a half dosage is more than half as effective as a full dose.  And in that case, under these circumstances, we should be willing to tolerate some more uncertainly in exchange for what is likely much more efficiency.

It really seems like the people who are designing these clinical trials are not good at framing this problem in terms if Bayesian statistics.  Once a vaccine was shown to be relatively safe and we had even the slightest evidence that it was more effective than a placebo, we should have released it in a variety of dosage schemes.  If it proved later to be ineffective or dangerous, it could have been recalled. Instead we just waited around for literally millions of people to be infected in the interest of rigidly following the same research design that doctors have been using for the past century.

[Fmr. Gov. NickG]

It seems like if we just decide to give a half, single dose, we could vaccinate everyone who wants it within about month.  Given that we are racing against a much more contagious strain now, I am reasonably convinced that this is the way to go.

This is actually a situation where we should trust the social scientists more than we trust the doctors.  Doctors are given very limited statistically training; it is very committed to orthodoxy and giving a binary yes/no result.  Whereas social scientists, because they have to be able to intepret a much wider range of quantitative methodolgies, are more adept at thinking probabilistically about these issues.

The vaccines weren't tested to work at quarter doses. Stop your buffoonery. See the post above you as to why. No more needs to be said.

The post above is exactly what I’m talking about with respect to methodological orthodoxy.  It’s just not suited to a unprecedented global pandemic.  From the very start, we should have been throwing everything we could think of against the wall as fast as we could just to see what sticks.  It’s likely that a lot of these ideas would have actively killed people.  But for every person we killed, we may have saved thousands.

How is this going to save anybody? The reason you have to give 2 doses is because the first dose only primes your immune system. That's why they're 60%ish effective. If you give less than that, they'll be even less effective. It might not even work at all. The best case scenario would be that they're still 60% effective but it's unlikely. Plus how many fewer people do you think will bother with the vaccines if they're only say, 30% effective? It sounds like we'll be lucky if half the healthy population will take them as is. Doctors don't get a lot of training is statistics but there are plenty of statisticians that work for the FDA and Pfizer and Moderna.

Maybe it will work, maybe it won’t.  So try it with some people and not others.  For example, make the half single dose immediately available to everyone, while reserving the whole double dose to the elderly.   FWIW, my reading of the data is that the first shot is actually much more than 60% effective once its given at least 10-14 days to take effect, maybe even as much as 90% effective.

[Fmr. Gov. NickG]

Maybe it will work, maybe it won’t. 

It's the won't that's the problem. We don't have time, and resources, to lose.

We’re already in a losing status quo.  We should have been playing a much less risk averse strategy from the start. 

I am not certain that a half-dose strategy will more efficiently immunize the population than a full dose strategy.  But my impression from the data suggest that it is more likely than not to do so.  And this impression has been increasingly supported by smart people whose views about the statistical interpretation evidence I trust.

All along the way, we’ve made choices designed to avoid any possibility of a worst case scenario.  And it has lead us about 90% of the way to a worst case scenario anyway.

[Fmr. Gov. NickG]

What evidence do we have that the dose that is being administered is the most efficient dosage? 
(The mere fact that it was the only dosage fully tested is not, by itself, evidence of that.)

[Fmr. Gov. NickG]

How are people getting vaccines now?
Are you guys like 70 or something?

As I posted earlier, my mom got lucky to just be at a vaccination site at the end of the day when they had extra stock that was going to spoil.  (She was with my dad who got the vaccine as a medical worker.)

[Fmr. Gov. NickG]

Biden will release all available vaccine doses in break from Trump administration policy of holding back stock for second dose

Excellent decision!

We also need to stop giving the vaccine right now to people who have already had covid. All the evidence suggests that they already have immunity that is at least as effective as the vaccine, so this is just wasteful during a time in which we need to be thinking mostly above maximizing efficiency of spreading immunity.  They should get the vaccine, but only once it is widely available to everyone.

https://www.washingtonpost.com/health/post-infection-coronavirus-immunity-usually-robust-after-8-months-study-shows/2021/01/07/d7d369a6-511a-11eb-b96e-0e54447b23a1_story.html

[Fmr. Gov. NickG]

Biden will release all available vaccine doses in break from Trump administration policy of holding back stock for second dose

Two doses are absolutely needed for there to be any real effectiveness. Hopefully somebody who actually knows what they're doing will convince Biden to backtrack on this.

What is your evidence of this?

[Fmr. Gov. NickG]

Biden will release all available vaccine doses in break from Trump administration policy of holding back stock for second dose

Two doses are absolutely needed for there to be any real effectiveness. Hopefully somebody who actually knows what they're doing will convince Biden to backtrack on this.

What is your evidence of this?

https://www.bmj.com/content/371/bmj.m4826

52% isn't enough to make a difference as far as spread, and 50/50 chance of getting it for general population means that higher risk patients will likely not have any real benefit.

If you actually look at the data day-by-day, the 52% figure comes from analyzing the the whole period after receiving the first dose but before receiving the 2nd dose.  The vaccine is basically totally ineffective for the first few days, and rises steadily thereafter.  If you just look at the period 14 days after receiving the first dose but before recieving the 2nd, I believe the vaccine was about 90% effective.

[Fmr. Gov. NickG]

Does anyone know if the vaccine is supposed to give lasting immunity, or if we’ll have to get a vaccine every year like the flu?

My gut feeling is that the COVID vaccine will be ineffective against the new strains of the disease, which might mean that we will have to deal with permanent lockdowns and millions of deaths per year until 2034 or 2035.

Saw something today that said at least one of the vaccines IS effective against the new strains.  Can't find the citation now.

https://www.cnn.com/2021/01/08/health/pfizer-vaccine-variant-strain-mutation/index.html

[Fmr. Gov. NickG]

Biden will release all available vaccine doses in break from Trump administration policy of holding back stock for second dose

Two doses are absolutely needed for there to be any real effectiveness. Hopefully somebody who actually knows what they're doing will convince Biden to backtrack on this.

What is your evidence of this?

https://www.bmj.com/content/371/bmj.m4826

52% isn't enough to make a difference as far as spread, and 50/50 chance of getting it for general population means that higher risk patients will likely not have any real benefit.

If you actually look at the data day-by-day, the 52% figure comes from analyzing the the whole period after receiving the first dose but before receiving the 2nd dose.  The vaccine is basically totally ineffective for the first few days, and rises steadily thereafter.  If you just look at the period 14 days after receiving the first dose but before recieving the 2nd, I believe the vaccine was about 90% effective.

https://www.nejm.org/doi/suppl/10.1056/NEJMoa2034577/suppl_file/nejmoa2034577_research-summary.pdf

Just to support my earlier post, look at the graph on p. 1 of the link with “Days after dose 1” on the x-axis.  You can see that for the first week, infections in the placebo group and vaccine group are nearly indentical.  However, after Day 14, there are almost no infections anymore in the vaccine group, despite the fact that subjects didn’t get the 2nd dose until Day 21.

[Fmr. Gov. NickG]

Biden will release all available vaccine doses in break from Trump administration policy of holding back stock for second dose

Two doses are absolutely needed for there to be any real effectiveness. Hopefully somebody who actually knows what they're doing will convince Biden to backtrack on this.

What is your evidence of this?

https://www.bmj.com/content/371/bmj.m4826

52% isn't enough to make a difference as far as spread, and 50/50 chance of getting it for general population means that higher risk patients will likely not have any real benefit.

If you actually look at the data day-by-day, the 52% figure comes from analyzing the the whole period after receiving the first dose but before receiving the 2nd dose.  The vaccine is basically totally ineffective for the first few days, and rises steadily thereafter.  If you just look at the period 14 days after receiving the first dose but before recieving the 2nd, I believe the vaccine was about 90% effective.

https://www.nejm.org/doi/suppl/10.1056/NEJMoa2034577/suppl_file/nejmoa2034577_research-summary.pdf

Just to support my earlier post, look at the graph on p. 1 of the link with “Days after dose 1” on the x-axis.  You can see that for the first week, infections in the placebo group and vaccine group are nearly indentical.  However, after Day 14, there are almost no infections anymore in the vaccine group, despite the fact that subjects didn’t get the 2nd dose until Day 21.

Maybe...let’s the actual people studying the vaccine come to that conclusion...
I’m not arguing with you but there is a reason they are doing this.

There is indeed a reason they are doing this.
The reason is that the field of medical research is wedded to an outdated orthodoxy of frequentist statistics.

This orthodoxy demands that you can't make a claim unless you have established an prior null hypothesis and then gathered enough evidence through controlled experiments to reject the null hypothesis with a 95% level of statistical confidence.

This is what we all learn in our first semester of statistics class.  But it is fundamentally the wrong way to be interpreting statistical evidence.

The people conducting the vaccine studies are unwilling to advocate for a 1-dose regime because the never explicitly tested a 1-dose regime, and the evidence that they coincidental gathered about the effect of receiving one dose may not rise to a 95% level of confidence in any case.

However, the the data that was gathered does contain -some- evidence of the effect of receiving just one dose.  And the evidence suggests that it is almost as effective as receiving two doses.  And if one does is -almost- as effective as two doses, giving one does to everyone will be much, much, more effective at producing rapid herd immunity than two doses.

We certainly can't be 95% confident that one dose is more efficient than two doses.  But we shouldn't have to be 95% confident; we should just need to be 50.01% confident.  

I am way more than 50.01% confident of this just based on a cursory glance of the data.  And my confidence is dramatically enhanced by the fact that a lot of medical professionals now are advocating for one dose based on this same data, and the ones who are advocating for it tend to be the ones whose statistical approach I trust more.

[Fmr. Gov. NickG]

I agree we don’t have the same certainty about a half dosage as we do about a full dosage.  But the data seems to suggest that a half dosage is more than half as effective as a full dose.  And in that case, under these circumstances, we should be willing to tolerate some more uncertainly in exchange for what is likely much more efficiency.

This is not accurate. The data in this case is not robust enough to be making statistical conclusions.

Instead of the effective rate, look at the ineffective rate.

Compared to non-immunized (placebo) participants, the placebo participants are 20 times as likely to be infected. Meanwhile those with one dose are 10 times a likely to be infected.

What I’m saying is that just by making statements like “robust enough to be making statistical conclusions”, you are buying into the outdated frequentist orthodoxy.  Modern Bayesian statistics doesn’t think like that.  The question shouldn’t be a binary “ is this enough to change our conclusion”?  All additional data we get should change our conclusion, the only question is how much it should change it.

And the people who got one does are only 10 times more likely to be infected when you measure them within the first few days after getting the vaccine.  When measured 14-21 days after getting the first dose, they are less than twice as likely to get infected.

[Fmr. Gov. NickG]

How did Israel get access to so much vaccine?  They’ve already vaccinated 20% of their population; not other major country is over 2%.  Even if we had actually used all our supply, we’d only be at 6%.

[Fmr. Gov. NickG]

It does seem like the vaccine situation is improving in the US after a horrible first few weeks.  

- The goal all along has been to vaccine 1 million people per day, and we are now up to about 800k people/day over the last few days.  

- There don't seem to be any major issues with vaccine supply which would slow down the process in the longer term.  

- Most states are moving into phase 1B in which (despite high profile exceptions) it should be much easier to make the public aware of how and where to get vaccinated.

- And Biden will finally move into office in a week. He seems genuinely committed to making this a priority, and this is exactly the sort of problem that a neoliberal technocratic administration like he has assembled should be best at addressing.

[Fmr. Gov. NickG]

How did Israel get access to so much vaccine?  They’ve already vaccinated 20% of their population; not other major country is over 2%.  Even if we had actually used all our supply, we’d only be at 6%.

Prime Minister Netanyahu?

Pfizer has agreed to speed distribution to Israel in exchange for records of adverse reactions. Israel keeps more records of their citizens, uses paper ballots, requires ID to vote, and has walls to keep out illegal immigrants.

Ah, so build the wall so we can all get vaccinated. Ok.

All the MAGA cultist anti vaxxers in the US are dragging down the numbers.

It's shocking what a disingenuous, belligerent nutcase jimrtex is when discussing the actual issues. He should really stick to the redistricting app.

Why do you think states with Republican governors are doing better with actual application of vaccinations?

For example, there are 16 States with more than 3% vaccinated. 11 of those 15 have Republican governors:

WV, SD, ND, VT, AK, NE, NH, MT, TN, IA, OK

Only five have Democrat governors.

ME, CT, CO, NM, RI

President Trump should get more doses to the Dakotas so that they don't run out.

It seems like vaccine distribution right now is heavily correlated with how white a state is.  Likely much more another example of institutional racism than anything else.

Here are the worst states by % of shots given:

Jurisdiction   Doses distributed   Doses administered   % shots used
Alabama   326,850   76,528   23.4
Georgia   770,625   183,870   23.9
North Carolina   820,825   211,572   25.8
Alaska   132,350   35,027   26.5
Arizona   563,025   151,844   27.0
California   2,833,400   782,638   27.6
Nevada   205,200   58,651   28.6
Mississippi   192,750   55,399   28.7

Hmm, what do AL, GA, NC, and MS have in common?  How about CA, NV, and AZ?

[Fmr. Gov. NickG]

Scheduled my first vaccine today, March 4th.

New Jersey is scheduling people this far in advance?  What group are you?
I’m surprised they have that much certainty both about vaccine availability and how many people arre actually going to show up for their appointments.

[Fmr. Gov. NickG]

According to the OurWorldInData vaccine tracker (https://ourworldindata.org/covid-vaccinations), today is the first day in which the US recorded vaccinating over 1 million people. (I'm not sure what the lag in this data is.)

And we are now at a 7-day average of almost 800k doses, compared with just 400k a week ago.  It does seem like we are getting to where we need to be here.

[Fmr. Gov. NickG]

The updated numbers for COVID-19 in the U.S. are in for 1/15 per: https://www.worldometers.info/coronavirus/country/us/

I'm keeping track of these updates daily and updating at the end of the day, whenever all states finish reporting for that day.

ΔW Change: Comparisons of Weekly Day-to-day Growth or Decline of COVID-19 Spread/Deaths.

• IE: Comparing the numbers to the same day of last week, are we flattening the curve enough?

Σ Increase: A day's contribution to overall percentage growth of COVID-19 cases/deaths.

• IE: What's the overall change in the total?

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1/3: <Sunday>

• Cases: 21,113,528 (+208,827 | ΔW Change: ↑49.16% | Σ Increase: ↑1.00%)
• Deaths: 360,078 (+1,396 | ΔW Change: ↑14.71% | Σ Increase: ↑0.39%)

1/4: <M>

• Cases: 21,353,051 (+239,523 | ΔW Change: ↑15.28% | Σ Increase: ↑1.13%)
• Deaths: 362,123 (+2,045 | ΔW Change: ↑0.05% | Σ Increase: ↑0.57%)

1/5: <T>

• Cases: 21,578,606 (+225,555 | ΔW Change: ↑15.03% | Σ Increase: ↑1.06%)
• Deaths: 365,620 (+3,497 | ΔW Change: ↑2.94% | Σ Increase: ↑0.97%)

1/6: <W>

• Cases: 21,857,616 (+279,010 | ΔW Change: ↑16.60% | Σ Increase: ↑1.29%)
• Deaths: 369,990 (+4,370 | ΔW Change: ↑4.07% | Σ Increase: ↑1.20%)

1/7 (Last Þ Holiday): <Þ>

• Cases: 22,132,045 (+274,429 | ΔW Change: ↑20.01% | Σ Increase: ↑1.26%)
• Deaths: 374,124 (+4,134 | ΔW Change: ↑20.28% | Σ Increase: ↑1.12%)

1/8 (Last F Holiday): <F>

• Cases: 22,456,902 (+324,857 | ΔW Change: ↑89.21% | Σ Increase: ↑1.47%)
• Deaths: 378,149 (+4,025 | ΔW Change: ↑80.49% | Σ Increase: ↑1.08%)

1/9: <S>

• Cases: 22,699,938 (+243,036 | ΔW Change: ↓15.42% | Σ Increase: ↑1.08%)
• Deaths: 381,480 (+3,331 | ΔW Change: ↑48.90% | Σ Increase: ↑0.88%)

1/10: <Sunday>

• Cases: 22,917,334 (+217,396 | ΔW Change: ↑4.10% | Σ Increase: ↑0.96%)
• Deaths: 383,275 (+1,795 | ΔW Change: ↑28.58% | Σ Increase: ↑0.47%)

1/11: <M>

• Cases: 23,143,197 (+225,863 | ΔW Change: ↓5.70% | Σ Increase: ↑0.99%)
• Deaths: 385,249 (+1,974 | ΔW Change: ↓3.47% | Σ Increase: ↑0.52%)

1/12: <T>

• Cases: 23,368,225 (+225,028 | ΔW Change: ↓0.23% | Σ Increase: ↑0.97%)
• Deaths: 389,599 (+4,350 | ΔW Change: ↑24.39% | Σ Increase: ↑1.13%)

1/13: <W>

• Cases: 23,616,345 (+248,120 | ΔW Change: ↓11.07% | Σ Increase: ↑1.06%)
• Deaths: 393,928 (+4,329 | ΔW Change: ↓0.94% | Σ Increase: ↑1.11%)

1/14 (Yesterday): <Þ>

• Cases: 23,848,410 (+232,065 | ΔW Change: ↓15.44% | Σ Increase: ↑0.98%)
• Deaths: 397,994 (+4,066 | ΔW Change: ↓1.64% | Σ Increase: ↑1.03%)

1/15 (Today): <F>

• Cases: 24,102,429 (+254,019 | ΔW Change: ↓21.81% | Σ Increase: ↑1.07%)
• Deaths: 401,856 (+3,862 | ΔW Change: ↓4.05% | Σ Increase: ↑0.97%)

Is this likely a trend?

Keep in mind that the spikes in case numbers the previous week were likely to some extent compensating for recording backlogs from the Christmas and New Years holidays.  So some drop is probably expected.  It seems to me like if you account for the holiday recording gaps, cases have actually been pretty flat for about six weeks.

[Fmr. Gov. NickG]

A lot of people are having to go through a lot just trying to get a vaccine
(see thread):
https://twitter.com/btshapir/status/1351218054580072451?s=20

Where did this guy sign up for any appointment?  For example, the website for LA County makes it clear that you should only sign up for an appointment if you are a healthcare worker:

http://publichealth.lacounty.gov/acd/ncorona2019/vaccine/hcwsignup/pods/

[Fmr. Gov. NickG]

https://twitter.com/BNODesk/status/1353436811276775425

Is this legal? Wouldn't it be the sort of issue that is decided state by state or even county by county?

This is definitely within the power of the federal government in general as a regulation of interstate commerce.

Whether it can be done by executive order as opposed to actual legislation is a bit more of a controversial question, though I still think it would be permitted given all the other stuff that is done through executive order in the modern era.

[Fmr. Gov. NickG]

Presidents have more power over federal property. If it's just some local bus service, the federal government doesn't have much power over that.

The federal government does have the power to regulate local buses.  They are considered part of interstate commerce even if they don't literally cross state lines.  This is the exact power used to justify the civil rights act which outlawed segregation on buses.

[Fmr. Gov. NickG]

I hate to say it but they should be aiming at 4 to 5 million vaccinations a day, at least. Negotiating between 1 million and 1.5 million a day is too slow. The more time you give this virus to be out there, the faster new variants will develop. That's why you need "Shock and Awe" to beat it back as fast as possible.

I'm still confused about whether Biden's goal is 100 million people vaccinated in 100 days or 100 doses (i.e. 50 million people) in 100 days.  

If it's the latter, that is way too slow, and we are already exceeding that number.  The former number should probably be our realistic goal, at least until more vaccines are approved in the US.

I believe we have contracts with Pfizer and Moderna for 200 million doses each to be fulfilled by July in regular increments.  This works out to about 200 million people in 200 days, which should be a large enough portion of the adult population to achieve herd immunity.  

I'm not sure it is possible for Moderna or Pfizer to produce more than they are already doing, and even they could do this, I'm not sure it would make sense to prioritize selling additional doses to the US compared to other parts of the world anyway.

[Fmr. Gov. NickG]

I WANT KIDS BACK IN SCHOOL NOW!!!

I actually took a deep look at US Covid statistics, so I am more confident than usual to answer this I may be doing the math wrong.

The state of Virginia seems to have somewhere around 820 cases / 100k people over the past 14 days (cumulative). That is an extreme level of risk, and even I (who generally support reopening schools) think that is excessive enough to close schools.

In fact, iirc you live in NOVA if I am not mistaken right? Using Fairfax County as the reference (which seems to be doing the best of the 3 main counties), there were 6854 cases reported over the past 2 weeks. That translates to 623 cases / 100k people over the past 14 days (cumulative); which is still not safe at all.

Honestly it is hard to draw a line as to when schools should be closed. My personal gut feeling was that they should be closed when cases exceed 500 cases/ 100k over 14 days. However it seems here they are remaining open with twice, or in some cases even 3 times that; so it's hard to say.

I will still stick with my 500 cases level; which means Virginia schools should remain closed. But it really depends on the level of risk people are comfortable with.

I don’t think the case levels of the entire population of a region should matter very much once the teachers and staff have been vaccinated.