COVID-19 Megathread 6: Return of the Omicron

[jimrtex]

The US is vaccinating people way too slowly. A top doctor says the federal government is to blame.

Dr. Ashish K. Jha, a top US doctor and the dean of Brown University School of Public Health, on Tuesday shared in a Twitter thread why he believed the rollout of COVID-19 vaccines in the US was flawed, and he said the issue begins with the federal government.

The US Food and Drug Administration in December authorised two different vaccines for COVID-19 — one created by Moderna and the National Institutes of Health, and another created by Pfizer and BioNTech — for emergency use in the US.

While people across the US have already begun to receive the vaccine, a limited supply means the vaccine won’t be widely available to all who need it well into 2021, prolonging the pandemic that has so far killed more than 336,000 people in the US, according to data from Johns Hopkins University.

According to an analysis published Tuesday by NBC News, at the current pace, it could take the US nearly a decade to vaccinate enough Americans to meaningfully bring the pandemic under control. The White House previously said it aimed to vaccinate 80% of Americans by the end of June, which would require more than 3 million vaccinations per day, according to the report. So far, the US has vaccinated just about 2 million people in 16 days.

More Trump administration incompetence, or a deliberate effort to sabotage the Biden administration at the cost of American lives? Given the last four years, either (or even both) seem plausible.

Flawed analysis by NBC.

It is unlikely that the aim was to vaccinate 80% of the US population by June, but rather 80% of the adult population, or around 200 million persons.

They also appear to be counting doses rather than persons vaccinated.

In essence they are projecting that initial doses will be administered for 21 days, and then for the next 21 days no first doses will be administered, as they go back and administer the second dose.

My impression was that the 80% of the population as a whole was a little unrealistic. 80% of the adult population sounds more reasonable.

We won't be achieving herd immunity for some time, but if we can get the rate of infection and death down, we might be able to return to a semi-normal.

The number of first doses doubled in the next five days.

[Torrain]

https://twitter.com/nytimes/status/1345819737389998082

Those aren't the words of a confident health official. Similar to the situation here, the vaccine rollout has been derailed by a toxic combination of desperation and poor scientific literacy.

Some of our officials have suggested 'mix-and-max' vaccine rollout, giving people two doses, but from different vaccines if they can't source enough of one. I cannot stress how incompetent and dangerous that idea is.

Unless cooler heads prevail, we're about to waste our vaccine stock. I'm beyond furious.

Sources (note, the Financial Times is a boring but trustworthy paper. It's like pre-Murdoch WSJ):
https://www.ft.com/content/afa31d12-c393-402b-9677-1fb312cfa1cf
https://www.ft.com/content/d97c72c5-ed23-4c2b-bf1c-9cc10b21f007

[ilikeverin]

Yeah, I'm not a fan of the tenor of these arguments. Yes, it's true vaccines aren't getting out very well... but deviating from the formulation of the vaccines that we know works just to get an extra, I don't know, 500,000 doses out this month doesn't make much sense to me if it might also reduce their efficacy. The problem is not the formulation of the doses, the problem is the logistics of the supply chain; changing the ways that we give the vaccines out does not actually fix the thing that's causing the holdups.

[Skill and Chance]

Yeah, I'm not a fan of the tenor of these arguments. Yes, it's true vaccines aren't getting out very well... but deviating from the formulation of the vaccines that we know works just to get an extra, I don't know, 500,000 doses out this month doesn't make much sense to me if it might also reduce their efficacy. The problem is not the formulation of the doses, the problem is the logistics of the supply chain; changing the ways that we give the vaccines out does not actually fix the thing that's causing the holdups.

IDK this feels eerily like the debate over masks in February/March to me: something that is very intuitive and will probably help but hasn't yet been proven, so officials refuse to recommend it.  Given the alternative is death for so many, perhaps we should try it?

[🐒Gods of Prosperity🔱🐲💸]

https://twitter.com/nytimes/status/1345819737389998082

Those aren't the words of a confident health official. Similar to the situation here, the vaccine rollout has been derailed by a toxic combination of desperation and poor scientific literacy.

Some of our officials have suggested 'mix-and-max' vaccine rollout, giving people two doses, but from different vaccines if they can't source enough of one. I cannot stress how incompetent and dangerous that idea is.

Unless cooler heads prevail, we're about to waste our vaccine stock. I'm beyond furious.

Sources (note, the Financial Times is a boring but trustworthy paper. It's like pre-Murdoch WSJ):
https://www.ft.com/content/afa31d12-c393-402b-9677-1fb312cfa1cf
https://www.ft.com/content/d97c72c5-ed23-4c2b-bf1c-9cc10b21f007

what is so incompetent and dangerous about the idea?

[Torrain]

https://twitter.com/nytimes/status/1345819737389998082

Those aren't the words of a confident health official. Similar to the situation here, the vaccine rollout has been derailed by a toxic combination of desperation and poor scientific literacy.

Some of our officials have suggested 'mix-and-max' vaccine rollout, giving people two doses, but from different vaccines if they can't source enough of one. I cannot stress how incompetent and dangerous that idea is.

Unless cooler heads prevail, we're about to waste our vaccine stock. I'm beyond furious.

Sources (note, the Financial Times is a boring but trustworthy paper. It's like pre-Murdoch WSJ):
https://www.ft.com/content/afa31d12-c393-402b-9677-1fb312cfa1cf
https://www.ft.com/content/d97c72c5-ed23-4c2b-bf1c-9cc10b21f007

what is so incompetent and dangerous about the idea?

The vaccines are constructed in radically different ways. If we wanted to mix-and-match vaccines, we'd need to do a full scale clinical trial to establish that there was any validity to that strategy.

Hypothetically, (and I stress, hypothetically), the vaccines are inducing immunity to the same virus, so it may be effective. The problem is, that the antigens used in the vaccines are not consistent.

It's just really bad science. We would never mix two chemotherapies and then test every lung cancer patient in the country with the mixture. We would run a small trial, then a longitudinal study, to establish effectiveness (let alone safety), before proceeding to a large population.

The nightmare scenario is that the different vaccines do not provide effective immunity when combined (as they were not formulated to be administered in this fashion), and we burn through our vaccine stockpile, with a large population believing themselves to be protected, while in actuality, they are vulnerable to both infection and spread of the virus.

My language in the original post could have been a little more muted, I apologise. It's just really frustrating to see this kind of stuff happen. It feels like we have not learned any lessons from the last year, and reminds me of the confusion the UK experienced in March 2020.

[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.

[Inmate Trump]

I get my first dose Wednesday morning.

[Dr. Arch]

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.

[Fargobison]

I do wonder if smaller doses would be effective in younger people but of course that would need to be studied more. I get my second dose tomorrow, first dose went ok outside of some chills and of course the sore arm. I don't agree with the one dose idea though, especially with the older population whose immune system is not as robust as a younger people. Two full doses are critical for that population.

It is amazing to see what has happened with Covid up here, we were in a meltdown just prior to Thanksgiving and now there are hardly more than 10 active covid patients in a hospital that had over 200 at our peak that I work at.

Some restrictions will be loosening here, mask mandate still in place though.

[Roll Roons]

I do wonder if smaller doses would be effective in younger people but of course that would need to be studied more. I get my second dose tomorrow, first dose went ok outside of some chills and of course the sore arm. I don't agree with the one dose idea though, especially with the older population whose immune system is not as robust as a younger people. Two full doses are critical for that population.

It is amazing to see what has happened with Covid up here, we were in a meltdown just prior to Thanksgiving and now there are hardly more than 10 active covid patients in a hospital that had over 200 at our peak that I work at.

Some restrictions will be loosening here, mask mandate still in place though.

Glad it's gotten so much better. Wonder what happened, since it seems like there was improvement even before the vaccine got distributed.

[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.

[Dr. Arch]

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.

[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.

[emailking]

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.

[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.

[emailking]

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.

[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.

[Fargobison]

I do wonder if smaller doses would be effective in younger people but of course that would need to be studied more. I get my second dose tomorrow, first dose went ok outside of some chills and of course the sore arm. I don't agree with the one dose idea though, especially with the older population whose immune system is not as robust as a younger people. Two full doses are critical for that population.

It is amazing to see what has happened with Covid up here, we were in a meltdown just prior to Thanksgiving and now there are hardly more than 10 active covid patients in a hospital that had over 200 at our peak that I work at.

Some restrictions will be loosening here, mask mandate still in place though.

Glad it's gotten so much better. Wonder what happened, since it seems like there was improvement even before the vaccine got distributed.

It burned through the state so fast and with such ferocity I think we missed a ton of positives. The states lack of density plus perhaps 30-40% of people getting the virus and more people finally realizing that a mask might be a good idea may have really beat it down. I just hope we can get the vaccine out to the nursing and group homes fast enough to avoid another wave.  

[Dr. Arch]

The updated numbers for COVID-19 in the U.S. are in for 1/4 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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<Last Numbers for 3/26-3/28 in this Post>
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12/27: <Sunday>

• Cases: 19,573,847 (+140,000 | ΔW Change: ↓26.24% | Σ Increase: ↑0.72%)
• Deaths: 341,138 (+1,217 | ΔW Change: ↓17.10% | Σ Increase: ↑0.36%)

12/28: <M>

• Cases: 19,781,624 (+207,777 | ΔW Change: ↑0.80% | Σ Increase: ↑1.06%)
• Deaths: 343,182 (+2,044 | ΔW Change: ↑7.41% | Σ Increase: ↑0.60%)

12/29: <T>

• Cases: 19,977,704 (+196,080 | ΔW Change: ↓7.03% | Σ Increase: ↑0.99%)
• Deaths: 346,579 (+3,397 | ΔW Change: ↓16.16% | Σ Increase: ↑0.99%)

12/30: <W>

• Cases: 20,216,991 (+239,287 | ΔW Change: ↑2.91% | Σ Increase: ↑1.20%)
• Deaths: 350,778 (+4,199 | ΔW Change: ↑23.72% | Σ Increase: ↑1.21%)

12/31 (Holiday/Last Þ Holiday): <Þ>

• Cases: 20,445,654 (+228,663 | ΔW Change: ↑17.76% | Σ Increase: ↑1.13%)
• Deaths: 354,215 (+3,437 | ΔW Change: ↑20.68% | Σ Increase: ↑0.98%)

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

• Cases: 20,617,346 (+171,692 | ΔW Change: ↑73.71% | Σ Increase: ↑0.84%)
• Deaths: 356,445 (+2,230 | ΔW Change: ↑86.30% | Σ Increase: ↑0.63%)

1/2: <S>

• Cases: 20,904,701 (+287,355 | ΔW Change: ↑28.47% | Σ Increase: ↑1.39%)
• Deaths: 358,682 (+2,237 | ΔW Change: ↑34.92% | Σ Increase: ↑0.63%)

1/3 (Yesterday): <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 (Today): <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%)

[○∙◄☻¥tπ[╪AV┼cVê└]

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.

Moderna found that a single dose was 80-90% effective. It's insane to insist on giving second doses to everyone who got a first dose while millions of people are going to wait months to get a single dose. It's obvious that we should focus on giving a single dose to as many people as possible for now. Obviously a second dose for an ICU nurse or a nursing home resident should be prioritized over a first dose for a healthy person working or going to school remotely in their 20s. Basically we could put everyone into maybe 10 tiers of priority and your priority for the 2nd dose is a couple of tiers lower than the first dose.

[emailking]

It's obvious that we should focus on giving a single dose to as many people as possible for now. Obviously a second dose for an ICU nurse or a nursing home resident should be prioritized over a first dose for a healthy person working or going to school remotely in their 20s.

Neither of those is obvious to me.

[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.)

[GeorgiaModerate]

https://twitter.com/Pervaizistan/status/1346283751861608449

[emailking]

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.)

I don't know that there is any and maybe it's not. But it's what we've got.