COVID-19 Megathread 6: Return of the Omicron

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Yeah, this is not looking good at the moment. It is reassuring to know, though, that Trump is focusing all of his attention on coordinating an effective response to this though, rather than spending all his energy tweeting about conspiracy theories. Oh, wait...

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

More than 180k cases today. sh**t is getting all too real. And it is clearly going to keep getting worse. The rate at which we are approaching the 200k cases per day marker is startling. Illinois alone is with 15k+ confirmed cases today, which is higher than CA or TX got in previous surges. The bad thing is there is no sign of any sort of deceleration, and policymakers (ha) are so far showing no signs of serious reaction. A relative of mine recently had a serious non-covid medical condition that required hospitalization, and was only barely able to get a hospital bed.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

This graph of the positivity rate hasn't been posted in a while, so it is worth taking a look at that again...



The really scary thing is that the rate of increase of the positivity rate is steeper/larger than it ever was during the July peak, and so far the rate of increase is increasing and shows no obvious sign of slowing down.

We are getting back up near to the sort of positivity rates we saw during parts of the initial March-April-May peak, and that is despite the fact that there are now many times more tests than there were back then. Obviously in some areas, like in the Dakotas/upper midwest, the positivity rates are significantly higher than the national average, and rival the New York positivity rates during the worst of the first peak. The high positivity rates suggest that on a national level, things are getting as bad as they were during the first peak. There are a few things that may be keeping deaths relatively lower, at least so far:

a) improved treatment - if proper medical care is available, better treatment methods have been devised which (somewhat) lower the fatality rate.
b) geographical dispersion - the current peak/outbreak, while concentrated more in the north, is spread across the whole country, rather than especially concentrated in a few locales like New York. To some degree this helped to ensure things didn't get too bad in New York, because doctors/materiel etc from other parts of the country were sent to New York. But this time around, everywhere is being effective, and there are not going to be spare doctors/nurses from other parts of the country who can help. The problem is that the "improved treatment" from item a) is going to start becoming less and less effective the more the medical system gets overwhelmed.
a) time - clearly we have not yet remotely hit the peak of the current surge, so things are clearly going to get worse in these respects, and unless we see some sort of slowdown very very soon, it looks like we are on course for them to be clearly quite a bit worse than in March-April-May.

Here are the hospitalizations:



These have already exceeded hospitalizations in the previous 2 peaks, and we are clearly going quite a bit higher. The slope/rate of increase of hospitalizations looks a bit slower than the the slope/rate of increase in the positivity rate, but unfortunately hospitalizations are a lagging indicator following cases, and it is unavoidable at this point that the rate of increase of hospitalizations is going to increase more over at least the next week or two or three, even if we suddenly start turning the situation around now (unless we run out of hospital beds and have fewer "hospitalizations" only because there is nowhere left to hospitalize people in some areas).

Looking at these graphs, I have to conclude that the only way to (maybe) avoid total disaster is to have a national lockdown, and have it now. By the time Biden is inaugurated, it will already be too late. But it is state and local officials that locked down the first time, not Trump, in any case. Stuff like mask wearing, while helpful, is clearly not enough - partly because not enough people comply with it, and partly because cloth masks that most people use are less effective than proper masks.

Barring that, how many deaths are we going to end up with? To me it looks like 500k is very plausible if not likely, and perhaps up to a million, depending on vaccine timelines and effectiveness.

It is pretty sad to hit these sorts of numbers relatively soon before we expect vaccines to start being available. If we could have just kept it somewhat under control for a little bit longer, seemingly a lot of this could have been avoided. It is in fact possible to keep the virus under control - look at countries like South Korea and China and others in Asia/Australia for the best examples. And also guess which countries have economies which are doing relatively well? Those same countries in Asia/Australia. But alas, we seem to be a failed society.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

There is no end in sight for this upswing. I shudder to think what's going to happen a week or two after Thanksgiving.

I don't think most people realize how bad this could get. 5,000+ deaths per day or even higher is a real possibility (2,000+ COVID, 3,000+ needed emergency medical attention and could not get it) if hospital systems start collapsing all over the country.

It really is unspeakably stupid to let that happen when we are on track to start getting vaccines administered in significant quantities over the next few months. If we as a country were rational, had a sense of common purpose, had a sense of the common good, and were organized, the government would re-schedule the Thanksgiving holiday so that there could be 2 Thanksgivings next year. This way people would not have to feel permanently deprived of the holiday. In the meantime, all we would have to do is hold off for just a few more months, and then at that point we could actually declare "mission accomplished." Actually, come to think of it the government should schedule a week long "V-C" day (Victory over COVID day) holiday for some approximate time to be finalized later in the summer/fall (or possibly even late spring depending on how things go) which could be set to occur once a sufficiently high share of the population has been vaccinated as a period of national celebration. This is what we would do if we were sensible, anyway.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

I vote for Democrats because I support left wing policy.

But why why why why why is the left so pro lockdown?

Why are Democratic Governors and local officials willing to let millions have no income and potentially become homeless just to stop some old people from dying?

No stimulus = no lockdown. And to be frank our national debt is already high enough. The best decision of many bad decisions is to just keep the economy open and no new stimulus.

With no federal stimulus money it is not worth leaving millions and millions homeless and incomeless just to keep some old people from dying. Let them die. I hate to say that but it is true. Do not destroy everyone's livelihoods permanently.

Of course, this discussion could be outdated in a few months. Vaccinations of even only the most vulnerable populations will be a major factor in allowing the economy to move again.

What a ridiculously uninformed take.

Nobody, or at least nobody sensible, is arguing that there should be lockdowns but that we should not have stimulus. Frankly, regardless of whether there are lockdowns there needs to be more stimulus, but especially if some people have incomes interrupted due to lockdown orders, their incomes should be supported during that time.

As for the "national debt," do you not realize that literally the only cost of stimulus spending is (potentially) inflation? And there is no sign of any inflation to be at all worried about at the moment (if anything, inflation is too low/disinflation/deflation is more of a risk):

CONSUMER PRICE INDEX – OCTOBER 2020

 The Consumer Price Index for All Urban Consumers (CPI-U) was unchanged in October
 on a seasonally adjusted basis after rising 0.2 percent in September, the U.S.
 Bureau of Labor Statistics reported today. Over the last 12 months, the all
 items index increased 1.2 percent before seasonal adjustment.

Other than the possibility of maybe, sometime, having more inflation due to extra spending capacity out in the economy, stimulus spending is literally costless. Even Fed chairman Jay Powell understands this, which is why he has practically been begging for more fiscal stimulus from Congress (even apart from any other lockdowns and for months on end). The only person who has been blocking that has been Mitch McConnell.

Stimulus spending increases the wealth held by the American public. When the government spends more money, someone in the public receives money in their bank account, and then either they spend it or buy a financial asset like a government bond. If people spend the stimulus money, they are better off because they get the stuff that they spend the money on (and then eventually the money gets passed on to someone who doesn't spend it, who owns a government bond in their retirement/pension account and becomes wealthier than before). And if you get stimulus money and don't spend it, then you can use the stimulus money to buy a government bond, and are now wealthier and can spend more in the future. Literally nobody is worse off as part of the bargain.

Don't get me wrong, if inflation were a problem, then this would not be the case. But fortunately for us, inflation is not a problem, and consequently stimulus is essentially free money for everyone and is also essentially costless for everyone. The reason why inflation is not a problem is, of course, that the economy is weak and will remain so for a while, with higher than normal unemployment (so while some stimulus spending is essentially a free lunch, in principle it is possible for there to be too much, though that is not the problem we face now).

The Federal government should stop issuing bonds and should simply spend money directly so that people like you would be less confused and misinformed about how government spending works (and the Federal reserve should simply directly issue bonds whenever it wants, or alternatively should control interest rates via interest on reserves rather than by buying/selling bonds, and there should be no government bonds issued at all).

People can be better off with no real cost, and the only person blocking that is, once again, public enemy #1: Mitch McConnell, because he wants the economy to be weaker so that Biden will be (eventually) blamed for it and because he wants to create a fake artificial crisis to force state and local governments to cut their spending.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Our national debt is at a dangerous level. Therefore, I oppose any new massive stimulus packages.

and we have almost 28 TRILLION DOLLARS of national debt! No more major stimulus packages please. I am done with this bull.

There is literally 0 danger from the "national debt" to anything. The only danger is an imaginary danger that is infecting your mind and causing you to support sabotaging the economy and making people worse off due to insufficient spending power circulating through the economy.

This, again, is why either the government should stop issuing bonds so that there would be no more "national debt," or alternatively maybe we should just rename the "national debt" to the "national asset" and then maybe you would not feel the need to be worried about it (every dollar of "debt" is held by someone as an asset). The only reason you are worried about it is that you are not informed about the details of how government spending works.

As for the "national debt" being 28 trillion, you know what is also pretty close to 28 trillion? Well, the distance to Alpha Centauri is about 25 trillion miles. Is that scary? No. It has no particular relation to anything; it is literally just a number. Big numbers are not scary just because they are big. You are just irrationally scaremongering with 0 basis whatsoever (probably not your fault though, you just don't know any better and are understandably confused, because it does *sound* scary).

We have far too many actual real problems to spend time worrying about non-existent totally imaginary problems - among which are the fact that the virus is currently on track to kill 500k+ people in the USA and cause long term health issues for many more. As far as the economy goes, spend your time worrying about unemployment and about inflation if you want to be concerned with actual issues.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Of course I would! But Covid 19 does not have a 50% kill rate.

And the vaccine isn't going to take 5 years. People are suggesting we just get through this since the vaccine is coming soon.

And I have made it crystal clear I oppose any conventions or large gatherings!

Large and small should be avoided if not necessary.

Yes but there are people willing to throw millions unemployed and with no income for months!

You can blame McConnell all you want but that is the fact of the situation.

McConnell is more likely to let more stimulus through if there are additional large economic hit from this current wave and additional lockdowns and/or other significant measures taken to bring the virus under control. The most likely way this would occur is that things continue to get worse in more states, and eventually red state governors are forced to take drastic measures as a last resort as the medical systems in their states get overwhelmed and deaths mount. Over the short term this would be worse for the economy, because of course the economic hit (not to mention the humanitarian hit) would be very bad. But over the medium run this would be better for the economy, because more spending power would be pumped into the system and eventually in a few years we would have a stronger recovery than otherwise.

Not saying that that is the reason to lockdown and/or impose other policies to take the current rampant outbreak seriously of course, but that is the fact of the situation.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

One thing to be at least a bit optimistic about is it seems like at least the rate of growth of new cases may have been going down somewhat at least over the past day or 2, so at least we may not be accelerating further than we already were. If we are lucky, maybe that is a real trend change, and not just a blip.

On the other hand:

a) I wonder if this might have partly to do with weather. It seems like in a lot of areas it warmed up a bit temporarily around 7-10 days or so ago (approximately coincident with the lag time for new cases to be expected to show up) but then got cooler again. To the degree that there is a relation between temperature and spread (this definitely seems to be the case) that may be partially responsible, and we should worry about current spread with lower temperatures.

b) At a certain point the number of tests starts to be a constraint in at least some areas, despite the overall increases in test availability since the early days of the pandemic. There are some states especially in the plains/upper midwest with very high positivity rates, where they would keep on finding more cases if they were not running into testing capacity issues with very high positivity rates. The higher the positivity rates get, the more this becomes a relevant factor.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Our national debt is at a dangerous level. Therefore, I oppose any new massive stimulus packages.

and we have almost 28 TRILLION DOLLARS of national debt! No more major stimulus packages please. I am done with this bull.

There is literally 0 danger from the "national debt" to anything. The only danger is an imaginary danger that is infecting your mind and causing you to support sabotaging the economy and making people worse off due to insufficient spending power circulating through the economy.

Late, but Greece circa 2013 agrees with this statement

The key difference you are overlooking is that Greece does not control its own currency and have its own central bank, whereas the USA does. Greece is in essentially the same position as US states and municipalities are in, as well as in the same position as you, me, other individuals, and private companies. You and I (and US states, and Greece) do have financial constraints to how much debt we can take on, but the US government is in a very different position because it has a money printing machine. Do you have a money printing machine? No. If you did though, you could print as much of it as you wanted. That is the position the US Federal government is in. There is no financial constraint to how much money the US government can create. The only constraints on what the US government can do are questions of how much money it is wise to print/create. The risk of creating too much money is that at a certain point, if you make too much of it, there may be inflation. So the US government does and should have to worry about macroeconomic considerations like inflation and the unemployment rate when setting its fiscal policy, but there is no reason to ever worry that the USA will run out of money. Currently, since inflation is low and unemployment is high, that is a signal that it is macroeconomically warranted for the government to run larger budget deficits. Of course, if we spend too much and inflation gets too high (and if the reason it is getting too high is we don't have underutilized productive capacity), then that would call for smaller budget deficits. But that is emphatically not remotely the current situation, and it won't be the situation in the foreseeable future, in particular if the Republicans keep blocking additional much needed stimulus.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Ok, if your solution is "money printer go brrr" change that from 2013 Greece to 2013 Venezuela I guess. Or Weimar Germany.

You seem to be selectively ignoring the fact that I didn't say that the money printer should go brrr to infinity, but rather I said that it should go brrr up until the point when we don't have unutilized productive capacity and when inflation becomes an issue.

In the case of Weimar Germany, they had hyperinflation because they did not stop the money printer from going brrr at the point when inflation became an issue. The main reason for this is that Germany had a lot of reparations payments due to the Versailles treaty which were totally crazy macroeconomically. Importantly, the German debt was denominated in foreign currencies, not in the German currency, so in order for Germany to pay debt denominated in dollars or pounds, it had to keep printing more of its reichsmarks, which had the effect of weakening the exchange rate of reichsmarks to other foreign currencies - and that set in place a vicious circle where in order to keep paying the foreign currency denominated debt, they had to print even more reichsmarks, which then caused the exchange rate to fall even further, etc.

If the USA similarly had a bunch of debt denominated in foreign currencies like the Yen or the Euro or something, then we could have a similar sort of issue. But instead, the US "national debt" is denominated in dollars (the USA's own currency).

Similarly to Weimar Germany, Greek debt is denominated in a foreign currency (the Euro), which similarly led to problems. It would have kept getting worse, but the European Central Bank instead fortunately abandoned its poorly designed system/policy and began buying the Greek bonds and bonds of other countries, which effectively removed the financial constraints on Greece issuing more bonds (but only to the limited extent that was allowed and to the extent that the ECB was willing to keep buying more bonds).

This is the underlying reason for the weakness of the European economy over the past 20 or so years - insufficiently large budget European deficits which are necessitated by the fact that they don't have their own currencies. And incidentally, this is also one of the causes of large US government budget deficits, because small budget deficits in Europe tend to cause European countries to run trade surpluses with the rest of the world (including the USA), which results in US government budget deficits.

I won't comment in particular on Venezuela, because I have not really followed the situation there in detail, but usually when Latin American countries get into trouble like this, they have taken on a lot of foreign-currency (US dollar) denominated debt, and often they are commodity exporters heavily reliant on a single commodity price (e.g. oil exporters) and get hit by a sudden drop in the price of oil. From what I have heard, the situation may also have resulted from other government policies of the Maduro government in Venezuela to some degree or other, but again, I have not followed the situation enough to be able to judge how much that is the case.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Another sad case of natural selection in action:

Former Alabama senator dies of Covid at age 78, and in his last words warns, 'We messed up'

A former Alabama state senator died of Covid-19 last week at age 78, officials said.

Former Sen. Larry Dixon, a Republican who also served as the executive director of the Alabama Board of Medical Examiners, died from Covid-19 on Dec. 4, the board said in a statement on Friday.

Dr. David Thrasher, a close friend of Dixon and a pulmonologist in Montgomery, told NBC News that Dixon's wife, Gaynell Dixon, told Thrasher that his last words to her were a prescient warning to the people of Alabama.

“We messed up, we let our guard down,” Dixon said, according to Thrasher. “Please tell everybody to be careful. This is real, and if you get diagnosed, get help immediately.”

Thrasher said his friend was exposed to the virus at a social gathering “with a couple of guys” that was hosted outside about two weeks ago.

Thrasher said he was unsure how many people attended, but he said he knew of two other men who attended the meetup and tested positive.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

William Shakespeare has been vaccinated.

This seems like a good thing to me. The guy is literally hundreds of years old by this point, so he should be one of the most vulnerable to the virus in the world. So it is good to see he is being prioritized to get one of the first vaccine doses.

https://www.bbc.com/news/uk-55233021

https://twitter.com/BBCHughPym/status/1336210741892968449

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

‘I’m sorry, but it’s too late’: Alabama doctor on treating unvaccinated, dying COVID patients

Dr. Brytney Cobia said Monday that all but one of her COVID patients in Alabama did not receive the vaccine. The vaccinated patient, she said, just needed a little oxygen and is expected to fully recover. Some of the others are dying.

“I’m admitting young healthy people to the hospital with very serious COVID infections,” wrote Cobia, a hospitalist at Grandview Medical Center in Birmingham, in an emotional Facebook post Sunday. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late.”

“You kind of go into it thinking, ‘Okay, I’m not going to feel bad for this person, because they make their own choice,’” Cobia said. “But then you actually see them, you see them face to face, and it really changes your whole perspective, because they’re still just a person that thinks that they made the best decision that they could with the information that they have, and all the misinformation that’s out there.

“And now all you really see is their fear and their regret. And even though I may walk into the room thinking, ‘Okay, this is your fault, you did this to yourself,’ when I leave the room, I just see a person that’s really suffering, and that is so regretful for the choice that they made.”

The thing is, these people didn't make their decisions in a vacuum. The information they acted on was contaminated, deliberately, by the GOP and Fox News. Republicans leadership are all effectively mass murderers. . That the Republican cultists share in the responsibility doesn't make what their leadership does any less vile. It just means that their cultists are also their victims.

Damn, I saw that and I came here with the intention of posting it (not having posted much in a while), but you beat me to it.

The full article is worth a read.

It is very sad, so many Americans are being murdered by Republican pond scum who have dissuaded them from getting a freely available vaccine which can (to a large extent) prevent death and severe symptoms.

And what is even worse, this has spilled over into other countries as well, due to the global influence and presence of American media and culture/tech (e.g. facebook), our pond scum are also culpable for the killing of far too many people in the rest of the world as well.



Also, I am glad the thread title was finally changed.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

https://twitter.com/DrewSav/status/1418235650101415943

I love drew!

Well, that is not exactly wrong. If there are renewed restrictions, the same idiots who ignored them earlier will also ignore them now.

However, it is effectively the same sort of argument as the argument that you should not bother voting (and voting for Democrats specifically), because even if you do vote for Democrats, and even if they do get a trifecta, they won't bother to do anything to stop "Republic"ans from rigging the electoral system (and the judicial system) in their favor, and consequently they won't be able to do anything regarding any policy issues in the future either, even if you continue to vote for them, and even if they suddenly changed to the point where they would actually do something if you did vote for them and if they did in the future actually manage to overcome all the obstacles that they previously (i.e. now) failed to eliminate that block them from doing anything - along with (probably/presumably) additional obstacles that "Republic"ans will probably add as soon as they re-gain power.

Likewise that appears not to be wrong either. It is also is essentially defeatist, and amounts to giving up. I can understand the impulse, but..... It is also like saying after Pearl Harbor that we may as well give up, because doing otherwise would be incredibly costly and difficult. And true, it was incredibly costly and difficult.

Or like saying at the start of the civil war that it is not worth bothering to keep the Union together and end the scourge of slavery, because the south would just continue to cause problems in the future (also not exactly wrong).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

https://twitter.com/DrewSav/status/1418235650101415943

I love drew!

Well, that is not exactly wrong. If there are renewed restrictions, the same idiots who ignored them earlier will also ignore them now.

However, it is effectively the same sort of argument as the argument that you should not bother voting (and voting for Democrats specifically), because even if you do vote for Democrats, and even if they do get a trifecta, they won't bother to do anything to stop "Republic"ans from rigging the electoral system (and the judicial system) in their favor, and consequently they won't be able to do anything regarding any policy issues in the future either, even if you continue to vote for them, and even if they suddenly changed to the point where they would actually do something if you did vote for them and if they did in the future actually manage to overcome all the obstacles that they previously (i.e. now) failed to eliminate that block them from doing anything - along with (probably/presumably) additional obstacles that "Republic"ans will probably add as soon as they re-gain power.

Likewise that appears not to be wrong either. It is also is essentially defeatist, and amounts to giving up. I can understand the impulse, but..... It is also like saying after Pearl Harbor that we may as well give up, because doing otherwise would be incredibly costly and difficult. And true, it was incredibly costly and difficult.

Or like saying at the start of the civil war that it is not worth bothering to keep the Union together and end the scourge of slavery, because the south would just continue to cause problems in the future (also not exactly wrong).

So you are advocating for lockdowns that still won't stop the spread ?

No, if you read my post I don't think I was advocating for any particular policy, but rather was simply noting that this particular reasoning for opposing lockdowns is kinda problematic.

I will say, however, that I think it is unfair to evaluate "lockdowns" as a policy in general by just looking at "lockdowns-as-practiced-in-USA-in-2020" and assuming that is the only possibility, especially when there are other parts of the world which had "lockdowns" that were much more successful.

Given this, obviously anyone would be a fool to advocate American-style lockdowns as a policy option. In truth though, all discussion of policy in the USA is kind of irrelevant and will be until fundamental structural issues are fixed, because the notion of "policy" presupposes having a functional government and rising to a basic level of social cohesion amongst the population.

And so as regards public health in general, the only viable "policy" I can see for the USA is to first alter the government so that it is possible to have functional public health policy in the first place, rather than make-believing that this is currently possible.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Had to take an ibuprofen/acetaminophen (single dose 250mg/500mg) for a posture-induced tension headache. It was over 24h after the second dose by that point--what's the risk of the antibodies being suppressed? I had no pain reliever prior to either dose, and none after the first dose.

I researched this briefly when I was taking the vaccine.

The most important thing to know is that when they did the vaccine trials, they had no restrictions on the use of pain relievers by people receiving the vaccines (and presumably a good # of people took one afterwards at varying points). So the high general vaccine efficacy found in studies is not assuming that you don't take any pain relievers.

However, there is some reason to believe that it is probably/logically a bit beneficial to delay taking pain relievers after taking the vaccine, based on some other vaccines being more effective if you do that. That is more likely to be the case with taking a pain reliever before (or potentially very soon after) taking the vaccine than if it is a longer time period. If there is such an effect though, it is also probably not that big in the first place.

So if you waited more than 24 hours, then you probably got the maximum possible benefit from your vaccine that you could realistically get.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

If you thought that Republicans were dumb before, just wait until the Delta variant plows through the remaining Republican unvaccinated population.

Cognitive deficits in people who have recovered from COVID-19
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext

Abstract

Background

There is growing concern about possible cognitive consequences of COVID-19, with reports of ‘Long COVID’ symptoms persisting into the chronic phase and case studies revealing neurological problems in severely affected patients. However, there is little information regarding the nature and broader prevalence of cognitive problems post-infection or across the full spread of disease severity.

Methods

We sought to confirm whether there was an association between cross-sectional cognitive performance data from 81,337 participants who between January and December 2020 undertook a clinically validated web-optimized assessment as part of the Great British Intelligence Test, and questionnaire items capturing self-report of suspected and confirmed COVID-19 infection and respiratory symptoms.

Findings

People who had recovered from COVID-19, including those no longer reporting symptoms, exhibited significant cognitive deficits versus controls when controlling for age, gender, education level, income, racial-ethnic group, pre-existing medical disorders, tiredness, depression and anxiety. The deficits were of substantial effect size for people who had been hospitalised (N = 192), but also for non-hospitalised cases who had biological confirmation of COVID-19 infection (N = 326). Analysing markers of premorbid intelligence did not support these differences being present prior to infection. Finer grained analysis of performance across sub-tests supported the hypothesis that COVID-19 has a multi-domain impact on human cognition.

Interpretation

Interpretation. These results accord with reports of ‘Long Covid’ cognitive symptoms that persist into the early-chronic phase. They should act as a clarion call for further research with longitudinal and neuroimaging cohorts to plot recovery trajectories and identify the biological basis of cognitive deficits in SARS-COV-2 survivors.

The size of the cognitive deficits they found seem to correlate pretty strongly with severity of symptoms, but they found negative effects even for mild symptoms.

Discussion
Our analyses provide converging evidence to support the hypothesis that COVID-19 infection is associated with cognitive deficits that persist into the recovery phase. The observed deficits varied in scale with respiratory symptom severity, related to positive biological verification of having had the virus even amongst milder cases, could not be explained by differences in age, education or other demographic and socioeconomic variables, remained in those who had no other residual symptoms and was of greater scale than common pre-existing conditions that are associated with virus susceptibility and cognitive problems.

The scale of the observed deficit was not insubstantial; the 0.47 SD global composite score reduction for the hospitalized with ventilator sub-group was greater than the average 10-year decline in global performance between the ages of 20 to 70 within this dataset. It was larger than the mean deficit of 480 people who indicated they had previously suffered a stroke (−0.24SDs) and the 998 who reported learning disabilities (−0.38SDs). For comparison, in a classic intelligence test, 0.47 SDs equates to a 7-point difference in IQ.

So .47 standard deviations = 7 points of IQ



7 IQ points lost if on a ventilator. Nearly 4 if you are hospitalized but not put on a ventilator, and lesser but clearly measurable amounts of IQ loss are to be expected if you get even mild symptoms (maybe a point or two on average).

So, the population is going to be getting dumber the more that people keep getting infected. That will be especially the case among Republicans, given the low vaccination rate of Republicans. So average Republican intelligence is going to drop (and has been dropping throughout the pandemic). Unfortunately, the same is true for non-Republicans also, but to a lesser extent (due to higher levels of vaccination).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

This is a follow-up from another thread, but it seems like it belongs more in this thread than in the one about NYC mask mandates, because this is really about broader issues with vaccine efficiency potentially declining over time and the potential need for booster shots.

More info on the Israel study:

https://www.timesofisrael.com/israeli-uk-data-offer-mixed-signals-on-vaccines-potency-against-delta-strain/

The Israeli statistics also appeared to paint a picture of protection that gets weaker as months pass after vaccination, due to fading immunity. People vaccinated in January were said to have just 16% protection against infection now, while in those vaccinated in April, effectiveness was at 75%.

Doctors note that such figures may not only reflect time that has passed since vaccination, but also a bias according to which those who vaccinated early were often people with health conditions and who are more prone to infection, such as the elderly.

Davidovitch stressed that all figures should be treated as preliminary and with limited relevance given the relatively small numbers of positive patients at the moment. “It’s quite early to comment, as the number of positive people is still quite low,” he said.

A lot that the Bloomberg article and our resident misinformation spreader intentionally left out.

(edited as quote was instead hyperlinked)

FWIW the Israeli data which indicates significantly decreasing vaccine efficacy after ~6 months or so, and other data from the UK which does not indicate much decrease in vaccine efficacy may BOTH be correct.

There are a few factors that may explain that seeming paradox.

First, in Israel they generally administered second doses 3-4 weeks after the first dose (which had been what the initial vaccine trials tested). However, subsequent studies found that a longer time between doses was more effective, more like 8-12 weeks.

Whereas in the UK, they adopted a strategy of trying to give out as many first doses as possible to try to build up partial immunity in a larger part of the population (rather than strong immunity in a smaller part of the population). The result of this was that second doses tended to be delayed longer, and ended up being administered on average in something more like that 8-12 week optimal time period.

So, this is one aspect that could explain some of the difference observed in Israel vs the UK. If that turns out to be a significant part of the explanation, that may end up being a problem in the USA, because a lot of people (myself included!) got their second doses as soon as possible after the first dose (4 weeks or so). It may be that booster shots end up being more necessary for people who had second doses shortly after the first dose than people who waited longer to get the second dose after the first one.

The second thing to consider is that Israel began vaccinating earlier than the UK. The main significant finding in the Israeli data, however, is that vaccine efficacy drops off sharply as time goes on. But Israel started vaccinating earlier than elsewhere and got going quickly, so you would expect that any time-dependent effect would be noticed in Israel first, but would take longer to show up in other countries like the UK that took longer to get going. Here's a graph from the Israeli data:

https://www.gov.il/BlobFolder/reports/vaccine-efficacy-safety-follow-up-committee/he/files_publications_corona_two-dose-vaccination-data.pdf



I don't read Hebrew, if anyone does maybe they can translate.

If you just look at those graphs, you can see very sharp drop-offs in efficacy for people who had their second dose in January, down to 16% against infection/symptoms, and 44% for people who had their second doses in February, compared to 75-79% for people who had second doses in April. By any standard, that is a massive difference and is definitely reason for concern, both because if you are infected you can still spread the virus (and help farm future variants), and also because even "mild" COVID is not necessarily "mild" as an ordinary person would understand the word "mild," and can be pretty hellish even if it is not outright life threatening. Not to mention the risks of potential long COVID and unknown long term health effects 5/10/20/30 years down the line.

At least one bit of good news is the drop-off for hospitalizations and severe COVID appears to be a lot less (maybe even, if we are very lucky, not a drop-off due to measurement error). But it could also be the case that efficacy against hospitalization and severe COVID drops off as well, but takes longer to drop off as much.

Another difference is that the vaccines themselves were different. Israel is basically all Pfizer, whereas in the UK it is largely Astrozenica, also with some Pfizer and Moderna. So it is possible that drop off in effectiveness might be more significant for Pfizer than other vaccines.

One thing that some people have pointed to (and also which the Bloomberg article which Hammy links to mentions) which could be a problem with the Israeli data is that they first vaccinated the oldest and most vulnerable people, so maybe the explanation might be just that the vaccine is less effective for those older/more vulnerable people.

However, the Israeli data does break things down by age, and they see the effect for younger people as well as for older people. On the other hand, they only have two age groups, 60+ and 16-59. There is obviously a lot more variation in age than just those two groups, so it is not ideal to only have two age buckets, but nevertheless seems to show that the explanation is very likely not purely age.

Here is data for age 60+:



And here for 16-59:



In both graphs, on the right you can see significant increases in breakthrough infections starting in the right (i.e. recent weeks), and starting more so in the bottom right (i.e. more so in people who were vaccinated earlier).



There is some informed discussion about this here:

https://www.reddit.com/r/medicine/comments/oq0od0/israel_health_ministry_claiming_pfizer_only_39/

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Redundant precautions prevent calamities.

There was no redundancy at Chernobyl.

Excellent post. People should pay more attention to this.

Unfortunately, human beings systematically underestimate the risk of large scale disaster from low probability events.

This is one of the major flaws in how human beings naturally think, and has been repeated many times throughout history.

Ideally we could learn from history, but if there is one lesson we can learn from history, it is that human beings do not learn from history.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Redundant precautions prevent calamities.

There was no redundancy at Chernobyl.

Excellent post. People should pay more attention to this.

Unfortunately, human beings systematically underestimate the risk of large scale disaster from low probability events.

This is one of the major flaws in how human beings naturally think, and has been repeated many times throughout history.

Ideally we could learn from history, but if there is one lesson we can learn from history, it is that human beings do not learn from history.

Are you saying that reimposing mask mandates is a good idea?

Nah, more agreement with pbrower2a's general point, rather than any particular application of it.

Mask mandates as a policy (note that actual enforced mandates are distinct from CDC "recommending" masks) are a complicated question at this point on a number of levels, and if I were hypothetically in the position of making a recommendation for what policies would actually be implemented at this point, then I would want to re-review the newest research as a starting point before deciding anything. And in addition to scientific understanding of the delta variant and the efficacy of vaccines over time (and masks) which is still an area where new evidence is coming up all the time. Some of the most important things to consider are areas where we simply lack knowledge because not enough time has passed, like about long COVID and the future potential evolution of variants. One of the primary things to be worried about is e.g. the potential evolution of a vaccine-resistant virus strain, something that is more likely to happen when we are in a situation similar today where a large part of the population is vaccinated and a large part also un-vaccinated.

But the policy merits/demerits of a renewed mask mandate would also depend on more than just scientific evidence. The fact that it is pretty clear that large numbers of people would not comply with renewed mask mandates and there is no real enforcement mechanism, and various other things like that also cannot simply be ignored.

As far as personal behavior, I will happily wear a mask when e.g. going into a grocery store at this point. This is not a big deal to me for ~30 minutes while walking around in a store. Part, though not all, of the reason for that is indeed "redundancy" as pbrower puts it. If there is even a small chance that I can make things a bit better by wearing a mask, it is worth doing so because the cost is very small. Much of that "small chance" is related not to known risks, but to the recognition that there are lots of things that we are still in the process of learning about and understanding, so significant unknowns remain, and in the presence of the unknown, caution is warranted.

At the same time, I recognize that it is a bigger ask for e.g. a person like yourself who is working in a store to wear a mask for an extended time period without respite - that is more burdensome and a bigger ask, so the risk/reward calculus is somewhat different.

I would also say that we shouldn't just get too focused on the policy merits or demerits of mask mandates when we could also be talking about the policy merits/demerits of other things including (but not limited to) vaccine mandates.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

https://twitter.com/AndySwan/status/1420131409646264334

"Everyone under 60 has a better than 99.9% chance of NOT dying of COVID, regardless of vaccination status. 

A huge % of persons above 60 have been vaccinated and also have a 99.9% chance of NOT dying of COVID

There is no justification for any mandates whatsoever."

It is true that immediate chances of dying from COVID are low for young people, especially if you are vaccinated. But there is more at stake here than just the individual chance of death for young people. There are other things to consider, such as:

a) The future evolution of variants (so far it looks like evolutionary selection pressure does not drive us towards the evolution of less severe variants, and if anything looks more like the opposite). Remember that SARS-1, the most similar virus to this we have seen before, had at least a 10% fatality rate or so. There is potential for this to get significantly worse 5 or 10 years from now.

b) Long COVID, which can occur even in significant numbers of "mild" cases. For SARS-1, a similar phenomenon was observed, and lasted a LONG time. Chronic health conditions are in many ways more worrisome than the effects of a normal "temporary" virus.

c) What happens with multiple re-infections over time. Personally, I am not that concerned for myself about the risk of getting infected with COVID 1 time now. What I am more concerned about is what happens if it becomes endemic I get it repeatedly e.g. 5-10-20 times over the next 10 years or over the rest of my life. We simply do not know what happens in that case. Infection one time could make you less vulnerable to a severe reaction the second time. But it could also make you more vulnerable (e.g. if a first infection causes chronic inflammation, inflammation is something that characterizes poor immune responses). This is obviously not unrelated to future variant evolution and to how long COVID works out.

These sorts of things, IMO, are the things we should really be talking about and trying to figure out, but hardly anyone is.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Yeah who cares that a non-insignificant portion of this country has effectively decided that the shots give you AIDS or something, let's make the people who actually looked at the science and the data and determined that a couple of shots would keep them and everyone else safer take another shot!  Hell, why stop there!  If Three Shots are ELEVEN TIMES AS EFFECTIVE surely that means that FOUR SHOTS are at least FIFTY TIMES AS EFFECTIVE!

WHat the hell are we even hesitating about?  How about we just tell vaccinated people to keep getting shots every 28 days, taking a day off every damn month due to the feeling that their arms are getting ripped off, while the most we ever expect from unvaccinated folks is to occasionally "wear a mask" when cases spike!

Great idea guys!

There is a new flu shot every year for a reason - because immunity wanes and a new shot is necessary.

The same sort of thing may be necessary for COVID, and if you are pretending that this is not a serious possibility, you have your head in the sand.

Or if we are lucky, maybe a 3rd shot will create true long-lasting immunity (we can hope, but I wouldn't hang my hat on that).

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Looks like this might get worse, CDC may have based it on flawed research....

Those tweets seem to be cherry picking.

Perhaps but if the CDC is going to make reccommendations to require masks for the vaccinated, then they need to be showing their work.

For better or worse, you are mischaracterizing what the CDC said. The CDC did not recommend that masks be required/mandated, they recommended that individuals in counties with high transmission wear masks. Those are different things.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

It doesn't really change anything when they haven't shown why they need to wear masks in either scenario. If they had said wear masks around unvaccinated elderly or the immunocompromised I would get it, those are high risk populations but to paint with such a broad brush should require hard data to back it up. It is hard enough to get people in those high risk areas to vaccinate to begin with, now if you are tossing around still needing a mask they will likely be even more hesistant.

Supposedly the CDC decision was based at least partly on some new unpublished data indicating that people who are vaccinated can be infected with the same viral loads as non-vaccinated people. It would be wise to at least wait for this information to be published before jumping to conclusions on our part either way.

I agree with you that vaccine hesitancy may be fed by not having the incentive of "you don't have to wear a mask," and that is a legitimate concern. But realistically, I think CDC is in a difficult position here. You are criticizing them now for not taking this into account sufficiently. But alternatively, if they did take it into account, then they would be criticized for making decisions based on politics rather than science. So they are sort of damned if they do, damned if they don't.

[Former Dean Phillips Supporters for Haley (I guess???!?) 👁️]

Yeah, it is true that evolution selects for viral transmissability, but it can be the case that the same mutations that make a virus more transmissable ALSO make it more severe and increase the fatality rate at the same time.

The delta variant reportedly has viral loads ~1000 times higher than the OG version of COVID. That is the main reason why it is more transmissable - in short, it is easier to infect other people with a virus if you have more of that virus in your nose/mouth etc. But higher viral load is also correlated with increased disease severity (in simple terms, if you have more virus in you, your symptoms are generally going to be worse), and the UK reported higher hospitalization rates with the delta variant, which is consistent with that. As far as I am aware, the base fatality rate for the delta variant is not pinned down, but it is reasonable to suspect it may be higher along with the hospitalization rate if measured properly. That is not easy to reliablyl estimate, partly because there are some factors that would bias the observed fatality rate downwards that need to be corrected for, like the fact that a good # of the most vulnerable people died in earlier waves, and many now being vaccinated, so delta cases are now skewed towards younger populations that are less likely to be vaccinated.