As reminders…

Alpha–Variant first identified in the UK

Beta–Variant first identified in South Africa

Gamma–Variant first identified in Brazil

Delta–Variant first identified in India

Omicron–Variant first identified in South Africa

Updating the chart above:

Ancestral: B.1.1.529 Omicron

Transmissibility: All the +

Immune Evasiveness: All the +

Vaccine Effectiveness: Check (for hospitalization)

Also as a reminder:

Coronavirus:

–South East Asia continues to be the brunt of disease activity. While China has reopened Shenzhen for business, its “Steel City” has been put on new restrictions. Most of the rest of South East Asia appears to have reached the peak of omicron/BA.2 activity and are starting to come down. Australia, though, may still be on the rise, but the velocity has been slower than the definitive omicron wave they had around the holidays. The Rt is ~1.1 per epiforecasts.io, but the velocity on that Rt is coming down, so a peak in new cases seems likely within the next couple weeks in Australia. Most of Europe appears to have topped off its BA.2 activity as well, and starting to come down on new cases. South Africa’s new cases muddle along at a very low level, so good news there in terms of trying to forecast the fall COVID season.

Hopefully, there isn’t one, or isn’t much of one.

–Had a good question come up from a reader on the utility of wastewater data.

The wastewater data is a leading indicator, which is a fancier way of saying that if wastewater detection rates are rising, there is a good, but not certain, chance that clinical cases in that region will increase within the next couple weeks as well. The CDC presents this data is relative (%) change versus a 15 day rolling average, and not absolute numbers. This is a useful directional indicator, but keep in mind, if the absolute number is low, it will not take more than a few additional cases to make a scary looking % change, and an orange or red dot on the CDC’s heat map.

So I mentioned the wastewater data last week, but did not explain this in detail. That was a mistake on my part. Instead, I cut to what I consider the key takeaway message–coupled with the increasing prevalence of the BA.2 variant, the wastewater data suggests that if the US is going to see a BA.2 wave, it will be in the next 2-4 weeks, and I would expect it to be “alpha” wavish in size if it hits.

There are a number of locations where the % increase in wastewater SARS-CoV-2 detection is increasing that we listed. However, most of them are from smaller absolute numbers in the previous 15 days.

If those trends increase over the next 2 weeks though, the currently stable and low rate of COVID clinical cases will increase in those same 2 weeks, as the wastewater increases over the previous 15 days start to spill over into actual positive clinical COVID tests.

If, by the end of the month, clinical COVID cases are still stable and low, the US likely dodges the BA.2 wave.

Dr. Fauci returned from obscurity on Monday to state that he thought the chances of a BA.2 wave in the US were low, despite high European activity. He could very well be right (and it is certainly rare for him to be that optimistic). Personally, I would give the wastewater data until the end of March to see if it kicks over into higher clinical COVID cases before I get that certain.

For what it’s worth, new cases in New York City are showing a slight trend up in the last week (but not a huge blowout). Seattle, Chicago and Milwaukee are all flat so far with minimal clinical case activity.

So TL;DR, use the wastewater increases as a signal you need to watch clinical case trajectories over the next couple weeks. For practical and travel purposes, I would focus more on the level of clinical cases where you are or are going for the chances you are going to run into SARS-CoV-2. In much of the US, those chances are reasonably small right now.

Not zero, but way less than this past Christmas through New Year’s.

–CDC revised pediatric deaths due to COVID down by 24%, finally acknowledging that some of them were misclassified, and a very sick child died with COVID (but of something else) and not SARS-CoV-2 itself. That’s not much a surprise, frankly.

–Moderna is looking to expand its vaccine as a low dose version for children under 6, following Pfizer’s lead. The White House floated this week that it is running out of allocated money for government reimbursed testing and a 4th vaccine for everyone. To be clear, they have money for pediatric and 65 and over (plus high risk) 4th booster shots. They’re just not sure they will have money to booster the world this fall. They would like an additional $22.5 billion, and this announcement comes after Democrats removed $15 billion in COVID spending from another, broader spending bill after being unable to reach an agreement on that bill with Republicans. So usual Congressional politics, and the announcement is likely just to pressure both sides to come to some mutually disagreeable number near the middle and pass it.

Why that takes Republicans at all in a Democratic majority House and Senate where they hold the tie break isn’t clear, but then again, I am not a politician.

Regardless, there may be government finance variables, and not merely the data that Pfizer has turned in, for a broad 4th booster effort in the fall. Still no public word on that data either, speaking of it.

Socioeconomic:

–Bloomberg Opinion published an op-ed from a highly credentialed economics professor with some… helpful?… suggestions for those of you concerned about inflation.

It started with the disclaimer that inflation really affects those making less than $300,000 a year–like, srsly and for real -effects-, you guys. And it went quickly downhill from there.

(98% of the United States makes less than $300K per year, before you ask–I just looked it up)

The Op-Ed tried to give “practical”, inflation mitigating suggestions with a breezy air of being generous with wisdom from a-high for all you ignorant peasants pulling $250K or less. Ideas that were mocked on Twitter included replacing meat in your diet with lentils (lentil prices are spiking too–and just wait until you see coffee this fall), and espeically the suggesting that since chemo for your dog costs on average $10K you should really make the cost conscious choice and have the vet just put your family dog to sleep instead.

Yes, this is the point we are rapidly reaching with inflation in everything.

–In lieu of anything intelligent from me this week, we have a plethora of good think pieces.

First up is global food production, why the green revolutions (the food ones–and yes, there have been at least two) are important, and the intersection with geopolitics. Just good solid facts the whole way through, and worth the email you need to submit (they do not spam) to read the whole article: https://www.thelykeion.com/the-geopolitics-of-food/

You should pair that with this thread (no pun intended), which is a farmer explaining nitrogen fertilizer use, the dynamics of winter vs. spring fertilizer use, fertilizer cost/benefit calculations farmers are making, and farming under very uncertain input and output price points: https://mobile.twitter.com/MikeNeaverson/status/1506396924022509569

–Speaking of global weight gain, I have discussed before an app (and lab testing) program called Zoe that can help guide healthier choices for you, by getting at least some data around your individual response to certain foods. That post is the page on the web archive that is not COVID related that has been found “by accident” from internet visitors the most, FWIW. Zoe worked better than anything else I had tried, but plateaued. However, that plateau was very sustainable, which was a first. In the new year, I discovered Noom, another app. Their angle is to help change your eating behavior to something that is sustainable for you, and helps you get to, and maintain, a healthy weight. Noom has also worked very well to continue where Zoe left off, and I highly recommend it. The couple tweaks I have made from its recommendations have pushed lean mass up, body fat down, about as much as I biologically can at this point, given my other lab values.

All of that is a long way of saying that while you are amazing (you’re my readers, after all), if you have been thinking about adjusting your body composition a bit, it’s not even Pareto principle. Easily 95% of the success comes from what and how you are eating, and sustaining your gainz (the ones with a “z”) all comes down to how sustainable the what and how you eat is for you. I think both Zoe and Noom do a good job helping with that, when you put in sincere effort. (Noom will help with the effort part). For the record, I have no financial interests in either program–I have just used both.

I have had readers reach out about the GLP-1 agonists, a class of diabetes medications that have been extending their labels to weight loss outside of diabetes. My employer makes one, so I cannot comment on them, and thank you for your understanding.

In the long run, it is more cost effective to find a healthy diet that works for you. Healthy foods (and even calorie dense, but delicious, foods when kept occasional and/or appropriately portioned) have no significant side effect concerns…

–Next think piece starts with food for thought about farming (pun intended), and moves from there to narrative. This one is a month old at this point, but worth revisiting: https://www.epsilontheory.com/narrative-and-metaverse-pt-2-gain-of-function/?wppb_cpm_redirect=yes

–Mostly, though, because it will segue you into the third part of that series, which was published today and I -highly- recommend reading. If you have only enough free articles left at this site for one, and do not wish to subscribe, opt for this one: https://www.epsilontheory.com/narrative-and-metaverse-pt-3-the-luther-protocol/

This is where Ben starts to say the part we all feel, we all sense, but cannot say.  Yet we know it is true.  I have tossed into these updates some of my own efforts at encouragement amongst this zeitgeist of general malaise, and thank you to those of you who have written back to tell me that they happened to hit you at just the right time, where that ineffable malaise of the world right now was laying heavy upon you.  It’s like Marcus Aurelius’ description of Rome in “Gladiator”, as something that could only be said in a whisper, and anything more and it would be lost.  There he was speaking of the ephemeral, yet tangible, angels of our better nature, in the idea of a more just, peaceful and equitable Rome—a mythical city on a hill; the very best Rome and Romans could achieve.  What we feel today is just as ephemeral, just as tangible, yet is the opposite of that. The exact opposite. Hence the low grade feeling of oppression.  The sense that we are somehow stifled.  We feel this is all so, so wrong, somehow, all on a knifes edge, but we can’t quite locate it and can’t quite explain why.

That is what Ben is describing when he says in the linked note:

“I’ll go farther than that.

I do not know a single person – myself included – who is not mentally more disconnected from the real world than they were a few years ago.

I do not know a single person – myself included – who is not mentally more vulnerable than they were a few years ago and, if we’re being honest with ourselves, is not feeling mentally … altered.

We are all LIVING less today than we were a few years ago. We are all LOVING less today than we were a few years ago. We are all REFLECTING less today than we were a few years ago.

The worst part is, we can’t even tell what we’re losing while we are losing it. We don’t have the words to describe what is happening to us, which means we don’t have thoughts of what we’re losing. Until it’s too late. Until it’s already gone.”

And he is struggling just as much as I have been with the words to capture what we all feel, what we all know.  What we all must ultimately defeat—that is our secret challenge for this decade.

–I am intrigued by the announcement Ben makes at the end of that “part 3” note, but the devil is in the details, and I look forward to the details on this program that I hope will be forthcoming soon.

–The suggestion to hold fast to the old truths is well taken.

–Even if it feeds my confirmation bias… agrees with me and points I have tried to make in these, and thus iz genyus : )

–And mostly just because this is a cool picture, and a reminder that despite everything going crazy in the world, there is still beauty, and still things that go right…

–Finally, should I ever win the lottery, in a quiet corner of the Carribbean, with plenty of sun and a constant cool sea breeze, there you will find Paladin’s Private Island. You’re all welcome to come. In the early or middle afternoon (it’s island time), when the direct sun is starting to get a little less comfortable and you should probably do something about lunch, you amble off the long, soft white sand beaches. You head toward a single story building painted in pastel colors living in the shade of the tree line, but with a spectacular view of the sea from its large, open air windows.

This is the Restaurant at the End of the World.

It’s only really open for this late lunch. The Tiki bar back on the beach, with the oversize Christmas lights on poles creating a patio of sand out towards the ocean covers the evenings.

There’s no dress code at the Restaurant at the End of the World. So your flip flops, linen button ups, t-shirts and sarong cover ups are all good. The menu is pastel multi-color on a chalkboard, although it never really changes much. Only the names of a few fish depending on what the anglers brought in that morning while you were still in bed. The decor isn’t much. It’s not dive, but not expensive, and is somehow that beach perfect utterly nondescript that makes the chill vibe of the place. Maybe that’s what keeps the temperature constantly, comfortably cool, because the few ceiling fans turning above you are moving too lazy to account for how you feel. In a corner is an old pool table, maybe some foosball too, and an old 80s arcade game tucked away. Every so often, those even get used a bit after lunch.

In the Restaurant at the End of the World, the beer is always cold. The tall glass sweats onto the table, soaking the square paper coasters which tear a little bit. The cocktails come with umbrellas, and the blackened mahi mahi sandwich is fresh, and secretly killer. Best on the planet, probably. At the Restaurant at the End of the World, you sit down, and time disappears, while you eat and watch the waves. The music is always playing, just loud enough to keep the timeless vibe, and Foreigner’s “I Want To Know What Love Is” gives way to some old Genesis.

You didn’t even notice the hours pass there, but it’s late afternoon now. The hot part of the day is gone, and you can get a few more comfortable hours on the beach now before dinner. So you leave the Restaurant at the End of the World and head back out towards the white sand and sun.

One other song on the playlist at the Restaurant at the End of the World? Well, it fits that vibe, sure. But lyrically, fits the present moment too.

Your chances of catching coronavirus this week are equivalent to the chances that you should have the sound on for this one: https://www.youtube.com/watch?v=oUt1-Y6oBsk

—Programming note: I expect to be in the BFE on Spring Break with the family at our regular update time next week. Barring something major dropping, there is a very low chance there will be an update next week. Will get back to it the following though…

<Paladin>