First, I feel the need to address the rumors out there.

Yes, the video that has gone semi-viral on the internet does, indeed, accurately reflect my warm up routine before I charge into the few moments borrowed to speed write these updates.

At least, the video is mostly accurate. The video in question is, quite obviously, not me even though it is my self-motivation ritual. A cursory glance and listen will show that it’s not me. For those of you a little lost, here is the link.

Obviously, I am not bald, nor do I have so epic a beard, and I certainly do not use some random song with pseudo-Viking lyrics trying to make it sound tough.

Everything else is, of course, accurate.

Except when I jump into a pond in the dead of winter with two battle axes, after a primal war cry, it’s to the one song guaranteed to rouse the warrior spirit, render aflame the heart, mind and soul and set both muscle and sinew to the legendary task at hand.

Specifically, this song, which only you who are truly stout of heart and full of courage should dare to call forth, your speakers ablaze: https://www.youtube.com/watch?v=-Jj4s9I-53g

So if you -really- want to capture my warm up routine, go re-watch the Insta link above to the music of that YouTube clip below.

“F*** YEAH PARSLEYYYYYYY_{YYYYYYYYyyyyyyyyyyyyy!!!!”}

Splash.

Now that we’ve cleared the air on that, onto the rest of the update…

Coronavirus

–Still out there, believe it or not, but transmitting at a dull, quiet roar across the world. In the US, the XBB.1.5 variant is chasing out the last of the omicron cousins. But there has been none of the doooooooom headline re-ignition of either a case wave or much evidence of increased severity, and that was pretty much our base case, as you recall. Hence, I haven’t been real aggressive about updating. There really has not been much to speak of.

–Even all the late breaking, “shocking” headlines should not be all that shocking. Let’s run all of those down real quick, although full disclosure, I am going to be lazy and not link the back issues. I’m sure all of you remember these topics, because they came up multiple times during the pandemic.

–US Department of Energy re-examines evidence about the origins of the SARS-CoV-2 outbreak in China, and concludes that a lab leak is the most probable explanation. Regular readers know we covered this multiple times. First, there are still propaganda reasons to put this out there, so keep at least a few caveats in mind. But put a gun to my head and make me choose, and I think it more likely than not that a virus got out of the Wuhan virology clinic where they were known to be doing a lot of coronavirus research, including what was clearly gain of function research. Do I think that SARS-CoV-2 was a bioengineered weapon that got loose, or was one of the gain of function strands? Probably not, at least on the weapon question. China’s record with vaccines and treatments was so dismal that there is no way this was a weapon–either that, or they forgot the part that you need to protect your own population from a bioweapon to make it even remotely plausible. As we covered, even then, they are a terrible idea, because they can mutate right around your vaccine and treatment and come back for you anyways. Was it a gain of function strain? Again, I’m not sold on the genetic “evidence” of this. I think that could just has easily happened do to cross contamination of a natural bat coronavirus with some of the modified strains, and a really unfortunate thing happened. I need to see the lab books to be conclusive on this, and we will never see those in our lifetimes, assuming the Wuhan Virology Institute has not torched the evidence already.

Regardless, the more likely than not shows why bona fide gain of function research is a terrible idea, because over the long run, an accident WILL happen. If the outcome of a risk you are repeatedly assuming is ruinous enough, there is no safe way to do it. None.

–On a semi-related note, and again, in the very weird position of defending the “honor” of Pfizer (probably the first time ever)–I still doubt that is what Pfizer is doing. I’m not sure anyone followed our advice to follow the monkeys, but the numbers they would need are so massive that it should show up regardless as a HUGE spike in demand. That said, I have also have not heard any follow up on the Project Veritas claims–but the inspections from the authorized agencies, if they happened, would likely not be publicized. No matter what they found.

–In other news, recent meta-analyses of available studies by a trusted and generally bias free source (short version here ) concludes that as a preventative public health intervention, masks were probably not effective. Hand washing may be effective though.

We knew this. We covered this a long time ago.

The more interesting question is the approach to masking in public that was more common in Asia before SARS-CoV-2. There the convention was that people with respiratory symptoms masked to prevent spreading their illness to others–not the inverse that was tried during the pandemic, to reduce spread to healthy people. I’m not sure there are real great studies of that intervention, which may be a little more common sense.

–Also in other news, and equally unsurprising to our readers, is that natural immunity from recovered SARS-CoV-2 infection may be superior to the vaccine boosters (for the omicron cousins) AND lasts far longer than originally thought. Because antibody levels and T-cells that fall below assay sensitivity come ROARING back the moment a SARS-CoV-2 cousin tries to slip back in.

This is the way we were taught in medical school that the immune system works. Glad the immune system has kept current with the cirriculum through the pandemic.

This was also covered ad nauseum here throughout the pandemic, and specifically questioning why the likely effectiveness of natural immunity was being ignored or discounted, when our understanding of the immune system should have assumed this was more probable than not.

–That said, the -roaring back- of the immune system when re-confronted with COVID may be part of the issue of the very rare, but some quite serious complications, that we do see even with mild COVID cases, and in particular related to blood vessels and clotting (auto-immune disorder data is a little muddied, but there are some anecdotal reasons to believe). These all quite rare. But they do still happen.

I know vaccine blaming continues to be a hot topic, but all the evidence, including a big data dump from the UK in particular, shows that ALL of these complications are still way more common in unvaccinated people with acute, severe COVID versus those who are vaccinated. Including all cause mortality–higher in the unvaccinated, and you really have to get into some cherry picked data sets for that NOT to be true (like focusing on some specific states, but ignoring others, which has been popular on the internet).

We’ve covered all of this before too though.

–And Ivermectin bubbled back to consciousness, mostly because the final version of the ACTIV-6 study was published. We covered the prelim results. They did not change. There is no evidence that ivermectin is effective in reducing severity or time of symptoms in mild or moderate COVID. Final version here.

–So no, it wasn’t just your pathologist friend here, ranting and raving through the pandemic. : ) Again, thanks for being along on the ride. You all have helped me, as much as I have hopefully helped you.

Hopefully -that- is the lesson we carry forward from all of this.

Pediatric liver failure of unknown origin

–Quick update on this. You may remember there was that momentary scare, probably a nasty adenovirus strain, causing unexplained, but still rare liver failure in kids that hit headlines not too far back. The long story short is investigation showed that when all the possible cases were collected and investigated, removing the ones for which a cause was found (a fair number), there was NO evidence of a recent increase in hepatitis associated ED visits, hospitalizations, liver transplants, or adenovirus type 40 or 41 among US children compared to pre-pandemic levels.

None.

It was a temporary statistical blip that got magnified by the media. Reports of new cases were already petering out by last fall. CDC short report here.

Avian flu

–A father and an 11 year old daughter hit the news for contracting an avian H5N1 flu in Cambodia. Presumably, they were around a lot of birds. Sadly, the little girl died this past week. The father so far has been asymptomatic, as have another dozen close contacts. Thus far, then, still no person to person confirmed transmission.

Brief Socioeconomic Notes

–There are a few worth mentioning. We had a reader send a Telegraph article covering the release of 10,000 WhatsApp messages from a UK government official that is intriguing for a few reasons. First, he’s writing a book–a memoir of COVID. Second, the release came from his ghost writer, a former journalist, who got the WhatsApp messages and was concerned that memoir was being steered in a direction that took the most charitable view of what actually transpired in those messages. She wanted the record to better reflect what really took place. Third, I can’t access the Telegraph article because it’s behind their unfortunately effective firewall, and this is the best I could put together from alternative sources covering the leak.

My guess is that they show what is absolutely predictable, and what you already know. In the very beginning, governments around the world were faced with a rapidly spreading disease, with insufficient testing capacity to find and trace everyone already infected, when they made the decision to lockdown (in various degrees). Sadly, they were not readers of the update, where we said there would be a socioeconomic cost to that decision. In fairness, that decision was a tough one to make because the disease severity was incompletely understood (but probably not as dire as the original Chinese data, which under counted mild and asymptomatic cases) and the pandemic threat (“bed’s taken”) was incompletely understood, and there was no vaccine or treatment available. Most politicians, I am sure, hedged on the side of caution, which in this case, was “two weeks to stop transmission.”

Transmission did not stop, because grocery stores are out of food in one week, and the riots thus start somewhere between day 8-10, so lockdowns were incomplete. England would always get the Black Death.

But, to have made so significant a decision, and then suddenly reverse course, would make the governments, and worse (in their minds), the politicians running those governments, look fickle and panicky. I am certain those WhatsApp messages and many like them show politicians predictably fretting over what would happen if they reversed course too soon. Thus a bias for doom headlines and prognostications was born, because that bias (conscious or unconscious and probably a mix of both) supported the decision they had already made. Again, I want to stress that initial call was a difficult one, made under time pressure, with high uncertainty but significant consequences to getting it wrong. I do empathize with them on the challenge of the call they had to make.

If you recognize this as a perfect set up for the “sunk cost fallacy” though, you’re right! And I would argue that is what happened, and you’ll also see on these messages and others like them. Which only creates more mistakes, like deliberate lies from Dr. Fauci, for example. Sadly, in seeking to defend the sunk cost, you only make the final crisis of confidence worse. Hence, the bonfire of the credibilities.

Does this argue for a new set of leaders, who may hopefully be less susceptible to sunk cost fallacy? Arguably, yes, it does.

If you can find them. This happens so often (LBJ’s decision to increase troops into Vietnam is the literal textbook case of sunk cost fallacy–and many traders on Wall Street could tell you a lot about this in practice too) that avoiding this is probably pretty difficult, no matter who the people involved are.

So the better solution over the long run, the lesson to be learned, is better decision process and better systems to check for this kind of sunk cost fallacy, and avoid it. As Popper once argued, no matter the political system, you have to assume that eventually, over a long enough time period, idiots will be in charge. The government, or system, best construed then is the one that automatically minimizes the damage the inevitable idiots can do.

The performance of many institutions during the pandemic suggests there is significant room for improvement in the systems in place to mitigate poor decision making and known cognitive bias traps.

–This chart comes from Epsilon Theory’s latest, and confirms what many of you likely suspected was already true. There is no better illustration of the cut-throat race for attention, and how little holds our attention for long (news story-wise), even when some of these are really pretty important and probably should be discussed within the Overton window a little more:

One week. That’s how long attention lasts for a “major” news story.

What’s also interesting is that the “stickiest” stories, with at or around 20% attention for the longest after the big one week drop are those with greatest narrative polarization. Look at “defund the police” and the “Dobbs decision” on abortion for example. The dark green that shoots back up in day 55 from peak news share? Hunter’s laptop. That’s narrative polarization with a refresh from new information.

Novelty captures the most attention. Hence, on to the next after a week. If it can hit those emotional triggers, and keep hitting them, that’s what tends to have staying power.

No. I don’t think this is ideal either.

Other notes

–I’ll keep these on an “as events warrant” schedule going forward. Before the year is out, I strongly suspect we’ll be doing one decent sized recap of all things coronavirus. At least, that’s the base case for now : )

–Your chances of catching coronavirus this week are <splash>.

Then a long moment of silence.

Long enough to start to worry, actually. How long can someone hold their breath? How quickly does hypothermia come on in cold water, on an icy day like today?

Finally, though, a secondary splash, and you can let go of that worried breath you didn’t know you were holding. Then the sound of thrashing, churning water below. Over which, distant, but distinct, over the muffling effect of the deep snow all around you hear:

“WOO! MUTHA’ F***ING SAGE AND THYME!!!! WE’RE GOING TO THE FAIR BABY!!!! GOING TO THE FAIR!!!! GET THIS UPDATE DONE!!!! LET’S GOOOO!!! AHHHHAHAHAHHHHH!!!!!“

And that’s your chances of catching coronavirus this week.

<Paladin>