Coronavirus Update: 11 Feb 2021
Coronavirus Archive–Alright, let’s get the “news which I cannot comment about” out of the way (since a few of you have asked already this week):
Pronounced “eh-tez-ev-ah-mab”.
Thank you for your understanding.
–On the whole, good news this week. Global new cases continue to drop. In the US, new case numbers continue to drop. Hospitalization rates, especially in high risk 65+ year old cohorts are falling as well.
–“But wait, then why is the CDC apparently recommending those ridiculous double masks? Why is the Biden administration reportedly debating domestic travel restrictions–having already barred entry to non-US citizens from a number of countries around the world?” I hear you ask.
–Part of that is worry over the new variants. As we’ve discussed, for all but the South Africa B.1.1.7 variant, a lot of that is an excess of excessive caution. Florida, for example, is up to 15% of new cases attributable to the UK variant. That’s consistent with a higher contagiousness (the Irish reported that close contacts now have a 22% chance of catching COVID from a known infection, up from ~11% in their experience earlier in the pandemic).
Yet, Florida is one of the few states on epidemiology tracking sites whose Rt is definitively below 1, and whose 95% confidence interval on that Rt is below 1. That’s a statistical way of saying Florida’s new case rate is tanking, and likely to continue to tank for the near term future.
There are no reports of outbreaks of re-infection in the states. Not in Florida. Not in states where the South African variant has been confirmed.
Again, hospitalization rates continue to go down. Vaccination marches on. If the contagiousness of the new variants was sufficient to overcome the increasing resistance in the population (both natural and vaccine acquired), we would expect to be seeing that in the Rt and the new case numbers.
So far, thank God, we’re not. With Florida in particular at 15% new cases due to UK variant, if Florida’s Rt and new cases don’t at least level off, if not start rising again in the next couple weeks, the UK variant will have shown that its contagiousness does NOT portend a new wave (by itself) and certainly is not equating greater hospitalization.
–Remember, the main threat of the virus is ability to put people into the hospital quickly and overwhelm the local health care system.
–Absent ability to cause re-infection, that threat is less threatening by the day.
–So why the CDC recommendation? Why even be discussing domestic travel restriction?
Again, these are not scientific decisions. “Science” is not sitting down and deciding these policies. Politicians are. They are sitting down and deciding how much risk of being blamed for a bad outcome they are willing to accept.
Perception of effectiveness is just as good as actually being effective.
Their best argument for efforts like these is to be pre-emptive about containing the new variants.
–Wanna know how effective they are? Recall back to about February/March of last year, when I first put out the “this will be a pandemic” warning.
The reason was you had multiple confirmed cases in several states with evidence of spread among those who had not traveled abroad at that point.
That was game over. You had lost containment at that point. Travel restrictions would not keep the virus from your shores–it was already there. It would keep the flow of new infectious points slower, and so was worth doing, but the wide spread of the virus was a foregone conclusion. Even lockdowns, at least temporarily, to get testing capacity up and learn the extent of the problem, was reasonable, especially for politicians. You need only glance at the history of the Black Death to know they would not stop the spread completely. I don’t remember “two weeks to stop the virus”–I do remember “flatten the curve”, by slowing infection spread as additional testing and hospital reserve capacity was built out.
–So let’s be honest about these variants, going just off our recent experience. Travel bans are not going to stop the spread of these new variants. They are already worldwide. And spreading. Don’t kid yourself. Restricting domestic travel to Florida, for example, even double masking, will not stop the UK variant from popping up from coast to coast. It’s already happening.
The same will happen for the South Africa variant too. That’s already in multiple states too, and multiple countries around the world (we’ll get to it shortly).
And that assumes you even bother to enforce the restrictions and rules you already have. I know some folks who were recently traveling abroad. They paid one of the many pop up testing services for travelers, who sent nurses and swabs to where they were staying for a rapid COVID test–since the rules are no admittance onto a plane out of that country OR back to the US without a negative result.
They were surprised that no one on the US side bothered to verify the negative COVID test when they got back–and they came in through one of the US’ main international hubs. Walked right off the plane and a few connections later back to small town America–no questions (aside from passports and tax duty forms) asked.
Politicians can no more stop the tide of COVID by proclamation alone than King Canute could stop the waves with his throne and a commanding tone.
—Perception of effectiveness is just as good as being effective.
–Speaking of the South Africa variant, I still have no clear idea what to make of it. The big news from South Africa this week is the AstraZeneca vaccine. Like the Novavax vaccine last week, the AZ vaccine is spike protein DNA in an adenovirus shell. The adenovirus shell attaches to a human cell when the vaccine is injected. The spike protein DNA does NOT incorporate into human DNA–but mRNA copies of it are made, and dumb ribosomes make the SARS-CoV-2 spike protein as previously discussed. From that point on, they are very similar to the Moderna and Pfizer mRNA vaccines.
So the AZ vaccine failed in the South Africa trial. It did NOT protect against infection by the B.1.1.7 variant. So hard, in fact, that South Africa is now trying to get rid of 1 million+ doses of the AZ vaccine they ordered already, expecting it to be as effective as it has been everywhere else.
But that’s now two vaccines that have gone into clinical trial against that variant, and humanity is now 0-2.
On the other hand, it’s not impossible that it has something to do with the kind of vaccine. We discussed last week that the mRNA vaccines (Moderna and Pfizer) appear to still be protective against the B.1.1.7 variant. At least in petri dishes. The antibodies they generate don’t bind quite as well to these variants, but they generate such a strong antibody response overall that they overwhelm the virus–in petri dishes. Results in humans may, admittedly, still vary. And so far, these vaccines failures have happened only in South Africa. Granted, that is the highest concentration of B.1.1.7 in the world at the moment, but there may also be South Africa specific reasons that are not completely understood yet where these adenovirus vector vaccines are not as effective.
Or it could be that B.1.1.7 really and truly gets around the first generation of vaccines. Regardless, don’t be surprised if you are asked to get another booster within the next year. Either to keep the initial antibody level higher, or a booster with more specific protection against this variant.
I’m also still not sure it’s getting past natural immunity. I know there was the clinical trial data from Novavax suggesting that it could, but I would have expected more follow up looking into that this week. So far, nothing. Also no reports of re-infection by this variant outside of South Africa (yet–but still early innings for B.1.1.7). And South Africa’s new case numbers and hospitalization numbers, so far as I can tell, are going down just as smoothly as the rest of the world’s.
So the B.1.1.7 situation will need to develop a bit more. And it will over the next couple weeks. Again, if we are not seeing “re-infection by South Africa variant” headlines screaming by the end of March, and no new wave headed by B.1.1.7 by the end of April, then we are still on course for “medically over” by July.
If it can re-infect, how easily and what percentage of the existing immunity is now at risk again will be the main determinants for how far back the clock gets reset. We’ll keep an eye on it.
–On the social front… and apologies already because this is likely to be “mini-Ramble” (the OGs know)…
You know this already. I don’t need to tell you. But I will anyways.
Major calamities like wars, natural disasters, pandemics–they are all temporary. S ome may last awhile, true, but they eventually end. When normal comes again–and it will, either later this year, sometime after. When normal comes again, it will not be normal. It will be “normal.” It come with quotes now.
For it will not be the normal that existed before the pandemic.
Everyone has had to embrace some degree of change in the past year. For some, in fact, this was their first brush with mortality. That realization that there was something new, something contagious, and something that just might be a threat to you personally. Confucius is reported to have said that everyone lives two lives–their first, and then they start the second when they realize the first one will end. For many, their second life began sometime last year.
On top of that, lockdowns and travel restrictions created a forced sabbatical for many. That’s not a bad thing. Hitting the pause button on activities, beliefs, for a period of time lets you more objectively view their effects and importance in your life. “Sober October” is a modern incarnation of this. Lets Joe Rogan and his comedian buddies hit the reset, or at least notice, if the weed and alcohol is becoming a problem for them, or distorting their thinking too much. Lent is a more classic version. Also a period of relative austerity. “What are you giving up for Lent?” Usually, we give up something we indulge in, but suspect is not healthy for us. Jamie Wheal, in “Stealing Fire,” describes these sabbaticals as necessary. Otherwise, it is too easy to get trapped into habits, even ones you enjoy, that no longer serve you but are being destructive. The sabbath is necessary to stay in the “flow state” of higher performance, greater peace that Jamie spends the rest of book describing. Recently, I discovered, quite by accident, that one reader got a head start on Lent this year and an even more ambitious asceticism through a program called Exodus 90.
Yes, for many, 2020 was a long sojourn through the desert.
Many won’t come out the same way they went in.
You can see this in the headlines already, talking of the end of many office jobs and much greater telecommuting. “Why did I ever do that commute?” “Well, the reason we live downtown is because we -don’t- want to commute. If we don’t have to be close to work in order to work, why don’t we move?” We’ve gotten to know kids, pets, spouses much better in the sabbatical thrust upon us.
For some others, it was the desire for that kind of connection that was heightened, and its absence in their lives is what the exodus of 2020 brought. You can see some of that in the headlines of mental health exacerbation during the year.
This all came to mind because I heard from a member of my graduating residency class in the last couple weeks. The pause gave them time to re-evaluate everything. Quit medicine entirely, moved to a small rural town in Colorado with a new significant other, running a spiritual retreat. That’s now over half of my residency class that no longer practices clinical medicine (ask me why some other time).
“Dying.”
“I feel like I am dying to my old way of life, my old way of thinking, of what I thought was important to me.”
I suppose that feels like you who is dying, but it’s not. That is the death of mental models. Remember–all models are wrong, but some are useful. The models that aren’t even useful? Those need to die. Things expectations you made some time ago and became so unconscious in you that you assumed they were part of you. How much your work mattered, for example. How the commute was worth it, important as it was. How the city was obviously the best place to live–why would you live anywhere else, honestly? If your job hit pause during the lockdown, maybe you learned just how much of your identity was tied up in what you do. Instead of who you are.
Models and modes that no longer serve are what is being cast into relief, and are what is dying.
Dying. Interesting choice of words, and I have no doubt it feels that way.
Think of how many people just in hotels and tourism had good consistent jobs, working with people, helping them have fun and getting paid for it.
How many of them were in a food pantry line for the first time six months later.
Or the immigrant family that had worked hard, scrimped and saved, and finally opened a small business. Making it in America. Until the lockdown closed it. The PPP loans went to billion dollar businesses that could stay open. As Radigan Carter so memorably put it, “if you had a sandwich shop, you were closed. If you had 200 sandwich shops, you were open.”
Think their second life began, as they learned we are all more fragile than we would have thought before? That an improbable event is not the same thing as an impossible event?
An underappreciated lesson in the book of Job is that if it could happen to Job, of all people… wild misfortune could happen to anyone.
Yes, even you.
Normal won’t be normal. But it will be “normal” again.
Everyone will be at a different place coming out of the wilderness. Some will be emerging to a spiritual retreat in Colorado. Some will have found they were on the path to their personal land of milk and honey already, and make but a few course adjustments to the new landscape. Some are still going through Hell. Yes, with the capital H.
This calls for patience. Patience and empathy. Folks are going to flail. Folks are going to fail, or feel like they are. Take none of it personally. All of us are updating mental models. Before you get angry, let the updates finish.
And avoid the temptation for the Great Cause. When a person has lost their anchor, any anchor that appears in the storm will do sometimes. There are absolutely politicians who will take advantage of that. Social media, desperate to sell even more attention, will happily help them with algorithms that will push you towards anything that anchors your attention.
Cults happen that way too.
Be careful out there until your own exodus is complete.
And help each other through the wilderness.
–You might find something in this:
–Farnam Street blog is also excellent (how I did not find until this year…)
–You hear such apocalyptic language these last couple years. You have the cults of Silicon Valley’s Mars colonization (by the best, brightest and most beautiful, to start over as a Galt’s Gulch in a nearly uninhabitable cold planet), and transhuman immortality by merging our memories and consciousness into the machine. You hear of hedge funders paying futurist professors the equivalent of their annual salary to tell them how to keep their social status advantages in a post-apocalyptic world where their money no longer matters. Why? I think part of it is that the death of the Pax Americana looks like an end of civilization, especially to those who have most benefited from it. This will be a decade where centuries happen–I think we all can feel it. The pandemic will be catalyst, not cause. If you want to know why, here’s the short version: https://www.radigancarter.com/dispatches/the-new-old-world
The book mentioned at the top of that post is well worth a read.
–Alright, enough taking advantage of a slow week! Your chances of catching coronavirus in many places in the world are equivalent to the chances that Tom Brady was going to tie the NBA’s Robert Horry for total championships this past Sunday–even when they were down early. But they’re getting closer to Big Shot Bob’s chances of winning another NBA title…
<Paladin>