covid-19

[RandBlade]

WTF is "age-adjusted EXTRA death" when its at home? Is that like what we would call "excess deaths"? I haven't seen Sweden's excess death figure but I'd be shocked if its as low as 3,000.

As for your final paragraph, you're wrong. The PM, Sunak and others were speaking to all sorts of scientists, including yes some scientists with contrarian views (who are still respected scientists in their own right) and ended up going with what the SAGE scientists decided in much less than 12 weeks. Now its not been 12 weeks since the vaccine program began but there's already data and science there to be followed but you want to piss around for 12 weeks. You're more dithering than Sunak.

I see the WHO this weekend came out and said that it was "wonderful" that the "bravery" of the UK has led to improvements in science leading to "greater protection" from the vaccine doses. Says the UK approach has been "vindicated" and "thank you British scientists".

Twitter Link

When the slow-moving WHO has already moved on, when are you going to get with the program? Will it take 12 weeks for you to do so? If so, you're far slower than Sunak. The science was always there, it was online for you to read, the logic and evidence was put out and a decision was made - and tens of thousands of British lives, hundreds of thousands of lives globally if our evidence is followed potentially, could be saved as a result. But you were furious at the decision making, arguing against it with the same misrepresentation and logic of demanding 100% proof as the Toadmeister or other lockdownsceptics arguing against lockdowns.

[LittleFuzzy]

Interesting to see you've joined the Toby Young 'Covid is no big deal, take the time to be 100% certain before doing anything' train of thought.

Next time you criticise someone for prevaricating on locking down I'll be sure to check if its been 12 weeks of prevarication or not yet.

It is understandable to take the approach the UK decided on, making the caveat that it is risky because we're not really sure about the efficacy and it might be they're keeping more people in the country at risk rather than less the way they're hoping. It's also understandable to decide that such a risky approach is too likely to result in less effective coverage than the recommended two-dose strategy. But you're not willing to concede that second one. You're lambasting anyone not following your One True Path on under-tested vaccinating strategies as murdering their own citizens.

[Aimless]

We can't say anything about the likelihood of the latter risk manifesting, and I don't think anyone has taken a firm position on it. RB hasn't read the posts responding to his claims properly, so he's arguing against things nobody has really said, on the basis of developments and misunderstood studies that have little bearing on the claims he thinks he's addressing.

[Flixy]

It is understandable to take the approach the UK decided on, making the caveat that it is risky because we're not really sure about the efficacy and it might be they're keeping more people in the country at risk rather than less the way they're hoping. It's also understandable to decide that such a risky approach is too likely to result in less effective coverage than the recommended two-dose strategy. But you're not willing to concede that second one. You're lambasting anyone not following your One True Path on under-tested vaccinating strategies as murdering their own citizens.

This.

I understand the British approach, and given the circumstances, I don't think it's a bad approach, but it does come with risks that should be acknowledged.

Also realise that if data comes in later to support that this was the right approach, that doesn't take away the initial risk. If you win thrle lottery, that doesn't mean buying lottery tickets is sound financial advice.

[RandBlade]

It is understandable to take the approach the UK decided on, making the caveat that it is risky because we're not really sure about the efficacy and it might be they're keeping more people in the country at risk rather than less the way they're hoping. It's also understandable to decide that such a risky approach is too likely to result in less effective coverage than the recommended two-dose strategy. But you're not willing to concede that second one. You're lambasting anyone not following your One True Path on under-tested vaccinating strategies as murdering their own citizens.

That's simply not true whatsoever. I haven't "lambasted anyone" for not following the policy that I think is a good idea, I have defended the policy as a good idea. There's a difference. If other countries don't want to take a risk I haven't condemned that - I have condemned not pre-ordering vaccines in a timely fashion, and failing to invest in their manufacturing, and failing to invest in Covax etc etc etc - but that is all agnostic to the 3 week or 12 week gap.

I think the EU's failure to invest in manufacturing of a vaccine, and failure to sign contracts causing a three month delay on their manufacturing, and priority on negotiating price rather than procuring vaccine supply was a catastrophic failure - but that's got diddly squat to do with the 3 week gap or 12 week gap. Even if the EU switched to a 12 week gap (which I think would be a good idea, but no more than that) it wouldn't magically conjure up the millions of missing doses they've not been able to get manufactured.

Israel is following the 3 week policy but have the doses available. I have applauded not criticised Israel's vaccine rollout.

What I have done is defend from attack what is being done and defend it as being a good idea when it was lambasted here as not science or "consistently the dumb thing" to do, or "no evidence", despite it being from a rigorous analysis of the science available at the time. I'm awaiting a bit of acknowledgement from people here that attacked it as "the dumb thing" to do that actually it wasn't dumb afterall, but I'm not holding my breath on that level of self awareness being reached. I am also hopeful that the evidence developed in this country can help save lives overseas with more risk-averse nations being able to follow our lead.

I don't deny there are risks, all choices during a pandemic are risky. I have never used the phrase "murdering their own citizens" nor would I.

[Timbuk2]

all choices during a pandemic are risky

Exactly.

And it is for this very reason that governments should follow what is known, in order to reduce those risks: ie what has been rigorously tested under clinical conditions with definitive results.

[RandBlade]

That's certainly one argument made by the lockdown sceptics like Toby Young, Carl Heneghan, Sunetra Gupta and more. They argue that since the case for action hasn't been made in clinical conditions with definitive results then effectively we shouldn't do anything.

Is that the route you really want to go down? Or should we listen to the scientific experts in SAGE, the JCVI, the MHRA, the Chief Medical Officers and other scientists saying "based on the evidence before us we think the best course of action is [this] because [reasons]" even if there is no definitive way of knowing because it isn't clinically proven?

What is known in order to reduce the risks is based upon the evidence actually available, even if it isn't "rigorously tested under clinical conditions with definitive results".

[RandBlade]

Fascinating excess deaths chart showing the folly of comparing between countries using their 'official' Covid 19 death figures.

Britain is one of the only nations to have recorded more Covid 19 deaths than the excess death figure. Russian stats are scary, especially noting the fact their deaths figure only goes up to November and looking where the chart stops in November. There is a part of me that wonders if Putin is OK with the virus dealing with Russia's demographics problem by letting it rip.

Despite Cockney Covid evolving in the UK, it seems the UK hasn't actually had that many excess deaths in the second wave compared to the first. Lessons learnt after the first wave?

Twitter Link

[Aimless]

Exactly.

And it is for this very reason that governments should follow what is known, in order to reduce those risks: ie what has been rigorously tested under clinical conditions with definitive results.

Problem is, we can't be sure to minimize risks by relying exclusively on conclusive proof—it may well increase risk. What is needed is a sound strategy for structured risk-/safety-analysis, that helps policymakers and their advisors more clearly appraise policy decisions. In the case of the 12 week delay for the Pfizer vaccine, one element of such an analysis might be to demonstrate—through rigorous modeling—that we should expect a clear benefit wrt overall attack rate under a wide range of conservative or grim but plausible assumptions about the vaccine and about specific regimens, in different groups, under different circumstances wrt the behavior of the pandemic (eg. wrt transmission once the new lineages begin to dominate). In other words, we should strive to show that, even when the odds are bad, the chosen strategy looks like it'll be good. In contrast to this approach, some people have sought to show that the odds are good—using evidence that does not speak towards the specific claims being made. Putting aside philosophical concerns, what this means is that we have no idea how sensitive the policy is to mistakes on our part, eg. if we have been too optimistic about specific parameters, or if we have not foreseen dangerous developments. So, to summarize: I don't believe we can—let alone should—be fanatically reliant on conclusive proof that might not materialize before it's too late, but we can—and should—at least perform an adequate risk analysis before choosing a strategy based on limited evidence.

What I have done is defend from attack what is being done and defend it as being a good idea when it was lambasted here as not science or "consistently the dumb thing" to do, or "no evidence", despite it being from a rigorous analysis of the science available at the time. I'm awaiting a bit of acknowledgement from people here that attacked it as "the dumb thing" to do that actually it wasn't dumb afterall, but I'm not holding my breath on that level of self awareness being reached.

"The people" = "the person", a person who hasn't engaged you much on this issue since that comment was made. As for the discussion on evidence, you haven't understood the specific points raised—by myself or by Wiggin. Hence your frustration with critical responses to your misdirected arguments.

That's certainly one argument made by the lockdown sceptics like Toby Young, Carl Heneghan, Sunetra Gupta and more. They argue that since the case for action hasn't been made in clinical conditions with definitive results then effectively we shouldn't do anything.

That is largely incorrect. The thrust of the covid denialists' arguments—both the ones you mention, and the others who have associated themselves with The Great Barrington declaration—is that we know that covid itself isn't all that bad, and that our prior belief should be that hugely disruptive and costly restrictions—eg. lockdown measures—are worse than the alternative, absent strong evidence showing a clear benefit. They portray interventions as being unnecessary, or disproportionate, or misdirected. Their reasoning is based on a number of false beliefs about the dangers of covid, the impact of the pandemic without interventions, and the evidence supporting those interventions. In no way is their reasoning comparable to anything that has been said in this thread (except, possibly, by Lewk); it is, if anything, comparable to your—and my—government's inadequate responses wrt the timeliness and thoroughness of interventions.

Fascinating excess deaths chart showing the folly of comparing between countries using their 'official' Covid 19 death figures.

Britain is one of the only nations to have recorded more Covid 19 deaths than the excess death figure. Russian stats are scary, especially noting the fact their deaths figure only goes up to November and looking where the chart stops in November. There is a part of me that wonders if Putin is OK with the virus dealing with Russia's demographics problem by letting it rip.

Despite Cockney Covid evolving in the UK, it seems the UK hasn't actually had that many excess deaths in the second wave compared to the first. Lessons learnt after the first wave?

The UK has relatively high excess winter mortality in general; I would expect estimates of excess covid mortality over the winter months to be mitigated by that, if they compare with the average for the same weeks in the preceding years. The measures that have been implemented also contribute to eg. lower mortality from eg. influenza and bacterial pneumonia, falls outside the home, etc. Seasonal mortality for these things varies between countries, so the impact of interventions is also likely to vary.

[RandBlade]

Wow. Stunning.

Twitter Link

[Timbuk2]

Israeli data showing no infections after 22 days from second dose of Pfizer.

[RandBlade]

Fantastic news, combined with the data coming out the UK it seems in countries distributing vaccines its having a massive real-world impact. Long may it continue.

[Aimless]

In my naivety, I'd assumed the construction of the massive Northvolt factory outside a nearby town had been put on hold. Turns out that was not the case—and it's now the epicenter of what will probably develop into a pretty bad outbreak, with the UK lineage accounting for a large share of cases. My county has been very good at managing the epidemic so far, by Swedish standards, but there's little a county can do to stop a company from gathering over a thousand construction workers from other parts of the country—and the continent—at a single site, crowd them together in barracks, and make them move around freely in the community with little to no restrictions. My hospital has been offloading several other hospitals in the region, but we're going to have our hands full with our own outbreak before long, thanks to ongoing contact with the town that has been hit by the aforementioned outbreak (and, of course, with other hotspots). The county govt. & hospital management hadn't realized that a lot of people who work in the ER don't actually belong to that department, so their vaccine rollout plan has overlooked many of us who're liable to meet covid patients under unsecure circumstances. They're reserving beds for covid patients at one—maybe two—of our wards, but have neglected to vaccinate the nurses, nursing assistants and half of the doctors who'll be working there. Most of our day-to-day activity involves acute care that can't be put on hold, so the inevitable attrition among staff that will result from exposure and sickness will be very difficult to manage. Technically, I'm supposed to have three months off for a time-sensitive research project, but they've already cannibalized a month of that time, and I'm counting on more being lost due to last-minute orders. It is what it is, but... this was very much avoidable.

[RandBlade]

Oh dear, hope things get better.

[wiggin]

Israeli data showing no infections after 22 days from second dose of Pfizer.

Fantastic news, combined with the data coming out the UK it seems in countries distributing vaccines its having a massive real-world impact. Long may it continue.

This is indeed good news but I want to be really clear that this data is also extremely thin. They didn't show that there are no infections after 22 days, they showed that there were no identified infections between days 22 and 24, when there had already been very few identified infections in the previous week. Will there be infections after 22 days, when you go out to months and add more and more vaccinated people? You betcha. But it certainly looks like a 2 dose regimen for Pfizer turns a single dose infection rate (near the peak of this graph) and drops it to much lower.

On a related note, I was reminded of a stark difference in vaccination rates today: my 33 year old sister in Israel just received her first dose of the vaccine. On the same day, my 67 year old father in the US received his first dose - and that only because he works in a school; my 67 year old mother will likely receive her first dose in a few weeks if she's lucky. I, meanwhile, am technically considered an essential worker (for reasons that are rather unclear to me), and may receive my first dose in another month or so. But my wife - broadly similar age and risk status to my sister - probably won't get her first dose until April or May.

[Hazir]

Given my new diagnosis I could be up for vaccination in March.

[RandBlade]

This is indeed good news but I want to be really clear that this data is also extremely thin. They didn't show that there are no infections after 22 days, they showed that there were no identified infections between days 22 and 24, when there had already been very few identified infections in the previous week. Will there be infections after 22 days, when you go out to months and add more and more vaccinated people? You betcha. But it certainly looks like a 2 dose regimen for Pfizer turns a single dose infection rate (near the peak of this graph) and drops it to much lower.

On a related note, I was reminded of a stark difference in vaccination rates today: my 33 year old sister in Israel just received her first dose of the vaccine. On the same day, my 67 year old father in the US received his first dose - and that only because he works in a school; my 67 year old mother will likely receive her first dose in a few weeks if she's lucky. I, meanwhile, am technically considered an essential worker (for reasons that are rather unclear to me), and may receive my first dose in another month or so. But my wife - broadly similar age and risk status to my sister - probably won't get her first dose until April or May.

A vaccine doesn't have to be 100% effective to be worthwhile, don't let the hunt for perfection be the enemy of the good enough for now. Absolutely there may be some more confirmed infections afterwards but even disregarding the "no infections" claim the distinction between 12,944 people infections in the unvaccinated group (166 per 10k) and 254 infections in the vaccinated group (6 per 10k) is absolutely remarkable. 166 per 10k to 6 per 10k even if the other group isn't a perfect control group is an amazing distinction.

As for the two doses being better than a single dose that certainly looks true but this is yet more evidence in my eyes to a single dose for as many people then the second dose strategy. The baseline at day 7 is 76 infections - even if you multiply that by 18 days (7 to 24) then that would be 1,368 infections or 32.8 infections per 10,000; which assuming they've made a like-for-like date range comparison would be an 80% reduction from the original dose alone. If the original dose gives 80% protection and the booster bumps that up to circa 99% potentially then its well worth doing the booster, but its even more worth (if limited supplies exist) getting it to as many people first.

Finally of course there's the herd immunity factor. As Israel, the UK and other nations approach getting everyone vaccinated then even if the vaccine protection is imperfect on an individual basis there should be fewer viral spread and thus fewer opportunities for the imperfect protection to fail.

[RandBlade]

Given my new diagnosis I could be up for vaccination in March.

Damn I hope your diagnosis isn't too bad. Not the reason to want a bump up the list I'm guessing.

[wiggin]

A vaccine doesn't have to be 100% effective to be worthwhile, don't let the hunt for perfection be the enemy of the good enough for now. Absolutely there may be some more confirmed infections afterwards but even disregarding the "no infections" claim the distinction between 12,944 people infections in the unvaccinated group (166 per 10k) and 254 infections in the vaccinated group (6 per 10k) is absolutely remarkable. 166 per 10k to 6 per 10k even if the other group isn't a perfect control group is an amazing distinction.

As for the two doses being better than a single dose that certainly looks true but this is yet more evidence in my eyes to a single dose for as many people then the second dose strategy. The baseline at day 7 is 76 infections - even if you multiply that by 18 days (7 to 24) then that would be 1,368 infections or 32.8 infections per 10,000; which assuming they've made a like-for-like date range comparison would be an 80% reduction from the original dose alone. If the original dose gives 80% protection and the booster bumps that up to circa 99% potentially then its well worth doing the booster, but its even more worth (if limited supplies exist) getting it to as many people first.

Finally of course there's the herd immunity factor. As Israel, the UK and other nations approach getting everyone vaccinated then even if the vaccine protection is imperfect on an individual basis there should be fewer viral spread and thus fewer opportunities for the imperfect protection to fail.

I am not disputing that 1 dose looks good and 2 doses look great (though I would hesitate to put numbers on them given such a small number of events, especially for 2 doses). I'm just disputing the headline of 'no infections after day 22', which really means 'we were only seeing a few infections a day before day 22 and now we saw three consecutive days with no infections'. It's not Tim's fault, this is what the Reuters graphic specifically says. But it's important to contextualize data to understand what it actually means - which, in this case, is not very much.

The broader story is quite encouraging, yes. We have about 6 weeks of data on a large scale rollout of the Pfizer vaccine and when used as authorized it certainly appears to be dramatically reducing infections. I look forward to longer term surveillance on ever larger cohorts, but the body of evidence supporting the as-tested use of the Pfizer vaccine is growing. I expect to see similar data come out from Israel with the Moderna vaccine in the coming months.

[RandBlade]

The body of evidence supporting the use of the Pfizer vaccine certainly is growing.

I wouldn't restrict that to just "as-tested". This evidence strongly supports the hypothesis that the UK is operating upon, though it will take more time for the UK's own data to come through to verify it.

I agree that no cases after day 22 is a stretch.

[wiggin]

The body of evidence supporting the use of the Pfizer vaccine certainly is growing.

I wouldn't restrict that to just "as-tested". This evidence strongly supports the hypothesis that the UK is operating upon, though it will take more time for the UK's own data to come through to verify it.

I agree that no cases after day 22 is a stretch.

The Israeli data tell you what your protection is at 6 weeks against an ever-shrinking control group when you administer the vaccine as it was authorized to be administered. There's some subtleties about their endpoints and the cohorts, but that's essentially the case. It doesn't tell you, for example, how a cohort would look like 6 weeks after receiving just one dose. Or the effect on individual protection for receiving a second dose at a different interval. Or the effect on overall morbidity in a population for trying different dosing regimens. Or, for that matter, the protection in the as-tested dosing regimen at 7 weeks.

We can use the data to make extrapolations and inferences and models, yes, and our results may be reasonably predictive depending on the robustness of our assumptions and our boundary conditions. But that's not what the data tell us.

[RandBlade]

I never said that the data shows six weeks after the first dose - it doesn't need to, the UK data will show that soon enough, but it is reasonable to extrapolate from 3-4 weeks what it will be like after 6 weeks.

What the Israeli data does do is further confirm the hypothesis that one dose alone after 3-4 weeks does indeed provide well, well over 50% protection. The rest of course is extrapolation but that is for me at least the key variable, if one shot gives well over 50% then barring anything goes catastrophically wrong then twice as many people at well over 50% protection is better than half as many people with even 100% protection.

[RandBlade]

Twitter Link

Good.

Helping out others less fortunate than ourselves is the right thing to do once we've vaccinated ourselves.

EDIT: More details.

[Aimless]

New Swedish study shows that, if you exclude non-EU/non-Nordic households, school closures/online-only education has a measureable but small impact on risk of transmission. I will never cease to be surprised by how easy it is to get published by ignoring reality. By excluding these households, the investigators excluded a large segment of the population that was disproportionately likely to be infected, to fall severely ill, and to infect other adults in the household—often with deadly outcomes. Their children are also a distinct group wrt exposure, due to severe socioeconomic segregation wrt housing & schooling. Because of testing restrictions for much of last year, these were also the households where transmission from children to adults were most likely to result in a positive covid test (due to hospitalization). No ill intent—they're nice people; it's just emblematic of the systemic disregard for a large part of the population.

[Loki]

Looks like the vaccine distribution was less an issue in the US as a whole than in this particular state. 44th in the country and no one is blaming the leadership.

[Lewkowski]

https://nypost.com/2021/02/12/cuomo-...ind-the-truth/

Gov. Andrew Cuomo’s top aide confessed privately this week that the administration suppressed the true COVID toll in the homes. She also offered an apology — not to the thousands of New York families who needlessly lost loved ones thanks to her boss’s mismanagement but to Democratic lawmakers put in a difficult “political position with the Republicans” by the coverup.

A federal investigation may be the only way to get the full truth of Team Cuomo’s order to nursing homes, populated by those most vulnerable to the virus, to take in COVID-positive patients. Not just the “what” of how many lives it cost, but the “why” behind this madness, and the months and months of coverup.

Melissa DeRosa, secretary to the governor, made the stunning statement on a video call with Democratic state lawmakers as she “explained” why the administration ignored since August their demands for nursing-home death data. It began when then-President Donald Trump “directs the Department of Justice to do an investigation into us,” she said. “And basically we froze.”

“Because then we were in a position where we weren’t sure if what we were going to give to the Department of Justice, or what we give to you guys, what we start saying, was going to be used against us while we weren’t sure if there was going to be an investigation,” she said.

[Aimless]

Twitter Link

[RandBlade]

QTWAIN.

[Timbuk2]

If it meant a quick return to total normality, everything open, bars, restaurants, crowds at concerts, gigs, sporting events, no more restrictions, no more masks ....

Would have a certain level of unpredictability I guess.

[Aimless]

If it meant a quick return to total normality, everything open, bars, restaurants, crowds at concerts, gigs, sporting events, no more restrictions, no more masks ....

Would have a certain level of unpredictability I guess.

Sure, but "quick return to total normality" for whom? Even if you assume just a few percent of infected adults experience issues that might be categorized as some sort of "long covid" type of syndrome—or post-covid complications—it means tens of thousands of working-age adults would be saddled with troublesome symptoms for at least several months, and a fraction of those would be at risk of lasting disability. UK society isn't equipped to handle the long-term impact of the govt's mismanagement as it is; this proposal risks making matters much worse. It's not a theoretical risk—we know that a few percent of adults with covid experience lasting problems—including significant disability—for several months after their recovery from the infection itself. Just yesterday, I met a colleague at another clinic who could barely work over three months after clearing the infection; another was incapable of working for nearly a month. Both healthy, active, very tough and capable physicians in their thirties. The govt. has built up a massive long-term burden already, by acting in ways that have ensured widespread transmission among working-age adults; is the UK ready to double that burden? I dunno mate, I just don't think it sounds like a rational bet.