Covid 7/7/22: Paxlovid at the Pharmacy

post by Zvi · 2022-07-07T14:30:00.432Z · LW · GW · 11 comments

Contents

  Executive Summary
  The Numbers
  Predictions
  Deaths
  Cases
  Paxlovid at the Pharmacist
  Vaccine Update Update
  Don’t Just Do It, Do More
  Free State of Florida Man
  FDA Delenda Est and its Busy Schedule
  Control, Control, You Must Learn Control
  The Death Cult
  In Other News
None
11 comments

Pharmacists are going to be allowed to prescribe Paxlovid, while doctors continue to be confused by the guideline of ‘you can give this life-saving medicine that cures disease to the people who are sick with that disease.’ The news on the vaccine update front is good. Cases and deaths went unexpectedly higher, which is slightly worrisome, but seems unlikely to indicate anything big.

On an unrelated note, I’ve also written a bit about a giving-people-money experiment in Chicago that did not go so well. With Covid quieting down, I’m likely going to be lowering the threshold for including non-Covid items in the weekly updates. The alternative was to have a growing backlog of things that I am unlikely to ever get to deal with.

Executive Summary

1. Get Paxlovid at your pharmacist, yay.
2. Vaccine update update is they are closer to updating.
3. Monkeypox continues to double every 10.5 days or so.

Let’s run the numbers.

The Numbers

Predictions

Prediction from last week (4th of July): 600k cases (-13%) and 1,800 deaths (-16%).

Results: 675k cases (-1%) and 2,272 deaths (+11%!).

Prediction for next week: 700k cases (+5%) and 2,250 deaths (-1%).

Cases and deaths both going unexpectedly higher implies there wasn’t much of a holiday effect. Deaths in particular have no reason to be higher even without a holiday effect, so that’s weird but I did adjust for Florida and the effect is still there in the South. My guess is some of this is random rather than permanent, but it’s hard to say, and I still have to presume that there was some amount of holiday effect to undo.

Deaths

Cases

Did you know this in many places represents medium or high levels of Covid?

All right then.

Paxlovid at the Pharmacist

You will be able to get Paxlovid prescribed to you directly by the pharmacist. Seems like an excellent development. I’m actually starting to notice a pattern of such pockets of sanity happening more often recently, after delaying long enough to let a lot of the value be destroyed, in quiet places where no one is looking. It’s as if they are worried someone will notice someone is optimizing for good outcomes in this hive of scum and villainy, and so they must be cautious.

You can also get Paxlovid at the Pop-Up here in NYC.

Meanwhile, doctors clamor for more clarity. Yes, we are allowed to prescribe life-saving medicine to (more or less) all our patients with Covid-19, but who should be taking Covid-19 sufficiently seriously that we should give them life-saving medicine for it? Should a healthy 50-year-old get life saving medicine, or are they at such little risk they shouldn’t bother, despite us locking them down for the better part of two years over this?

I mean, who needs a cure, anyway? So many confusing questions.

Vaccine Update Update

Matthew Yglesias reminds us that vaccines work better when you update them, and that we need to update our vaccines faster, and that other considerations don’t much matter.

Back in February of 2021, the FDA suggested that in the future, variant-optimized vaccine updates would be fast-tracked for approval.

They suggested at the time that companies “would need to submit new data that shows the modified vaccine produces a similar immune response and is safe, similar to the process for annual flu vaccines,” and this could be done “without the need for lengthy clinical trials.”

That would have been a good idea! But instead they seem to have opted for months of intensive clinical trials. The problem there, which should be obvious, is that while the clinical trials enhance our confidence that the new booster is in fact more effective against Omicron, they also radically decrease the real-world efficacy of the Omicron-optimized booster by ensuring that it gets into people’s arms far too late. As the original coverage stated, the FDA understands this tradeoff perfectly well in the case of the flu vaccine. Incidentally, it is genuinely true that because flu vaccines are sort of rushed out the door, their efficacy varies a great deal from year to year. In theory it would be better to test more carefully. But time is of the essence so the best thing to do, all things considered, is approve vaccines quickly and let people get their annual shots.

Doing the same for Covid seems like a no-brainer, but for some reason they didn’t do it.

The good news, however, is that they very recently announced that future optimized boosters will be able to skip the clinical trials.

Next time will be different, this last link says. Won’t make same mistake a third time.

NEW YORK (Reuters) – The U.S. Food and Drug Administration will not require companies to submit clinical trial data on COVID-19 vaccines modified to protect against the BA.4 and BA.5 versions of Omicron in order to authorize those shots, a top FDA official said on Thursday.

Dr. Peter Marks, head of the agency’s Center for Biologics Evaluation and Research, told Reuters the agency will rely on data from clinical trials vaccine makers have run on shots designed to combat the BA.1 lineage, as well as manufacturing data, for emergency use authorization submissions before the fall.

…

Marks said he believes regulators from other countries are seriously considering using BA.1-based vaccines, which some drugmakers have already been producing and may be available sooner.

I can’t help but notice that ‘we can update quickly without a trial’ is what they said when they first made the vaccines. So I am skeptical that we’ll return to that policy.

It does not give solace to know that other countries are going to act even stupider, and choose to update to a version that is all but known to be less effective over a version that is more effective. Instead, we simply used a less effective vaccine for seven months, and this one time we are going to let it not get put back into another clinical trial afterwards and get caught in a never-ending loop of always being behind. This one time, we will have something up-to-date for one shining moment.

Yet I see nothing here to indicate this is a general policy change to ‘give people the version of life-saving medicine most likely to net save their life even if we haven’t specifically tested that particular version for so long it is no longer the right version’ and every reason to think that because BA.4/BA.5 are a sub-variant off of BA.1 and the whole thing is super embarrassing they are going to do a one-off waiver.

If the Pi variant breaks immunity again, do you expect them to waive the clinical trial requirement for a vaccine update? I don’t. Certainly I do not expect this if that Pi variant is about as dangerous as Omicron. If it was suddenly far deadlier as well, I hold out hope that this would matter, but it would be a modest amount of hope at best.

Don’t Just Do It, Do More

This is a very long thread about the art calling for the doing of more.

In particular, it is about noticing that if you go around screaming about how dangerous Covid is, there will exist a group of people who think that it will definitely, deterministically kill you.

As in:

That thread continues for a long time, in case you need any more pushback on the article in question. You get the idea.

People are not great with subtlety or nuance. And scaring them in this way might not be good for either mental sanity or public trust.

As usual, people are talking literally, others are trying to pretend that first group could not possibly have been talking literally, but, yeah.

No, really.

Drink!

There is one study helping spread such misinterpretation this week but there’s always a study this week. There will be one next week, too.

There are reasonable ways in which it would be a very good idea to do more, in particular involving the vaccines. The problem is that no one cares. The only people who do still care are mostly some combination of public health or Cult of Superficial Safety people who think we should Do More all the time about everything, and those who have bought into the idea that Covid is far, far more dangerous than it is, especially reinfections and Long Covid.

That’s the thing. There will, over and over, be claims that say 1 in 5 people will get Long Covid with no evidence that reinfection is safer, or what not. And then any normal person will go ‘wait, that does not make any sense, I know lots of people who got Covid, often multiple times, that we even know about, and all but one of them are fine’ and then they start quite rightfully ignoring you.

This is better than many alternatives. I do not want the Doing of More to occur on most fronts. The Doing of Nothing is, as I’ve said many times now, feeling like it is mostly a case of ‘your terms are acceptable’ given the practical alternatives. I don’t like not funding vaccines, but you cannot win them all.

Free State of Florida Man

The Florida Man will continue, until further notice, to be Ron DeSantis. He has a thing to say about anyone who has a thing to say about him.

This is a pattern. If you speak out against DeSantis, and he has any levers of power to go after you, he will use them. Doesn’t matter if you’re a professor at a Florida university or the almighty Disney corporation, words can never hurt him but he’s going to take the gloves off to be sure.

That does not, of course, discourage those for whom DeSantis lacks such levers, which is most people, especially those outside Florida and even more especially most of Twitter.

Such folks tend to focus on the DeSantis’s failure to Sacrifice to the Gods. You see, people are dead. Or, mostly nowadays, people are testing positive.

If you’re not inflicting pain on your citizens to make it go away, that all becomes your fault. That’s simple logic. Hence things like this:

Except yes, we do need to stop with this Covid theater, and citing that Florida had mostly average numbers of deaths and cases is not going to make people dislike what he did with the place. DeSantis’s Covid response is popular, and especially popular among Republicans. Every time people post something like this, thinking they’re giving it to him real good, the chance DeSantis becomes president goes up a little bit.

If you do not understand this, you are confused about both Florida and man.

FDA Delenda Est and its Busy Schedule

Did you know that what is freedom and your sacred right is determined by the FDA?

If it is approved by the FDA, well then, we must protect your rights of access at all costs. If it’s not approved by the FDA, it’s illegal, period. Nothing else should determine when it is our body, our choice versus when it is… not that.

Biden will now get back to telling people to stop charging market clearing prices for gasoline or he’s going to stay angry and you don’t like him when he’s angry.

A fun little story about how the FDA took time out of its busy schedule and went after Lazy Cakes melatonin-infused brownies to forced them to change their label, because…

“The inclusion of melatonin in baked goods raises numerous health concerns,” Sen. Dick Durbin (D–Ill.) wrote to the Food and Drug Administration (FDA) in May 2011, asking the federal agency to launch an investigation because the “sweet, chocolaty taste may encourage consumers to eat well over a recommended quantity of melatonin.”

There are so many FDA and Cult of Superficial Safety (their motto: “Why? Just ‘Coss!”) tropes there. The fear that someone might take more than the ‘recommended’ amount of something (while, of course, anyone consuming brownies is likely consuming a lot more calories and sugar than the ‘recommended’ amounts, in ways far more damaging than melatonin, and yet in a huge surprise I intended to do this every so often anyway.) The idea that if you combine perfectly normal, legal, safe and sensible thing A with other similar thing B, in a way that makes customers happy, it is suddenly a blameworthy thing to do because you see customers might prefer A+B to B, and that would be bad.

And of course, it’s important to remember that the FDA’s reach exceeds its grasp, and how just awful it is that something might be dangerous to “young children.”

As the FDA had its eye on the cakes, state and local officials in several jurisdictions went ahead and banned melatonin-infused products. A statewide ban of melatonin brownies, the Arkansas Department of Health declared, was necessary because the products could be especially dangerous to “young children”—even though “potential side effects associated with taking this hormone have not been fully determined.”

Sounds scary like that. Potential side effects have not been fully determined, oh no, there might be any potential serious side effects at all, at some dose with some duration in some population, that we find at some point. So we had better be careful. Please do not notice that this is a fully general argument for banning actual everything a human might do or consume.

The FDA has also continued to ensure we are safe from effective sunscreen. This particular example is so egregious that a law was passed, and the FDA simply ignored it.

…In 2014, Congress passed a law attempting to speed access to sunscreen ingredients that have been in wide use in other countries for years, but it hasn’t really worked. “The FDA was supposed to be fast-tracking these ingredients for approval, because we have the safety data and safe history of usage from the European Union,” Dobos said. “But it seems to continually be stalled.” According to Courtney Rhodes, a spokesperson for the FDA, manufacturers have submitted eight new active ingredients for consideration. The agency has asked them to provide additional data in support of those applications, but none of them has yet satisfied the agency’s requirements.

All your sunscreen are belong to us.

The good news is they have temporarily suspended their demand that Juul cease all sales, which if implemented is likely to kill quite a few people.

Control, Control, You Must Learn Control

Advocates warn America at risk of losing control of Monkeypox.

The details represent our utter failure to respond in reasonable fashion to Monkeypox, in all the same ways we failed to respond reasonably to Covid-19. This does not bode well for the next actually scary pandemic.

The good news is that we are not at any risk of losing control of Monkeypox.

The bad news is that this is because we were never at any risk of being in control in the first place.

What does the word ‘control’ mean here? There was never any willingness to take the kinds of actions necessary to stop the spread of monkeypox within the subcultures where monkeypox has been spreading. Thus, there was only one way this could go for those subcultures. Which is exactly how it is going, in case anyone wanted to see the definition of exponential growth.

There was never any hope of control, in that sense.

And in the sense that this indicates that authorities are doing exactly nothing that impacts the spread of monkeypox.

The question is whether monkeypox spreads sufficiently that it is a threat to spread beyond those subcultures, and be something everyone has to worry about. I continue to believe the answer to that question is mostly no, beyond an awareness that if you see signs of pox you should get the hell out of there.

The Death Cult

The Dutch signed an agreement to cut down on Nitrogen use, which they will do by shutting down farms in the middle of a potential worldwide famine. The farmers are understandably not thrilled and are protesting, using various methods.

The policy in question will require Dutch businesses to reduce nitrogen emissions nationwide by 50% and up to 95% in some provinces by 2030, with cows and fertilizers being significant contributors.

“The honest message … is that not all farmers can continue their business,” a government statement reads.

The agriculture industry isn’t the only one being targeted, though — aviation has also come under fire.

According to Climate Change News, by the end of 2023, Schiphol airport, one of the busiest in Europe, will be forced to limit annual flights to accommodate just 440,000 passengers (12% less than the number of flights in 2019).

…

Climate change activists are, of course, thrilled by the developments, with Greenpeace calling the cap on airport traffic a “historic breakthrough.”

“It is good that the Cabinet realizes that Schiphol has, for years, been flying beyond all boundaries when it comes to noise, nitrogen, ultrafine particles and the climate,” Greenpeace activist Dewi Zloch said in a statement.

The good news is with all the extra requirements for pilots we probably couldn’t have kept all those flights in the air regardless. At least now the planes might be on time.

Now they’re blocking the airport, which seems like it only encourages the bastards?

Shutting down farms during a famine definitely feels like it falls under ‘things that would have gone into certain novelizations of government intervention causing civilizational collapse except it would have made the whole thing feel too far fetched.’

There are those who think that not having an industrial civilization would be a good thing. That producing less food would mean more people, which would also be a good thing. Those people seem to have a large say in European policy decisions. I do not expect this to end well.

In Other News

New Fargo study finds no effect of school mask mandates on infection rates.

It seems they’re still denying hospital visitation rights to the unvaccinated?

Mexico’s wise president moves to end daylight savings time.

Delta cuts college requirement for pilots given they still need an absurd 1,500 hours of flying, usual suspects assume that any reduction in any requirement must somehow endanger safety of the safest form of travel in the history of mankind. Does not occur to them that the 1,500 hours might have something to do with the shortage.

BBC may not know the words but it definitely knows the music.

Schools at least do something, in the sense that kids who were kept out of school for extended periods and instead forced to do highly terrible ‘remote learning’ instead did quite poorly, in proportion to how long the schools stayed closed. Or at least they avoid the harm from remote learning.

Evergreen Tweet in the style of Hillary Clinton, perfect, no notes.

How we should think about most Covid precautions, in one Twitter thread.

Biden administration looking to open up our formula market to imports and a diversity of suppliers. Great idea, but why did we want until after we dealt with our shortage of formula? Perhaps something about trying to optimize for good outcomes in a hive of scum and villainy.

Meanwhile in California, AB-5 is set to force the trucking industry to make radical changes that at best will dramatically increase shipping costs. At worst, it will greatly disrupt the ability to ship things, many things won’t get shipped, and it gets rather ugly. The thing is that this is exactly the kind of thing that renders such systems inflexible. It both limits supply and also limits ability to increase supply. There’s a substantial chance this gets pretty ugly.

Movie stars are getting older. If this wasn’t part of a general pattern one might say it was good news, people valuing quality and experience rather than churning hot 19-year-olds. In the context of other things getting older, not as encouraging.

They are also suffering from hyperinflation. Please give generously.

In case you didn’t have a high probability of doom given AGI, let’s help nudge you a bit. DeepMind is already explicitly optimizing for what will be approved of rather than what would turn out well.

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