# Covid 9/17: It’s Worse

post by Zvi · 2020-09-17T15:10:01.649Z · LW · GW · 41 comments

## Contents

  Positive Test Counts
Extra No Good Very Bad Numbers: Meanwhile In Europe
United Arab Emirates Joins Vaccine Club
Football Coach Gives Us Some Straight Talk
Play Ball!
Burn Baby Burn
Vaccine Responsibility
Going Forward
None


Last week we learned there is plausibly a simple, cheap and easy way out of this entire mess. All we have to do is take our Vitamin D. In case it needed to be said, no. We are not taking our Vitamin D. There’s definitely some voices out there pushing it, including the nation’s top podcaster Joe Rogan, but I don’t see any signs of progress.

Instead, as school restarts, the outside gets colder and pandemic fatigue sets in, people’s precautions are proving insufficient to the task. This week showed that we have taken a clear step backwards across the country.

I see three ways for things not to get steadily worse for a while. Either a vaccine arrives, which is unlikely, something else new (that we see little sign of) arrives to change behavior for the better, or this week was a blip. It’s only one week of data, it follows labor day, and it is wise not to move too quickly to extrapolation. The effect size seems too large, though, and too distributed among outcomes, to be coincidence.

In terms of news, it was a quiet week. There was some bluster, but little substance.

Let’s run the numbers. They’re not good.

### Positive Test Counts

This doesn’t look too bad on its own. Whether it’s good, bad or very bad news depends on whether testing is improving. If testing were still ramping up, it could easily count as good news, even with the worrying reversal in the South. Unfortunately, that’s not what happened. Testing actually declined this week to 4.63 million tests, the lowest value since the first week of July.

Alas, the positive test percentages:

This was very surprising to me. It would not have been too surprising to see things level off around previous levels. But to have it also reverse so suddenly indicates a major change. The default hypothesis is that the reopening of schools is finally taking its toll, now that it has had time to accumulate sufficient compound damage. If that’s the case, we’re in for at least several more weeks of things getting worse.

What’s weirder is that the death counts are headed in the wrong direction, despite what were clearly positive trends in leading indicators several weeks ago.

Deaths by Region

Labor day weekend was too far in the past to provide much of an excuse here. The Midwest and Northeast are clearly headed in the wrong direction. The South and West could claim this is a backlog issue and things are still fine, especially the West, but it does not look good. If that’s what happened while leading indicators were improving, what’s going to happen over the next few weeks?

### Extra No Good Very Bad Numbers: Meanwhile In Europe

I’ve mostly limited the scope of this column to the United States, but it needs to be pointed out that much of Europe looks like it’s got its own second wave at this point. Spain and France are already there, and the U.K. is well on its way. Germany is holding steady so far and we can hope that holds. When you don’t eradicate, vigilance can never end. Then eventually it does, or the seasons change and tip things over the edge as behaviors adjust to that.

Given all our advances, one hopes that this won’t come with too many deaths even if the infection numbers get out of control.

Numbers told the story main this week. The rest is more of a round up.

### United Arab Emirates Joins Vaccine Club

Best news of the week: UAE announces emergency approval for use of COVID-19 vaccine. One more country, albeit a relatively small one, sees the light and rolls the favorably weighted dice.

Here’s to you, UAE. Except that you don’t drink, and neither do I. So hats off, instead.

### Football Coach Gives Us Some Straight Talk

I didn’t know I could love Coach O even more, but the results are in and it turns out I absolutely can do that. The man tells it like it is. LSU coach Ed Orgeron — ‘Most’ of team has contracted coronavirus

That’s the SEC. Here, it just means more.

The problem is not that the team has some players who have caught Covid-19. The problem is that the team has players that haven’t caught Covid-19! They might catch it in the future. So we need to have backups ready for those players.

My assumption is that LSU’s campus is full of college kids who don’t care if they get Covid-19, so a ton of them got Covid-19 right away, and none of this has anything to do with football. I saw stories saying it was all over the dorms.

Or you could take the other approach, look like you’re acting all responsible, and be the fun police without actually making anyone safer. I’m looking at you, PAC-12. But I’m not looking at you, Big 10, because unlike most people these days, I believe in forgiveness.

### Play Ball!

You are the Big 10 conference. Cause you had a bad day. A really bad day. Even worse than when they added Rutgers and Maryland. You’ve taken one down. Cancelled your entire season, like many other things, over nothing.

You sing a sad song, hopefully while socially distanced, to turn it around.

Then you realize you’ve made a huge mistake. You get your shirt together. You mumble something about a ‘proper daily testing regime.’

It’s going to be a tight schedule. By waffling, they’ve made it so that an outbreak that causes delays could endanger several teams and their ability to play a full season – there’s only room for one off week. And like others, they made the mistake of scheduling that off-week rather than holding it in reserve to handle a crisis.

But what matters is, they’re back, and we’re playing. The PAC-12 is still not back. They’re really pushing the scheduling window to its breaking point, but they’re working on it. Besides, we all know they were going to get excluded from the playoff regardless, like they do every year, so it doesn’t matter that much if they play further into December or even January.

More football. Ergo, more peace.

### Burn Baby Burn

The west coast of the United States is more than a little on fire. The air is not fit for humans to breathe. The sky is frequently the wrong color. Photos of this past month’s sky and its resemblance to something that isn’t part of a post-apocalyptic wasteland have been unfavorably compared to photographs from the Blade Runner 2045 movie. It’s pretty bad out there. Presumably this is having an effect on Covid-19, but it’s not obvious which way – if everyone does everything indoors that’s bad, but if they can’t even go outside to get to other people, that’s good for the moment, I guess?

The bigger point is that once again we have two distinct versions of ‘scientific consensus’ about what’s going on with these fires. From what I can tell, here’s the situation.

California used to naturally burn periodically, on its own. It wasn’t great, it was bad enough to sometimes make the air bad, but it kept things in balance.

For about a century, California has been aggressively putting out every fire it can find. There has effectively been the mentality of a ‘war on fire.’ This has led to an accumulation of a massive amount of fuel.

We know that the way to deal with this is controlled burn. But when someone starts a controlled burn, they get punished for it. They have to file environmental impact statements (because the fire will damage the air today, and that’s no good, even though we now see the alternative), deal with lots of regulations and so on. If something goes wrong, they get the blame and the lawsuits. It’s much easier to just not burn, so mostly people don’t burn. Certainly no one private does controlled burns, and the public does maybe 30,000 acres a year even with extra efforts. But the historical average was millions of acres, so we’re doing essentially nothing.

Thus, lots of giant fires.

We then hire a combination of overpriced unionized labor that demands overtime pay so good they occasionally start the fires themselves, and prison labor we barely pay at all that’s now unavailable because of fear of Covid-19. And we use them to fight all the fires, including ones that don’t threaten anything of value and thus would be net positive to allow those to continue. So we have anything like the resources necessary to stop this.

Also, climate change is a thing, which is also making things somewhat worse.

So what do the Democratic politicians and most media outlets say?

That this is “a climate damn emergency” and that the “scientific consensus” is that this is all the result of climate change.

Thus. Everyone involved gets to act all righteous and feel like they’re scoring points in the political wars. They make Sacrifices to the Gods that, even if they work as intended, only mean that things will continue to get worse but ever so slightly slower. That’s their response to this “emergency.”

Because if it’s all due to climate change, they don’t have to actually do anything that might stop the fires. Like more controlled burns, or devoting more or smarter resources to protecting what needs protecting. The things that might help anyone actually alive today not need to flee across the country.

I bring this up because the parallel to how those same media and political sources deal with Covid-19 should be obvious. Claim they know what the “science” says. Blame things that don’t matter. Actively interfere with the things that might help, massively slow or block any useful action while denying its possibility or effectiveness. Call for gigantic long term sacrifices that offer little tangible gain. While simultaneously claiming it would have been impossible to actually prevent the problem or mitigate its effects.

Label anyone who says otherwise “anti-science” and irresponsible and just awful.

Covid-19 is not some outlier. These people lie. About everything. All the time.

Not every time. They do sometimes tell the truth, when it suits them. But if anything, that only makes it more difficult. As the old joke goes, it’s easy to tell the truth from Pravda, because everything in Pravda is a lie. But The New York Times is trickier, because sometimes it tells the truth.

### Vaccine Responsibility

The main Covid-19 nominal headlines this week were about vaccines. Trump continues to promise a vaccine by late October. The head of the CDC says that’s not going to happen. Trump says the head of the CDC is ‘confused.’ The CDC walks the comments back. On net, this showed some attempt by the CDC to not kowtow to Trump, but then a kowtow, so on net seems like a wash.

Gates and Fachi and others continue to say not to expect a vaccine. All this back and forth.

For those worried, yes, the halted vaccine trial from last week has resumed and never had a good reason to pause.

The net visible news on this was presumably bad, as indicated by the Good Judgment Project which has us down to a 59% chance of 25 million doses administered by the end of March.

It’s all talk. None of this substantially changed my view of the current state of the vaccine research.

A vaccine will be available in October if Trump is able to override the CDC and FDA, and make it happen by fiat to help its reelection chances. If it can’t do that, the vaccine will wait a few more months at minimum, and then we’ll see what happens. I continue to think distribution would be the right thing to do and the objections are deeply wrong, and of course that none of that has anything to do with why Trump is going to try to overrule those objections.

The other big comment from the head of the CDC was that ‘masks could be more effective than the vaccine.’ Which is the kind of thing one says when one thinks it is more important to look like a Very Serious and Responsible Person, who is saying Very Serious and Responsible Things, and is properly encouraging vigilant mask usage. We wouldn’t want people to think that something else might help them. Think of what they might do!

Trump pushed back hard on that as well, as he would regardless of the statement’s truth value. The same way the statement was made without regard to its truth value, beyond finding a way to show it could possibly be technically correct. If that.

I grow weary of it all. It’s the fatigue setting in. The same bluster. The same warnings that it will not be over until the Proper Authorities say it’s over. The same downplaying and dismissals by the White House. No authorities we can trust. Round and round and round we go. When it stops, I’m trying to guess, and the prognosis doesn’t look great.

### Going Forward

We’re getting close to the election. I did a look at the betting odds, and found some instances of small free money available for those interested. As time goes by, focus will shift away from Covid-19 as a health problem, and towards the upcoming election and its details. Everything will more and more be in that light and only that light, from all sides. My guess is that this will decrease the amount of meaningful virus news, and we’ll be more focused on the pure numbers.

Meanwhile, the virus will ignore all that, because the virus doesn’t care.

This blog does its best to stay out of politics despite discussing politicized issues. It would many times have said something about ‘a plague on both your houses’ except that seems a little on the nose. I have a strong preference on outcomes, which readers can presumably guess – but saying it outright wouldn’t convince anyone. You have all the information you need, to decide which candidate you prefer. Vote accordingly. If you are in a swing state and can afford to cast your vote in person, do so, to facilitate a quick, clear and peaceful resolution of the election – the Covid-19 risk involved will be minimal, and it helps reduce the tail risk from a disputed election.

I’ll also start another experiment this week. If you see news you think should make next week’s summary, throw it into the comments, with links if possible, and we’ll see if together we can cover things a little easier. I see no reason not to try that out. I’ll check both the LessWrong version of this post and the original for such comments.

comment by philip_b (crabman) · 2020-09-18T09:59:00.885Z · LW(p) · GW(p)

I've asked Zvi what he thinks about long term consequences of being ill. Due to his answer, my current thinking, which I use to calculate the cost of COVID-19 to myself in dollars, is as follows. COVID-19 long term consequences for myself have 2 components: something that lasts about half a year, and something that's permanent. Or at least modelling it as if it has 2 components is not too bad.

The 1st component contains strong fatigue, low grade fever, headaches, or loss of taste and smell and has probability 3% given covid. The 2nd component is permanent lung, heart, or brain damage and I guess has probability about 0.5% given covid. However, this probability estimate is very uncertain and can easily change when new data arrives.

I've eyeballed DALY loss estimates for various diseases according to www.jefftk.com/gbdweights2010.pdf (which is a DALY estimate study cited by Doing Good Better) and thought. Due to this I've got estimates of how bad those two components if they happen are:

If the 1st component happens, for its duration I will lose 20% of my well-being (as measured in DALY/QALY) and 30% of my productivity. If the 2nd component happens, then for the rest of my life I will lose 8% of my well-being and 10% of my productivity.

If you want more details about how I got these percentages, then I can only say what rows in table 2 of that study I found relevant. They are

• Illness - Coefficient (lower is better, no adverse effects is 0%, death is 100%) - My comment
• Infectious disease: post-acute consequences (fatigue, emotional lability, insomnia) - 26% - The 1st component is basically this
• COPD and other chronic respiratory diseases: mild - 1.5% - The 2nd component may realize as this
• COPD and other chronic respiratory diseases: moderate - 19% - The 2nd component may realize as this
• Heart failure: Mild - 4% - The 2nd component may realize as this
Replies from: Owain_Evans
comment by Owain_Evans · 2020-09-23T10:56:03.597Z · LW(p) · GW(p)

Which study were you looking at?

I agree it makes sense to split into two components. Your first component could be called "mild but long COVID". By "mild", I just mean the person didn't ever require extensive hospital care. The second component sounds like permanent damage due to acute COVID. People with acute COVID were hospitalized and often spent long periods in intensive care. My thoughts/questions for you:

Mild+long COVID (1st component)

• Studies: I haven't seen any rigorous, large-scale study that tries to estimate how common this is. How to do a study? Ideally there's a natural experiment, where you can compare matched populations with high vs low COVID rates (e.g. Milan vs. Rome, SF vs. LA, Stockholm vs Oslo). Failing that, you at least sample randomly from all people who had COVID using antibody tests or population PCR testing and then find a demographically matched control group. You take objective measures of their condition, e.g. employment, sick days, fitness test, and various medical tests of health. A "quick and dirty" approach is to find workplaces where a high proportion tested positive (hospitals in first wave in London/Lombardy/Madrid/Wuhan, meat plants, sports teams) and find out what proportion of people are back at work full-time.
• Demographics: From existing (flawed) studies and surveys, it seems to be more common in middle age than say 10-15 year olds and 60+ year olds. It seems more common among women (perhaps more than 2:1), which I believe fits some other post-viral or auto-immune conditions. If this holds up, it might give some update in terms of personal risk.
• Duration: You give a 6-month expected duration. How did you estimate this? The reference class for this component is presumably post-viral and auto-immune conditions, which (IIRC) have a longer than 6-month expected duration. Presumably you are updating on actual evidence from Long COVID sufferers. (There's also various reports of people who experienced mild symptoms having some organ damage on examination. This might also suggest a more than 6-month duration for full recovery.)

Chronic Post-Acute COVID (2nd component)

• Studies. There seem to be more studies of this component because you just need to follow up with people who were hospitalized and so there aren't the same sampling issues.  The UK is doing a large study on this. The reference class for this study is (presumably) people suffering from the conditions caused by acute COVID, which include pneumonia, ARDS, cytokine storm, vascular problems, etc. I think there aren't large absolute numbers of people in their 20s without comorbidity who were hospitalized in any one location, and so getting a well-powered study on them might be non-trivial.
• Demographics. Severity rates for COVID are very sensitive to age and somewhat sensitive to comorbidity. Does your 0.5% estimate take this into account? I can imagine that for someone in their 20s without comorbidity, the rate of chronic damage from acute COVID would be less than 0.5%. (For such people, I'd guess death rate is < 1/5000 and that permanent damage is less than 10x more likely than that. But I'm fairly uncertain about this.)

Future treatment: If the rates of these two kinds of post-COVID are as high as you estimate (0.5% and 3%), then there will be millions of people across Europe/US/Mexico etc. with these conditions. So there will be a huge incentive to improve treatments. Maybe some kinds of "permanent" damage are very hard to ameliorate, but if you're doing the projection out for 20-30 years from today, I'd be optimistic. (It seems that hospital treatment for COVID has already improved significantly. There'll be lots more cases in the next 6 months and so further improvements are expected).

comment by jimv · 2020-09-17T20:58:40.533Z · LW(p) · GW(p)

In this post and the last one, you've indicated that you don't see a point to pausing a vaccine's trial in the face of an adverse event, and that normal processes should be overridden.

I think this may be a case where contemplating Chesterton's Fence is appropriate.

I've seen several people who I would trust to understand this stuff well lay out justifications for due caution in the vaccine development process.

Here's one set of reasons from a biostatistician (Natalie Dean):

"Widespread use of an unproven vaccine:

• Gives people a false sense of security if efficacy is really low
• Diverts resources away from other interventions (fixing testing!)
• Makes it harder to evaluate better vaccines
• Jeopardizes safety
• Erodes trust in the process"

And another biostatistician (Thomas Lumley):

"...the political situation has raised a real possibility that the President of the USA would try to make the FDA authorise a vaccine without convincing evidence that it works. I don’t use words like ‘disaster’ lightly, but this would be a disaster, both for COVID prevention and for the long-term credibility of vaccination. We need a vaccine that works, and we need people to know that it works."

https://www.statschat.org.nz/2020/09/14/not-quite-alarmed/

Lumley again, specifically on the issue of a pause:

"Vaccines aren’t intrinsically safe; they are safe when approved because they get thoroughly investigated first.

The immediate question for the trial sponsor and investigators in this case is whether the adverse event, whatever it is, significantly changes the risk:benefit balance of the vaccine candidate, as explained to the study participants (and to the company’s investors). So far, no-one knows, but AstraZeneca seem to be handling this appropriately, and there’s no obvious reason to expect that to change."

I have no reason to doubt that these experts share all our desires for this disease to be dealt with as quickly as possible. They're saying that we should still take appropriate care in developing and testing vaccines. There is at least a risk that reducing normal precautions could increase the duration of the disease causing problems, if we're left with a less effective vaccine, or if the first vaccine is not safe enough so people lose trust, not just in that one but in all subsequent vaccines.

And although the paused trial has been resumed, that doesn't provide evidence that it "never had a good reason to pause". In fact, possibly the reverse. The prompt resumption shows that the processes that the investigators wanted to go through were possible to be conducted quickly, lessening their costliness (in terms of time to successful vaccine).

Replies from: Zvi, Dagon
comment by Zvi · 2020-09-17T22:41:46.370Z · LW(p) · GW(p)

In the case of the pause, I wasn't saying that it was time, that day, to give the vaccine to the public. I was saying that they should continue the trial while they investigate the one case, until such time as they actually find a problem linked to the vaccine, so as to not lose time. The downside risk there seems to be almost zero.

The quotes above are all just further "ethicists" who make their prestige and money from expressing concerns and stopping people from doing things, expressing concern and stopping people from doing things, and forcing their procedures on people regardless of whether they make sense. Nothing there is new to me.

As Dagon says, if you think we should use the same speed and standards now that we would use in a non-crisis that wasn't causing massive damage to lives and livelihoods and the entire world, then I don't think that's how trade-offs work and am confused.

I won't get further into the specifics, but I find the arguments raised here both things I've dealt with before, and highly uncompelling.

Replies from: jimv
comment by jimv · 2020-09-18T08:30:15.527Z · LW(p) · GW(p)

In the case of the pause, I wasn't saying that it was time, that day, to give the vaccine to the public. I was saying that they should continue the trial while they investigate the one case, until such time as they actually find a problem linked to the vaccine, so as to not lose time. The downside risk there seems to be almost zero.

A direct downside risk of not pausing a trial when you identify an adverse event that shows your vaccine might have harmed one of your volunteers is that you might harm more of your volunteers.

A knock-on downside risk from that is that fewer people might feel confident volunteering if you're not taking reasonable precautions with their safety, so you might find it harder, or at least slower, to complete your trial.

I would also suspect that there would be contagion of this distrust, making it harder to run trials of any vaccines, both for COVID and into the future.

..."ethicists" who make their prestige and money from expressing concerns and stopping people from doing things...

Might be worth noting that probably no one is strictly stopping you from taking a vaccine of unknown effectiveness and safety. They are just reducing your probability of doing it down to 0.5. If you feel that the tradeoffs favour taking it, then you can volunteer to be in a trial. The world needs people who are willing to put themselves in that position.

Replies from: rockthecasbah
comment by rockthecasbah · 2020-09-21T13:19:08.015Z · LW(p) · GW(p)

To clarify, are you adopting an ethical position where it is wrong for one person to put themselves at risk to benefit others? Or are you asserting that there is more suffering and death in the world where the trial continues than in the world where it stops? Do you perhaps believe that causing suffering by inaction is less morally wrong than causing suffering by action? Looking for crux.

Replies from: jimv
comment by jimv · 2020-09-23T19:19:07.089Z · LW(p) · GW(p)

are you adopting an ethical position where it is wrong for one person to put themselves at risk to benefit others?

No. Volunteers in a clinical trial like this are putting themselves at risk to benefit others, and I feel that is a good thing.

I am concerned about people's ability to give informed consent. It seems like a hard problem in general to give prospective volunteers a sense of how much risk they are being exposed to - one issue being that people might tend to assume 'well, whatever they're saying about risks, it must be pretty safe it they wouldn't be doing it'. I feel that the ethical thing is to be as good at ensuring consent is informed as is practicable.

I tend to feel that if you continued to admit volunteers to a trial when a potential serious event had occurred, this issue of consent might get trickier. If you don't tell the next volunteers at all, then it feels like you're withholding information, meaning their consent is inadequately informed, so I'd be pretty concerned about that. If you do tell them, but continue admitting them, the message of 'yeah, something bad maybe happened and we want you to know about it before you agree' might be read by volunteers as having an implicit content of 'but it's not that bad or we wouldn't still be injecting you'.

Of course you might end up with the information putting lots of prospective volunteers off. In that case, you might lose people who would have been volunteers after a pause.

Or are you asserting that there is more suffering and death in the world where the trial continues than in the world where it stops?

I think this is closer to my sense. My guess is that in expectation, a world in which we take pauses (as short as possible) to investigate potential problems with emerging vaccines for a disease like COVID 19, is likely to have less suffering in the long run. Vaccines are not inherently safe, nor are they necessarily trusted by the public even if they are safe. Actions that might let an unsafe vaccine slip through the net have the potential to cause vast harms in terms of the reduced uptake of lots of other vaccines. Even the perception that a vaccine was rushed without taking appropriate safety precautions can result in it getting blamed for things that it doesn't cause (see the story of the 1976 swine flu vaccine https://www.bbc.com/future/article/20200918-the-fiasco-of-the-us-swine-flu-affair-of-1976 ). Actions that show that care was taken to vet and understand any potential harms will help to improve uptake across all the range of vaccines.

Replies from: rockthecasbah
comment by rockthecasbah · 2020-09-23T20:10:18.793Z · LW(p) · GW(p)

I’m not a philosopher so I won’t say much about your earlier point. It’s worth noting that lots of painful but clearly worthwhile events in history are not worthwhile in your ethical system. For example, the soldiers at D-Day had much greater uncertainty about their odds of survival than the vaccine trial victims (some beaches were much more dangerous than others). If it’s unethical to allow a volunteer to hurt themselves unless they have total certainty of the risks, the Normandy landings were totally unethical regardless of the suffering in occupied Europe. You can take that ethical system if you want, but it is very distant from conventional ethics.

Excess us deaths are about 10,000 per week. So a one week delay in a vaccine would cost 10,000 deaths. You say a loss of trust in vaccines is possible if the trial is not stopped is possible. But it is also true that if Russia and China start mass Good-enough vaccine distribution long before the US people may lose trust. Can you make an argument that if trials are not suspended a loss of trust in vaccines is more likely than if they are continued? Otherwise the argument isn’t very compelling, no?

Replies from: jimv
comment by jimv · 2020-09-24T19:08:27.679Z · LW(p) · GW(p)

My understanding is that there was conscription during WW2, so the comparison is somewhat weakened if we're not talking about volunteers anyway. But in an armed conflict, I think people have a fair sense that the flying bullets makes it "really rather dangerous", even if they couldn't quantify it. My problem with how informed consent can be is around issues like we know there are biases where people have a tendency toward a dichotomy: low risk becomes zero risk in their minds. (To the extent that this applies at the other end of the spectrum, high risk would become near certainty, so further makes the war situation different in nature.)

Can you make an argument that if trials are not suspended a loss of trust in vaccines is more likely than if they are continued?

This seems self evidently true to me. I struggle to envisage a situation where people see caution that they perceive to be excessive and become more reluctant to take vaccines in the future.

Good to have a number for some comparisons. From a quick search, I see the WHO estimates that measles deaths globally fell from 535,600 in 2000 to 124,000 in 2017, but rose to 142,300 in 2018. That seems to show that vaccine uptake can make differences in the tens to hundreds of thousands. Yes, I'm comparing globally to one country, but on the flipside, I'd envisage that negative harms from increased skepticism could aggregate over years-to-decades, and over numerous diseases.

https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide

Replies from: rockthecasbah
comment by rockthecasbah · 2020-09-24T22:58:43.978Z · LW(p) · GW(p)

My problem with how informed consent can be is around issues like we know there are biases where people have a tendency toward a dichotomy: low risk becomes zero risk in their minds.

If the changes in risk are very small, in this case of order one in ten thousand, the ethical consequences of people miscalculating that risk are small. We already know that millions of people were willing to take huge risks (<1/100) for altruistic reasons. Why would we assume these volunteers would desist if they "rationally" evaluated the risk at one in ten thousand instead of approximating it at 1 in a hundred thousand?

So for the set of actions that put others in harms way, you believe that the ethics of said action depends on the percent difference between their perceived risk and the actual risk? That is really really weird and far from the point. Say I volunteer for activity A on the assumption that the risk is 1 in a million, but the actual risk is 10 in a million. Then I volunteer for activity B on the assumtion that the risk is 1 in a hundred, but the actual risk is 1 in ten. In both cases the proportion of risk change is a factor of 10, so you would argue they are equally unethical But the change in absolute risk change in activity B was 9%, which is a huge chance of dying! If I am volunteering I am very interested in the absolute change in risk, who cares about the percentage change, because I'm worried about dying not being wrong.

We don't have to baby people just because they use heuristics to do good.

This seems self evidently true to me. I struggle to envisage a situation where people see caution that they perceive to be excessive and become more reluctant to take vaccines in the future.

People don't spend that much time thinking about your particular institution's paricular norms when they assign a trust value (because there are lots of institutions so they don't have unlimited time). This is the reason courts are built like they are, so people can actually watch the judge deliberate and explain his reasoning. People do not trust courts because juries are statistically good at identifying guilt or because they know the regulations in their jurisdiction in detail. They judge the courts on big noticable surface characteristics that touch their lives and their communities.

They will remember stuff like "did the vaccine work" "did we get it first" and maybe "did people have negative reactions on facebook". The choices made in one particular trial will be long long forgotten. The UK's choice to continue the trial gets them more data faster to release a safe vaccine to the genpop. Those are things that touch people. So the UK might experience higher "trust in vaccine institutions" later than the US. It could go the otherway too, but I think the UK choice is stronger in expectation.

Also, the generation who stopped taking measles had forgotten how bad viruses are. I doubt they'll repeat that mistake after this.

comment by Dagon · 2020-09-17T21:56:07.537Z · LW(p) · GW(p)

If you think the identical processes and level of caution should be used for an emergent pandemic as for relatively small-scale long-standing viruses, you're not doing cost/benefit analysis very well. It's very hard for me to simultaneously believe that it's so risky that we should all avoid travel and most leisure activities, AND that the vaccine is so unimportant that we shouldn't accept more risks than we otherwise would.

I'll respond to Natalie Dean's quote, because they're easy bullet points.

Gives people a false sense of security if efficacy is really low

Perhaps true, but efficacy would have to be ridiculously low for it to be a net loss. Which will show in early trials and uses.

Diverts resources away from other interventions (fixing testing!)

Do both!

Makes it harder to evaluate better vaccines

Only to the extent that it's effective and very common. Which is a good outcome in itself.

Jeopardizes safety

More than a 6-month delay would? I doubt it.

Erodes trust in the process

That implies that anyone trusts the process now.

Replies from: rockthecasbah
comment by rockthecasbah · 2020-09-18T01:53:13.920Z · LW(p) · GW(p)

Good points Dagon.

See also this marginal revolution comments section, where several comments do show their work. Different conclusions, but this way of arguing for is more effective for finding the option that saves most lives in expectation.

comment by romeostevensit · 2020-09-18T04:51:13.280Z · LW(p) · GW(p)

A classic soticism technique is to think about what ill-fortune might befall you, so that if it actually happens it won't stress you out quite so badly. In the spirit of that, consider that the FDA will probably tell people that the correct dose of vitamin D is far too dangerous and must be left in the hands of doctors once you're already extremely ill, rather than at the time it might actually prevent you from developing severe symptoms at all.

I've personally started laying the groundwork with friends and family that no, 10 pills of vitamin D really won't kill you so that if the time comes and they are having symptoms hopefully it will have sunk in enough. You don't want to try to convince people of something new once they're already scared and stressed out.

Replies from: TheMajor
comment by TheMajor · 2020-09-18T07:47:54.633Z · LW(p) · GW(p)

For reference, what dose are you thinking of? Here in EU-land I can only get 5ug (200 IU) supplements easily.

Replies from: romeostevensit, romeostevensit
comment by romeostevensit · 2020-09-18T09:13:35.822Z · LW(p) · GW(p)

also the EU wants you to be deficient and therefore in this pandemic specifically, wants you to die. No one is getting to sufficient d status on 200iu pills. I take 5k a day.

Replies from: TheMajor
comment by TheMajor · 2020-09-19T07:31:12.131Z · LW(p) · GW(p)

I think Hanlon's razor applies here. Thank you for sharing the 5k/day, I will make a serious effort to obtain similar doses.

comment by romeostevensit · 2020-09-18T09:12:40.900Z · LW(p) · GW(p)

https://www.sciencedirect.com/science/article/pii/S0960076020302764?via%3Dihub&fbclid=IwAR0T0Myc9wExci5wWP1ciU3bv-d1i7pGvnyNT1AMDGOit7smc-vKX8S0ovQ

my understanding is 60-100k iu on day one then booster shots of 30-50k iu twice more separated by several days. (have to convert from the injection amounts to d3)

comment by Douglas_Knight · 2020-09-17T23:14:51.667Z · LW(p) · GW(p)

For those worried, yes, the halted vaccine trial from last week has resumed

I don't believe that this is true. All the articles from last week say that it's only the British trial resuming, not the American. I believe that British trial is almost full, so it's irrelevant that it resume, whereas the American trial, the biggest, has barely begun. I'm not sure how far Brazil and India have gotten. I guess India resumed on Tuesday. Here is an article about FDA not resuming.

comment by Liron · 2020-09-17T22:25:07.625Z · LW(p) · GW(p)

Now that so much of California has burned, does that mean we’re in good shape for a few years of mild fire seasons?

Replies from: Zvi
comment by Zvi · 2020-09-17T22:42:35.874Z · LW(p) · GW(p)

My understanding is it definitely helps versus not having had them! But that historically the amount burned each year was very, very large, so I'm not sure if we actually better off next year than this year, or only less worse off than we could have been.

Replies from: Raemon, gbear605
comment by Raemon · 2020-09-17T23:01:22.899Z · LW(p) · GW(p)

For frame of reference, looks like ~3 million acres burned this year, and in the past decade it's ranged from half a million to 1.5 million or so.

So, while this is more than usual, and probably we'll regress to the mean a bit anyway, it's not like this year was so much more that we should expect it to dramatically change future years.

Replies from: gbear605, jmh
comment by gbear605 · 2020-09-18T03:02:14.768Z · LW(p) · GW(p)

It's been going up significantly over time - the trend-line goes from about 500k acres in 2000 to 1.5M acres in 2020, making me doubt a regression to the mean. Even excluding 2020, the trend-line goes from less than 500k acres in 2000 to about 1.1M acres in 2019. I'm expecting more years like this one in the future, although hopefully not quite as bad.

(data from Wikipedia)

Replies from: Bucky
comment by Bucky · 2020-09-22T10:42:26.686Z · LW(p) · GW(p)

It's worth noting that the R-squared value for a linear trend-line for 2000-2019 data has  so a constant prediction of 750k acres would only be marginally less accurate. (I think your excluding 2020 graph also excludes 2019 but the story doesn't change much either way)

It looks like up until 2016 everything was fairly constant and since then 3 out of 4 years have been bad.

Replies from: gbear605
comment by gbear605 · 2020-09-23T02:45:53.686Z · LW(p) · GW(p)

Hm, when I was making the excluding-2020 graph I was intending to include 2019 as well, but it might have been taken out accidentally.

comment by jmh · 2020-09-18T00:04:59.084Z · LW(p) · GW(p)

Are the figures for the past decade the total burned, the planned burn or just the wild burn?

I ask because I read something, not closely at all, sometime in the past week or so, that seemed to be saying for the past decade environmental policies and regulators have been preventing so much of the planned burn the west has a serious problem Based on that one might think that rather than some mild years coming up more of the same, and even more of that, might be more likely.

For those living there I just say "Hope that is wrong!"

Replies from: Raemon
comment by Raemon · 2020-09-18T00:56:30.489Z · LW(p) · GW(p)

I was going off wikipedia California Wildfires (search for "Post-2000")

I've heard mixed things about the "preventing the burn" – my current very very vague correct-me-if-I'm-wrong understanding is that "people actively preventing burns" was a 20th century thing, and nowadays there's some kind of consensus of "okay we need to do more planned burns", but, it's sort of intrinsically tricky how to cause that or incentivize it. (because, it is still totally possible for people doing controlled burns to fuck up and cause major damage, and it's some combination of 'politically unpalatable' and possibly also 'actually a bad idea' to just encourage people to burn things willy nilly)

comment by gbear605 · 2020-09-18T02:56:47.187Z · LW(p) · GW(p)

Per the Wikipedia page this year more than 3% of the state has burned (and it's continuing to burn), and thus a good deal more than 3% of the forestable land area has burned. Unless all the forests burned every 20-30 years, this would suggest that this year was significantly more than the historic average. Given that the past decade has averaged about 1 million acres, and the state is about 100 million acres, and not all the state is able to be forested, I'd guess that the last decade's averages have been at least around the historic average if not more.

Replies from: PeterMcCluskey
comment by PeterMcCluskey · 2020-09-19T01:15:23.158Z · LW(p) · GW(p)

This Wikipedia page says the pre-1800 average was 4.4 million acres. So it looks like burning every 20 years was typical for a California forest.

Replies from: gbear605
comment by gbear605 · 2020-09-19T03:07:21.760Z · LW(p) · GW(p)

Huh wild. I guess I have heard about redwood trees surviving forest fires, so that makes some sense, but man those'd be some big fires.

Replies from: jkaufman
comment by jefftk (jkaufman) · 2020-09-19T16:15:51.394Z · LW(p) · GW(p)

I think it's the other way around: If your forest is burning every 20 years then the fire is relatively minor. There's much less accumulated fuel so it won't burn as hot or be as destructive as we see now.

Replies from: gbear605
comment by gbear605 · 2020-09-19T18:33:45.443Z · LW(p) · GW(p)

That makes more sense - there would be more land on fire, but the fires would be weak fires, not the destructive fires that we're getting now.

comment by Joe_Collman · 2020-09-17T16:14:40.210Z · LW(p) · GW(p)

Thanks.

All we have to do is take our Vitamin D

Certainly a good idea, but I think your post from last week may be overconfident in the likely impact.

Since it's important, and I'm not sure if most people saw it, I'll repost this video looking at the molecular biology of vitamin D, which I talked about in this post [LW(p) · GW(p)].

I remain a non-expert, so I hope that more knowledgeable people than I will have some thoughts on the implications for vitamin D impact in healthy people.

Replies from: Zvi
comment by Zvi · 2020-09-17T22:35:37.019Z · LW(p) · GW(p)

I'm trying not to overstate the case, but not making too much of an effort - e.g. enough to avoid overstating it if taken out of context. I'm saying more that, it might be enough, we've declined to figure that out along with many other things, and that if it *was* enough that it wouldn't cause behaviors to change.

Replies from: Joe_Collman
comment by Joe_Collman · 2020-09-18T02:06:59.189Z · LW(p) · GW(p)

Oh sure - I agree with almost all of what you've said, and with the direction of your conclusions. I certainly don't want to suggest that people should be wary of taking supplements.

On a population level, I agree that it's plausible that widespread D supplementation may be enough. On a personal level, I wouldn't want people assuming that good D levels are sufficient to make them ~92% safer than baseline; perhaps they really are, but I don't think that's certain enough to take an "Unless you’d put someone vulnerable at risk, why are you letting another day of your life go by not living it to its fullest?" approach.

While few readers will organise raves after reading that sentence, it does strike me as possible the 92% result could impact behaviour: to an extent, it should. But given that there's room for doubt in the interpretation of low D measurements (if serious Covid is causing them, and pre-existing deficiency isn't implied), it seems important not to go too far.

comment by fraidykluofficer.com · 2020-09-23T12:14:39.595Z · LW(p) · GW(p)

Last week we learned there is plausibly a simple, cheap and easy way out of this entire mess. All we have to do is take our Vitamin D.

tldr;

Taking vitamin D supplements can help, if you are deficient, but it is not a cure.

There is no "simple, cheap and easy way out of this entire mess".

Excerpt:

To protect himself from COVID-19, Dr. Anthony Fauci has long said he’s skipping hugs and handshakes, wearing a mask, and staying off of planes. Last week, he acknowledged adding another step to protect his health: taking supplements of vitamin-D.

“If you are deficient in Vitamin-D, that does have an impact on your susceptibility to infection,” Fauci, head of the National Institute of Allergy and Infectious Diseases, said in an interview posted on Instagram last week. “So I would not mind recommending—and I do it myself—taking vitamin-D supplements.”

However, while spurious claims that vitamin-D can prevent or treat COVID-19 have proliferated online, including some recommending potentially dangerous doses, it’s important to point out that Fauci wasn’t talking about vitamin-D helping with COVID-19 in particular. Instead, he was speaking more broadly about vitamin-D’s importance in caring for our immune system. (...)

How should people think about their vitamin-D intake during the pandemic? For starters, don’t view it as a silver bullet protecting you from COVID-19—there’s simply not enough scientific evidence for that. But if you’re one of the many Americans with insufficient vitamin-D levels, it may be a good idea to increase your intake—if not to protect yourself from the virus directly, then at least to improve your health more broadly.

comment by charlesoblack · 2020-09-19T15:16:46.331Z · LW(p) · GW(p)

FWIW, I think the graphs could be a little easier to read if you used the same colors consistently. The positive test percentages graph has one fewer element in it, and the color order is different from the other graphs (blue is West vs Northeast).

comment by Randaly · 2020-09-18T03:30:24.079Z · LW(p) · GW(p)

2049, not 2045.

Trump continues to promise a vaccine by late October. The head of the CDC says that’s not going to happen. Trump says the head of the CDC is ‘confused.’ The CDC walks the comments back. On net, this showed some attempt by the CDC to not kowtow to Trump, but then a kowtow, so on net seems like a wash.

This is missing the last step, which is that the CDC then walked back its walk back (?!?). See here:

The CDC scrambled to explain; by about 6 p.m., the agency was claiming Redfield had misunderstood the original question and was referring to the time period when all Americans would have completed their Covid-19 vaccination.

The CDC’s initial statement was plainly false: During Wednesday’s Senate hearing, a senator asked Redfield when a vaccine will be “ready to administer to the public,” and Redfield acknowledged the precise question before delivering his response.

“If you’re asking me, when is it going to be generally available to the American public, so we can begin to take advantage of a vaccine to get back to our regular life? I think we’re probably looking at late second quarter, third quarter 2021,” he said.

At around 9 p.m. Wednesday, however, the CDC contacted reporters to rescind its statement walking back Redfield’s prior comments, saying only that it had not been “cleared” by higher-ups.

AFAICT where this wound up was that Redfield then issued a bland statement that a vaccine was important.

comment by Pattern · 2020-09-17T16:19:26.122Z · LW(p) · GW(p)

A vaccine will be available in October if Trump is able to override the CDC and FDA, and make it happen by fiat to help its reelection chances.

I have a strong preference on outcomes, which readers can presumably guess – but saying it outright wouldn’t convince anyone.

As a utilitarian, or as a matter of "values"?

Replies from: Zvi
comment by Zvi · 2020-09-17T22:34:23.631Z · LW(p) · GW(p)

Who said I was a utilitarian? I am saying that I have a clear preference order, and one candidate is above the other (and also prefer a clear and accepted victory to a disputed one, no matter who wins).

Its above refers to Trump's administration in that sentence, yes.

comment by bmc · 2020-09-18T05:36:22.508Z · LW(p) · GW(p)
I continue to think distribution would be the right thing to do and the objections are deeply wrong, and of course that none of that has anything to do with why Trump is going to try to overrule those objections.

How much do we know about the interactions between vaccines? If a rushed and ineffectual vaccine A is wildly distributed, is it likely that an unrushed vaccine B will still be just as effective?

comment by gbear605 · 2020-09-18T02:51:13.327Z · LW(p) · GW(p)
The bigger point is that once again we have two distinct versions of ‘scientific consensus’ about what’s going on with these fires.

Perhaps it's all my filter bubble, but what I'm hearing democrats say is that the issue is caused by a history of mismanagement combined with climate change. After all, the mismanagement hasn't changed significantly over the last twenty years, but the fires have gotten significantly worse over the last twenty-thirty years. The people I know who have lived in California for the last fifty years have talked about how until the mid-90s, they didn't hear about wildfires at all, and since then it's significantly gone up. Looking at the list of twenty largest fires since 1932, ten are since 2010 and an additional seven were between 2000 and 2010. Only three were before 2000. Graphing the acres burned over time since 2000 shows a clear increase, and that remains even if you remove this year's fires.

Obviously there's more time for brush to accumulate, but as other comments have mentioned, the fires burning have removed some of that brush, taking away fuel, so that's likely close to a wash, and I doubt that it could explain an increase of 3x on the trend-line.

Overall, climate change seems like a necessary cause for these fires, even if not a sufficient one. Of course, the mismanagement is also a necessary cause - and I've certainly seen plenty of left-leaning leaders blaming California for that - but keeping both causes in mind is important, especially when one issue is local to California and the other issue is global.