Category: Current Affairs
In the study, 112 patients received 2.8 grams of each of the antibodies, and 156 received placebo. The difference in viral load was statistically significant at day 11, unlike some doses of Lilly’s single-antibody cocktail. There was also a statistically significant reduction in viral levels three days and seven days after infection.
The treatment also improved symptoms, according to a scored questionnaire, and resulted in fewer hospital and emergency room visits. Visits to the hospital or ER were made by 5.8% of patients in the placebo group, but just 0.9% of those who received the antibody combination. That difference, however, was just barely statistically significant.
Lilly said that it has already begun talking to regulators around the world about its single antibody treatment, and has filed with the Food and Drug Administration for an emergency use authorization…
Lilly said it anticipates it could have as many as 1 million doses of its one-antibody treatment, LY-CoV555, available in the fourth quarter of 2020, with 100,000 available this month. But for the combination therapy, just 50,000 doses will be available in the fourth quarter of 2020.
Both antibody regimens have been well-tolerated, with no serious side effects, the company said.
Here is the full story from StatNews. Big news, but not a surprise to everyone.
For me one of the most fun episodes, here is the audio, video, and transcript. And here is the longer than ever before summary, befitting the chat itself:
Audrey Tang began reading classical works like the Shūjīng and Tao Te Ching at the age of 5 and learned the programming language Perl at the age of 12. Now, the autodidact and self-described “conservative anarchist” is a software engineer and the first non-binary digital minister of Taiwan. Their work focuses on how social and digital technologies can foster empathy, democracy, and human progress.
Audrey joined Tyler to discuss how Taiwan approached regulating Chinese tech companies, the inherent extraterritoriality of data norms, how Finnegans Wake has influenced their approach to technology, the benefits of radical transparency in communication, why they appreciate the laziness of Perl, using “humor over rumor” to combat online disinformation, why Taiwan views democracy as a set of social technologies, how their politics have been influenced by Taiwan’s indigenous communities and their oral culture, what Chinese literature teaches about change, how they view Confucianism as a Daoist, how they would improve Taiwanese education, why they view mistakes in the American experiment as inevitable — but not insurmountable, the role of civic tech in Taiwan’s pandemic response, the most important remnants of Japanese influence remaining in Taiwan, why they love Magic: The Gathering, the transculturalism that makes Taiwan particularly open and accepting of LGBT lifestyles, growing up with parents who were journalists, how being transgender makes them more empathetic, the ways American values still underpin the internet, what he learned from previous Occupy movements, why translation, rotation, and scaling are important skills for becoming a better thinker, and more.
This bit could have come from GPT-3:
COWEN: How useful a way is it of conceptualizing your politics to think of it as a mix of some Taiwanese Aboriginal traditions mixed in with Daoism, experience in programming, and then your own theory of humor and fun? And if you put all of that together, the result is Audrey Tang’s politics. Correct or not?
TANG: Well as of now, of course. But of course, I’m also growing, like a distributed ledger.
COWEN: You’re working, of course, in Taiwanese government. What’s the biggest thing wrong with economists?
TANG: You mean the magazine?
COWEN: No, no, the people, economists as thinkers. What’s their biggest defect or flaw?
TANG: I don’t know. I haven’t met an economist that I didn’t like, so I don’t think there’s any particular personality flaws there.
COWEN: Now, my country, the United States, has made many, many mistakes at an almost metaphysical level. What is it in the United States that those mistakes have come from? What’s our deeper failing behind all those mistakes?
TANG: I don’t know. Isn’t America this grand experiment to keep making mistakes and correcting them in the open and share it with the world? That’s the American experiment.
COWEN: Have we started correcting them yet?
TANG: I’m sure that you have.
That is the topic of my latest Bloomberg column, here is one excerpt:
The more time passes, the more I wonder if I have, in fact, contracted an asymptomatic version of Covid. The chance of that was quite small in February, but as each month passes it becomes modestly more likely. That realization could easily nudge many people into taking just a bit more risk.
Another train of thought considers the possibility of having a pre-existing protective immune response, perhaps from T-Cells. Experts are not sure of the likelihood or magnitude of this effect, but some have suggested that as many as one-third of Americans may have some built-in protection.
Again, as the months pass, it’s rational for me to upgrade the probability that I have such a protective immune response. With the passage of time, I will feel more protected than I used to.
The basic reasoning is straightforward: Since I haven’t caught a bad form of it by now, I must be relatively safe. Many Americans may or may not grasp the finer points of the immunology and the Bayesian statistical reasoning, but that is a very common-sense kind of response.
And so such people will take more risk — to the detriment of the broader community.
There is much more at the link, including a discussion of intertemporal substitution. These are some reasons why initially good (or bad) Covid responses tend to get worse, relevant for Europe as well.
I am very happy to see this new and urgently needed study. They have heeded the stricture to show their work. The authors are Donald A. Berry, Scott Berry, Peter Hale, Leah Isakov, Andrew W. Lo, Kien Wei Siah, and Chi Heem Wong, and here is the abstract:
We compare and contrast the expected duration and number of infections and deaths averted among several designs for clinical trials of COVID-19 vaccine candidates, including traditional randomized clinical trials and adaptive and human challenge trials. Using epidemiological models calibrated to the current pandemic, we simulate the time course of each clinical trial design for 504 unique combinations of parameters, allowing us to determine which trial design is most effective for a given scenario. A human challenge trial provides maximal net benefits—averting an additional 1.1M infections and 8,000 deaths in the U.S. compared to the next best clinical trial design—if its set-up time is short or the pandemic spreads slowly. In most of the other cases, an adaptive trial provides greater net benefits.
And what is an adapted trial you may be wondering?:
An adaptive version of the traditional vaccine efficacy RCT design (ARCT) is based on group sequential methods. Instead of a fixed study duration with a single final analysis at the end, we allow for early stopping for efficacy via periodic interim analyses of accumulating trial data…While this reduces the expected duration of the trial, we note that adaptive trials typically require more complex study protocols which can be operationally challenging to implement for test sites unfamiliar with this framework. In our simulations, we assume a maximum of six interim analyses spaced 30 days apart, with the first analysis performed when the first 10,000 subjects have been monitored for at least 30 days.
That means of course you might cut the trial short. Kudos to the authors for producing one of the most important papers of this year.
That is the title of my latest Bloomberg column. Here is one excerpt:
The larger question is how to know when this great stagnation is ending. Counterintuitively, the answer might be when people are most upset — because that’s generally how most humans react to change, even when it proves beneficial in the longer run. These feelings arise in part from the chaos and disruption brought about by some pretty significant changes.
People, here is the good news and the bad news: Change is upon us. We are entering a new era of crises — in politics and biomedicine, with climate and energy, and not incidentally, about how prudently we spend our time.
The regretful truth is that progress is never going to be easy. The great technological advances of the late 19th and early 20th centuries, remember, were followed by two world wars and the rise of totalitarianism. Innovations such as radio and the automobile improved countless lives but also broadcast Hitler speeches and led to destructive tanks.
I’m not predicting the same catastrophe for today. I’m only saying that when the discontent is palpable, as it is right now in America, keep in mind that true breakthroughs may already be underway.
The examples are in the longer text. Recommended!
Tyrone — my evil twin brother — received so much hate and love mail from his recent pronouncements about QAnon that he felt emboldened to offer additional opinions. As you might expect, he prefers to spew his hateful bile on matters of life and death. In particular, he has been following the debates about Covid and whether new treatments should be accelerated in their availability. Anyway, I told him I was willing to pass along another of his letters, as a kind of experiment (not quite a clinical trial) whether Tyler or Tyrone is a more beloved writer on MR. I am sure you readers — and especially commentators — stand ready to defend my honor!
So here is his (as usual) fallacy-ridden missive:
Tyler, I don’t see why you let the defenders of FDA stalling get away with their dawdling. They all end up with the same argument — if we let wonderful, salt of the earth Americans take beneficial medicines, treatments, and vaccines, we will not be able to set up informative clinical trials. Why partake in the trial when you can just get the stuff through normal means?
That is so lame! First, they could simply pay people to partake in those trials. Isn’t that in essence what the NBA did with its Covid testing in the bubble? If the value of those clinical trials truly is so high, it should be possible to internalize enough of those benefits to encourage participation. If institutional barriers stand in the way there, let’s obsess over fixing those.
Why should we force so many Americans to be sacrificial lambs, just to subsidize the trial costs? Let those costs be taken out of grant overhead! (And admin. salaries, if need be.)
If the current medical establishment is not as able as the NBA, well OK, can’t they just admit it and plead patheticness? We can send them to take care of Major League Baseball, and put Adam Silver and Lebron James in charge of our health care.
Second, there is another way to keep the trial up and running. Approve use of the treatment, but allow the suppliers to charge very high prices! Better yet, use the law to make them charge high prices and if need be forbid insurance coverage.
“What will it be sucker? Fifty percent chance of the placebo, or 100k for those monoclonal antibodies?”
I assure you Tyler that will restore a separating equilibrium. Furthermore, in the meantime only the most meritocratic of wealthy men will get the treatment outside of the trial, all for the better. If need be, you can pull away the price floor when the clinical trial is complete, in the meantime you have satisfied the Pareto principle.
And what about the Hippocratic Oath ? “Do no harm”? Is that not invoked so selectively by the public health commentators? Surely you realize they court public opinion and high status by taking sins of commission far more seriously than the far less visible sins of omission?
Is it not harm to deny patients ready accessibility to a treatment with positive expected value?
Is it really such a great rejoinder to insist “We can’t let those patients improve their lot by raising pecuniary costs for the medical professionals running their trials! That is true Hippocratic harm and must be avoided at all costs, because in fact we medical people would be too feckless to overcome that problem…”
Sigh. At that point I had to stop reading and transcribing. I am sorry readers, I didn’t know that Tyrone in his spare time was studying economics and indeed some logic as well. Maybe he has even been reading MR. That makes him less interesting, less funny, and maybe a bit too much like Tyler. That is not why you come to read Tyrone, and indeed you might as well be reading Tyler.
What can I do to make Tyrone better and more eccentric again? Perhaps try to get him premature access to some of those special treatments? Stay tuned….
Here is the story, note the treatment is making a very good impression:
Prof Peter Horby, who is part of Oxford University’s national Recovery trial, which aims to identify potential treatments for Covid-19, said “about three hospitals in the north” began using the drug last weekend. He said the drug was due to be rolled out to another 30 to 40 UK hospitals next week.
He told BBC Radio 4’s Today programme that the drug, REGN-COV2, was “very promising” and “very potent”.
“The class of drugs, these artificial antibodies, have been around for quite a while now, and they’ve been extensively used in inflammatory conditions and cancers, and they’re pretty safe and well understood, and so the technology is something that I think we have confidence in,” Horby said.
“This particular drug has probably been given to, I would think now, four or five hundred patients, mild or severe patients in different trials, and so far there’s been no worrying safety signals.
“In the laboratory, in cell cultures, it has a very strong effect against the virus, and there have been studies in artificial animals where it also shows benefits. So probably of the drugs that are available, it’s one of the most promising.”
Horby said a single dose of the treatment provided prolonged protection for a month to six weeks, making it “quite attractive for the older population”.
I hope Donald Trump “twists” the arms of the scientists at the FDA into speedy Emergency Use Authorization, and “politicizes” them into doing the right thing.
Twist, Donald! Yes, they are accountable too. Twist harder! That’s why we gave you the monoclonal antibodies.
And please don’t tell me in response that we can expect ordinary Americans to apply for the compassionate use exception, or sign up for clinical trials.
In an interview Friday afternoon, Regeneron’s chief executive, Dr. Leonard S. Schleifer, said Mr. Trump’s medical staff reached out to the company for permission to use the drug, and that it was cleared with the Food and Drug Administration.
“All we can say is that they asked to be able to use it, and we were happy to oblige,” he said. He said that so-called compassionate use cases — when patients are granted access to an experimental treatment outside of a clinical trial — are decided on a case-by-case basis and he is not the first patient to granted permission to use the treatment this way. “When it’s the president of the United States, of course, that gets — obviously — gets our attention.”
In my non-specialist but not entirely uninformed opinion, this is basically an effective treatment, and barring major unobserved genetic risk factors Trump will recover. The risk of side effects is not significant. But of course neither the FDA nor Regneron will let me do the same. Or you.
There is such cacophony when Trump pushes the FDA to speed vaccine approval — mere pressure rather than an action. Yet when he actually gets a promising treatment through the process “prematurely” — only for himself — not a single person is yelping. Not even his worst enemies and most vicious opponents. Nor do I see anyone arguing that the President is being allowed to take excess risk, and that the judgments of the regulators should be enforced consistently and for the good of the office of the presidency.
Nope. Model that! (Hint: start with the idea of status.)
In the meantime, I think the common intuition about the Trump monoclonal antibodies case is essentially correct, and it ought to be applied most broadly. And not just for presidents.
Here is the full NYT story.
Comments are open. But if you as a reader click on the comments link, the fault is yours not mine.
And yes, you can find a parking spot in most parts of Manhattan these days, another novelty. Did I mention that my hotel room cost less than a third of what I’ve normally paid?
I visited the Museum of Modern Art, operating under stringent visitor restrictions and with its tourist clientele mostly gone. I had just about every gallery to myself, and thus an unparalleled look at the museum’s masterpieces. If a room had even a few other visitors in it, I moved on and came back later.
The center of the city has moved downtown, to Greenwich Village and surrounding areas. Many streets are closed to cars, and restaurants have put their tables on the sidewalk or the street. Instead of choosing a place on the basis of the food, the menu now just has to be “good enough,” with the key variables being the quality of the seating and the degree of the spacing. I have never seen that part of town feel so alive. The most vibrant single street for both food and socializing was slightly further north in Koreatown, starting at 32nd and Broadway and spreading two blocks to the east.
Here is the rest of my Bloomberg column on that topic. By no means is my entire assessment so positive, but that is the excerpt you are getting today.
A herd immunity data point: Borough Park in NYC has one of the highest antibody rates seen in the developed world: 43.9%, based on a huge testing program covering almost 1/3 of local pop. This week positivity rates of Covid-19 tests coming back hit 17%.
Here is the abstract of a new paper by
We have studied the evolution of COVID-19 in 12 low and middle income countries in which reported cases have peaked and declined rapidly in the past 2-3 months. In most of these countries the declines happened while control measures were consistent or even relaxing, and without signs of significant increases in cases that might indicate second waves. For the 12 countries we studied, the hypothesis that these countries have reached herd immunity warrants serious consideration. The Reed-Frost model, perhaps the simplest description for the evolution of cases in an epidemic, with only a few constant parameters, fits the observed case data remarkably well, and yields parameter values that are reasonable. The best-fitting curves suggest that the effective basic reproduction number in these countries ranged between 1.5 and 2.0, indicating that the curve was flattened in some countries but not suppressed by pushing the reproduction number below 1. The results suggest that between 51 and 80% of the population in these countries have been infected, and that between 0.05% and 2.50% of cases have been detected; values which are consistent with findings from serological and T-cell immunity studies. The infection rates, combined with data and estimates for deaths from COVID-19, allow us to estimate overall infection fatality rates for three of the countries. The values are lower than expected from reported infection fatality rates by age, based on data from several high-income countries, and the country population by age. COVID-19 may have a lower mortality risk in these three countries (to differing degrees in each country) than in high-income countries, due to differences in immune response, prior exposure to coronaviruses, disease characteristics or other factors. We find that the herd immunity hypothesis would not have fit the evolution of reported cases in several European countries, even just after the initial peaks; and subsequent resurgences of cases obviously prove that those countries have infection rates well below herd immunity levels. Our hypothesis that the 12 countries we studied have reached herd immunity should now be tested further, through serological and T cell immunity studies.
Via Alan Goldhammer.
Addendum: From Catinthehat in the comments:
It’s a simple homogeneous model Ni(t+1)= Ni(t) * Ro * Si(t) / Ntot -> Infected at time t+1 = Infected at time t * Ro * the proportion ( of the population) susceptible at time t. where t is discretized.
They fit the step t to an infection duration , then they fit Ro, to reproduce the shape of the curve for each country and at each step they multiply the infected by a parameter p (the undetected case ratio) to fit to the total population. This acts as an accelerant to the epidemic . Each country has its own p.
The main issue is that you can look at any epidemic curve and fit it that way and you will rather automatically reproduce this high immunity threshold which comes from your homogenous model.
In Europe you can’t assume the undetected ratio is so high ( 1000x to 2000 x) so you must conclude social distancing stopped the epidemic, because your strategy would not fit experimental data.
In the countries fitted , the paper must conclude the epidemic raged fairly undetected, fairly quickly and infected most of the population.
That is the topic of my latest Bloomberg column, here is one excerpt:
Now consider another of my favorite pastimes, watching professional basketball. I have been following the NBA bubble with great interest. The Miami Heat are now favored to reach the NBA Finals, even though they were only the fifth-ranked team in the East at the end of the regular season. What happened? They have played with grit and determination, and their entire active roster showed up in first-rate physical shape. That’s not easy to do after a five-month layoff, as it required tremendous discipline.
In contrast, the Los Angeles Clippers were among the favorites to win the NBA title. They were recently eliminated by the Denver Nuggets, a very good team but not previously a top contender. In the final quarter of the last game of the series, the victorious Nuggets played with energy and verve, while the Clippers seemed to be gasping for air. After their defeat, some of the Clippers admitted that inferior conditioning was part of their problem.
So “staying in shape during a five-month layoff” is now a critical skill for a basketball player. But this doesn’t necessarily mean the Clippers need to revamp their roster. Maybe they should just wait for a return to normal times.
Might these changes in quality affect your choices beyond work — such as your decisions about friends, family relations, romance, and much more? Should you buy a dog, knowing you probably won’t be homebound two years from now? How about dating? On a first date, presumably, looks should matter less and social carefulness more. But again, for how long? It would be very strange, and probably unwise, to form a lasting relationship based on how well your romantic interest wears a mask.
Sadly the world has entered a new paralysis, most of all because no one knows when things will return to normal, or what might become normal, or what might remain strange. When this pandemic ends, one thing we can all look forward to is making better plans.
Recommended, at least until the pandemic is over.
Many of you ask me for reports of my evil twin brother Tyrone, but of course I demur because I am too embarrassed to pass along his doings. They get worse and worse. Nonetheless, Tyrone said he was going public with this one, so I thought the damage was done in any case. The sad news is that Tyrone is now an active proponent of QAnon. How can he fall for such fallacies and stupidities? He sent me this letter to explain his decision:
You have yourself blogged about the import of child abuse, and asked why it is not condemned more widely, most of all among elites. You even wrote that the right wing ignored the issue — I thought it is time to remedy that! We needed a right-wing movement to protect the world’s most vulnerable citizens, and it turned out that looked like QAnon. Besides, who is more of an elite than I am?
To be sure, the QAnon movement has its excesses, but do not all social movements? At least it attacks criminals rather than defending them. The key question is whether social movements shine a light on abusive practices that need further scrutiny, and there QAnon passes with flying colors.
QAnon truly has attracted attention — just look at all the complaints about Facebook enabling it. In this world you haven’t arrived until someone can turn a criticism of you into a criticism of Facebook.
Jeffrey Epstein was convicted of…stuff…and the world’s elites continued to treat him as normal and to take his money and fly on his plane. He wasn’t cancelled.
Roman Polanski had a successful and feted career after repeatedly doing very bad…stuff.
The sexual abuse of children has turned out to be rampant in the Catholic Church and also in Hollywood.
I saw the new HBO documentary Showbiz Kids: “In my experience, I know a lot of kids that grew up in the industry. And what surprised me when I got older was finding out that pretty much all of the young men were abused in some way, sexually.”
French intellectuals — and was there ever more of an elite than them? — petitioned to repeal age of consent laws so they can do…bad stuff…with less fear of the consequences. (See? Petitions really are wrong!)
By the way, Berlin authorities placed children with pedophiles for thirty years. And that is in Germany, a country with relatively responsible governance.
This is all so sickening I can’t go on any further, and we haven’t even discussed all that goes on over the internet.
There is in fact an epidemic of child abuse, it ruins or seriously damages many millions of lives, and elites are complicit in covering it up and refusing to address the preconditions that generate so much of it. These same elites often downplay or discourage the elevation of social conservatism, one of the few possible regulatory mechanisms society might have. In the very worst situations, these elites are directly complicit in covering up the abuse of children. Many of the elites partake in it themselves.
Which group has done more to publicize these failings than QAnon, the worthy successor to The Jerry Springer Show?
Yes, Yes I know. I do not endorse all of their hypotheses concerning political economy. Maybe Donald Trump will not in fact set all things straight, and perhaps the apocalypse is not around the corner. No, the molesters do not worship Satan, but given their behavior they might as well. Should we lock up all those journalists? I don’t know. Comet Ping Pong was never as good as Pupatella anyway. But look — this is what you get when you build a mass movement. The message does get dumbed down and the crazies climb on board, just as we have Antifa and some other weird groups and demands connected to what are otherwise valuable social marches. Tyler — you have to get used to this new world of internet communications! Walter Cronkite is gone. Either compete or give up, and I’m not willing to do the latter.
For whatever structural reason, elite media seem less obsessed with child abuse as an issue than is “non-elite media.” That is simply a reality we need to work with, and our unwillingness to discard traditional canons of journalism has led to the perpetuation of these abuses for centuries, indeed dating back to the very founding of the American nation.
Haven’t you read Marcuse on repressive tolerance?
“But actually diving into the sea of trash that is social science gives you a more tangible perspective, a more visceral revulsion, and perhaps even a sense of Lovecraftian awe at the sheer magnitude of it all: a vast landfill—a great agglomeration of garbage extending as far as the eye can see, effluvious waves crashing and throwing up a foul foam of p=0.049 papers. As you walk up to the diving platform, the deformed attendant hands you a pair of flippers. Noticing your reticence, he gives a subtle nod as if to say: “come on then, jump in”.”
The rot runs much deeper than the fallacies of QAnon.
Besides, it seems that the guy behind QAPPANON (don’t ask) is “
And Tyler, I know your criticize me for following these conspiracy theories. But you yourself have written of the need to imagine a future very different from the present and then bring it about? Is that not what a conspiracy tries to do? Do we not need to counter these evil conspiracies with some more benevolent plans?
Most of all, when it comes to evaluating social movements, you can only elevate so many victims at once. Isn’t the notion of children as the true victims the most universal and indeed the only vision that can unify this great nation? People complain about the truth-stretching in QAnon, and OK I get that, but isn’t their real worry the revolutionary re-appropriation of which groups in society can be granted true, #1 victimhood status? Just as Christianity accomplished a similar revaluation way back when? (And look at some of the wacky stuff that they believe — ever read The Book of Revelation Tyler?)
I don’t want QAnon to be in charge, but what other tool do we have to force elites to deal with this issue? Aren’t these just Saul Alinsky tactics? QAnon isn’t going to control Congress anyway.
Besides, is not apophenia one of the roots of creativity? Have not Millenarian movements played key and sometimes beneficial roles in Western history? Is not Christianity itself a Millenarian movement? How about all that weird ass shit on the back of your dollar bill?
Child abuse is the #1 issue in society right now so…pick your side! If you don’t like it, stop your silly blogging and come up with a better anti-child abuse movement.
TC again: See? This is why Tyrone doesn’t appear much on this blog any more. It used to be a funny or sometimes even thought-provoking schtick, but these days things are so out of control you’ve got to stick with message discipline. You can’t just let one speculation lead to the next, because we have so many crazies with major league internet platforms.
Rationalism. Fact-checking. Only one family member at a time (sorry sis!).
Please return tomorrow, or perhaps later in the day, for a proper analysis of the incidence of property tax reform in eastern Colorado. And perhaps there will be some new service sector jobs as well — you can apply! In the meantime, let’s hope that Tyrone’s QAnon fandom isn’t one of them.
And no, I’m not going to try to reenter the Philippines.
Dan Murphy emails me:
I’m wondering if the pandemic is having an outsized effect on the underground economy relative to the economy as a whole. For instance, many of the small businesses that are shuttered or scaled down would be more likely to engage in unreported cash transactions than the online retailers who have thrived. One further, consumers purchasing from small business are less likely to use cash as payment for sanitary reasons or because their payments are processed through Seamless or Uber Eats. With estimates of the size of the underground economy between 11 and 23%, could a 10-50% reduction in these transactions mean we are significantly underestimating the size of the slowdown?
Any thoughts? Any pointers on further discussion?
Do any of you know of good treatments of this?