Category: Medicine

Fortschritt

by  Tyler Cowen in

Germany has decided to stop using the coronavirus infection rate as its yardstick for deciding if restrictions should be in force to contain the spread of the virus, Chancellor Angela Merkel said on Monday.

The seven-day incidence rate was a key measure in determining whether restrictions could be imposed or lifted, with infection thresholds of 35, 50 and 100 per 100,000 people triggering the opening or closure of different parts of society.

But as the number of people who are fully vaccinated rises, calls have grown for the incidence rate to be dropped as a measure to determine whether lockdowns are necessary.

“We decided today that we no longer need comprehensive protective measures when the number of cases or incidence is 50, because a large proportion of the people are vaccinated,” Merkel said.

When will California do the same?  Here is the full story.

The problem with fitting third doses into a regulatory structure

by  Tyler Cowen in

That is a key theme of my latest Bloomberg column, here is one excerpt:

In the U.S., President Joe Biden’s administration is now pushing third booster shots for people who already have been vaccinated. That might be a good idea, but it too creates additional uncertainty for travel and migration — and for social interaction more broadly. If three doses are so important, should people be allowed to travel (or for that matter interact indoors) with only two doses? The bar is raised yet again.

Of course the issues do not end with the third dose. If the efficacy of the second dose declines significantly in less than a year, might the same happen with the third dose? How long before four doses are necessary, or maybe five? Or what if yet another significant Covid variant comes along, and only some people have a booster dose against that strain? What then counts as being “sufficiently vaccinated”?

Many Americans seem to be keen to get their third dose, but by the nature of counting that number is fewer than the number willing to get two doses. Furthermore, many people might just tire of the stress of dealing with an ongoing stream of obligatory booster shots and stop at one or two.

The sad reality is that the “two-dose standard” may not last very long, whether abroad or domestically (the same is true of the even weaker one-dose standard with Johnson & Johnson and AstraZeneca). Vaccine mandates will become harder to define and enforce, will be less transparent, and will probably be less popular.

If you tell people that three doses are needed for safety, but two doses are enough to get you into a concert or government building, how are they supposed to sort out the mixed messages? It is not obvious that enough people will get the third dose in a timely manner to make that a workable standard for vaccine passports.

Add to that the problems with the Johnson & Johnson vaccine, which originally the government urged people to get. Now those people are not being given comparable chances to obtain boosters — in fact, they are not yet being given specific guidance at all. Are they orphaned out of any new vaccine passport system, or will (supposedly dangerous?) exceptions be made for them? Or do they just have to start all over?

The big international winner from all this is likely to be Mexico, which has remained an open country and is not relying on vaccine passports. In general I do not admire Mexico’s lackadaisical Covid response, but the country may end up in a relatively favorable position, most of all when it comes to tourism and international business meetings.

As for the U.S. and Europe, the temptation to escalate required safety measures is understandable. But the previous vaccine standards were largely workable ones. If they are made tougher, they might break down altogether.

Recommended.

Covid markets in everything, certified air ambulance regulatory arbitrage edition

by  Tyler Cowen in

“We weren’t sure what was going to happen … if they were going to separate us or put us in a hospital,” said McElroy. “I didn’t know if I was going to need a respirator.”

None of that happened. Within 72 hours, the couple was on a Learjet back to Arizona.

Before they left, Underwood purchased memberships with Covac Global, a medical evacuation company launched by the crisis response firm HRI in the spring of 2020. It meant the couple didn’t pay a dime for their repatriation, said McElroy.

Commercial airlines and private jets can’t fly travelers with Covid-19 home, but certified air ambulances staffed with medical teams can.

While some companies evacuate travelers who require hospitalization, Covac Global retrieves travelers who test positive for Covid-19 and have one self-reported symptom. About 85% of evacuees are returned home, while the rest need hospital attention, said CEO Ross Thompson.

When CNBC first spoke with the company in March, it was performing about two to three medical evacuations every month. Now, that number has climbed to about 12 to 20.

Here is the full story, via Shaffin Shariff.

They had better hurry up and distribute those AstraZeneca doses

by  Tyler Cowen in

Movement data from last weekend show Melburnians engaging in what experts have called thousands of small transgressions with the potential to drive COVID-19 infections higher, as the effect of 200 days of lockdown takes an emotional toll.

Google mobility data compiled by The Age reveals that across the state last Friday and Saturday, people were moving more than at any time since mid-July last year when complacency prompted Premier Daniel Andrews to plunge the state into stage-four lockdown and mandatory mask-wearing.

Last weekend saw a spate of breaches including an organised takeaway pub crawl in Richmond and an engagement party in Caulfield North attended by 69 guests. The couple involved in the illegal party have received $5400 fines. Two of their parents were also fined and other guests are being interviewed.

Some metropolitan municipalities including Glen Eira and Bayside recorded their highest lockdown movement levels last week, ahead of a number of mystery cases appearing in St Kilda.

Professor Mike Toole from Melbourne’s Burnet Institute, who lives in a mobility hotspot in the inner south, said he was shocked to witness large groups of people gathering in parks at the weekend.

Here is the full article, via Rich Dewey.  And the Sydney lockdown is now extended until the end of September, with masks mandated for outside as well.  Elsewhere:

Walmart, Target and Lowe’s, by contrast, all lifted sales forecasts this week after beating expectations for the three months to the end of July. While demand for toilet paper and cleaning supplies has cooled after 2020s pantry hoarding, the appetite for other products was broad-based.  Party supplies, apparel and travel gear flew off Walmart’s shelves. At Home Depot, an early cache of Halloween decorations sold out almost immediately. Swimsuits and children’s clothing were similarly popular at Target and, in another sign of confidence, more customers returned to Walmart and Target store aisles after a year of browsing online.

Here is the associated FT article.  Which set of values do you prefer?  Which do most people prefer?

How sad that our regulatory state is still failing us

by  Tyler Cowen in

When Pfizer representatives met with senior U.S. government health officials on July 12, they laid out why they thought booster shots would soon be necessary in the United States. Data from Israel showed the vaccine’s effectiveness waned over time, especially in older and immunocompromised people.

But officials from the Centers for Disease Control and Prevention disagreed, saying their own data showed something quite different, according to four people with direct knowledge of the meeting who spoke on the condition of anonymity.

Other senior health officials in the meeting were stunned. Why hadn’t the CDC looped other government officials on the data? Could the agency share it — at least with the Food and Drug Administration, which was responsible for deciding whether booster shots were necessary? But CDC officials demurred, saying they planned to publish it soon.

That episode, say senior administration officials and outside experts, illustrates the growing frustration with the CDC’s slow and siloed approach to sharing data, which prevented officials across the government from getting real-time information about how the delta variant was bearing down on the United States and behaving with greater ferocity than earlier variants — an information gap they say stymied the response…

“It’s not acceptable how long it takes for this data to be made available,” said a senior CDC official, who spoke on the condition of anonymity to discuss internal matters. “It’s done in a very academic way. Cross every ‘t,’ and dot every ‘i,’ and unfortunately, we don’t have that luxury in a global pandemic. There’s going to be a need to have a significant cultural shift in the agency.”

Here is the full Washington Post story by Yasmeen Abutaleb and Lena H. Sun.

A reader’s wishes for Covid coverage

by  Tyler Cowen in

From my email:

“In the last 18-19 months why have these stories not been written:
•       Why no stories on hospice care in the United States relating to covid19 statistics (hospice has been removed from our common lexicon)? I’ve asked you this before, I know.
•       Why no stories on the earnings of publicly held life insurance companies ?
•       Why no stories about strategies written about the myriad of home health care providers in this country? What is their role in lessening hospital stays in the last 18 months. Did they play a role?
•       Why know detailed explanation of how excess deaths are calculated – what are the excess death estimates for the next 5 years? I assume the data is easily found.
•       No actuaries providing keen information and insights?
•       Detailed investigations and stories of the traveling nurse industry ?  I know several, interesting stories to say the least. Mostly regarding compensation.
•       No keen insights from the coroners industry? The inexact science of “cause of death” in the last 100 years.

Would love you thoughts on my questions and why have there been no stories about the above?”

The FDA and CDC Standards on the J&J Vaccine and the Immunocompromised are Unintelligible

by  Alex Tabarrok in

Last week the FDA authorized and the CDC now recommends a third mRNA booster for the immunocomprimised. The CDC says:

Who Needs an Additional COVID-19 Vaccine?

Currently, CDC is recommending that moderately to severely immunocompromised people receive an additional dose. This includes people who have:

  • Been receiving active cancer treatment for tumors or cancers of the blood
  • Received an organ transplant and are taking medicine to suppress the immune system
  • Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response

That’s very reasonable but the headline is inaccurate because the CDC then goes on to say:

The FDA’s recent EUA amendment only applies to mRNA COVID-19 vaccines, as does CDC’s recommendation.

Emerging data have demonstrated that immunocompromised people who have low or no protection following two doses of mRNA COVID-19 vaccines may have an improved response after an additional dose of the same vaccine. There is not enough data at this time to determine whether immunocompromised people who received the Johnson & Johnson’s Janssen COVID-19 vaccine also have an improved antibody response following an additional dose of the same vaccine.

So if you got one dose of J&J and are immunocompromised then you can’t get a second dose. But if you got two doses of an mRNA (which is already more effective than one dose of J&J) and are immunocompromised then the CDC recommends a third dose. None of this makes any sense. The weasel words there ‘isn’t enough data to determine’ indicate a typical failure to think in Bayesian terms and use all the information available and a typical failure to think in terms of patient welfare and expected cost and benefits.

Notice also the illiberal default. Instead of saying ‘we don’t have data on the J&J vaccine and the immunocompromised so we are not at this time recommending or not recommending boosters but leaving this decision in the hands of patients and their physicians’ they say ‘we don’t have data and so we are forbidding patients and their physicians from making a decision using their own judgment.’

Hat tip: Pharmacist CB.

This should be hailed, and yet there is mostly silence from the elites

by  Tyler Cowen in

Florida Gov. Ron DeSantis rolled out a new state treatment plan to help fight COVID-19, announcing Thursday that the state will start dispensing Regeneron monoclonal antibodies through mobile clinics…

DeSantis is urging people at high risk — the elderly, the obese, people with diabetes — to get the monoclonal antibodies at the first indication of COVID-19.

Florida is making the antibody therapies more widely available by opening a rapid response unit in Jacksonville with an eye toward expanding across the state.

Here is the full story.

Fluvoxamine seems to work against Covid-19

by  Tyler Cowen in

That is from a project funded by Fast Grants.

Our Regulatory State Isn’t Learning

by  Alex Tabarrok in

Outsourced to John Cochrane:

Delta is the fourth wave of covid, and amazingly the US policy response is even more irresolute than the first time around. Our government is like a child, sent next door to get a cup of sugar, who gets as far as the front stoop and then wanders off following a puppy.

The policy response is now focused on the most medically ineffective but most politically symbolic step, mask mandates. An all-night disco in Provincetown turns in to a superspreader event so… we make school kids wear masks in outdoor summer camps? Masks are several decimal places less effective than vaccines, and less effective than “social distance” in the first place.* Go to that all night disco, unvaccinated, but wear a mask? Please.

If we’re going to do NPI (non pharmaceutical interventions), policy other than vaccines, the level of policy and public discussion has tragically regressed since last summer. Last summer, remember, we were all talking about testing. Alex Tabarrok and Paul Romer were superb on how fast tests can reduce the reproduction rate, even with just voluntary isolation following tests. Other countries had competent test and tracing regimes. Have we built that in a year? No. (Are we ready to test and trace the next bug? Double no.)

What happened to the paper-strip tests you could buy for $2.00 at Walgreen’s, get instant results, and maybe decide it’s a bad idea to go to the all night dance party? Interest faded in November. (Last I looked, the sellers and FDA were still insisting on prescriptions and an app sign up, so it cost $50 and insurance “paid for” it.) What happened to detailed local data? Did anyone ever get it through the FDA’s and CDCs thick skulls that even imperfect but cheap and fast tests can be used to slow spread of disease?

…And then we indulge another round of America’s favorite pastime, answers in search of a question. Delta is spreading, so… extend the renter eviction moratorium. People who haven’t paid rent in a year can stay, landlords be damned.

All true. I got dispirited on testing. It’s insane that we don’t have cheap, rapid testing and good ventilation ready for a new school year. As I wrote about earlier, even the American Academy of Pediatrics is shouting from the rooftops that the FDA is deadly slow. The eviction moratorium is a sick joke. Just a backhanded way to redistribute wealth without a shred of justice or reason. Disgusting.

Here’s one more bit (but read the whole thing there is more.)

To learn from the mistakes, and institutionalize better responses would mean to admit there were mistakes. One would think the grand blame-Trump-for-everything narrative would allow us to do that, but the mistakes are deeply embedded in the bureacracies of the administrative state. Unlike bad admirals in WWII, nobody less than Trump himself has lost their job over incompetent covid response. The institutions have an enormous investment in ratifying that they did the best possible job last time. So, as in so many things (financial bailouts!) we institutionalize last time’s mistakes to keep those who made them in power in power — which means we do not learn from mistakes.

Covid dispatch from a relatively non-Straussian country

by  Tyler Cowen in

Most people will end up contracting the coronavirus, the head of the Health Ministry’s advisory committee for infectious diseases predicted on Monday.

“The [real] question is whether the infected person is vaccinated or not. It’s unavoidable that the pandemic will infect the majority of the population. It won’t disappear in another half a year,” Dr. Tal Brosh told the Kan public broadcaster.

Brosh, who also heads the infectious disease department at Assuta Medical Center in Ashdod, said he doesn’t see a reason to shutter Ben Gurion Airport, arguing that would distract “from the main problem — morbidity within in the country.”

WWAFS?  How many of our mainstream public health experts would even consider addressing such a question at this point?  Do you think they are telling you the truth?

p.s. Which again is the country with the best data?

Addended p.p.s.: “Between 90% and 94% of British adults have some degree of immunity to coronavirus from full or partial vaccination, or prior infection, the U.K. statistics office estimates, based on statistical analysis of blood samples.”

Here is the full story.  Via Rich B.

At this point, do you wish to simply not look too closely at the Delta data?

by  Tyler Cowen in

The delta Straussians also don’t want to debate safety claims very much. They fear that studying the data more closely will worry and paralyze us more, without much limiting the overall number of infections. In their view, vaccines have made things about as safe as they are going to get, and the contagiousness of delta will create lots of infections, albeit mostly relatively safe ones.

That’s what the proprietor of one of my favorite local restaurants believes. He is aware of the delta strain, and knows it is worse, though without being up on the numbers or the details. Earlier in the summer, he lifted the mask mandate for his restaurant, and he isn’t interested in restoring it. He is not a “Covid denialist,” but he figures normal business has to continue at some point and that point is now. Someone may well catch Covid in his restaurant, but those people might well have caught Covid anyway.

Our school reopenings face a similar paralysis-inducing dilemma. If we test every child every day, it will seem as if we have far too many cases of Covid, and the schools will shut again quickly. Nonetheless, given that delta is highly contagious, many of those children will catch Covid whether or not they go to school…

I do not rue the growth of delta Straussianism among my fellow citizens. If you can’t do anything about delta, if your institution needs to reopen sooner or later, if the booster shots in large numbers are not right around the corner, and yet another new variant might be coming along anyway, maybe you really do just need to get on with things. Restaurant reservations are robust, and the gym industry is surging back. I do not wish to reverse those trends, and it is hard to believe those customers are only the Covid denialists.

Here is the full Bloomberg column, which also offers a take on the British test and trace system.