Category: Medicine

Molnupiravir against Covid

Molnupiravir against Covid (Bloomberg).  It might cut the death rate in half, the market has been boosting the Merck share price.  And more here: “…molnupiravir works by introducing genetic errors that garble the coronavirus’s genetic code. That means it may be more resistant to mutation, and may even work on other coronaviruses or RNA viruses.”  And StatNews here.

You people are crazy

So, I decided to attempt a measurement to quantify this phenomenon. On Wednesday, September 22nd, in the 1:00 pm hour, I observed 400 Stanford cyclists on Lasuen Mall, a popular campus street for bicycles. I simply noted whether each cyclist wore a mask, a helmet, neither, or both. Here are the final tallies:

Total cyclists: 400 – (100%)

No mask, no helmet: 195 – (49%)

Mask, no helmet: 134 – (34%)

Helmet, no mask: 42 – (10%)

Mask and helmet: 29 – (7%)

That works out to a masking rate of 41% and helmet-wearing rate of 17%. So, Stanford students are about twice as likely to wear a mask on a bicycle as a helmet. To be certain, there’s a margin of error here — I can only count so many cyclists at a time, and I’m sure I missed some. But the point stands that at one of America’s leading research universities, students wear masks on bicycles at a higher rate than they wear helmets.

Here is the full article by Maxwell Meyer.

Revisionism on Deborah Birx, Trump, and the CDC

Photo Credit: Official White House Photo by Shealah Craighead

In October of 2020 Science published a long article by Charles Piller titled Undermining CDC with the subtitle “Deborah Birx, President Donald Trump’s COVID-19 coordinator, helped shake the foundation of a premier public health agency.” The article focuses on a battle between Deborah Birx and the CDC over collecting data from hospitals with the basic message that Birx was an arrogant Trump tool who interfered with the great CDC. One year later, much of the article has a different cast beginning with “premier public health agency”. Hmmpfff. The opening now reads to me as almost laughable:

Zaidi lifted her mask slightly to be heard and delivered a fait accompli: Birx, who was not present, had pulled the plug on the Centers for Disease Control and Prevention’s (CDC’s) system for collecting hospital data and turned much of the responsibility over to a private contractor, Pittsburgh-based TeleTracking Technologies Inc., a hospital data management company. The reason: CDC had not met Birx’s demand that hospitals report 100% of their COVID-19 data every day.

According to two officials in the meeting, one CDC staffer left and immediately began to sob, saying, “I refuse to do this. I cannot work with people like this. It is so toxic.” That person soon resigned from the pandemic data team, sources say.

Other CDC staffers considered the decision arbitrary and destructive. “Anyone who knows the data supply chain in the U.S. knows [getting all the data daily] is impossible” during a pandemic, says one high-level expert at CDC. And they considered Birx’s imperative unnecessary because staffers with decades of experience could confidently estimate missing numbers from partial data.

“Why are they not listening to us?” a CDC official at the meeting recalls thinking. Several CDC staffers predicted the new data system would fail, with ominous implications. “Birx has been on a months long rampage against our data,” one texted to a colleague shortly afterward. “Good f—ing luck getting the hospitals to clean up their data and update daily.”

Scott Gottlieb tells this same story very differently in Uncontrolled Spread (my WSJ review).

Deborah Birx convinced the Coronavirus Task Force to direct money to the CDC to modernize its reporting of the COVID hospital data, but the CDC said no.

…The federal government had bought the entire available supply [of remedsivir], and HHS needed to know where to ship its limited doses [but]…the CDC didn’t have actual data on who was currently hospitalized for COVID, just estimates built off a model….Birx said that the government couldn’t ship scarce doses of the valuable medicine to treat estimated patients that were hypothetically hospitalized according to a mathematical formula. So she gave hospitals an ultimatum. If they wanted to get access to remedsivir, they would need to start reporting real data on the total number of COVID patients that they admitted each day. Hospitals quickly started to comply…Rather than cajole the CDC into fixing its reporting system, Ambassador Birx and Secretary Azar decided to recreate that structure outside the agency. The had concluded that getting the CDC to change its own scheme, and abandon its historical approach to modeling these data, would have been too hard.

…Under the new reporting system, 95% of US hospitals soon provided 100 percent of their daily hospital admission data. In an unfortunate twist, the CDC declined to work with the new data, worrying that since it wasn’t their data, they couldn’t assure its providence and couldn’t fully trust its reliability. As one senior HHS official put it to me, the CDC “took their ball and went home.”

…The cofounders of the COVID Tracking Project, one of the most authoritative and closely watched enterprises to report bottom-line information about the pandemic, would later say of the [HHS/Teletracking data], “the data set that we trust the most–and that we believe dose not come with major questions–is the hospitalization data overseen by the Department of Health and Human Services. At this point, virtually every hospital in America is reporting to the department as required. We now have a good sense of how many patients are hospitalized with COVID-19 around the country.” [Link here, AT]

Gottlieb’s story strikes me as much closer to the truth. Why? Notice that on most of the facts the stories agree. Gottlieb says the CDC refused to work with the HHS data and took their ball and went home. The Piller story has CDC people sobbing, angry, and saying “I refuse to do this.” Check. What differs is the interpretation and everything in Piller’s story is infected by an anti-Trump perspective. I don’t blame Piller for being anti-Trump but Trump plays no role in the story he just hovers in the background like a bogeyman. Piller says, for example:

…Birx’s hospital data takeover fits a pattern in which she opposed CDC guidance, sometimes promoting President Donald Trump’s policies or views against scientific consensus.

“Fits a pattern.” Uh huh.

Birx sometimes “promoted President Donald Trump’s policies.” Promoting the policies of the President of the United States? Why that’s practically treason!

Promoting views that go “against scientific consensus” Yeah, the “scientific consensus” of workers at the CDC.

Trump obviously had no interest in how hospital data was collected yet he is portrayed throughout as the hidden puppeteer behind the story.

Gottlieb’s story removes Trump from the equation and that rings true because we now know that the Biden administration has been as frustrated with the CDC as was the Trump administration. Politico writes, for example:

…senior officials from the White House Covid-19 task force and the Food and Drug Administration have repeatedly accused CDC of withholding critical data needed to develop the booster shot plan…

…the CDC advisory committee episode in late August only reinforced perceptions in the [Biden] White House that the agency represents the weakest link in a Covid-19 response…

The agency has for years struggled with obtaining accurate disease data from state health departments, and the pandemic strained the country’s public health infrastructure, causing massive delays in reporting and case investigation.

Withholding critical data. Struggling to obtain accurate data. Massive delays. Sound familiar? Indeed, if these parallels weren’t enough we even have CDC Director Rochelle Walensky overruling CDC scientists to allow boosters–but Walensky, unlike Birx, gets the benefit of the doubt so the story isn’t sold as Walensky going against scientific consensus to promote President Biden.

Evaluations of Trump colored evaluations of all the people and policies of the Trump administration leading to reporting that was sometimes unjust and inaccurate. It will take time to sort it all out.

Covid facts, about men

The largest declines in life expectancy were observed among males in the US, who experienced a decline of 2.2 years relative to 2019 levels, followed by Lithuanian males, with a decline of 1.7 years.

“For western European countries such as Spain, England and Wales, Italy, Belgium, among others, the last time such large magnitudes of declines in life expectancy at birth were observed in a single year was during world war two,” said José Manuel Aburto, the study’s co-lead author.

Here is more from the FT.  The United States arguably has the “highest variable males” in the entire world.  And this result is part of the downside of that, noting that the upside is considerable as well.

Air Filtration and UV Disinfection Greatly Reduce Viruses in Hospital Wards

As I wrote earlier, it’s puzzling that there isn’t more attention given to air filtration and UV light disinfection in hospitals, since these techniques have been shown to kill superbugs.

A recent paper also shows that air filtration and UV disinfection can greatly reduces SARS-COV-II in hospital wards. The authors installed portable air filters with UV disinfection on two COVID hospital wards in the UK. The air was tested for viruses, bacteria and fungi before the filters were turned on, during the time the filters were on and then again after the filters were turned off.

The results:

Airborne SARS-CoV-2 was detected in the ward on all five days before activation of air/UV filtration, but on none of the five days when the air/UV filter was operational; SARS-CoV-2 was again detected on four out of five days when the filter was off.

Importantly, in addition to greatly reducing SARS-CoV-2 the portable filters and UV light also greatly reduced multiple viral, bacterial, and fungal pathogens. In the figure at right Air Filter Off is on the left and Air Filter On is on the right.

Is “wrestled” the right word here?

The advisers also wrestled with the practicalities of endorsing a booster shot for only Pfizer-BioNTech recipients, when close to half of vaccinated Americans have received Moderna or J. & J. vaccines.

“I just don’t understand how, later this afternoon, we can say to people 65 and older, ‘You’re at risk for severe disease and death, but only half of you can protect yourselves right now,’” said Dr. Sarah Long, a pediatrician and infectious diseases expert at Drexel University College of Medicine in Pennsylvania.

I feel I do understand how, though of course I do not approve.  Here is more from the NYT.  And for a further multi-cocktail blitz of what I can only call immoral insanity:

Committee members also expressed concern on Thursday that some recommendations — particularly that certain younger Americans be allowed booster shots after an assessment of individual risks — would mean that only the wealthy and educated would gain access to additional shots.

Better that no one get such doses?  Maybe so, just read further:

Some experts seemed to suggest on Wednesday that it might be better to hold off on recommending any booster shots until recipients of all three vaccines could qualify for them.

Still a train wreck, the whole thing.  At least the CDC head has had the guts to override the vaccine panel.  Of course there is no single way to get it right with a few rules, so how about injecting a greater dose of individual choice?  Or do they need to make a special rule letting people in vaccine-shy Kentucky get boosters too?

One Billion Vaccinations in a Month!

The news on world vaccinations is good. As of late September of 2021 we have vaccinated 3.43 billion people (2.51 billion people with 2 doses). Even more impressive over the last 30 days the world vaccinated one billion people. That is a tremendous achievement. There are about 7.9 billion people in the world so 44% of the world has had at least one dose and nearly a third of the world population has  had two doses. We are on track to fully vaccinate 70% of all adults in 2021 and most of the world that wants a dose by early 2022. Judging by the US, demand will be more of a constraint than supply as we hit ~60% of the world population.

The NYTimes on the FDA and Rapid Tests

In July of 2020 I wrote in Frequent, Fast, and Cheap is Better than Sensitive:

A number of firms have developed cheap, paper-strip tests for coronavirus that report results at-home in about 15 minutes but they have yet to be approved for use by the FDA because the FDA appears to be demanding that all tests reach accuracy levels similar to the PCR test. This is another deadly FDA mistake.

…The PCR tests can discover virus at significantly lower concentration levels than the cheap tests but that extra sensitivity doesn’t matter much in practice. Why not? First, at the lowest levels that the PCR test can detect, the person tested probably isn’t infectious. The cheap test is better at telling whether you are infectious than whether you are infected but the former is what we need to know to open schools and workplaces.

It’s great that other people including the NYTimes are now understanding the problem. Here is the excellent David Leonhardt in Where are the Tests?

Other experts are also criticizing the Biden administration for its failure to expand rapid testing. Even as President Biden has followed a Covid policy much better aligned with scientific evidence than Donald Trump’s, Biden has not broken through some of the bureaucratic rigidity that has hampered the U.S. virus response.

In the case of rapid tests, the F.D.A. has loosened its rules somewhat over the past year, allowing the sale of some antigen tests (which often cost about $12 each). But drugstores, Amazon and other sellers have now largely run out of them. I tried to buy rapid tests this weekend and couldn’t find any.

The F.D.A.’s process for approving rapid tests is “onerous” and “inappropriate,” Daniel Oran and Dr. Eric Topol of Scripps Research wrote in Stat News.

For the most part, the F.D.A. still uses the same cumbersome process for approving Covid tests that it uses for high-tech medical devices. To survive that process, the rapid tests must demonstrate that they are nearly as sensitive as P.C.R. tests, which they are not.

But rapid tests do not need to be so sensitive to be effective, experts point out. P.C.R. tests often identify small amounts of the Covid virus in people who had been infected weeks earlier and are no longer contagious. Rapid tests can miss these cases while still identifying about 98 percent of cases in which a person is infectious, according to Dr. Michael Mina, a Harvard epidemiologist who has been advocating for more testing

Identifying anywhere close to 98 percent of infectious cases would sharply curb Covid’s spread. An analysis in the journal Science Advances found that test frequency matters more for reducing Covid cases than test sensitivity.

As I said on twitter what makes the FDA’s failure to approve more rapid antigen tests especially galling is that some of the tests being sold cheaply in Europe are American tests just ones not approved in the United States. If it’s good enough for the Germans it’s good enough for me!

Emergent Ventures India, new winners, third Indian cohort

Angad Daryani / Praan

Angad Daryani is 22-year-old social entrepreneur and inventor from Mumbai, and his goal is to find solutions for clean air at a low cost, accessible to all. He received his EV grant to build ultra-low cost, filter-less outdoor air purification systems for deployment in open areas through his startup Praan. Angad’s work was recently covered by the BBC here.

Swasthik Padma

Swasthik Padma is a 19-year-old inventor and researcher. He received his EV grant to develop PLASCRETE, a high-strength composite material made from non-recyclable plastic (post-consumer plastic waste which consists of Multilayer, Film Grade Plastics and Sand) in a device called PLASCREATOR, also developed by Swasthik. The final product serves as a stronger, cost-effective, non-corrosive, and sustainable alternative to concrete and wood as a building material. He is also working on agritech solutions, desalination devices, and low cost solutions to combat climate change.

Ajay Shah

Ajay Shah is an economist, the founder of the LEAP blog, and the coauthor (with Vijay Kelkar) of In Service of the Republic: The Art and Science of Economic Policy, an excellent book, covered by Alex here. He received his EV grant for creating a community of scholars and policymakers to work on vaccine production, distribution, and pricing, and the role of the government and private sector given India’s state capacity.

Meghraj Suthar

Meghraj Suthar, is an entrepreneur, software engineer, and author from Jodhpur. He founded Localites, a global community (6,000 members from more than 130 countries) of travelers and those who like to show around their cities to travelers for free or on an hourly charge. He also writes inspirational fiction. He has published two books: The Dreamers and The Believers and is working on his next book. He received his EV grant to develop his new project Growcify– helping small & medium-sized businesses in smaller Indian cities to go online with their own end-to-end integrated e-commerce app at very affordable pricing.

Jamie Martin/ The Queen’s English 

Jamie Martin and Sandeep Mallareddy founded The Queen’s English to develop a tool to help speak English. Indians who speak English earn 5x more than those who don’t. The Queen’s English provides 300 hours of totally scripted lesson plans on a simple Android app for high quality teaching by allowing anyone who can speak English to teach high quality spoken English lessons using just a mobile phone.

Rubén Poblete-Cazenave

Rubén Poblete-Cazenave is a post-doctoral fellow at the Department of Economics at Erasmus University Rotterdam. His work has focused on studying topics on political economy, development economics and economics of crime, with a particular interest in India. Rubén received his EV grant to study the dynamic effects of lockdowns on criminal activity and police performance in Bihar, and on violence against women in India.

Chandra Bhan Prasad

Chandra Bhan Prasad is an Indian scholar, political commentator, and author of the Bhopal Document, Dalit Phobia: Why Do They Hate Us?, What is Ambedkarism?, Dalit Diary, 1999-2003: Reflections on Apartheid in India, and co-author author (with D Shyam Babu and Devesh Kapur) of Defying the Odds: The Rise of Dalit Entrepreneurs. He is also the founder of the ByDalits.com e-commerce platform and the editor of Dalit Enterprise magazine. He received his EV grant to pursue his research on Dalit capitalism as a movement for self-respect.

Praveen Tiwari

Praveen Tiwari is a rural education entrepreneur in India. At 17, he started Power of Youth to increase education and awareness among rural students in his district. To cope with the Covid lockdown he started the Study Garh with a YouTube channel to provide better quality educational content to rural students in their regional language (Hindi).

Preetham R and Vinayak Vineeth

Preetham R. and Vinayak Vineeth are 17-year-old high-schoolers from Bangalore. Preetham is interested in computing, futurism and space; and Vinayak is thinking about projects ranging from automation to web development. They received their EV grant for a semantic text analysis system based on graph similarity scores. The system (currently called the Knowledge Engine) will be used for perfectly private contextual advertising and will soon be expanded for other uses like better search engines, research tools and improved video streaming experiences. They hope to launch it commercially by the end of 2022.

Shriya Shankar:

Shriya Shankar is a 20-year-old social entrepreneur and computer science engineer from Bangalore and the founder of Project Sitara Foundation, which provides accessible STEM education to children from underserved communities. She received her EV grant to develop an accessible ed-tech series focused on contextualizing mathematics in Kannada to make learning more relatable and inclusive for children.

Baishali Bomjan and Bhuvana Anand

Baishali and Bhuvana are the co-founders of Trayas Foundation, an independent research and policy advisory organization that champions constitutional, social, and market liberalism in India through data-informed public discourse. Their particular focus is on dismantling regulatory bottlenecks to individual opportunity, dignity and freedom. The EV grant will support Trayas’s work for reforms in state labor regulations that ease doing business and further prosperity, and help end legal restrictions placed on women’s employment under India’s labor protection framework to engender economic agency for millions of Indians.

Akash Bhatia and Puru Botla / Infinite Analytics

Infinite Analytics received their first grant for developing the Sherlock platform to help Indian state governments with mobility analysis to combat Covid spread. Their second EV grant is to scale their platform and analyze patterns to understand the spread of the Delta variant in the 2021 Covid wave in India. They will analyze religious congregations, election rallies, crematoria footfalls and regular daily/weekly bazaars, and create capabilities to understand the spread of the virus in every city/town in India.

PS Vishnuprasad

Vishnuprasad is a 21-year-old BS-MS student at IISER Tirupati. He is interested in the intersection of political polarization and network science and focused on the emergence and spread of disinformation and fake news. He is working on the spread of disinformation and propaganda in spaces Indians use to access information on the internet. He received his EV grant to build a tool that tracks cross-platform spread of disinformation and propaganda on social media. He is also interested in the science of cooking and is a stand-up comedian and writer.

Prem Panicker:

Prem Panicker is a journalist, cricket writer, and founding editor of peepli.org, a site dedicated to multimedia long form journalism focused on the environment, man/animal conflict, and development. He received an EV grant to explore India’s 7,400 km coastline, with an emphasis on coastal erosion, environmental degradation, and the consequent loss of lives and livelihoods.

Vaidehi Tandel

Vaidehi Tandel is an urban economist and Lecturer at the Henley Business School in University of Reading. She is interested in understanding the challenges and potential of India’s urban transformation and her EV grant will support her ongoing research on the political economy of urbanization in India. She was part of the team led by Malani that won the EV Covid India prize.

Abhinav Singh

Abhinav recently completed his Masters in the Behavioral and Computational Economics program at Chapman University’s Economic Science Institute. His goal is to make political economy ideas accessible to young Indians, and support those interested in advancing critical thinking over policy questions. He received his EV grant to start Polekon, a platform that will host educational content and organize seminars on key political economy issues and build a community of young thinkers interested in political economy in India.

Bevin A./Contact

CONTACT was founded by two engineers Ann Joys and Bevin A. as a low-cost, voluntary, contact tracing solution. They used RFID tags and readers for consenting individuals to log their locations at various points like shops, hotels, educational institutions, etc. These data are anonymized and analyzed to track mobility and develop better Covid policies, while maintaining user anonymity.

Onkar Singh Batra

Onkar Singh is a 16-year-old developer/researcher and high school student in Jammu. He received his first EV grant for his Covid Care Jammu project. His goal is to develop India’s First Open-Source Satellite, and he is founder of Paradox Sonic Space Research Agency, a non-profit aerospace research organization developing inexpensive and open-source technologies. Onkar received his second EV grant to develop a high efficiency, low cost, nano satellite. Along with EV his project is also supported by an Amateur Radio Digital Communications (ARDC) grant. Onkar has a working engineering model and is developing the final flight model for launch in 2022.

StorySurf

Storysurf, founded by Omkar Sane and Chirag Anand, is based on the idea that stories are the simplest form of wisdom and that developing an ocean of stories is the antidote to social media polarization. They are developing both a network of writers, and a range of stories between 6-300 words in a user-friendly app to encourage people to read narratives. Through their stories, they hope to help more readers consume information and ideas through stories.

Naman Pushp/ Airbound

Airbound is cofounded by its CEO Naman Pushp, a 16 year old high-schooler from Mumbai passionate about engineering and robotics, and COO Faraaz Baig, a 20 year old self-taught programmer and robotics engineers from Bangalore. Airbound aims to make delivery accessible by developing a VTOL drone design that can use small businesses as takeoff/landing locations. They have also created the first blended wing body tail sitter (along with a whole host of other optimizations) to make this kind of drone delivery possible, safe and accessible.

Anup Malani / CMIE / Prabhat Jha

An joint grant to (1) Anup Malani, Professor at the University of Chicago, (2) The Centre for Monitoring Indian Economy (CMIE), and (3) Prabhat Jha, Professor at University of Toronto and the Centre for Global Health Research, to determine the extent to which reported excess deaths in India are due to Covid. Recent studies show that that the pandemic in India may be associated with between 3 million to 4.9 million excess deaths, roughly 8-12 times officially reported number of COVID deaths. To determine how many of these deaths are statistically attributable to Covid, they will conduct verbal autopsies on roughly 20,000 deaths, with the results to be made publicly available.

And finally:

Aditya Dar/The Violence Archive

A joint grant to Aaditya Dar, an economist at Indian School of Business, Kiran Garimella, a computer scientist at Rutgers University and Vasundhara Sirnate, a political scientist and journalist for creating the India Violence Archive. They will use machine learning and natural language processing to develop an open-source historical record of collective public violence in India over 100 years. The goal is to create accessible and high-quality public data so civil society can pursue justice and governments can make better policy.

Those unfamiliar with Emergent Ventures can learn more here and here. EV India announcement here. More about the winners of EV India second cohort here. To apply for EV India, use the EV application click the “Apply Now” button and select India from the “My Project Will Affect” drop-down menu.

Note that EV India is led and run by Shruti Rajagopalan, I thank her for all of her excellent work on this!

Here is Shruti on Twitter, and here is her excellent Ideas of India podcast.  Shruti is herself an earlier Emergent Ventures winner, and while she is very highly rated remains grossly underrated.

Scott Gottlieb’s Uncontrolled Spread

Scott Gottlieb’s Uncontrolled Spread is superb. I reviewed it for the WSJ. Here’s one bit:

If there’s one overarching theme of “Uncontrolled Spread,” it’s that the Centers for Disease Control and Prevention failed utterly. It’s now well known that the CDC didn’t follow standard operating procedures in its own labs, resulting in contamination and a complete botch of its original SARS-CoV-2 test. The agency’s failure put us weeks behind and took the South Korea option of suppressing the virus off the table. But the blunder was much deeper and more systematic than a botched test. The CDC never had a plan for widespread testing, which in any scenario could only be achieved by bringing in the big, private labs.

Instead of working with the commercial labs, the CDC went out of its way to impede them from developing and deploying their own tests. The CDC wouldn’t share its virus samples with commercial labs, slowing down test development. “The agency didn’t view it as a part of its mission to assist these labs.” Dr. Gottlieb writes. As a result, “It would be weeks before commercial manufacturers could get access to the samples they needed, and they’d mostly have to go around the CDC. One large commercial lab would obtain samples from a subsidiary in South Korea.”

At times the CDC seemed more interested in its own “intellectual property” than in saving lives. In a jaw-dropping section, Dr. Gottlieb writes that “companies seeking to make the test kits described extended negotiations with the CDC that stretched for weeks as the agency made sure that the contracts protected its inventions.” When every day of delay could mean thousands of lives lost down the line, the CDC was dickering over test royalties.

In the early months of the pandemic the CDC impeded private firms from developing their own tests and demanded that all testing be run through its labs even as its own test failed miserably and its own labs had no hope of scaling up to deal with the levels of testing needed. Moreover, the author notes, because its own labs couldn’t scale, the CDC played down the necessity of widespread testing and took “deliberate steps to enforce guidelines that would make sure it didn’t receive more samples than its single lab could handle.”

Read the whole thing.

Addendum: My previous reviews of Michael Lewis’s The Premonition, Slavitt’s Preventable and Abutaleb and Paletta’s Nightmare Scenario.

Covid markets in everything

A pastor is encouraging people to donate to his Tulsa church so they can become an online member and get his signature on a religious exemption from coronavirus vaccine mandates. The pastor, Jackson Lahmeyer, is a 29-year-old small-business owner running in the Republican primary challenge to Sen. James Lankford in 2022.

Lahmeyer, who leads Sheridan Church with his wife, Kendra, said Tuesday that in the past two days, about 30,000 people have downloaded the religious exemption form he created.

And:

Some institutions request a signature from a religious authority, but Charles Haynes, senior fellow for religious freedom at the Freedom Forum in Washington, said that those institutions could be on a shaky ground constitutionally. Haynes said that if a person states a sincere religious belief that they want to opt out of vaccination, that should be enough.

“He’s not really selling a religious exemption,” said Haynes, who compared Lahmeyer’s exemption offer to televangelists who sell things like prayer cloths. “He’s selling a bogus idea that you need one.”

Here is the full story, via Brett D.

My January 2020 Bloomberg column on Covid

I thought this one worthy of a redux, here are a few segments:

First, most emergency rooms are not equipped to handle a very high volume of cases, especially infectious diseases…The general economic problem is that emergency rooms typically are not equipped with full surge capacity, nor are there enough emergency room add-ons or substitutes available on very short notice.

And:

Very often, when a pandemic breaks out, talk turns to macro remedies such as air travel bans and quarantines, as China is instituting. Yet often the more important factor is the strength, resilience and flexibility of local public health institutions, and those qualities cannot be created overnight. Just as the Chinese health-care system is undergoing a major test right now, there is a good chance that the U.S. will too.

And:

An additional test could concern child-care and telecommuting. Will U.S. schools need to be shut? At the very least it is something officials should have been planning for. Even if schools are not closed, some number of parents will keep their children at home, whether out of rational fear or not. Anti-vaccine sentiment is fairly high and rising, after all, and even the wisest parents will prefer to be safe than sorry.

Keeping one’s children at home means that fewer people will go to work. Even those with external child-care options, such as day care, may be reluctant to leave their children outside the home for the same reasons they fear the schools. The new question then becomes how robust are work plans, and U.S. supply chains, to a higher than usual rate of workplace absenteeism. There also may be an especially high level in China, which could strain U.S. and other supply chains relying on Chinese producers. Many businesses may need to amend their plans on the fly.

Once again, pandemic preparation is about the flexibility of decentralized institutions. These are not problems that can be solved by top-down planning. Instead, they rely on longstanding institutional capacities, high levels of social trust and improvisational skill.

If and when a good vaccine becomes available for the virus, that will again be about the improvisation and flexibility that will allow for scalability and eventual production and distribution. It is usually difficult to solve such problems quickly, but still there is better and worse performance — and that can make a big difference.

And:

The very first problem the U.S. is likely to face is one of risk communication. Of course the correct message will depend on how the data evolve, but in general there is tension between warnings that get people to take notice, and those that scare them underground or into counterproductive forms of panic.

If you tell people how terrible things are, they feel a loss of control. Many will retreat into conspiracy theories, spread mistrust of health-care institutions, or withdraw altogether from social or professional activity. Those who are sick may be afraid to seek medical attention, for fear of having their movements constrained, driving the disease further underground and distorting the data. Again, trust is of paramount importance.

Recommended.

What’s the Right Dose for Boosters?

The Biden administration says booster shots are coming, but the FDA hasn’t decided on the dose. Moderna wants a half-shot booster. Pfizer a full shot. But could the best dose for Americans and for the world be even less?

COVID-19 vaccines are the first successful use of mRNA vaccine technology, so a lot remains unknown. But identifying the smallest dose needed to provide effective boosting is critical to protect Americans from adverse effects, increase confidence in vaccines, and mitigate global vaccine inequity.

We’ve known since earlier this year that a half-dose of the Moderna vaccine produces antibody levels similar to the standard-dose and newer information suggests that even a quarter-dose vaccine may do the same. If a half or quarter dose is nearly as effective as a standard dose for first and second shots then a full dose booster may well be an overdose. The essential task of a booster is to “jog” the immune system’s memory of what it’s supposed to fight. Data from the world of hepatitis B suggest that the “reminder” need not be as intense as the initial “lesson.” And in the cases of tuberculosis, meningitis, and yellow fever vaccines, lower doses have been as good or better than the originals.

Lower doses could also reduce risks of adverse effects.

That’s myself and physicians Garth Strohbehn and William F. Parker on the Med Page Today. Strohbehn is an oncologist and specialist in optimizing doses for cancer drugs. William Parker is a pulmonologist and professor of medicine at the University of Chicago.

Covid and intertemporal substitution

That is the topic of my latest Bloomberg column, here is one bit:

Before the vaccines came along, it made great sense to enforce masking norms. If infections could be shifted into the future, an eventually vaccinated citizenry would be much better protected.

There is a less obvious corollary: Those same mask norms make less sense when large numbers of people are vaccinated. Masking still will push infections further into the future, but if the vaccines become marginally less effective over time, as some data suggest, people may be slightly worse off later on (they’ll also be a bit older). The upshot is that the case for masking is less strong, even if you still think it is a good idea overall.

Still, many people prefer to abide by fixed rules and principles. Once they learn them and lecture others about them, they are unlikely to change their minds. “Masking is good!” is a simple precept. “Exactly how good masking is depends on how much safer the near future will be!” is not. Yet the latter statement is how the economist is trained to think.

And this:

Some of the consequences of intertemporal substitution are a bit ghastly, and you won’t find many people willing to even talk about them.

For example: Say you are immunocompromised, and you either can’t or won’t get vaccinated. You might be justly mad about all the unvaccinated knuckleheads running around, getting Covid, and possibly infecting you. At the same time, you wish to minimize your required degree of intertemporal substitution.

So if you are (perhaps correctly) afraid to go out very much, you are better off if those same knuckleheads acquire natural immunity more quickly. Yes, it would be better if they got vaccinated. But barring that, a quick pandemic may be easier for you to manage than a long, drawn-out pandemic, which would require heroic amounts of intertemporal substitution.

Recommended.  And yes there is a “don’t overload your health system” qualifier (most of the U.S. is OK on this front right now), which I’ve written about multiple times including as early as January 2020.

Operation Warp Speed: A Story Yet to be Told

Operation Warp Speed was by far the most successful government program against COVID. But as of yet there is very little discussion or history of the program. As just an indication I looked for references in a bunch of pandemic books to General Perna who co-led OWS with Moncef Slaoui. Michael Lewis in The Premonition never mentions Perna. Neither does Slavitt in Preventable. Nor does Wright in The Plague Year. Nor does Gottlieb in Uncontrolled Spread. Abutaleb and Paletta in Nightmare Scenario have just two index entries for Perna basically just stating his appointment and meeting with Trump.

Yet there are many questions to be asked about OWS. Who wrote the contracts? Who chose the vaccines? Who found the money? Who ran the day to day operation? Why was the state and local rollout so slow and uneven? How was the DPA used? Who lifted the regulations? How was the FDA convinced to go fast?

I don’t know the answer to these questions. I suspect when it is all written down, Richard Danzig will be seen as an important behind the scenes player in the early stages (I was involved with some meetings with him as part of the Kremer team). Grogan at the DPC seems under-recognized. Peter Marks at the FDA was likely extremely important in getting the FDA to run with the program. Marks brought people like Janet Woodcock from the FDA to OWS so you had a nominally independent group but one completely familiar with FDA policy and staff and that was probably critical. And of course Slaoui and Perna were important leaders and communicators with the private sector and the logistics group but they have yet to be seriously debriefed.

It’s also time for a revisionist account of President Trump’s Council of Economic Advisors. Michael Kremer and I spoke to the DPC and the CEA early on in the pandemic and argued for a program similar to what would later be called OWS. The CEA, however, was way ahead of the game. In Sept of 2019 (yes, 2019!) the CEA produced a report titled Mitigating the Impact of Pandemic Influenza through Vaccine Innovation. The report calculates the immense potential cost of a pandemic and how a private-public partnership could mitigate these costs–all of this before anyone had heard the term COVID. Nor did that happen by accident. Thomas Philipson, the CEA chair, had made his reputation in the field of economic epidemiology, incorporating incentives and behavioral analysis in epidemiological models to understand HIV and the spread of other infectious diseases. Eric Sun, another CEA economist, had also written with Philipson about the FDA and its problems. Casey Mulligan was another CEA chief economist who understand the danger of pandemics and was influenced by Sam Peltzman on the costs of FDA delay. So the CEA was well prepared for the pandemic and I suspect they gave Trump very good advice on starting Operation Warp Speed.

In short, someone deserves credit for a multi-trillion-dollar saving government program! More importantly, we know a lot about CDC and FDA failure but in order to know what we should build upon we also need to know what worked. OWS worked. We need a history of how and why.