# Covid 7/29: You Play to Win the Game

Few things warm my heart more than playing to win the game. Few things sadden me more than observing someone not playing to win the game. 

Usually, that means they are playing a different game instead, whether they admit it or not, and whether or not they know it themselves. The game, from this perspective, is simply that which you are playing to win, and your revealed preferences define the game’s rules and objectives.

This week saw some excellent playing to win the game. The NFL, many parts of the government and a number of corporations began imposing vaccine mandates, hopefully causing a cascading effect. It’s at least a start. There’s a lot of ways in which we collectively are revealing ourselves not to be playing the game of ‘get people vaccinated’ let alone the game of ‘prevent Covid while minimizing costs.’ The lowest hanging fruit remains _fully approving the vaccines,_ which we somehow still have not done.

A central question continues to be how effective the vaccines are against Delta. The Israeli claims turn out to probably be the result of basic statistical mistakes, so those scary numbers are now mostly off the table, although that still leaves us a range containing meaningfully distinct answers. 

Another central question is Long Covid, for which we got some actual data, so there’s a section analyzing that.

The big mystery remains why Delta suddenly peaked and turned around, first in India, and now in the UK and the Netherlands. These turnarounds are excellent news, and I presume we will see a similar turnaround at a similar point, but what’s causing them to happen so quickly? I don’t know.

Meanwhile, the numbers got worse slightly faster than I expected. Let’s run them..

The Numbers
-----------

Predictions
-----------

Prediction from last week: 360,000 cases (+50%) and 1845 deaths (+10%)

Result: 392,000 cases (+62%) and 2042 deaths (+21%). 

Prediction for next week: 610,000 cases (+55%) and 2,450 deaths (+20%). 

Things got worse slightly faster than expected. I doubt things are ready to turn around, but there are signs of the control system starting to act which should accelerate, and between vaccinations and infections (most of which likely do not result in positive tests and therefore known cases) immunity is building up, so I continue to expect the pace of growth to drop off a bit. I’d be unsurprised by numbers between about +40% and +70% for cases.

Deaths
------

| Date | WEST | MIDWEST | SOUTH | NORTHEAST | TOTAL |
| --- | --- | --- | --- | --- | --- |
| Jun 10-Jun 16 | 368 | 611 | 961 | 314 | 2254 |
| Jun 17-Jun 23 | 529 | 443 | 831 | 263 | 2066 |
| Jun 24-Jun 30 | 550 | 459 | 706 | 186 | 1901 |
| Jul 1-Jul 7 | 459 | 329 | 612 | 128 | 1528 |
| Jul 8-Jul 14 | 532 | 398 | 689 | 145 | 1764 |
| Jul 15-Jul 21 | 434 | 341 | 732 | 170 | 1677 |
| Jul 22-Jul 28 | 491 | 385 | 1009 | 157 | 2042 |

![](https://lh5.googleusercontent.com/WFosn-qvr_YgRTNQcIy2YUkeRoyNmia5LJD-N5FYGin4HIf0LpygvlwmtxBtTJ2MwTw1wGOQn5_ASKT3VgXu7Py_0RxUv-eAxnQHmBUyQ0zJ7txDxX-T6kevrQLa6tmSxd6SOBTu "Chart")

Deaths are going up slower than cases, but faster than one would have hoped. I interpret this partly as last week’s number being artificially low, and partly as the South having a problem with its most vulnerable being partly unvaccinated, and thus we see a rise focused on the South including as a share of the cases. 

Things will continue to get worse until several weeks after cases turn around. The question is if we can continue to see deaths lag behind cases, as they continue to do so in the UK. My guess is we won’t do as well as some other places, especially in the South, but will still be doing better than our case counts alone would suggest.

Cases
-----

| Date | WEST | MIDWEST | SOUTH | NORTHEAST | TOTAL |
| --- | --- | --- | --- | --- | --- |
| Jun 3-Jun 9 | 25,987 | 18,267 | 32,545 | 11,540 | 88,339 |
| Jun 10-Jun 16 | 23,700 | 14,472 | 25,752 | 8,177 | 72,101 |
| Jun 17-Jun 23 | 23,854 | 12,801 | 26,456 | 6,464 | 69,575 |
| Jun 24-Jun 30 | 23,246 | 14,521 | 31,773 | 6,388 | 75,928 |
| Jul 1-Jul 7 | 27,413 | 17,460 | 40,031 | 7,065 | 91,969 |
| Jul 8-Jul 14 | 45,338 | 27,544 | 68,129 | 11,368 | 152,379 |
| Jul 15-Jul 21 | 65,913 | 39,634 | 116,933 | 19,076 | 241,556 |
| Jul 22-Jul 28 | 94,429 | 60,502 | 205,992 | 31,073 | 391,996 |

![](https://lh5.googleusercontent.com/i34dEvzZQrTrVJovIboTMtt0M5ykYBVfGtAki4OPWD-LQv56yKa0X-0t7Att4xhyyyX-lmKl-FHF7l-Lf4XzilgDbGismI6yYBi9FNkY9U-4NLf1IygKDP4OarJAQVyAA4vZN6y7 "Chart")

Vaccinations
------------

![](https://lh6.googleusercontent.com/KOqJKcgWUsymJtBoqRogb4JA5CBBypfiYd-XlcKrBvrCXtwCSGiQlsl7_cyKrvL2E4kWwT200A6FomWdqPIfYDJUtxWzsCPM0PmxjbmGkdVQ6dVM92upjzymmzjvqVCEiFNJtKYF)

![](https://lh5.googleusercontent.com/5pzTj9MkktRlGzKdWeMZNm5GyoHPdnHHuZBpRB1jd1K9CRhQsKYM7ti0_gFPgRnm2rbw_wg5Lg424g67KHkddiLRwUHiiUg7GLAk3bASm_o3pFjQ60mOJlx0tcJT10FZ0aiqWifl)

![](https://lh4.googleusercontent.com/wDlr7H11jwA84A36fwiIDIaypKSqD5Vxu-KeVBFzlwFlE4P18lBXnOHIEKQAxbt-xIQN3e2sOlZBASPMxr3oHHaLwVxnYRjDHuv18YlCJpCYkGBM6QRS2h62RBC05bcydBYoYO_C)

![](https://lh6.googleusercontent.com/zzvZ9owDVRzAeK6shh-LSNIVUWQkcpSHySWw60Io6qmz_RCcGi5FipwgfKks-9ui8yJ7YW0DwgTmdcS5BEIxoD4D0e8EozWlYVyLGlupOjyFiZu0kLQQjJ9mqepBcPgLS6zVl2WD)

People respond to incentives. With the costs of not being vaccinated rising on all fronts, more people are making the decision to get vaccinated. The remaining people are harder to get, but efforts benefit from the growing social proof and social pressure from previous vaccinations. It also helps that previously reluctant politicians, with notably rare exceptions, are increasingly getting with the program.

Vaccination Effectiveness
-------------------------

[This thread takes the Israeli evidence (that likely was a quite sloppy statistical error, see the next section), combines it with antibody measures, and suggests that antibody counts decay with a half life of a few months](https://twitter.com/michaelzlin/status/1418749519269752833), so under this hypothesis vaccinations continue to protect you from severe symptoms and death but after five months lose half their effectiveness at protecting against infection. I hate the smugness and overconfidence here, and also based on the clinical trials and result of one dose it doesn’t make any sense that a 75% reduction in antibodies would cut protection against infection by 50%. Nor do I buy that there would be a threshold effect big enough to cause the curve she’s analyzing here. 

Also, this isn’t a half-life:

![](https://lh3.googleusercontent.com/9bfNc-sjp5aExghieUYLciyu1UcZN6Dmx_-f5eycor_LFEOAqT6UQdOKfuYO6mem9BdDJvTekPxPY0VNb5r4AYxjYSZZ2oZrp5H4RihM3UxvxHRdsqOVxJRsOFUjmEDJRDaoqEIC)

Even if we take this fully seriously, it’s a steady state that we get to in 3-5 months, and the median gets to its low point after three (which is likely random variance, but the point stands that most of the effect is in place after month three). It certainly doesn’t seem anything like ‘half life of 100 days’ the next link in the thread cited, so I notice I’m confused.

I am noting such arguments here for completeness, but I do not put much weight on them. As usual, when one has a new hypothesis, one must then reconcile it with all the different data points, and alarming ‘vaccine stops working’ theories keep implying, well, that vaccines aren’t mostly working, when they obviously mostly are. You can’t _both_ argue that we suddenly don’t think vaccines work as well against Delta, _and_ that vaccine protections fade rapidly over time, _and_ also that Delta is so much more infectious to begin with among the unvaccinated, because such claims combine to not be even slightly compatible with the observed data in other places.

Then on Wednesday, [Pfizer came out with data that the vaccine remains effective after six months](https://www.washingtonpost.com/health/2021/07/28/pfizer-data-shows-vaccine-protection-remains-robust-six-months-after-vaccination-even-company-argues-that-boosters-will-be-needed/). That’s the headline. The actual data is not as encouraging:

![](https://lh6.googleusercontent.com/6FcVeLO_mx6m37yhkKAZ6rMRw3-H50QtK6Da8VKD6XDZHs5pAOE68HsO_cCTjLOrUiFoNxWclckm5p9xfxG59qDXFZByUZmfo5VEhxus1NbIZcAfP8MRVQX2W652e2g5TlF5nlkh)

Contrary to Pfizer, that’s quite the drop in effectiveness. The protection against death remains robust, and yes 84% is still quite good compared to what we would have asked for a year ago, but ‘remains effective’ is giving the wrong impression if this data holds up. 

The other news here is that Pfizer plans to be calling for booster shots. It seems that a _three_ dose regimen is much more effective than a two dose regimen, now that we’ve had the ability to test such things, and some places are moving to implement this already. The data here suggests that the third dose will bring things back to at least the early stage 96% effectiveness and plausibly even higher. If I am offered a third dose, I will happily accept it.

There is the concern that giving people third doses while others have not had the opportunity even for first doses is not ethical. I respect that perspective, but do not share it, and will leave it at that. 

On That Israeli Data on Delta’s Effectiveness
---------------------------------------------

Israeli data has been suggesting remarkably low effectiveness of vaccinations against Delta. [This thread suggests this comes from… using the wrong denominator](https://twitter.com/dvir_a/status/1420059124700700677). The explanation is, the Israeli outbreak started in very highly vaccinated areas, and the effectiveness numbers came from the percentage of cases that were among the vaccinated, but they were comparing that to the overall population numbers. So, whoops.

If true, as I believe it probably is, that would explain things and be on some levels comforting, but on other levels it’s the opposite of comforting, because this is saying that the Israeli outbreaks started in highly vaccinated areas. So, whoops again. 

I’m inclined to believe that such simple mistakes were happening here, because [the Israeli numbers simply _didn’t make any sense_](https://twitter.com/kmedved/status/1420403226818514953)_._ They were incompatible, even with each other, let alone with what we were seeing elsewhere. And I’m definitely at the point where such stupid mistakes aren’t surprising. This one is rather stupid, but that’s the way such things seem to often go.

Delta Variant
-------------

For those who need it: [Thread explaining basics of how vaccine protection interacts with spread of Delta.](https://twitter.com/nataliexdean/status/1418577831097901056) 

[CDC has reversed course on its mask mandates.](https://apnews.com/article/health-coronavirus-pandemic-79959d313428d98ab8aa905bbe287ba0?utm_medium=AP&utm_source=Twitter&utm_campaign=SocialFlow) Masks will be back in schools, where I’ve learned first hand and the hard way that schools feel compelled to follow the guidelines. They’re suggesting indoor vaccinated masking in ‘areas where there is a surge’ which doesn’t really make a lot of sense and will cause some confusion, but perhaps the hope is it will make intuitive sense to regular people. It’s good that when the facts change, the CDC changes its mind, at least.  

There are two central facts about Delta one’s model must explain. First, the dramatic takeover of the pandemic and rise in overall cases across countries. Second, [the sudden reversal of those trends in many places](https://twitter.com/NateSilver538/status/1419291281264676868), including India, the UK and the Netherlands:

![](https://lh6.googleusercontent.com/3JN3EwmvJs6Tu--o1G-PGx2dYZel-ZZwMAJuF1iE22-6f8HdPJ8uhINPrAAOfPvf0K9r2OkjemMg2WRH8XV54cPMvl2KlIeR3fwCTWpxeJS87htJ1pdicNZy9jfv-bSAwDCqwvBS)

![](https://lh3.googleusercontent.com/22VpW4Gwe1YI-YA5Ce08mU0oKxSydU8whPWPpwEkttyL-quKgTjf55TNPY7YDaOwvLOtz0XmbJeSLcEPSVZRqphcu2QJc9-hhteJa3XUa9eOawnblUrdcrOofsG8C0xWZzxafLPc)

The Dutch numbers are down by half, the UK is not far behind. 

If you zoom out, the case numbers are still large. 

![](https://lh3.googleusercontent.com/r89tQ5V7zOi1pcKscuKakpYR67tRxqx39DttxyRY-zPSY3Wj7o8Tvp5Y01ZVwzaFF9leaqiqHDL1Cezuxe9QbGateHafKE4EXX7L_na-2v5sCw6atNEWd41o3mUQGCFIQj5EqSSq)

But the _death_ numbers barely register:

![](https://lh5.googleusercontent.com/2ygfkYsJ0iyYi7ycFKjBkHYsvt52s_N2Oruv_1rm6FdHoKdcG4x4EeRb4Zx0sS7p1P9UTD37TqXhlPYQJkAZd7iVaBVpDr-7jcgQ2ZeEHIkvd2kVsfL_mcz-9Qfzk8J9CBJDPEjD)

It will take another week or two for the UK/Netherlands death numbers to peak, but this is what vaccinating the vulnerable looks like where it counts.

[Here’s some data from Minnesota:](https://twitter.com/janashortal/status/1420073735307071491)

![](https://lh3.googleusercontent.com/36Q6316VSgLYPG072Ls51tRISk4BFK74viFROq2HTYpmX5O0664VbVj78dE1N-AZdQc8aRs6aewMxvei_8xeIpRrj6nBPDnvpvoO6q_2hgOoBEwpjtGdawwQugola96I7SH_8wzh)

If we take this at face value (it’s not normalized sufficiently so there’s a bunch of reasons not to, but they point in various directions), it suggests about the same ratios in effectiveness for Delta between the vaccines that we saw for the older strain. Moderna’s effective dose is higher than Pfizer’s, which potentially could be responsible for that differential, although I’m still mostly inclined to treat the two as the same until we get a lot more similar data points elsewhere. Normalizing properly for exactly when vaccinations were in effect is tough, but for context Minnesota at the time had just under 30k confirmed infections since May 1.

The data below from San Diego is better normalized, and I’m going to say that this is enough non-normalized data points. 

[This graph is pretty bizarre](https://twitter.com/EricTopol/status/1419308647054671874) when taken at face value, and I presume it shouldn’t be, and is only the county of San Diego, but still seems worth noting:

![](https://lh6.googleusercontent.com/yLvOIQi9ZQlNevWSp8JXcnmiFcazxcGAzr9ZkcJ8tK2qylyIca3bL9lUWLyC8sbeqqhCUV-M5GPPrAO8Zj2v8RjqP7xWRdTd3OAl6MbVbzYM5irlCS5IsuOesdJqTb3uFKECDfuB)

Details:

![](https://lh3.googleusercontent.com/AOtvgfmrKhPu9qkBQ1vVWS0c3wFx-p1l9FdaiK3GnWLpuloLtfq05Dh5DxSGCNGiY8eykjn7uq2ltfujsAdd81qrUd1DsvvlhBow3AMbrobfiD3qZLOj-8nctG-BgNyLH1qyIZ_E)

At the lefthand side, we have about 3 cases per 100k among the vaccinated and 9 among the unvaccinated, a ratio of 3:1. That’s a surprisingly small ratio. 

At the end of May, cases among the vaccinated level off, but cases among the unvaccinated continue to drop until about June 10.

Then the cases among the unvaccinated shoot up, and at the end, we have 16 unvaccianted cases per 100k and 2 vaccinated cases, for an 8:1 ratio. In July, this is most definitely representing a pandemic of the unvaccinated.

![](https://lh4.googleusercontent.com/9CGFxyDmhY5yGsB58N-jseGN_MH7w7DEwBIuqesvy3CWYJMGGfPBtCMp2-G8e_QsTdbbvCvde_RDibFKnJQzbEXDB-3BB4Kmc4pT_RsiDtum2f5Jb49qOTHdhknqDgJvi5YjX8fp)

The question is, why would this ratio suddenly get much _bigger_?

If Delta is, as everyone now fears, reducing the effectiveness of vaccinations, you’d expect the ratio to go _down_ rather than up. Whereas this new 8:1 ratio implies a much _higher_ effectiveness level, unless one can explain it via other factors.

One possible explanation is that early on the vaccinations went to highly vulnerable people, whereas now they’re more evenly distributed, but that would only explain contrasting March with June, not June with July, where that effect is going to be small.

Another is to [claim this didn’t happen](https://twitter.com/Hi_Dr_Nick/status/1419372327347892232):

![](https://lh6.googleusercontent.com/B0xZopfdrLSeEevSmCKlAk_pPf6g6nJvQALuFFqd6tra3TmwNFrYueNJ6vXlJ_xZwpdCVHQzrXNCyVn10cvzTNpARSCfjaQizFAl-I3aMymUGYimDUFZf8oTZFE_vC7YIBFtE0wx)

If we look at the ratio that had emerged before that period in early June, we do get a different picture then, but that period where the unvaccinated cases are going down but vaccinated cases went up is super weird for its own reasons, and the contrast with the left side of the graph is still clear. At a minimum, a constant ratio does not suggest any decrease in effective immunity.

A third is to say that San Diego’s numbers are quirky because someone’s are going to be quirky.

Here’s [another Tweet that shows Marin County](https://twitter.com/bert_gilfoyle/status/1419336540023447553):

![](https://lh4.googleusercontent.com/HDkbbdfe3p-8YZX5BZzxm3o0L0umEVcHQIhWZdQxS2rS0SkBcbAxX240HTk-A9IIj29MYxD6ZdHWrz2zGk84Jjgq9NOg8QS7Jwl6tPCebrRrGoxtxsJUIylWp2zmD4x0M3AHKwgN)

Looking at that, I see a ratio of just over 4:1 rather than 8:1. I don’t see a big shift to higher ratios in July, but I also don’t see a shift to _lower_ ratios either.

I tried briefly to find similar charts or data for larger areas and it wasn’t obvious where they were. If anyone can link to one it would be appreciated. The normalizations here make the data much more useful but I’d prefer a much bigger and ideally more representative area.

Vaccinations are great, but what matters is immunity, and vaccines are only one way to get immunity. Antibodies are not a perfect proxy for immunity, but they’re likely the best one available, and [the numbers in the UK on antibodies are very, very high…](https://twitter.com/YJM_YJM/status/1418538190701580288)

![](https://lh6.googleusercontent.com/AEjHzV0xGYzHCC3u_y91ckiFV7BGRMaXq7JzJqM9QnUL0W_udpEKz36xQxYkxP8-yJi5zhJfLwg2XCKQbSI01H9cJlStIWtrRJJ8mplEVeOHT-F1DFBkedIMWwsNLjwWrT5P8ZHe)

When this many people have antibodies, it’s both scary that cases for a while were going up anyway, and also easy to understand how there might be a rapid peak followed by a reversal. It’s especially easy to see this if the serial interval averages two or three days instead of five, so things that happen tend to happen fast. 

If 90% of people are immune, then each additional 1% that becomes immune reduces spread after that by a full 10% even if everyone is otherwise identical. Whatever vectors still remain for the virus to spread burn themselves out rapidly, until there isn’t enough left to sustain the pandemic. 

It is possible that this is simply what it takes to turn the corner on Delta. If so, then if the USA has roughly 70% of adults having been vaccinated, than we would turn the corner when about two thirds of the unvaccinated have been infected at some point sufficiently to develop antibodies, with the understanding that many Covid infections don’t lead to a positive test and therefore don’t show up in the statistics, and also a lot of them already happened over the past year and a half. 

It still doesn’t explain the _full extent_ of the rapid turnarounds in India and the UK, but it helps explain it. Lag in the control system also helps, but again I notice my model remains surprised by this. 

You Play to Win the Game
------------------------

Last year, the NBA figured out how to do Covid testing. This year, it’s all about vaccinations, and the NFL is stepping up. 

As we all know, in the NFL and also in life, [You Play To Win The Game](https://www.youtube.com/watch?v=b5-iJUuPWis). 

[Winning isn’t everything, it’s the only thing](https://www.youtube.com/watch?v=-AyzWEqd7tA&ab_channel=MovieMusicClips).

What does it look like to play to win, when it comes to Covid-19?

[It looks like this.](https://twitter.com/dick_nixon/status/1418281203988373504) [Here’s the key operating principles.](https://twitter.com/TomPelissero/status/1418257495550738432) 

![](https://lh6.googleusercontent.com/OgixMrsPlKSQTFJx_FqdoAINJrLDx3_twUK0DQLkpnbm2P8--yEg9wzYockpueiT0y235-Y4489lZtBvbVxYDPn8O3fVDd7-nlicva0JBBHHlzIpQbbgb-LVRYfuA1LceR-uS1TY)

![](https://lh3.googleusercontent.com/XEoauXA2arRZw8ly2CYUPzzOvk0ewt94_xJhCGETDBlCN9opFBxWZ59FzFnXni4rAhAWWjTbuCsptmMOwFCOhpoG9bAwXRuPGs3MdiYKmQgotxJuw6LxOP8DeMsAMqnLtJfRTwMX)

![](https://lh4.googleusercontent.com/taVaA6YIWZYshdefw4SSufWaQ_x7w0bXFKwUlndNXav9j5Dp8eaSztiLKNK5IA9yrY_MZortZCQtyTUa0kBpO_nItOJHjusv3ebdrQfFwYvukcIyNmX4SA6IRHTW4z_ffM-H2mrA)

![](https://lh3.googleusercontent.com/sTbR9qBB-dYJVs53rM0mlpQ73yLlgZS-Lm2ADi9P-gjrd0VEGGznGgnZ4N5Yd7w8Go0SghvggO-N4sSootV7asPAdFMA-cTr3n6LPfgOdm65ZgDMHcZ62FH-LBrtXpLgZzlfp_s5)

![](https://lh6.googleusercontent.com/D4pmFYSu9-DKJk_yFPcMmlU0bR_PgHR-mjFddRYcSx3kJRvtMOSOxo7m5pUzxIoCVgDOrnEe3-hIfuXPHq3UNRtv1s7_nKPZ_tL6yoSB0d_zyIHRfHhOcnxi_9DwWHoGne_T_MfI)

[Here’s what would trigger a forfeit](https://twitter.com/TomPelissero/status/1418257495550738432):

![](https://lh5.googleusercontent.com/Eu6Jd8ZtnVBTatEG6S9pz1MYTXLysu3chGeBcOnx7by04NwYlixPJHZ4Jrommz6JBX7EtIpUAuuvKezTqw4TMnxOI_44vaNgeXMd1YC01azsRIqBfJedn7-MqTkS74_3pXIHQC4J)

In other words:

If your vaccinated players force us to cancel the game, we’ll try to do the best we can for everyone involved.

If your unvaccinated players force us to cancel the game, f*** you. You forfeit the game for all purposes where you want to win, the game is cancelled for all purposes where you wanted to lose, and the league will focus on ‘minimizing the financial and competitive burden’ _exclusively on the other team._ Not you. You’re on your own.

Oh, and regardless of vaccination status, if there’s an outbreak that cancels the game, [_the players on both teams don’t get paid for that game:_](https://twitter.com/TomPelissero/status/1418257495550738432)

![](https://lh4.googleusercontent.com/fHBZTkXK1V9kk0zJpjQJ39c2iRUZWBdag0C7FeZUdESWicw-bSpZvDk_pjxdXdwnSyXkHbSs_4I4XeVVna-OTWOnUIzK-AGpeAsnhsQ91zFLlgcN8tJB0JjvwbMYZUaTT2NxsFvi)

That’s what it looks like when you play to win. 

[Some NFL players are less than thrilled with this situation](https://www.thedailybeast.com/nfl-covid-plan-pisses-off-anti-vaccine-playersbut-it-just-might-work).

[For example:](https://twitter.com/SethBurn/status/1418298513478361088)

![](https://lh5.googleusercontent.com/f-Tolsik-blb78USOQv-odmoYRONUuXcfIt3FEnz6CKYAkPWHEbH639KaDPvyim31DAonNCEb7rr2h7DgtUZkGWNpsRVavxhW55-W7G4ARTZ1PLv2uvJMa33LQKhnirVJnsuKHtH)

Yes, it turns out that not protecting yourself against infectious disease can put you in a position to hurt your team. Who knew?

[Who else we got?](https://twitter.com/CourtneyRCronin/status/1418628745049493508)

![](https://lh4.googleusercontent.com/N7dNKpRV-5xvDv8cwlBxWGZVxR58wn01XDveTC3_CGuoTryKgmyhztHrRgSd-Fwj2yxIU0TzesvjO8g33k9KSJMovvm9PksGACTzE3xL8KjCHX4B0QhFMZI6xOlsU4vX8XCpHy44)

I hope someone compiles all of these together, and then continues in the sacred tradition of arranging them into a YouTube montage video set to [Taylor Swift’s I Forgot That You Existed](https://www.youtube.com/watch?v=p1cEvNn88jM&ab_channel=TaylorSwiftVEVO). 

Good luck, Mr. Hopkins and all the rest of you, in all your future and hopefully far away endeavors.

[The Pac-12 is considering following suit](https://www.espn.com/college-football/story/_/id/31864237/commissioner-george-kliavkoff-says-pac-12-considering-use-forfeit-rule-covid-19-outbreaks). It does make a lot of sense the way the commissioner George Kliavkoff put it:

![](https://lh3.googleusercontent.com/FQsdyCCnePtf4SquFTOvwDWaBZSRHHrEAgx85wzhchowAti-7Ll6y5fQbR_6tcQLYnTBnfJQV_5H6FnafS1r_D28C_FrCxV2Ni0PvL9AlZhx2AaH55ARiSJGpgE7uIZX7JG4q792)

Most of the Pac-12 schools have vaccine mandates in place in any case. [Washington State is currently trying to figure out what to do when its coach refuses to get with that program](https://apnews.com/article/sports-health-college-football-coronavirus-pandemic-washington-state-cougars-football-55d5f36ff0d319720d4662928d2023c3).

We need more of that ‘can do, and if you choose not to do that’s on you that you didn’t do it’ spirit.

Others Playing To Win the Game
------------------------------

The good news is we are indeed seeing more of this spirit, and there seems to be momentum behind these efforts.

New York and California are requiring government workers who don’t get vaccinated to get weekly tests and wear masks indoors. New York at least is not providing a testing option for health care workers, it’s vaccination or you are (very understandably) fired. Virginia is mandating vaccinations for health workers, as is the veterans administration.

From Bloomberg’s daily newsletter:

![](https://lh4.googleusercontent.com/9NGQCXbZ2U1vPET5rhsN4RWrDSH4Pd9yaRx_WhIBMfUyrOfRrXB0SYNXDbstpM3ayJEONzVueJO4S0nnIcFGfbQ7TcVgzi6L-_6-UB5kYL0FUc2SCk1OdnjE0K7HaNN6yKMWJGqT)

![](https://lh3.googleusercontent.com/hYMvI9JQFoFJ6nyCfQS93j6YjTYaDkXsguZoENQN5qZ1JfkVV66kNDIHCqfvqMBJG3Qqut5fr6Pdc5oZybpZnNd8Pu3qp5G1QFQh_no22n8U4NqjDKFPQw16RHCw7_s3_DOmmRnE)

Reports are that Biden will follow shortly with a similar rule for federal employees, if he hasn’t already by the time you read this.

[Companies are now able to get in on the act](https://twitter.com/BNODesk/status/1420546982456737796):

![](https://lh4.googleusercontent.com/9Ibj1_Ba0bnk8verzJal8iqhYeQ5_BIBzx1IyX0DriaCQh_w8HazPMeRvgOjwgjHI4t3mzw-OgxLxtK5gLVepBjD1_JAT5APePqf5_n1Xbgyc8aADCNIVJ9a6i85Km3kX69Ezvf_)

My hope is that this effort continues and spreads, and more and more private employers will be emboldened to enact similar policies. If I was a private employer whose employees were interacting with each other in person or with customers in person, I’d hope to be more worried about what would happen if I _didn’t_ mandate vaccination, including legal consequences, than what would happen if I did, and this transition will go a long way. As usual, [we blame people via Asymmetric Justice](https://thezvi.wordpress.com/2019/04/25/asymmetric-justice/) for action but not inaction, so the less a (soft via testing and masking requirements) mandate seems like a bold choice to take action and more like a default state that protects the employer from liability or an outbreak among the other employees, the better. These things matter.

And once again, we gotta get full authorization as soon as possible. A huge amount of the lack of mandates is the lack of full authorization. If we got it, this cascade could kick into high gear quickly, and give a justification for a change in policy. At this point, any efforts to get people vaccinated that don’t involve a demand for full authorization are impossible to take seriously. How can we be mandating vaccinations but not be ready to fully approve them?

A bonus is it creates positive selection in employees. If anyone quits or otherwise goes ballistic about the situation, that was likely a time bomb on your team in one form or another, they’re definitely bad at risk management, and this gives you the opportunity to be rid of them. It’s hard to hire right now so that could be short term trouble, but identifying and getting rid of bad employees is both highly difficult and valuable. 

Many other countries also continue to get with the program. [Here’s Israel this week](https://twitter.com/aaronsibarium/status/1418634868850896897), playing to win:

![](https://lh3.googleusercontent.com/VyGUynNZwKy_XZvwENImKDGfXdgQCZr4Za7ZOuCa4qJv-oWRKImRJZ1JmyzdzwUgl_bm9uMtBk1QiYdwbPtn2zV77CAeTTX7VcrIY8tPgw5NKd57XAgJJwFkGpZbhQyIEYvN66IM)

I more than fully endorse this take on all of these developments:

![](https://lh6.googleusercontent.com/zPV1knaIbnywNQbNSDdr9f3E-PmKd4T08mbOnCUpQKDan1iKSl92ziyvLcf7WNCliWhkNiuKoqqjQf38M0-Itmoy-ZDCyAaUQ9EG3pxkottwlHd7EaLu6XbveffDiA4-DqM2LKS5)

![](https://lh3.googleusercontent.com/NyFbuHcjkbIDtEkBnmwDJUvsPSp24Y-rlg7jdS30Ia-3sRw28lVeBoctd2sNE1aRdJH24GNTHfIN0bQvui0c1DKZymoHU5iDiEBo0z3pfcNrKUKb-C_Pwrwe4jQMnEgWZreK_S_g)

Long Covid
----------

[We finally have some real data to look at.](https://twitter.com/chrischirp/status/1418696473177362432) 

![](https://lh3.googleusercontent.com/j1g402qvFJPpjc_6kiQ8o5sFzYmmwaY3v0a-Jpqn07O32uUH81nAZJH7xFI9qukf5vjUVQcQymQcvQmiMr4KKSXbNABNV8FFUy8ss2RKLLs_B_k45LfQ3Q-pf6vfSkdp7kR3Pujv)

![](https://lh3.googleusercontent.com/90oSbSA9nX4506zscI71ApTbskY29QGsLOy-0ALIpTBErPd1YLrVk61x8DUCr6namVzvfYXV1jj_2cYIvAsX-1F-JtxYM00htTirLoR3G7GiC9Sz4fTlwp-yizhG9T_QHllWuUGK)

![](https://lh6.googleusercontent.com/7sK9O3INpMR-2WvgTe6NQmzoPDeQ6Sdx4odshQnCXhWvmESLbPN29GPsWgrEPCgbDuLaq_5tro52E_V9ALAdjL9SYxPxdqsazjXOy74lc_HoK04q2XpCNZkw2TTq1vJOqWXEcYmY)

![](https://lh3.googleusercontent.com/FsVC3lirVxaIABq9Rd3G6Cx2n1hP-AdrbpJQ4TFV65E0RR2daB-Fu4ET10YbF8WjeYcVM7-H1HV3qVr0GX4jtc8_qQaPeDDTUx9kESOsEH7fE71V-wW9PTQMgF4Yq3bNXo5hpOqR)

![](https://lh6.googleusercontent.com/pbEyjZ5RnbPDiBSWERLVEdhNwtmvi8vwQ9fsvc-qQvfmavIMgDl7JuQyfA_3pdHOOiO3kli1I6ghrjrf5T4ukCJG3IizwCB1gDlubEbRqRNVI3aX_QpBRg5HY0UpBkQS6NwvzaM1)

![](https://lh5.googleusercontent.com/dUrlbd3PGDat4ou_mnFZIg3xiostufSFn8XiIbppVmBq-JR2s_wu6ZUwl0cGJA-nXMKHkfjDp7XeOAKqtvNarMUBRAKCg5I6GDMLJ4Kg1XRFADNlHo2zUf-Gp2Ky9k9EtSqaL6Xp)

![](https://lh4.googleusercontent.com/3H7vtoS-9z9FpKiKPENfcMCxaF7JOayAFv8aEzEgJkz7Q6nhQY34Sq1zFRaXmX-ffVVWTm-pt6_WRrhMxiCgebm-9KR0d0-jO5ZarBXzJBUMFQgBXqxjg0wmVRossveVJu0PCDhU)

The original paper is [here.](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00324-2/fulltext#seccesectitle0013)

  
Headline findings:

![](https://lh6.googleusercontent.com/36McGq4fn0ua_gUIlnyieplfmLQ-uj_SJXrwf-GoTRE3T8tfddHxIUyFKT1qjqfiN_GDhgdy80Zqpr7q1XkIR0BHuLAbgkjtw80mUqNqEO8EaV-FL7fGs5lNOGADynZ_87UoO6WI)

![](https://lh5.googleusercontent.com/DxsXaWw-VUFHPNJNP4P8kXeTfl2xX0zwXctTVlwVhyYfctre4W06w4BU9EEplsduhTJV1iGnOAPNg9cPaazEHfIQJWpFi_JWIbsvPMtaYamxPJab0ro4vFCDO6wX6TPKyfDIJbd1)

This raises, and/or lets us more usefully address, multiple questions. Should we believe the results of this study? Do these effects seem real? If they are real, what can either an individual or our society in general do about this? Does this change anything if it is true?

First, no matter what the flaws here, a big thank you for running this at all. It does seem like this is a big advance in information value over previous sources. This stuff is hard, and doing something concrete is better than not doing it. This does seem to rise to the level of something useful. 

Second, as usual, studying such things is really hard and there are lots of problems, so let’s get right to some of those.

First off, baseline methods.

![](https://lh4.googleusercontent.com/7_lm1eyWKMyq1SmLra7OrzFZkY7orgJanHEG9caaLQWl2acBWn-l0mM2yy4OL8GetNX-8fVV4Wrf7h-8f53_EYyh76pe_p6HmgeXDFcK5H_E3RNTtktS0NaE16MxJNJfkTWZc2mZ)

![](https://lh3.googleusercontent.com/x6Qlo9K1QBUpn1iCPgYjahfNEOIMHklAttUemuimmOiBnFbv0fjYjH3dLs1-4uRRKuENwp5qcOAL-zN1FAEXVo0jc1_gGHrOOKgvDRHK1QOb-R0FqaK4rk3SHaNSygmQSUAQfsET)

There is an obvious concern here. People were recruited to do an intelligence test by offering them an intelligence test. Which, yes, right on, very on the nose and efficient incentivizing, but we do have to worry about the selection effects from that and whether the standard controls handle them.

Here’s what they controlled for: “Nuisance variables were age, sex, racial-ethnicity, gender, handedness, first language (English vs other), country of residence (UK vs other), education level, vocational status and annual earning.”

Handedness! So other than the bonus handedness, this is your basic check of control variables for basic demographic information and socio-economic status. 

Before going further, there are three potential confounding factors here that seem like big issues.

The first is that _choosing to take the test_ could be a function of one’s situation and practical intelligence. If I had Covid and fully recovered and felt fine, I would not be so curious about taking an intelligence test. If I had Covid _and had continued problems,_ then I would plausibly be much more interested to know how I did on such a test. In theory, this could be the whole situation, since those who feel stupid due to non-Covid reasons or due to lockdowns wouldn’t feel the same curiosity and wouldn’t opt in, whereas those who had Covid _and happened to also feel stupid recently_ would take the test. 

The second is that _being intelligent helps prevent Covid-19,_ after controlling for the other factors. The study was done in 2020 so vaccination isn’t relevant, but plenty of other decisions matter. How and when people decided to mask, including how much care was put into doing it properly with a good fit, determines both how likely they were to get Covid and how severe their case was likely to be. Social distancing is similar. As is making a wide variety of other good decisions about how much risk to take. Intelligence also correlates with the type of work that can be done remotely, even controlling for income and education, which improves ability to social distance. Intelligent people tend to be more rule abiding in general, including when the rule is dumb, which in this case is net useful. And so on.

The third is that it looks like they’re using self reports of Covid-19. 

![](https://lh3.googleusercontent.com/v7xRAwBlXHBe-lkJdjfo5wOMq6De2L0Ab_Xk8YG8nwNa6vyGNqjvABqq0cxB7pwlRsBLbhtTQz6EBD8Fpz4avcgCkF7FYZMM4yyaImLhpimSmO0SFNilFXXsWLKp3FCEzzB7Wi_k)

It makes sense to worry that people would conclude from their long term issues that they likely had Covid-19, or from a lack of such issues that they likely didn’t have it, which could once again confound the results here.

In theory, one could have controlled for all this, by having people take the test _before_ Covid-19. Even now, one could attempt to measure the impact level of the second effect by then following up with the people who took the test and seeing which of them later got Covid, although changing conditions will change the size of the correlation – so it’s more of a ‘check if this is a substantial effect or not’ check than anything else, and now with vaccination everything is different. For the first effect, again, you’d need to find a way to measure things in the other order, possible in theory but not easy or cheap. For the third you could do antibody tests since this was pre-vaccinations. 

But all of that is tricky and expensive.

The huge advantages of doing what they actually did were that it was practical, it was ‘ethical’ and it was relatively inexpensive. I point out issues, but I think the study was likely done roughly the right way in context, picking the low hanging fruit. From a civilizational perspective we could and should have done far better, but that’s not the fault of the people doing what they can.

Looking ahead, it does seem like intelligence didn’t have too big an effect on chance of getting Covid, based on a follow-up test. This could still eat up the whole observed effect, but I’m less concerned about it than before reading about that. Also a little sad that this effect turns out to be so small, for other reasons.

I also approve of their methods for analyzing the results, especially combining the nine tests into one number. There are a lot of worries I conspicuously _don’t_ have here.

Here’s the breakdown by symptoms and gender:

![](https://lh3.googleusercontent.com/snBWuS3fCjiN5g9qn8nOmRdxuOpvawApPMUWXT0mquI0L-o0nwgKpGW-0szzQax29XmM-cxgzW3dMUhskk6gyCneiD0RwfObhW6sNFdfjcdULs5gGSo8OolU5_u_Ttmo_rwUUVeQ)

I’m noting it because that righthand column is pretty strange. It’s lower average age, and suddenly it’s very male whereas the other groups are increasingly female and older as symptoms became more serious. Low sample size is presumably the answer (44 people) but it’s still kind of weird.

Lower in the same table, it’s clear that _almost none_ of these people had a positive Covid-19 biological test, so this is almost all self-diagnosis:

![](https://lh6.googleusercontent.com/LDlDfbCzCxhpNJKwlnVFQ53F0lOmgbeGyH7rFi_VRhR4xf3ci2529pe1q-jDTEB49iaQ2G0yg7UrIZ4LObC94ycgP54nKcyhaT5JpVnrgDaUEqongaPI1di2R9RYiFTx2CvGDrB_)

Then we look at the headline chart. 

![](https://lh5.googleusercontent.com/0mC5Skr33bIZ5YQPnFfWZTA0PeMV5qJPvkKkhq9Tl2KcVyr2m3hOqzo1OhDc3Jw2gb_plL7ncYZ72ktN8zU5F4GyLFQja0Zd0fIeJgzs5hw__DQNlq0Vmy1W1_aYzfA0d12k0TCb)

One standard deviation in an IQ test is about 15 points, so this is an average of about 0.5 points or so for the first group, 1 point for those not requiring assistance, 2 for those getting help at home, 4 for those hospitalized and 7 for those who went on a ventilator. 

The first thing to note is that this effect that grows as symptoms get more severe _makes a hell of a lot more sense_ than the mysterious ‘Long Covid doesn’t care how bad your case was’ nonsense. I’m far more willing to believe a proportional effect that grows with symptoms than a blanket ‘nope, you technically got Covid and now you roll versus this other thing at constant odds’ hypothesis. And of course if you’ve been in the hospital on a respirator, it’s not going to be good for your cognitive performance. 

So that adds a lot of credibility to the findings. 

This is their explanation of why we shouldn’t worry about pre-morbid differences (e.g. how smart people were before):

![](https://lh3.googleusercontent.com/3zHDxBQ0qSbb43OHrT9O0PZF0pGM9Iod4mgRPFeJnGmLdu6mLyS7eakoQoxx4Ucd-EcxpFd4BofcLCwulC2U5OdjOIFrCDgwvYBQkOwp1pvV9t2I9V6Pnik2LcuAzAjT1qiTq0Qz)

I find this helpful but not fully convincing. One worry is that they’re claiming that those that were ill should have otherwise had higher cognitive performance. I don’t find this plausible, so it makes me skeptical their controls are sufficient. It _does_ mean that I’m no longer concerned that the intelligence differences are too big here, since presumably Covid doesn’t _help_ cognitive performance and that caps the differences at the effect sizes. The second check, following up with a questionnaire to see who later got Covid, is also helpful in capping the effect size of ‘smarter people get less Covid’ but doesn’t address the other concerns. I’m also sad we didn’t ask those people to retake the tests.

I also am skeptical that this effect could fail to _partly_ fade with time or as symptoms fully go away, whereas they are claiming to not see such effects. 

As always, also, there’s the question of whether this effect is unique to Covid or is a general property of many infectious diseases. In some sense it does not matter, but in other senses it matters a lot – or at least points to our failure to be consistent, with several potential ways to address that.

This is their note that the effect size here is indeed a big deal, which it is:

![](https://lh6.googleusercontent.com/zwdE8DeiOTzJGEnjODfia2PrVqk9fxrS_E--MFSvqVgo-eA72-DLtR0VxA54smdSeU96a2HAjr8rpJssDlb1vtZhQ1pnZc4BTY8RiUh-tuiu_aKWSsELEsS2Kz2h2OCak_juWgEB)

The line that the 0.47 SD drop is more than 10 years of decline in global performance between 20 and 70 is very interesting, because it suggests an intuitive way to measure how much we should care about this effect – we can think of this as similar to _aging._

Every year, we all age one year, and a lot of stuff gets harder. For those of us over the age of 25 or so, it’s kind of terrible, and we need to put a lot more effort into making it stop. 

So, in theory, this is suggesting that relatively mild (but still symptomatic) Covid is still doing something of similar magnitude to causing our brains to age two years, and as it gets more serious things get much worse. On average over all symptomatic cases we’d be looking at about three years.

If that’s all true, that’s really bad! Once again, you do not want to get Covid. And one can now think about how much life not lived would be justified in the name of not catching Covid, if one is at only small risk of death. 

I don’t find it likely they are underestimating the size of _this particular_ effect, and I can see how the effect could be smaller or not be there, so that somewhat reduces the expected effect size. But then one must also account for other distinct problems. 

Then there’s the question of how this interacts with vaccinations and children. If you get long Covid roughly the same way you get other symptoms, that’s going to be a big reduction in risk, especially for the very young. My prior would be that this protection is somewhere in between the protection against infection and protection against death. 

You’d also want to adjust for Delta, since all this data was from 2020. My presumption is degree of symptoms mostly controls for that, but it’s plausible that this doesn’t fully control for that. 

This Long Covid effect _definitely would still be_ a bigger danger for most people than death, even before vaccinations. I’d much rather take the very small risk of death than accept this level of accelerated cognitive decline, plus any longer term non-cognitive effects, and it isn’t close even under relatively minimizing assumptions, and multiplying for the uncertainty that this effect is real.

The question then remains, what costs are worth bearing to reduce the probability that this happens to you, individually or collectively.

Which in turn, as always, _depends on one’s ability to change that number._ Postponing the problem isn’t worth zero, but it’s only worth enough to care much if it buys time for a permanent solution, or there’s a permanent solution you’re willing to implement. That’s true both individually and collectively. Postponement can also help if it is ‘bending the curve’ in ways that matter, but that doesn’t impact Long Covid much. 

There’s the temptation to say ‘oh no, this is terrible, something must be done, this is something, therefore we must do it’ where the something is an effort to kick a can down the road at very high cost, and which may or may not be able to do much of even that. 

Vaccine Hesitancy
-----------------

[This LA Times piece looks at those who are getting vaccinated now in a local community, and finds highly reasonable thinking going on](https://www.latimes.com/california/story/2021-07-24/ready-for-their-shot-as-the-delta-variant-surges-vaccine-procrastinators-answer-the-question-why-the-long-wait). Of course, these are exactly the previously hesitant people _who then did get vaccinated._ So it makes sense that such people would seem more reasonable, and would not be at all representative of those who still haven’t gotten their shots. It is consistent with the model that there are a bunch of people doing cost-benefit calculations who are relatively easy to get, and then a bunch of people who are much harder to get. 

[This thread compares anti-vax people to victims of a con](https://twitter.com/EBHarrington/status/1418304261880958977), with resulting implications for how one should communicate with them if one is attempting to persuade and convince rather than make one feel better about having taken the proper symbolic action. [Cooling the mark](https://infofranpro.wdfiles.com/local--files/19520101-on-cooling/19520101%20On%20cooling.pdf) via people in the community that have earned people’s trust is so crazy an idea it just might work, but requires that such people be convinced first.

Note of course that such framing explicitly assumes the conclusion, that not only are vaccines safe and effective and the right thing for everyone both socially and individually, but that the evidence for this is so sufficient that if you don’t believe it, you’ve been conned. I don’t think that’s right. Many have effectively been conned by misinformation or the need for tribal signaling, but others are doing a calculation with different information and getting a different answer. I strongly believe they’re _wrong,_ but it seems plausible that treating such people as con victims is (at best) highly condescending and that they would notice. We are doing a rather terrible job conveying the information about vaccines in a way that is accessible, understandable and credible to such people, and the fact that vaccines _happen to be highly safe and effective_ doesn’t excuse that.

[This paper provides an interesting model of vaccine hesitancy](https://www.nber.org/system/files/working_papers/w29075/w29075.pdf) (via MR). In it, people are effectively doing an approximation of a cost-benefit analysis on vaccination, so the more prevalent the disease, the higher the willingness to vaccinate, which is clear from past outbreaks. 

One consequence of this is that if you reduce the number of cases, vaccinations go down. Thus, this model claims vaccine passports are ‘ineffective’ in the sense that they don’t increase vaccinations, and could even backfire, _because they reduce prevalence._ I find their math to prove too much and therefore am confident they’re technically wrong to draw their conclusions so broadly, but accept the underlying dynamics as things that are real and that matter. 

Oddly, [Tyler thinks this makes a strong case _against_ such passports](https://marginalrevolution.com/marginalrevolution/2021/07/why-vaccine-passports-are-a-welfare-dominated-approach.html). I would claim the opposite, because reducing prevalence is a good thing. If we can do something that both incentivizes vaccinations and prevents cases at the same time, that’s good, and if the reduction in cases means we don’t on net cause vaccinations, then that seems fine. Otherwise, you are in the world where you outright want more cases in order to show the bastards and own the reds, which is a bullet I really hope no one is biting.

Regardless, under such a model, _lowering costs of vaccination_ is the obvious choice for getting people vaccinated, and it continues to be a highly efficient strategy. Drive that cost negative. More precisely, one wants to reduce _perceived_ costs, which can involve changing people’s models of vaccine effectiveness and/or safety, and/or changing the difficulty and costs of vaccination. 

Periodic Reminders (You Should Know This Already)
-------------------------------------------------

[In case you need a short video explanation for how the mRNA vaccines work and were developed, we got you](https://twitter.com/SethBurn/status/1419433440110419971).

[Your periodic reminder that our travel restrictions make absolutely zero sense (MR).](https://feeds.feedblitz.com/~/659856822/0/marginalrevolution~The-Farrago-of-International-Travel-Restrictions.html)

[And yes, a sensible system would be entirely feasible](https://twitter.com/NateSilver538/status/1419677361222557705):

![](https://lh4.googleusercontent.com/SdDBs8uXTWCoHVMfGz1eMdOG49JICsmzEgUCAxODP7qb2zpJ99Nbie5CYX156EO5KHyo2CydolTuML-D3yJkRGI10JuM1WmErY1za6WRu4nMaYL0EoFMhEsHd91XPcNyyxQodHcH)

[This explanation rings far too true](https://twitter.com/mattyglesias/status/1419251468939431941):

![](https://lh4.googleusercontent.com/mYlLppHA7TAT9mw74Ls-OyrmSmmiOA3QmZLYDOMBCCcJ20LTTSu1NXWufijK0Z_U75_gQ8woMQuq-g1oZt0ZR8_udirQ7XORM2mDE_TmkFValF7VRpPEFmJYvlZuFwh3BjX7FBnU)

![](https://lh4.googleusercontent.com/r3esahaqW6h0UyQiFYYU8hR_DoiwJJmQmMxU7TeUUHd41ITNTG6fL1zvhlwrHqtFHWLYyupANVpqf1sDi0ZB2vDvnlY_lFms5M6q-68Q6VzizD_2wkXGu6NgAVq_3eT1EHEUsX7e)

Your periodic reminder: [The FDA and cost benefit analysis are not on speaking terms](https://www.slowboring.com/p/fda-cost-benefit), nor does the decision process much correspond to what is safe and effective let alone what is in the public interest. Hence, we approve $50,000 drugs that don’t work and then are forced to collectively pay for them out of the public treasury, but can’t fully approve the same Covid vaccines and definitely can’t mandate them, and so on. Yeah, yeah, same old, FDA Delenda Est, stop using such procedures to tell people what they’re legally allowed to do, also stop using such procedures to decide what we pay for without looking at costs against benefits, and at a bare minimum stop equating those two decisions. The suggestion from the link of letting government officials choose what is mandatory and paid for versus what is forbidden on an ad hoc per-item basis seems to miss the point of ‘are those our only choices?’ and I’m not sure if it’s better or worse than status quo. 

In other FDA Delenda Est [it’s-not-news-but-it-was-news-to-him non-news](https://twitter.com/WilliamAEden/status/1418785479990915075):

![](https://lh5.googleusercontent.com/3aSPvcZ93lQkqKkZEg8eVP4t-aEsG24IVp_k9Yp0vUn-NnHYjZr2uocAEaev87XjAj3IQFvFXsf3OyM4dKXJDnJbUseRuPLdNsP7ZGemDuwAdiZkWwUrb-5Sb95QcqxCQWvZqjMw)

[WaPo reminds us that Japan is failing at vaccinations by doing the things you would do if you wanted to fail at vaccinations.](https://www.washingtonpost.com/opinions/2021/05/04/why-is-japan-failing-so-badly-vaccinations/) This includes insisting on distribution by only doctors and nurses, holding out until way too late for a homegrown vaccine, a labyrinth approval process and demands for domestic testing of the vaccines, confusion about rules and a general lack of urgency, among other things.

(If for some reason you want to financially support these weekly posts and/or my writing in general, [you can do so via my bare bones, no rewards of any kind Patreon that is set up exclusively for that purpose](https://www.patreon.com/thezvi). On the margin this does shift my time a non-zero amount towards these posts. However: I do not _in any way_ need the money, please only provide funds fully understanding I already have plenty of money, and if and to the extent that doing this would make your own life better rather than worse.)

[The whole blood clot issue around AZ was never a thing](https://twitter.com/alexwickham/status/1420658568123006981). Of course Pfizer has similar instances of blood clots to AZ, given that _not getting vaccinated at all_ also has similar instances. Also Covid-19 itself actually does cause blood clots, but hey. 

The term ‘genuine’ fury is interesting here, since we knew all this already. It also does not matter, for the purposes of the EU’s motivations, whether or not the concerns _turn out to be_ valid. Their perception of the situation at the time would remain unchanged.

Also happy to see this report properly label the people opposing AZ as anti-vaxxers, from anti meaning against and vax meaning vaccine:

![](https://lh6.googleusercontent.com/ezTvwCqpXo8-IC6xNaGWwEJsrb82xU7d2qYIFDONl-4W7YDzACkIpoRJNDXqBND7WODll8kCJ-4odrngcQwtbheTKSdxBqFSI5-HgfBhj045Xdok-e53DCwv1WVs1aGn3ofmvrKd)

![](https://lh6.googleusercontent.com/oaoLX3zMYTjuLsyh0rwdB5kqlHUK5_nn1X7nJhuXVYG_UZCMTZiUV-I5CIRwvkTVLQvXLzfNxCrDTD0LHx5YC0ihRakG9bSMkCcayD7V7YVlwcXcUGIkDt-AVxKt03vsu9uJwteh)

![](https://lh5.googleusercontent.com/1TRdhrhLKocprCghluagAIDUu1j-3Qzq8oNY2fIAaW0aT5Vfvq0R63es7sOwfvbcn7JqyNdQ0gaTT2L_vk-JqQBVyEtrSWGcFOhPIj-SGF-QP5oyFa0ra-xSPbKOiz92Ue4n_zN8)

To what extent is it true that the European backlash against AZ was due to spite resulting from Brexit? My guess is this was not all that central, but was a substantial contributing factor on the margin. That doesn’t especially make this better or worse, it merely notes that the European Union countries were inclined to make such a self-destructive move for overdetermined reasons. 

[Very Serious People do not care about physical world models, a case study](https://twitter.com/yaneerbaryam/status/1420484703941971980) ([Warning: Someone Is Wrong On the Internet](https://xkcd.com/386/)):

![](https://lh3.googleusercontent.com/tGj5SP5HWt6B1uZyaVmMvsgwJJPVIypngKj0pgRsOD1jGHrfE4Bh88ra6YPPdfrSXsMA-ZrFk1NEqP1G19WciJ9BRIn_Ki4ZtmaLxio7BJJMyNr1zF1aC_7p8iffMk9yeJR89hst)

![](https://lh4.googleusercontent.com/7GW_Xyupfg9S8Ra6XexT8RLU2pyYUa2D71ROEusOeO_Fo9TpTzt6V3CEBwUAwTBbDSgai5UhE7tY4784avtheZHQk40E8FTal_Y2FewUSD0v5ydOTHInkCzuCi2leN9uI9U3Yros)

![](https://lh4.googleusercontent.com/lZVKF3eQCt7QzxoaxpZz6owzn1Ub4eywjDj0G1418mdSi5U2-nQ1qA6GzlxaKA0HEPHps1amYUaqXopJ-6n0-Xfei0cHeIMKLTRzupn31HnwQjIHS5WlujVcxazbliwjzcNKRSEe)

Sir, the virus did not mutate _among the few remaining infections in Israel_. The current pandemic in Israel _is not causally related, at all,_ to the few remaining cases of Alpha or the original strain that were still present in Israel. 

It comes from Delta. If Israel had achieved actual zero Covid but not also instituted large new measures to keep Delta out, Delta would still have arrived from overseas, same as it arrived from overseas in every country except one. And if anything, it would have spread _faster,_ because they’d have gone even more fully back to normal, so there’d be a worse problem now instead of a better one. 

Feels wrong to pick on such statements, but for a while I’ve been feeling the need to pick out a clean example, and this fits the bill. Also points out an important dynamic – local containment only matters for the medium to long term up until you cycle strains. There’s a strong instinct to contain the virus ‘in case it mutates’ but if it mutates elsewhere all your containment efforts mean nothing, so this only matters to the extent that you stop the mutation from happening at all, anywhere. Which is an important consideration, but not for stomping out the last few cases in one place while things continue to rage full blast in others. Much better to help out those other places.

In Other News
-------------

Scott Alexander’s post [Things I Learned Writing the Lockdown Post](https://astralcodexten.substack.com/p/things-i-learned-writing-the-lockdown) is excellent and from my perspective is much better and more interesting than [the actual lockdown post](https://astralcodexten.substack.com/p/lockdown-effectiveness-much-more). I don’t have the bandwidth to respond properly this week, so noting here that I haven’t done so.

[There’s this great highlighted comment at AstralCodexTen](https://astralcodexten.substack.com/p/things-i-learned-writing-the-lockdown/comments#comment-2435039) and I have nothing to add:

![](https://lh5.googleusercontent.com/XTgw1Zxk2VolfVSwOT0vSAHbI-s1AoQ_crXEJJiTwjY0mYD1ulL3yGckTui9VeAQLeOF1SkELO62rwiwLBd1cw17cPGp9UxeP0Ce3hW2EpIVN3N-vXlPzMuZK42df6XB6IRULr8q)

In the [monthly links post at ACX](https://astralcodexten.substack.com/p/links-for-july), Scott also points to [the poll that showed remarkable support for permanent lockdown in the UK](https://www.economist.com/britain/2021/07/10/some-britons-crave-permanent-pandemic-lockdown):

![](https://lh4.googleusercontent.com/kryNBTVSJ-rsNoz6PXo4ZZV-hksBmrUDNGn5I38gqEAjpxkmeTEmOHGTnrGRMyn7nuXBVZ354trM-_3BYfBxn4gsEZrVof7WD3Tie5uMZ7GD5Txyp-g1MwIZUtdxykRDdgbeFFBF)

But then reminds us that if you ask the questions with slightly different wording, people act more sane, and [a permanent lockdown then only gets the 3% support](https://archive.is/wzPtR) you would expect from the Lizardman’s Constant:

![](https://lh5.googleusercontent.com/_SYnGEhp8r1ZL5MM2UIQN5cDcqFeOln0QxjT0llntN-MXrp4xzPQaUhF5PufT1dALJpBuPUEe-LxLi9LxWu63uxhgbYKNOaWbcQiURmIEd4moxDpf5xOgrHBclqg-7lovOg6fJ3j)

They have a graph but it’s hard enough to read as it is so I’m not putting it in directly.

![](https://lh5.googleusercontent.com/P-nb1Lio21ruGeUlyIvFLxCWLY1thS_pB9kBtTE6UygPV8LTIySlvnV7bBT7PDOpnAoWbE_9BSYf8fwuGAoz11HBwNj_8xQCQxPFEySz_aXU8NHnYBWb_G-qlxxd3Q02z3-0JeuI)

That makes this most of all a manufacturing consent story. Merely by changing a few words and giving people the correct word associations, you can get many people to agree to give up their freedoms and way of life, _permanently._ That’s scary. Not all of them, not quite this easily, but quite a lot of them. 

You love to see it: [UK changes guidelines to emphasize outdoors and de-emphasize surfaces.](https://twitter.com/s8mb/status/1418518176426610691) 

![](https://lh5.googleusercontent.com/ePscnGTsFcfuoYI7nKmnubLbDzbWR56M8yCbJREnsXtsPRwV7rqPDpKLMH5JA7ho0h3KWOOeKPJsQfl7a1Xhu4WNruq-riKTe3kUPXnxLgTfXe-0umJoaKMzgwtHa07mmSbm0R6p)

Standard disclaimers that this like everything else is in no way medical advice and not to do anything illegal, [but also this happened](https://twitter.com/sashachapin/status/1419486344363925512) and further investigation seems logical:

![](https://lh5.googleusercontent.com/78jyUC1C5U68KM35rQ0uf4z9IHolhJGEl7vwAFRRU1rPDRIlcg0nCAuDjzP_EIZRaj5canxqyzH-ysFNLsQgU18V9ctrz0FMsevDx6LGp245eQRbwL45sZokxIoaPVkLYsm100hW)

I am not the biggest fan of psychedelics in practice under current conditions, but there’s a ton of potential upside. Our refusal to investigate their potential properly, for this and many other things, is a colossal expected value error, potentially our biggest one. 

Incentives matter, [so this is mostly great](https://twitter.com/pitdesi/status/1419878224826359808/photo/1) (via MR), but remember that if it’s $200 to get them to sing it might be considerably more to make them stop:

![](https://lh3.googleusercontent.com/6TtNB-coye_94aVYscI42JZplh0ZOCxkI5opQu3PZtRPPI4vR2YL8uCZTIkUN3kCjWMn2yBD6aJEJyzP0xIM5qsi8blr2d_fRwyzApihcmynHYFrdLkq6fxPJknecXTnj-S9rFUM)

[Incentives matter, dominatrixes requiring vaccination for dungeon entry edition](https://www.rollingstone.com/culture/culture-features/bdsm-dommes-subs-vaccination-covid19-1201121/). Seriously, incentives matter, stop pretending this is all so difficult.

The standard check for whether mask mandates are back says yes: ![](https://lh5.googleusercontent.com/yuGXASnPUAHCJOYP7-S5UaVuM0-sQd7lDqXvBFdauw6XiQY01ZKkDVOZVfW7ap7Mh9t9t1OZm1chJ0HjPI7RrMzIN1x1l5SnVBgERh8JBSjpjtIpnwMZqQIqbzt-dT9lTzEHkHj-)

Not Covid
---------

The lighter side presents:

I[nteresting whether or not they are transitive survey results of the week](https://twitter.com/AgnesCallard/status/1419313031314542593):

![](https://lh3.googleusercontent.com/65ubPlvbfYHjj3OpGjZqJsIguUcbNRxq-MZ9b0z8ifiCIvVl4R3HrZ0jnsme60uTB0hOZKNNKAN_vXOCRqNm9uPa_3jTUBxyGsnSAkJulNQpllG5RvSOarPKcPrmR80L0BtOcRYn)

![](https://lh4.googleusercontent.com/aTVO-XgSkIFVFBeKDQcGZfSWn0MeyeCvUgZF7fxw_D3ahwXXaMRORKjFm5j5qI7396O1EIuo0zAADY6Xui5dKlR_8JnWnpNmxCkND3rQa5nOB7wxLTHC7AmLydnTWZCSCvLZHTY4)

![](https://lh5.googleusercontent.com/hVx1Li8r6NyzvAPHTVyk4NlqrPY5XjFT8mr5Jt0wVddYgSqoeaxBNNjuNgi-TI627nEuJyrmADI9tUbLe0uXbn6V6jd6GZo4xqyN6HM2vXx74cBJUr9JLAH53kqVi1IvCNNGr7_a)

Taken together to see what happens, these imply that about 90% of people think billionaires have lives they’d rather live, and about 70% support for the superiority of the life of the True Philosopher even when you exclude the 21% who implicity endorse it by already claiming to live it. Of course, Robin is an economist and Agnes is a philosopher, and have followers accordingly, but let’s not let that ruin our fun.

Especially given this:

![](https://lh6.googleusercontent.com/K6IG8jsZsnvrFsztWlPlA3NZXsJ3jYfYwp75HpRD0zTgwt_Lab8B_mvX37q7dd6MXeo6am04QrQg4pKx0LsKEtG7mLZb6vMR3vdLZ9rDfWk29fKPhTel1e8celyvnqnIs4RLURCT)

![](https://lh5.googleusercontent.com/ITOiAgpXJirTasmktluCtEzDdD_vefrRvrAvjx-cftQrMqnNkvxcHhu00E0R72yR0Vq3ZtkaEsQTbTxVGuAlaSSC6g3bI1a4dGo3mdQEAG871I5yqqZ_85r9Fqozd1nBF7x7hXWz)

![](https://lh4.googleusercontent.com/twkqzW8trpCO3b14G9ScAB6eWxEjjZnCEWOPt0t_H1YY3encp2ftVjs1ZZC8gOhf1vmx9tW3ATFS5NfGkmCxPZyI1kZ0h1LPexRrBfKMOt7BWa3Ww8C90cCA1IPX1EARbKtGBWBf)

![](https://lh4.googleusercontent.com/GP9SqbxGEhU8PDoYUo5CNBVyrrxUupeMmwktnXMR9WHW0GygkHXjgrh73MW_adQhywy9zu2qPlwlc0LK8LFl6YkKKkTkB6meRx4BGLB_oQBICh4bioHjwTaR93G3QmErDPYmke6I)

![](https://lh5.googleusercontent.com/m19VlNriCwM5w1IR_fxCKTXaw0WVGU2YBAGmpfXMusnEc8uf38RusixtrkwFocpx-S3-yGBbUHnEvF1oawrnXKLfMsX5ZNrQulv07sRfLNND9K3jmdYtSDdFs0wEPmZDCHPU0CWs)

![](https://lh6.googleusercontent.com/zapktat7KTUu1V7Io9TVVk6kNMDxqltB9I0QTIS9OxuWUtGnWaCVmLs0ljllSPAsVwXyi_e7KYE8UzItmkDtRLmn4-r0al3Stfgz93oYNMsMUhOh9-LiwOgjQbP1xE2sKkMGDv7t)

![](https://lh3.googleusercontent.com/Aji8pu22DbcZXRG6cBnTjLutag9ei0fqnsELMUzwOvPu3nCXGzioBxmyT69tWkE5kEQKduSFpniGW4O_Lj-XPTZ2FX5VKfvCqYJJKekvVxvEV40jJ7Xm3et2dej1wZl1MkYcJdgG)

Mostly I find this rank ordering sensible. Olympic, Pulitzer and Academy Award winners get the glory but their overall lives don’t seem like they should automatically be all that tempting to most people, whereas billionaire or nobel prize winner seems a lot more tempting. I’d like to live in a place where greatness was widely considered worth its price, so I worry about people not seeing things that way.

The other thing to observe is that this implies that for the samples in question, life is pretty damn good. If it wasn’t, there would presumably be a much bigger willingness to switch tracks to people who very clearly ‘made it’ and have a lot going on. I tend to agree. My life is pretty great, too, whether or not I count as a true philosopher.