About that “failure” of an Afghanistan evacuation

Rarely do the media takes and reality diverge so much, but damn do they here.  Excellent piece from Drum.  I love that he provides answers to the ignorant and bad faith questions many were asking.  No, this was not perfect– what is?!– but, honestly, about as good as we could possibly do, given the circumstances..  Amazing the degree to which people are just willing to ignore the circumstances.  Anyway…

The Kabul evacuation is winding down and it looks like the final numbers will be in the neighborhood of 20,000 Americans rescued and 100,000 Afghans—all in the space of two weeks. I wonder how many people understand just how extraordinary that is in historical context? Certainly the United States has never pulled off anything close to that size, and very few other countries have either.

And you hardly have to be a Biden stan to understand that there are pretty easy answers to most of the criticisms that have been raised.

  • We were suffering almost no casualties, so why didn’t we just stay in Afghanistan? Because things were peaceful only due to the Taliban cease-fire. If we had stayed, the Taliban would have started fighting again and US casualties would have escalated.
  • Why were weapons left behind? Because those weapons had been given to the Afghan army as part of the turnover. [emphases mine]
  • Why was Bagram air base closed? Because we only needed one airport and the military decided that Kabul was a better choice.
  • Why was there so much chaos? It’s easy to see how it looked that way if you were caught in the middle of it, but there wasn’t, really. There were thousands of Afghans who wanted to flee the country and they all surrounded the airport hoping for evacuation. There’s nothing anyone could have done about that, and for the most part the crowds were handled well and processed as efficiently as anyone could have hoped for.
  • Why did it take so long to approve visas for Afghans who qualified for evacuation? It didn’t. We approved visas for 100,000 Afghans in two weeks! And to the extent that this was slower than it could have been, it’s because the Trump administration deliberately sabotaged the process before they left office.
  • Why didn’t we rescue everyone? As always, there are limits to American power. The Taliban controls Kabul, and rescuing literally everyone who wanted to get out was never remotely feasible.
  • Why didn’t we start evacuation earlier? Because we couldn’t. As long as the Afghan government was in power, we had to support them. Starting a mass evacuation would have been an obvious signal that we thought they were doomed.
  • Why didn’t we know that the Taliban would take over so quickly? That’s a very good question, and it was certainly a failure on our part. On the other hand, literally everyone made the same mistake. There wasn’t a single analyst or reporter on the ground who thought the Taliban would take control of Kabul in less than a month.

Nothing is perfect. Obviously there were security breakdowns on Monday the 16th. The suicide bombing on the 26th was an enormous tragedy. The future of Afghanistan under the Taliban is likely to be a violent and miserable one for a lot of people. There’s no need for defenders of the evacuation to pretend that literally no mistakes were made.

That said, if you can look past partisanship; and neocon defensiveness; and individual stories of grief and hardship; and huge crowds on the ground that inevitably gave the impression of chaos—if you can look past all that to the bare facts on the ground, the evacuation of Kabul should go down as one of the shining moments of the US military. That hardly compensates for 20 years of bungling, but taken on its own it was a magnificent effort.


Where’s my Covid pill?

I meant to post this a long time ago, but I’m finally getting around to it due to my PS 310 lecture on presidential power in policymaking yesterday.  I said, imagine that next week a pill came out that was basically a cure for Covid and ended the pandemic.  Obviously, Biden would have pretty much nothing to do with that, but we all know that his popularity would increase considerably.  And, of course, that’s actually not an entirely crazy notion.  Over a year ago I was doing near daily searches for EIDD-2801 in hopes that this would be the technological breakthrough that would really save us.  Alas, not to be.  And I still don’t understand why the trials are taking so long with so much Covid out there, but, somehow, there still seems to be a chance that molnupiravir (as it’s now known) could end up making a real difference:

Researchers from around the world are testing other antivirals already known to work in pill form. One such compound, called molnupiravir, was developed in 2019 by researchers at Emory University and has been tested against viruses including influenza and Venezuelan equine encephalitis virus.

In partnership with Ridgeback Biotherapeutics of Miami, the Emory team carried out experiments in mice that were so impressive that Merck approached them to bring the drug into human clinical trials for Covid-19.

“We thought this molecule was really amazing,” said Daria Hazuda, vice president of infectious disease and vaccine research at Merck.

In a trial of hospitalized patients, however, molnupiravir seemed to have no effect on the disease. In April, the companies announced they were scrapping the trial.

“I see that, and I’m like, ‘Yeah, no duh,’” said Dr. Tim Sheahan, a virologist at the University of North Carolina. “It’s not surprising to me that those kinds of medications would not make a dramatic improvement in someone’s outcome when they’ve been sick for several days.”

The companies began a second study last fall, this time testing the drug on people recently diagnosed with Covid-19. That trial is continuing, and Merck is recruiting volunteers with a higher risk of infection, such as older people with obesity and diabetes. Dr. Hazuda said the trial should deliver clear results by October…

Last week saw the first results of this planning. The Department of Health and Human Services announced that it would purchase from Merck 1.7 million doses of molnupiravir at a cost of $1.2 billion, provided that the current trial leads to authorization by the Food and Drug Administration. The government may seek similar deals for two other antivirals far along in clinical trials, according to Dr. David Kessler, the chief science officer of the Biden administration’s Covid-19 response team.

The hope “is that we can get an antiviral by the end of the fall that can help us close out this chapter of the epidemic,” Dr. Kessler said in an interview.

One of the drugs the government is considering is AT-527, developed by Atea Pharmaceuticals. The compound has already proven safe and effective as a treatment for hepatitis C, and early studies suggested it might also work against Covid-19. Roche has partnered with Atea to test it in people, and the companies are currently running a late-stage clinical trial.

The other drug on the government’s radar was created by scientists at Pfizer, adapted from a molecule initially designed in the early 2000s as a potential drug for SARS. That drug had sat on the shelf for years, but last spring, the scientists decided to modify its structure so that it would work against the new coronavirus’s protease. More than 200 Pfizer researchers joined forces on the effort on the molecule, known for now as PF-07321332.

The drug had been designed to be taken intravenously, but the Pfizer researchers succeeded in altering its structure to work as a pill. When mice were given the drug orally, it reached high enough levels in the body to block the coronavirus. Pfizer launched a clinical trial in March to study its safety in people, and expects to move to later-stage testing next month.

Dr. Kessler acknowledged that there will be challenges in using such pills to drive down hospitalizations and deaths from Covid-19. People will need to gain access to the drugs as soon as they test positive. “Your testing programs are going to have to be linked to your treatment,” he said.

And if the history of antiviral research is any guide, the first drugs for Covid-19 will probably only offer modest benefit against the disease, Dr. Fauci said. But that would be a good start.

I’m no expert in anti-viral medication, to say the least, but I feel like even I know enough to know that the greatest chance for efficacy is early in the disease course, not once someone is already hospitalized.  What was up with that?!

And, okay, at best, not going to be the magic pill that bumps up Biden’s approval by 10 points, but, maybe, hopefully, something that makes a real difference.

Also, how is nobody talking about the strong evidence that a basic, old-school SSRI, fluvoxamine, is dramatically effective in reducing hospitalization by 31%?!  That’s huge!  This is a readily available, highly tolerable medication.  Why aren’t we dosing the crap out of people with this already?  From Vox:

But scientists haven’t stopped searching, and the results of a new massive clinical trial suggestthey’re getting somewhere. In a large, randomized clinical trial conducted with thousands of patients over the past six months, researchers at McMaster University tested eight different Covid-19 treatments against a control group to figure out what works.

One drug stood out: fluvoxamine, an antidepressant that the Food and Drug Administration has already found to be safe and that’s cheap to produce as a generic drug.

These new results follow some promising findings in small-scale trials last year. In those smaller studies, researchers found that fluvoxamine was strikingly good at reducing hospitalization for Covid-19 patients — but small-scale trials can sometimes turn up spurious good results, so those findings were obviously tempered by a lot of caveats.

This study, called the TOGETHER study, is a lot bigger — more than 3,000 patients across the whole study, with 800 in the fluvoxamine group — and supports the promising results from those previous studies. The authors released it this week as a preprint, meaning that it is still under peer review.

Patients given fluvoxamine within a few days after testing positive for Covid-19 were 31 percent less likely to end up hospitalized and similarly less likely to end up on a ventilator. (Death from Covid-19 is rare enough that the study has wide error bars when it comes to how much fluvoxamine reduces death, meaning it’s much harder to draw conclusions.) It’s a much larger effect than any that has been found for an outpatient Covid-19 treatment so far.

“This is a huge finding,” study co-author Ed Mills, a professor of health sciences at McMaster University, told me. “The game changers are things we already had in the cupboards.”

What makes this result potentially such a big deal is that fluvoxamine is inexpensive and has already been FDA approved for obsessive-compulsive disorder (OCD), so any doctor can prescribe it for Covid-19 using their clinical judgment (what’s called “off-label” prescribing). It’s a pill, which means it doesn’t need to be administered in a hospital or by a medical professional.

Also, a good twitter thread here.  And, if you get a positive test and are over 30, you may well qualify for a clinical trial testing the drug (also Ivermectin! though, I did read on twitter that, if accurate, you can opt-out of the Ivermectin possibility).  Honestly, though, anybody I know who is immunocompromised and got a Covid positive I would absolutely encourage to ask a physician for an off-label prescription.  

My dog’s DNA, whether you wanted it or not.

I gave pretty much all the money I’ve received so far for being in the J&J vaccine trial to the Givewell maximum impact fund.  My one indulgence, was using a payment to buy a dog DNA test.  I really thought my dog was “mostly” Golden Retriever with some Chow and others.  But, in fact, equally split between Golden and Chow, but only at a combined 60%.  Also, recognizing that these are estimates (they really should have error bars like my ancestry.com results) I’m highly skeptical that my dog is 31/30 not 25/25 on the main mix.  Seems to me that, almost surely, his parents are an even Golden/Chow mix and then a full-on mutt with quite a mix.  That, of course, would be 25/25/…  The evenly matched 30% just makes no sense– or am I missing something?  Anyway, meet my dog’s (estimated) ancestry.

Incentives aren’t enough; we’re going to have to mandate more

Important new analysis taking a look at the various financial incentives to get people vaccinated and, unfortunately, the results suggest a big fat zero.  The abstract:

To encourage COVID-19 vaccination, many states in the US have introduced financial incentives ranging from small, guaranteed rewards to lotteries that give vaccinated individuals a chance to win $1 million or more. We compiled information on statewide incentive programs along with data on daily vaccine doses administered per 100,000 individuals in each state. Leveraging variation across states in the daily presence of incentives, we used difference-in-differences regressions to examine the association between these incentive program indicators and vaccination rates. Difference-in-differences analysis showed that 24 statewide incentive programs were associated with a non-significant relative decline in daily vaccination rates of 8.9 per 100,000 individuals (95% CI [-64.3,46.5]; p=0.75). Furthermore, there was no significant difference in vaccination trends between states with and without incentives in any of the 14 days before or after incentives were introduced. Lotteries and other incentives offered by 24 states were not associated with a significant change in COVID-19 vaccination rates. More substantial incentives or mandates may be necessary to raise vaccination rates. [emphasis mine]

Well, damn.  Would’ve been really nice if this gentler approach was actually effective.  But, now that we’ve got full approval, time to mandate, mandate, mandate.  For example, I love to see the latest from my alma mater, “Duke University tells all employees they must get a COVID-19 vaccine or be fired.”

Quick hits (part II)

1) Something tells me if the impact from the wildfires out west were happening on the East coast there’d be way more media coverage.  Something about this article and it’s images really got through to me.  Just… damn.

Smoke from the Caldor fire shrouded Emerald Bay, near South Lake Tahoe, Calif., on Wednesday.

2) I don’t love the “puppy” description for a 14-month old pit bull mix, but if you watch the video (and read the context) there’s just no way this police officer should be on the force.  And rules that allow police to shoot any dog that comes towards them under any circumstances lead to an ongoing dogmaggedon.  If you’ve spent 5 minutes with dogs, you clearly recognize this is a dog coming to play, not attack.  “Body-cam footage shows police shoot a ‘playful’ puppy: ‘He was curious and excited to greet this officer’”

3) Yes, of course the energy we spend on air conditioning makes climate change worse, but, come on, articles telling people to not use air conditioning are not the way to save the planet.  Not to mention, this one goes full woke Vox with a whole section on how air conditioning is “racist.”  

4) Ezra’s take on Afghanistan this week was so, so good.  But, I’ve already given you a lot of NYT links, so here’s an extensive excerpt:

To state the obvious: There was no good way to lose Afghanistan to the Taliban. A better withdrawal was possible — and our stingy, chaotic visa process was unforgivable — but so was a worse one. Either way, there was no hope of an end to the war that didn’t reveal our decades of folly, no matter how deeply America’s belief in its own enduring innocence demanded one. That is the reckoning that lies beneath events that are still unfolding, and much of the cable news conversation is a frenzied, bipartisan effort to avoid it.

Focusing on the execution of the withdrawal is giving virtually everyone who insisted we could remake Afghanistan the opportunity to obscure their failures by pretending to believe in the possibility of a graceful departure. It’s also obscuring the true alternative to withdrawal: endless occupation. But what our ignominious exit really reflects is the failure of America’s foreign policy establishment at both prediction and policymaking in Afghanistan.

“The pro-war crowd sees this as a mechanism by which they can absolve themselves of an accounting for the last 20 years,” Senator Chris Murphy, Democrat of Connecticut, told me. “Just think about the epic size of this policy failure. Twenty years of training. More than $2 trillion worth of expenditure. For almost nothing. It is heartbreaking to watch these images, but it is equally heartbreaking to think about all of the effort, of lives and money we wasted in pursuit of a goal that was illusory.” …

It is worth considering some counterfactuals for how our occupation could have ended. Imagine that the Biden administration, believing the Afghan government hollow, ignored President Ashraf Ghani’s pleas and began rapidly withdrawing personnel and power months ago. The vote of no-confidence ripples through Afghan politics, demoralizing the existing government and emboldening the Taliban. Those who didn’t know which side to choose, who were waiting for a signal of who held power, quickly cut deals with the Taliban. As the last U.S. troops leave, the Taliban overwhelms the country, and the Biden administration is blamed, reasonably, for speeding their victory.

Another possible scenario was suggested to me by Grant Gordon, a political scientist who works on conflict and refugee crises (and is, I should say, an old friend): If the Biden administration had pulled our allies and personnel out more efficiently, that might have unleashed the Taliban to massacre their opposition, as America and the world would have been insulated and perhaps uninterested in the aftermath. There have been revenge killings, but it has not devolved, at least as of yet, into all-out slaughter, and that may be because the American withdrawal has been messy and partial and the Taliban fears re-engagement. “What is clearly a debacle from one angle may actually have generated restraint,” Gordon told me. “Having spent time in places like this, I think people lack a real imagination for how bad these conflicts can get.”

Let me offer one more: Even though few believed Ghani’s government would prevail in our absence, and the Trump administration cut them out of its deal with the Taliban, there’s widespread disappointment that the government we supported collapsed so quickly. Biden has been particularly unsparing in his descriptions of the Afghan Army’s abdication, and I agree with those who say he’s been unfair, underestimating the courage and sacrifice shown by Afghan troops throughout the war. But put that aside: Americans might have felt better seeing our allies in Afghanistan put up a longer fight, even if the Taliban emerged victorious. But would a multiyear civil war have been better for the Afghans caught in the crossfire?

Brian Katulis, a senior fellow at the Center for American Progress, put it simply: “I think there’s a lot of cognitive dissonance, and smart people are struggling with how to rationalize defeat. Because that’s what we have here in Afghanistan — a defeat.” …

The tragedy of humanitarian intervention as a foreign policy philosophy is that it binds our compassion to our delusions of military mastery. We awaken to the suffering of others when we fear those who rule them or hide among them, and in this way our desire for security finds union with our desire for decency. Or we awaken to the suffering of others when they face a massacre of such immediacy that we are forced to confront our passivity and to ask what inaction would mean for our souls and self-image. In both cases, we awaken with a gun in our hands, or perhaps we awaken because we have a gun in our hands.

To many, America’s pretensions of humanitarian motivation were always suspect. There are vicious regimes America does nothing to stop. There are vicious regimes America finances directly. It is callous to suggest that the only suffering we bear responsibility for is the suffering inflicted by our withdrawal. Our wars and drone strikes and tactical raids and the resulting geopolitical chaos directly led to the deaths of hundreds of thousands of Afghans and Iraqis.

This is the deep lacuna in America’s foreign policy conversation: The American foreign policy establishment obsesses over the harms caused by our absence or withdrawal. But there’s no similar culpability for the harms we commit or that our presence creates. We are much quicker to blame ourselves for what we don’t do than what we do.

My heart breaks for the suffering we will leave behind in Afghanistan. But we do not know how to fix Afghanistan. We failed in that effort so completely that we ended up strengthening the Taliban. We should do all we can to bring American citizens and allies home. But if we truly care about educating girls worldwide, we know how to build schools and finance education. If we truly care about protecting those who fear tyranny, we know how to issue visas and admit refugees. If we truly care about the suffering of others, there is so much we could do. Only 1 percent of the residents of poor countries are vaccinated against the coronavirus. We could change that. More than 400,000 people die from malaria each year. We could change that, too.

“I want America more forward-deployed, but I want it through a massive international financing arm and a massive renewable energy arm,” Senator Murphy told me. “That’s the United States I want to see spread across the world — not the face of America today that’s by and large arms sales, military trainers and brigades.”

The choice we face is not between isolationism and militarism. We are not powerful enough to achieve the unachievable. But we are powerful enough to do far more good, and far less harm, than we do now.

5) I had never really thought about how much it sucks to be a tennis great of declining skills getting whipped by no-names in the 1st and 2nd round as opposed to a star from a team sport who manages to have a farewell tour while competing far below peak ablity:

There are many reasons that tennis does not lend itself to perfect endings. The modern game imposes immense physical demands and a relentless schedule. Its ranking system rewards consistent, elite play and punishes those whose aging bodies only allow them to dabble with lower seeds and more difficult early-round matches. The knockout format prevents anyone, regardless of past performance, from being guaranteed a grand setting for a final match, which can easily occur on a random Tuesday in a half-empty stadium.

The result is a stark choice for even the best tennis players: Go out on top while most likely leaving some championships on the table, or meander through a frustrating descent into being OK at best, which can be less than fun in a sport that shines its brightest lights on the top two or four players and lumps nearly everyone else into something of an also-ran category.

A star on a team sport can flicker then fade amid the protection of teammates. There’s an unforgiving loneliness to stardom in tennis.

The tennis equivalent of Derek Jeter’s gift-collecting farewell tour as the Yankees’ shortstop — an unproductive .256 batting average over 145 games coupled with not good but not embarrassing defense — is a lot of early-round losses to journeymen.

6) Just came across this study from March that just a good solid surgical mask (type II) does a good job with protecting aerosols while hardly impacting the difficulty in breathing.  And, just use a hack or two to make it fit better and you are in quite good shape. 

7) I so want to say “yes” to this even though I recognize the inherent problems, “Would It Be Fair to Treat Vaccinated Covid Patients First?” 

8) David Zweig with a solid piece in New York, “The Science of Masking Kids at School Remains Uncertain.”  I’m entirely okay with accepting “uncertain,” but with “nonetheless plenty of suggestive evidence that indicates this really is a good idea, and one who’s potential benefits almost surely outweigh the costs.” 

9) Among the various diet trends I’ve been interested in, I was pretty intrigued by this high/low glycemic index thing for a while.  Now, I just simply try and focus on more healthy food and calorie counting when I really want to lose weight.  Interestingly, some solid research suggests it doesn’t actually matter all that much.  

High-glycemic index (high-GI) foods (so-called fast carbs) have been hypothesized to promote fat storage and increase risk of obesity. To clarify whether dietary GI impacts body weight, we searched PubMed and the Cochrane Database of Systematic Reviews for observational studies reporting associations between BMI and dietary GI, and for meta-analyses of randomized controlled trials (RCTs) comparing low-GI and high-GI diets for weight loss. Data on 43 cohorts from 34 publications, totaling 1,940,968 adults, revealed no consistent differences in BMI when comparing the highest with the lowest dietary GI groups. In the 27 cohort studies that reported results of statistical comparisons, 70% showed that BMI was either not different between the highest and lowest dietary GI groups (12 of 27 cohorts) or that BMI was lower in the highest dietary GI group (7 of 27 cohorts). Results of 30 meta-analyses of RCTs from 8 publications demonstrated that low-GI diets were generally no better than high-GI diets for reducing body weight or body fat. One notable exception is that low-GI diets with a dietary GI at least 20 units lower than the comparison diet resulted in greater weight loss in adults with normal glucose tolerance but not in adults with impaired glucose tolerance. While carbohydrate quality, including GI, impacts many health outcomes, GI as a measure of carbohydrate quality appears to be relatively unimportant as a determinant of BMI or diet-induced weight loss. Based on results from observational cohort studies and meta-analyses of RCTs, we conclude that there is scant scientific evidence that low-GI diets are superior to high-GI diets for weight loss and obesity prevention.

10) Of course Democrats’ plans to make Medicare a lot better are going to come under zealous assault from those who may stand to lose, such as dentists and insurers.  Money before better health for more Americans, of course.  

11) I really need to write another post about boosters, especially in regard to J&J.  For now:

As vaccine makers set their sights on boosters, new studies unveiled on Wednesday from Johnson & Johnson and Pfizer-BioNTech demonstrated that extra shots can dramatically raise antibodies against the coronavirus.

The companies said they were submitting the new data to the Food and Drug Administration for evaluation, and Pfizer has formally asked the agency to authorize a booster shot. The Biden administration said last week that it wants to provide booster shots for all Americans eight months after vaccination.

The Johnson & Johnson one-shot vaccine was absent from the government’s booster plan announced last week. But with the new data, the company hopes to be part of the initial distribution of additional shots, which could happen as early as September…

In its new study, Johnson & Johnson tracked 17 volunteers from last year’s clinical trial. When given a booster shot at six months, their antibodies against the coronavirus jumped nine times as high as after the first dose. The data has not yet been published in a scientific journal.

Small studies of Moderna and Pfizer-BioNTech booster shots have found comparable jumps in antibody levels, as the companies reported on recent earnings calls.

On Wednesday, Pfizer and BioNTech released new data from 306 people showing that a third dose given five to eight months after the second caused a strong immune response. The level of antibodies against the coronavirus in the volunteers more than tripled, the companies reported.

The side effects of a third injection were about the same as after the initial two doses, the companies said. The underlying data was not included in the news release, nor were the dates or location of the study specified. The companies said they were preparing a scientific publication describing the research.

12) I didn’t even realize today that an open tab from an old (i.e., 2020) article was actually about epistemic trespassing.  “Which Experts Should You Listen to during the Pandemic?
It should be a no-brainer: your best bet is to follow those who have actual expertise.”  Turns out Ballantyne’s twitter thread was better because I had a bunch of issues with this.  Basically, using a bunch of anecdotes of “epistemic trespassing” to say, “see, and they were wrong.”

Trespassers lack that well-tailored expertise. What they actually do know does not always transfer to new and different topics. Worse, they often lack the awareness that such tailored expertise exists. Their gaps in knowledge remain invisible to them.

Meanwhile, let’s ignore the fact that all sorts of people with “tailored expertise” kept on insisting on “droplet” transmission and denying airborne for months and months after many without this “tailored expertise” had correctly concluded otherwise.  Sure, ceteris paribus, go with those with the real expertise.  But, quite often, not else is equal.  I’ll take my ivermectin now :-).

13) Interesting take from Frum, “The One Thing That Could’ve Changed the War in Afghanistan: Had Osama bin Laden been killed or captured in December 2001, justice would have been served in the way Americans like: fast, hard, and cheap.”

Had the United States caught and killed Osama bin Laden in December 2001, the U.S. military presence in Afghanistan would have faded away almost immediately afterward. I cannot prove that. It’s only an opinion from my vantage point as one of President George W. Bush’s speechwriters in 2001 and 2002.

Had U.S. forces succeeded against bin Laden in 2001, justice would have been served in the way Americans like: fast, hard, and cheap. Republicans could have campaigned in the elections of 2002 as the winners of a completed war—and pivoted then to domestic concerns. Remember, if George W. Bush learned one single lesson from his father’s presidency, it was that even the most overwhelming military success does not translate into reelection. In November 1992, the elder Bush won 37 percent of the vote against a Democratic nominee who had opposed the triumphant Gulf War.

Bin Laden’s survival doomed any idea of pivoting back to domestic concerns. Without a kill or capture of bin Laden to show, the swift overthrow of the Taliban government seemed very much a consolation prize.

The road opened to the Iraq War.

Again, this is only one man’s opinion, but I don’t believe Bush was yet committed to a ground war against Saddam Hussein when he delivered his “Axis of Evil” speech in January 2002. That speech identified Iraq’s weapons potential as a deadly serious security threat. It said the same of Iran’s and North Korea’s weapons potential, and Bush had no intention of fighting either of them. There were and are many ways to address weapons potential short of a ground war, whether sanctions or sabotage or air strikes.

Yet in the year after that speech, the decision for war coalesced. Something had to be done against Islamic terrorism that was not Afghanistan; the Iraq War became that something. A strange dichotomy split the U.S. foreign-policy elite. Prominent figures in the Bush administration—Vice President Cheney, Secretary of Defense Donald Rumsfeld—wished fiercely to escape Afghanistan. This wish was partly because of their determination to finish off Saddam Hussein, but it was also a policy preference in its own right. (For what little it’s worth, that’s how I personally felt at the time: However steep the odds against a stable future for Iraq, that urbanized and literate country was a more promising terrain for U.S. strategic goals than hopeless Afghanistan.)

14) Good stuff from Pew, “How Americans feel about ‘cancel culture’ and offensive speech in 6 charts”

In the September 2020 survey, Americans said they believed calling out others on social media is more likely to hold people accountable than punish people who don’t deserve it. Overall, 58% of adults said that in general, when people publicly call others out on social media for posting content that might be considered offensive, they are more likely to hold people accountable. In comparison, 38% said this kind of action is more likely to punish people who don’t deserve it.

A chart showing that partisans differ over whether calling out others on social media for potentially offensive content represents accountability or punishment

Views on this question differed sharply by political party. Democrats were far more likely than Republicans to say that this type of action holds people accountable (75% vs. 39%). In contrast, 56% of Republicans – but just 22% of Democrats – said this generally punishes people who don’t deserve it.

In a separate report using data from the same September 2020 survey, 55% of Americans said many people take offensive content they see online too seriously, while a smaller share (42%) said offensive content online is too often excused as not a big deal.

A chart showing that Democrats, Republicans are increasingly divided on whether offensive content online is taken too seriously, as well as the balance between free speech, feeling safe online

Americans’ attitudes again differed widely by political party. Roughly six-in-ten Democrats (59%) said offensive content online is too often excused as not a big deal, while just a quarter of Republicans agreed – a 34 percentage point gap. And while 72% of Republicans said many people take offensive content they see online too seriously, about four-in-ten Democrats (39%) said the same.

15) What could be better?  Matt Grossman interviews Ezra Klein about how political science informs our understandings of politics in the modern world.

16) Really, really interesting analysis from Chait: “Why the Media Is Worse for Biden Than Trump”

And they’re right: Conservative media really does command enormous audiences that frequently dwarf its mainstream-news counterparts. But this merely underscores the fact that what we think of as “the media” only accounts for a portion of the American news-media diet. The other half of the media is simply a vehicle for partisan propaganda. And whatever its failings, the last week has amply demonstrated once again that the nonconservative mainstream media is not that.

This is not necessarily to deny that the mainstream media has some kinds of liberal bias. It’s certainly true that, as the electorate has grown more polarized by education, the mainstream media’s near-total reliance on college graduates has made it much more socially liberal than the overall country. (One stark example of this bias was the stampede last year to dismiss the COVID-19 lab-leak hypothesis as a “racist conspiracy theory.”) For the sake of argument, I am willing to concede that this liberal bias outweighs other cross-cutting biases. I would simply maintain that liberal bias is not the only determinant of media coverage.

Above all else, it treats bad news as more important than good news. And so, while mainstream media often covers Republican presidents critically, it metes out the same treatment to Democratic presidents. For instance, the American media’s coverage of COVID — which a study found to be more relentlessly negative than coverage in almost any other country — probably hurt Trump, but now it’s hurting Biden. Even many situations that a Democratic president handles almost perfectly — think of President Obama’s innovative response to the BP oil spill or the Ebola outbreak — will produce little reward, just scary headlines disappearing and the subject being dropped in favor of the next looming disaster.

Traditional journalistic norms may have weakened, especially in subjects like culture and sports, but they remain intact in most newsrooms, and especially in political coverage. Those norms enshrine a certain definition of objectivity that implicitly favors, in addition to social liberalism, hawkish foreign policy, deficit reduction, and bipartisanship.

Putting aside the ethics of the media’s approach, the political effect seems clear enough. Most Democratic voters will experience Democratic administrations as a mixed bag, at best. Republican voters, who mostly absorb the news through party-aligned media, will experience Republican administrations as an unmitigated triumph. The four-year experiment in Trump proved conclusively just how low the conservative media’s standards of truthfulness and competence are for a Republican president. If nothing else, Trump proved conservative media will support anything its party’s leader does.

Even the most dishonest, incompetent, and scandal-ridden Republican presidency imaginable — which more or less describes the one we just had — will still have a media environment divided almost equally between scorching criticism and obsequious fawning. On Trump’s worst days, the Fox News chyrons depicted him as a triumphal leader. On Biden’s best days, the conservative media was still giving him hell. In recent days, CNN and MSNBC looked a lot like Fox News, all hyping chaos in Afghanistan 24/7. That is the kind of comprehensive media hostility Trump never had to worry about.

Quick hits (part I)

1) Are the Covid vaccines victims of their own success?

When Covid-19 vaccines were reported last fall to be roughly 95% effective at preventing symptomatic Covid-19 infections, the world rejoiced — and even veteran scientists were blown away. Very few vaccines are that protective. Those made to fend off viruses like SARS-CoV-2 — viruses that invade the nose and throat, like flu — typically aren’t at the high end of the efficacy scale.

That was the good news. Now, however, our soaring expectations for Covid-19 vaccines are in the process of sinking back to earth.

With the more transmissible Delta variant of SARS-2 circulating, it is increasingly apparent that, even if mRNA vaccines like Pfizer’s and Moderna’s offer impressive protection against severe Covid infections, they aren’t going to prevent infections in the upper respiratory tract of some proportion of vaccinated people.

“We all wish that that this would be gone. That we would get a vaccine and … we would control it,” Kathryn Edwards, a vaccine expert at Vanderbilt University, told STAT. “But I think that looking back, probably that wasn’t always realistic.” …

A critic of the booster decision, Anna Durbin, believes the high bar set by the results of the Phase 3 clinical trials of the Pfizer and Moderna vaccines is now negatively impacting U.S. vaccination policy.

“I think these vaccines are a victim of their own success,” said Durbin, a vaccine researcher in Johns Hopkins Bloomberg School of Public Health. “Now we expect perfection. And if it’s less than perfect, we want a booster.”

I think Durbin is wrong, though.  The vaccines really were nearly perfect against Alpha.  They’re not against Delta.  It’s that we had a real vision of normal life again this summer because there were so few breakthrough infections of vaccinated people.  Now even the vaccinated must live in fear of each other as a potential vector.  That sucks.  And it’s not unreasonable to get back to where we were a couple months ago if a booster can realistically achieve that.

2) Pretty much everything you want to know about Covid and airborne transmission in one amazing Science article.  Written by some of the best public scientists of the pandemic.  Long and thorough, but really quite accessible.  

3) Now that you’ve read that, you might be thinking about how to monitor your air quality.  Dustin Poppendieck’s got you covered.  

4) Spencer Bokat-Lindell on using more nuclear power to combat climate change.  Yes, yes, and yes. 

Its proponents often point out that nuclear power is responsible for the fastest decarbonization effort in history. In the 1970s, France embarked on a sweeping, centrally planned expansion of its nuclear power industry to break its dependence on foreign oil. Over the next decade, it managed to expand its economy even as it cut its emissions at a rate that no other country has achieved since. Today, France derives 70 percent of its electricity from nuclear power.

Why shouldn’t the United States follow suit? “A rapid increase in nuclear energy would slash emissions from the power sector, as the French example makes clear,” The Atlantic’s Robinson Meyer wrote in 2019. “Even today, France’s carbon density — its carbon emissions per capita — ranks well below that of Germany, the United Kingdom and the United States.”

While renewable energy has made enormous strides in recent years, nuclear power still has distinct advantages. Solar and wind farms, for example, take up much more space than nuclear plants, and they provide power only as the weather allows. In part for that reason, several recent studies have found that utilities could achieve 80 percent zero-carbon electricity by 2030 using today’s renewable energy technology, but cleaning up the last 20 percent will prove more difficult.

There are several proposed ways of solving renewable energy’s storage problem — including huge battery arrays and hydrogen fuel — but those technologies aren’t yet up to the task, my colleague Brad Plumer wrote last month.

From a public health perspective, nuclear power is also much safer than fossil fuels, Joshua S. Goldstein, Staffan A. Qvist and Steven Pinker argued in The Times in 2019. According to one study published this year, air pollution from fossil fuels killed a staggering 8.7 million people in 2018. By contrast, Goldstein, Qvist and Pinker noted that in 60 years of nuclear power, only three accidents have raised public alarm, and just one — Chernobyl — directly caused any deaths.

What about nuclear waste, which can remain radioactive for tens of thousands of years? Compared with climate change, it’s a much easier environmental problem to solve, they wrote. More than 90 percent of spent fuel can be recycled, and that which can’t could be entombed in repositories deep underground, as is done in Finland.

In 1987, Congress settled on plans to build a national nuclear waste repository in Nevada, but local, state and federal opposition have thwarted the project for decades. As a result, America’s nuclear plants keep their waste on site in steel and concrete casks that were not intended for permanent storage.

5) Given my strong reaction against the “stay in your lane types” (seriously, just think about how much good Zeynep has done going outsider her “lane”), I really liked this from Noah Smith taking on the idea of “epistemic trespassing.” 

Ballantyne’s essay is basically a 24-page argument that people should stay in their intellectual lane. He starts out with some well-known examples of people who are respected experts in one field becoming quacks in another field — Linus Pauling hawking vitamin C, and so on. Ballantyne then cites other people who have complained about the same phenomenon (Plato!). Following anecdote and argument-from-authority, he then goes on to make a number of conjectures about the harms from epistemic trespassing. Finally, having argued to his own satisfaction that epistemic trespassing is a problem, he throws out some proposals for solutions — basically, more interdisciplinary collaboration and intellectual modesty.

Now, I’m all for interdisciplinary collaboration and intellectual modesty, as a general rule. But although Ballantyne raises interesting points and creates food for thought, he fails to make a conclusive case that what he calls “epistemic trespassing” is, on balance, bad for society. And his arguments raise uncomfortable questions that he doesn’t really wrestle with — most importantly, the question of who gets to decide who’s a trespasser.

Actually, though, after Ballantyne explains his actual take nicely in this twitter thread.

6) This “Planet of Cops” essay from Freddie deBoer from a few years ago (he just re-published it) is great.  

7) The Novavax vaccine is cool and effective and facing major delays in getting approved.  That’s a real shame.  Makes you realize how lucky we are that Pfizer and Moderna both proved to be so good at this.

8) One reason, I think, that ineffective cloth masks (to be clear, there are many effective ones, too) remain so popular is because a lot of people think that medical masks are one use only.  In theory they are.  In practice, they are designed for all day in surgery, which means a bunch of trips to the grocery store.  And, in fact, this study showed N95’s holding up to use by medical workers for a good 40 uses.  

9) And speaking of masks, this is nice, “How to choose and care for your kid’s masks.”  It includes two handy spreadsheets which led me to an (in stock!) Allett mask which we just got today, but, fortunately fits my daughter (and her small 10-year old face) great and worked well during dance class.  

10) The media has done a really poor job of properly covering the Afghanistan evacuation and Eric Boehlert is on it.

Six days ago, as she prepared her airlifted exit from Kabul, CNN reporter Clarissa Ward declared that the United States’ effort to evacuate thousands of Afghans was doomed to failure. “I’m sitting here for 12 hours in the airport, 8 hours on the airfield and I haven’t seen a single US plane take off,” she reported. “How on Earth are you going to evacuate 50,000 people in the next two weeks? It just, it can’t happen.”

Ward seemed to speak for most journalists who lined up for days to condemn President Joe Biden and to predict a perilous future for the Afghanistan capitol. (Talk of “mass murders” and U.S. embassy employees being taken hostage were in the media mix.) Wildly eager to portray the U.S. troop withdrawal as a “humiliating” and “disastrous” “fiasco,” the media were sure the story was going to get much worse.

And they were wrong.

“In fact, it didn’t take 2 weeks to evacuate 50,000. It took 10 days,” Sen. Chris Murphy (D-CT) tweeted in response to Ward. “Lots of work still to do, but it might be time for a bit of a reassessment by the media of this operation given the actual results.”

Don’t hold your breath waiting for journalists to acknowledge that their assessments of Kabul have been badly undercut by the stunning evacuation success.

For the first 10 days of the refugee crisis, the media obsessed over “optics” and how they were “disaster” for Biden. Suddenly though, the press shows little interest dwelling on the optics of successfully extricating nearly 100,000 people without a single U.S. casualty. Instead, the press remains married to its narrative.

That early media emphasis on optics was all consuming. “President Biden’s Reassurances on Afghanistan Contradict Chaotic Images on the Ground, Capping Week of Bad Optics For His Administration,” CNN announced.

According to the New York Times, the optics were so bad they threatened to doom Biden’s entire presidency. “The chaotic endgame of the American withdrawal has undercut some of the most fundamental premises of President Biden’s presidency,” the paper claimed, in a page-one piece that implied the Democrat was incompetent, void of empathy, and “struggling to assert command over world events.”

Those turned out to be hollow claims, given the U.S.’s commitment to evacuating so many people this month, and nearly 20,000 on Tuesday alone.

11) Catherine Rampell, on Afghan refugees and Republican bad faith:

Trumpy nativists, posing as fiscal conservatives, want you to question whether the United States can afford to take in Afghan allies and refugees.

The better question is whether we can afford notto.

The Republican Party has cleaved in recent weeks over the issue of Afghan refugees, specifically those who served as military interpreters or otherwise aided U.S. efforts. On the one hand, Republican governors and lawmakers around the country have volunteered to resettle Afghan evacuees in their states. Likewise, a recent CBS News/YouGov poll found that bringing these allies to the United States is phenomenally popular, garnering support from 76 percent of Republican respondents. Influential conservative constituencies are invested in this issue, too, including veterans’ groups and faith leaders.
On the other hand, the Trump strain within the GOP has been fighting such magnanimous impulses with misinformation.

Xenophobic politicians and media personalities have been conspiracy-theorizing about the dangers of resettling Afghan allies here — even though we had previously entrusted these same Afghans with the lives of U.S. troops and granted them security clearances. And even though they go through additional extensive screening before being brought to our shores.

No matter; if you listen to Tucker Carlson and his ilk, you’ll hear that these Afghans are apparently part of a secret plot to replace White Americans, and that untamed Afghan hordes are going to rape your wife and daughter.

Often these demagogues try to disguise their racist objections to refugee resettlement (and immigration more broadly) as economic concerns. Their claim: that however heartbreaking the footage from the Kabul airport, compassion for Afghan refugees is a luxury Americans simply cannot afford.

12) First soccer game of the season later this morning and now I know the secrets to the pre-game and half-time pep talks.

There is, however, a science to motivating people in this way. To better understand the various tools that help people get psyched up in the moments before important performances, I talked extensively with academics and practitioners in business and a variety of other fields. I discovered that while every individual has his or her own tips and tricks, according to the science, most winning formulas include three key elements: direction giving, expressions of empathy, and meaning making. The most extensive research in this field—dubbed motivating language theory, or MLT—comes from Jacqueline and Milton Mayfield, a husband-and-wife team at Texas A&M International University who have studied its applications in the corporate world for nearly three decades. Their findings are backed by studies from sports psychologists and military historians. And all the evidence suggests that once leaders understand these three elements, they can learn to use them more skillfully.

Three Elements, Carefully Balanced

The Mayfields describe direction giving as the use of “uncertainty-reducing language.” This is when leaders provide information about precisely how to do the task at hand by, for example, giving easily understandable instructions, good definitions of tasks, and detail on how performance will be evaluated.

“Empathetic language” shows concern for the performer as a human being. It can include praise, encouragement, gratitude, and acknowledgment of a task’s difficulty. Phrases like “How are we all doing?” “I know this is a challenge, but I trust you can do it,” and “Your well-being is one of my top priorities” all fit into this category.

“Meaning-making language” explains why a task is important. This involves linking the organization’s purpose or mission to listeners’ goals. Often, meaning-making language includes the use of stories—about people who’ve worked hard or succeeded in the company, or about how the work has made a real difference in the lives of customers or the community.

A good pep talk—whether delivered to one person or many—should include all three elements, but the right mix will depend on the context and the audience. Experienced workers who are doing a familiar task may not require much direction. Followers who are already tightly bonded with a leader may require less empathetic language. Meaning making is useful in most situations, but may need less emphasis if the end goals of the work are obvious.

13) So, this is old, but just came across it yesterday, “Why Are Private-School Teachers Paid Less Than Public-School Teachers? One explanation: The working conditions are better in private schools, so instructors are willing to take a salary cut.” 

Both of these positions overlook the simplest explanation. The labor markets are just plain different—and those differences may hold meaningful lessons.

The first main difference is licensure. Public education has more jobs to fill (87 percent of all teaching jobs nationwide) and fewer people to fill them. That’s because whereas private schools hire whomever they want, state laws require public schools to hire only licensed teachers.

That means public schools have greater demand for workers, and smaller supply. Any economist—really, anyone who’s slept through an Econ 101 lecture—can tell you what comes next. In order to fill their staffs, public schools will need to offer a more attractive wage. They aren’t splurging, any more than private schools are scrimping. It’s just the market—two different markets, in fact—at work.

This brings us to the second main difference between publics and privates, and to the crux of the paradox. How can private schools pay their teachers less, yet offer an education for which parents gladly spend tens of thousands per year? The answer is right there in the question.

Private schools can pay less precisely because they’re better. Not necessarily for students, but for teachers.

Class sizes are smaller—a 12:1 student-to-teacher ratio, compared with 16:1 at public schools. There’s also less red tape—private teachers answer to principals and parents, rather than to principals, parents, and three meddling levels of government. And the families at private schools are, quite literally, invested in education.

14) Delta airlines policy of punishing unvaccinated employees with higher health insurance rates sure feels good, but, alas, we really don’t want to start getting into a world (again!) where we price health care based on individual conditions and behavior.

There are also reasons to be uncomfortable that such proposals are being widely discussed. “I’m worried that making an exception for covid or someone’s vaccine status starts us down a slippery slope,” says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University. Denying health insurance coverage for preexisting conditions, even seemingly minor ones, ended only with the passage of the Affordable Care Act. “It was a long, hard-fought battle to end the practice,” she says.

Lots of things in day-to-day life are risky, Corlette notes. “Should we charge people more if they work with toxic chemicals in their day job?”

Many Americans seem to understand that people shouldn’t be singled out by an optional health status. A recent poll by Eagle Hill Consulting Research found that almost 6 out of 10 oppose the idea of charging unvaccinated Americans higher insurance premiums. “Even employees who are vaccinated might oppose higher rates, as they could worry this could lead to more health-care costs placed on employees,” says Eagle Hill CEO and President Melissa Jezior.

That’s not an unreasonable fear. In the ongoing battle over who will pay our ever-increasing medical bills, consumers all too often get tagged as “it.”

If you believe, like I do, that health care is a basic human right, narrowing access to care is a step backward. Costs should not be conditional on someone behaving in a medically approved way.

None of this is to excuse those who choose to be unvaccinated. In some ways the unvaccinated are freeloaders, benefiting from the risk reduced by those of us who got jabbed even as they raise the risk to the immunocompromised and others around them. These days, the unvaccinated account for the vast majority of the pandemic strain on our health-care system. Every eligible American needs to get vaccinated.

But we don’t need to give employers and the medical industrial complex another excuse to raise people’s bills, no matter how worthy the end goal. If Delta or other companies are concerned about unvaccinated employees, they should tackle the issue in the most direct way possible: mandate that all their employees get jabbed. They’ve got the power to require vaccination, and no extra premiums are needed.

15) I’ve not loved the Supreme Court decisions this week and seen a lot of angry takes, but, I think Drum is probably right in his contrarianism here:

The progressive left is outraged at the Supreme Court based on two recent rulings:

  • In 2019, President Trump put in place his “Remain in Mexico” policy, which required migrants seeking asylum to stay in Mexico while their cases were being adjudicated. On his first day in office, Joe Biden rescinded the policy. On Tuesday the Supreme Court ordered the policy to be reinstated pending a full hearing.
  • Last month Biden was set to allow the CDC’s eviction moratorium to lapse, but under pressure from progressives he ordered it to be continued. On Thursday the Supreme Court ruled that the moratorium had to end.

Strictly as a matter of law, are these two rulings really so outrageous? Regarding the first one, the Supreme Court has frequently said that a policy, once put in place according to the rules, can’t be “arbitrarily and capriciously” ended. Since Biden killed the “Remain in Mexico” policy on his first day, it seems like you can make a pretty good case that it was arbitrary, can’t you?

On the second one, the Court had clearly signaled months ago that it wouldn’t approve an extension beyond July 30. Biden himself didn’t expect to win a SCOTUS battle, and sure enough he didn’t.

IANAL and I’m more than willing to hear from lawyers who know the law and have opinions about this. But tentatively, at least, it’s not clear to me that there’s anything to be all that outraged about.

16) Hooray, John McWhorter is now an NYT columnist.  Here he takes on performative anti-racism at University of Wisconsin:

The University of Wisconsin has apparently done Black people a favor. It lifted away a rock.

It was a big one, 42 tons, and at least some Black students thought of it as a symbol of bigotry. Because, you see, 96 years ago, when the rock was placed where it was until just now, someone in a local newspaper called it — brace yourself — a “niggerhead.”

That didn’t settle in as a permanent nasty local moniker for the rock. It was just something some cigar-chomping scribbler wrote in 1925. But still, the Wisconsin Black Student Union, making one of the kinds of demands such groups started pushing with especial fervor last year, insisted that the rock be taken away, with the backing of the school’s Indigenous student organization. News reports say the rock had troubled students over the decades; some saw it as a “racist monument,” as one put it, whose absence now allows them to “begin healing.”

The students are fashioning their take on the rock as a kind of sophistication or higher awareness. But what they are really demanding is that we all dumb ourselves down.

The idea, it would seem, is that there is no difference between the past and the present, that what some writer said one day during the Coolidge administration would be hurtful to a student walking past the rock while texting last month, that this rock is representative of racism in the same way that a Confederate statue is representative of Southern racism.

So apparently the passage of time is an illusion? That’s sophisticated indeed as a literary conceit, but what’s deep in Faulkner becomes mere performance when it’s wielded to have a rock lifted away because of what one person called it almost a century ago.

And a crude performance at that. The students essentially demanded that an irrational, prescientific kind of fear — that a person can be meaningfully injured by the dead — be accepted as insight. They imply that the rock’s denotation of racism is akin to a Confederate statue’s denotation of the same, neglecting the glaringly obvious matter of degree here — as in, imagine pulling down a statue upon finding that the person memorialized had uttered a single racist thing once in his or her life.

We are to pretend these students are engaged in something called critique. Interesting, though, that the root of that word, “krei,” originally referred to making distinctions, as did the root of the word science as in knowledge. These students are implying instead that on race matters, the advanced way is to resist distinguishing.

The philosopher George Santayana analyzed criticism as “dividing the immortal from the mortal part of the soul,” as in isolating for posterity that which is true, essential. These students’ critique suggests, among other things, that something that hurts you makes you weaker. Is that really what we want to classify as truth — essence? How can the same people who would lustily insist that Black people are strong get behind having a rock removed from their sight because of something some boob wrote about it some 100 years ago?

If the presence of that rock actually makes some people desperately uncomfortable, they need counseling. And as such, we can be quite sure that these students were acting. Few can miss that there is a performative aspect in the claim that college campuses, perhaps the most diligently antiracism spaces on the planet, are seething with bigotry. The Wisconsin rock episode was a textbook demonstration of the difference between sincere activism and playacting, out of a desire to join the civil rights struggle in a time when the problems are so much more abstract than they once were.

17) I did quite enjoy the first season of Ted Lasso (not started the second yet).  I had no idea about this real-life Ted Lasso coaching in Germany, Jesse Marsch, though in this case, he really knows soccer and has been really successful.  I’m always skeptical of how much difference the coach’s emotional approach to his/her players makes, but this take is certainly making the case for a Lasso-like approach.

18) Another oldie but goodie I came across this week from Alex Tabarrok “Firefighters Don’t Fight Fires”

19) Another really good piece about the future evolution of Covid, this time from Katherine Wu.

If evolution is a numbers game, the coronavirus is especially good at playing it. Over the past year and a half, it’s copied itself quickly and sloppily in hundreds of millions of hosts, and hit upon a glut of genetic jackpots that further facilitate its spread. Delta, the hyper-contagious variant that has swept the globe in recent months, is undoubtedly one of the virus’s most daring moves to date. This variant is the product of unfettered transmission, and will thrive further on it; if allowed to, Delta could morph into something even more formidable. “Delta is already a really strong competitor,” Michal Tal, an immunologist at Stanford University, told me. “It could get significantly worse.”

We can’t precisely predict what worse will look like. There is no playbook for evolution. Delta could continue to ratchet up its rate of spread, or it could be ousted by another super-infectious variant. But the speed that has powered Delta’s transmission for months probably can’t sustain SARS-CoV-2 forever, at least not on its own. Humanity’s collective immunity to the virus is growing, which means the next variants we encounter might be better off taking a tack that relies a lot more on stealth. “There’s some sort of tipping point where immune evasion becomes a bigger fitness advantage than transmission,” Stephen Goldstein, an evolutionary virologist at the University of Utah, told me. No one yet knows exactly where that tipping point is—just that we will probably, eventually, collide with it.

This transition will mark a new stage in our extended parlay with SARS-CoV-2. Viruses depend intimately on their hosts—and the global population no longer looks or acts as it did when this one was a fresh threat. A large fraction of us, especially in vaccine-wealthy countries such as the United States, now have some degree of immunity, simultaneously suppressing the pathogen’s ability to pass among us and pressuring it to circumvent those shields. Our defenses are upping the ante for the virus. And the virus will likely rise to meet it.

The cyclical nature of this game might sound disheartening. But nothing will ever put us back at square one. Even as the virus evolves away from us, we can give chase. As immunity builds, our dalliances with the virus will trend milder, shorter, and less frequent. With vaccination on our side, we’re giving the virus fewer turns at the board, and slowing the pace at which the game is played. Although we can’t yet trounce SARS-CoV-2 for good, we can buy ourselves time to make our next decisive move.

20) And speaking of evolution, if you are interested in the topic at all (you should be), the story of how Palmer amaranth as evolved into a super-herbicide-resistant superweed is absolutely fascinating (and very concerning for the future of agriculture).  Just trust me and read this great NYT Magazine feature.  

Our testing failure

I’m planning on visiting with some out-of-town family on Sunday and what I would really love to do is give all of us a rapid test beforehand.  But, because this is America and we’re stupid, that will cost at least $12.50 per person.  I thought maybe I could 2 for $20 instead of $25 at Amazon.  I can if I want to wait a month.  Meanwhile, in Europe, they are everywhere and less than $1 a test.  Yes, you read that right.  

Among the many, many failures we’ve had, I see two of the hugest failures (especially since they really are so easy to remedy) as 1) the lack of emphasis on good masks (cloth masks without decent filtration properties are so Spring 2020, but that’s still what a ton of people are wearing– and they are less comfortable to boot, because they’re not exactly designed for breathing, unlike non-woven polypropylene); 2) are pathetic and dramatic under-utilization of cheap rapid tests.  Alex Tabarrok on the latter.  I keep getting sad and angry every time I think about this:

We have vaccine abundance in the United States but not test abundance. Germany has test abundance. Tests are easily available at the supermarket or the corner store and they are cheap, five tests for 3.75 euro or less than a dollar each. Billiger! In Great Britain you can get a 14 pack for free. The Canadians are also distributing packs of tests to small businesses for free to test their employees.

In the United States, the FDA has approved less than a handful of true at-home tests and, partially as a result, they are expensive at $10 to $20 per test, i.e. more than ten times as expensive as in Germany. Germany has approved over 50 of these tests including tests from American firms not approved in the United States. The rapid tests are excellent for identifying infectiousness and they are an important weapon, alongside vaccines, for controlling viral spread and making gatherings safe but you can’t expect people to use them more than a handful of times at $10 per use.

We ought to have testing abundance in the US and not lag behind Germany, the UK and Canada. As usual, I say if it’s good enough for the Germans it’s good enough for me.

How are we so damn bad at this?  And, actually, seriously… how?  Seems like nobody even cares enough for a NYT or Atlantic or New Yorker or whomever journalist to do the deep dive to explain this failure.  But a massive failure it is.  And as with all of our Covid failures it means needless suffering and death.  


Is Afghanistan like drug rehab?

What?  Here goes…

One of the great insights I’ve gotten from Mark Kleiman is that even when drug treatment “fails” that is, the person relapse and starts using drugs again, it can still pass a cost/benefit analysis.  There can be so much benefit to just keeping a person of drugs for 3 or 6 months or whatever, that even if they start using again, the costs of the treatment program are more than offset by the benefits.  

This is what I thought about when reading a recent Rauch take on Afghanistan:

Imagine owning stock in a company that goes bankrupt. Holding a fistful of worthless shares, you feel regretful, dismayed, even angry. All that money … lost. What a mistake! What a failure!

But wait. Suppose you had bought the stock 20 years ago and it paid dividends every year. Those dividends helped cover your family’s mortgage and put your kids through school. Doesn’t that cast a different light on the matter? Despite the disappointing ending, you can feel pretty good about your investment.

This is the calculus America is facing in assessing its 20-year stabilization campaign in Afghanistan. Abruptly, though not entirely unexpectedly, the Biden administration is pulling out. No one knows what will happen next, but most analysts expect the Taliban to tighten its grip on the countryside and perhaps conquer the whole country—possibly without much of a fight. Emboldened, the Taliban have been pressing forward aggressively and made some significant gains.

Conventional wisdom sees another in a string of lost U.S. wars. “America’s war in Afghanistan is ending in crushing defeat,” headlines The Economist. The U.S. is “calling an end to the whole sorry adventure, with almost nothing to show for it,” the magazine editorializes. In Foreign Policy magazine, Emran Feroz writes, “The war began as it is ending, in failure.” A headline in the same publication says “Afghanistan Is America’s Greatest Strategic Disaster.” Those are only a few random examples of countless declarations of defeat.

Well, hold on a minute. Humility cautions us not to be confident of how Afghanistan will look in five or ten years. But let’s assume, for argument’s sake, that the Taliban do retake power and resume their campaign to make Afghanistan medieval again. Assume a refugee crisis, human rights violations, and even resumption of terrorist activity. Yes, that would be bad. Yes, history—and, possibly, American voters—would judge President Biden harshly for it.

But it would not have made the campaign a mistake—or even, on its own terms, a failure. To the contrary: Even assuming the worst, the operation should be considered at least a partial success and well worth the effort—flawed and limited, to be sure, but better than the alternatives and far from a strategic or moral catastrophe…

As for the Afghans, they assuredly suffered in the war, but they suffered more under Taliban rule. Michael O’Hanlon of the Brookings Institution figures that the war may have cost 400,000 Afghan lives over the past 20 years, but he guesstimates that U.S. activities there saved a million or more lives, a significant net positive.

Consider: Infant mortality dropped by half during the U.S. operation. Life expectancy improved by six years. Electricity consumption, a key quality of life indicator, increased by a factor of 10. Years in school increased by at least three years for men and four for women. University graduates rose from under 31,000 to almost 200,000. (Those and other indicators are available at the Brookings Afghanistan index.)

Those are a lot of lives saved and improved.

So, I was going to write this post.  And then I didn’t.  And then in yesterday’s exchange with BB, he wrote this:

I’m really bothered by people saying we spent 20 years and $2T for nothing. If I had a drug that allowed people to live more freely and without imposition of religious authoritarianism, but only for a limited period of time, would you take the drug? What if that drug also helped limit the advance of terrorist attacks elsewhere in the work and perhaps (we cant be sure) dramatically reduce the number and frequency of such attacks? The question, I think is what’s the cost relative to the benefit and what other ways might there have been to achieve it?

So, not quite the same drug argument as mine, but when he brought that up I knew I had to write this post.

So, was Afghanistan policy right?  Probably not?  Was it worth it? ¯\_(ツ)_/¯.  Were there very real benefits that we should include in our analytical calculus and mean that in no way was it a total waste?  Absolutely.  


Police reform– NC Edition

From the N&O:

For the first time, North Carolina could soon keep track of when police officers kill people, or are caught lying under oath in court, or receive complaints from the community.

If Gov. Roy Cooper signs a criminal justice bill that passed the N.C. General Assembly with near-unanimous support in recent days, state officials will be ordered to start tracking that sort of information.

The bill, Senate Bill 300, is a bipartisan effort to crack down on bad cops — and to try to figure out whether problems like excessive force in the criminal justice system are confined to a small number of officers, or if they are more systemic.

“One of those things that shouldn’t be a partisan issue, but often becomes a partisan issue, is criminal justice reform,” said Sen. Danny Britt, a Lumberton Republican and the bill’s lead sponsor.

The bill would create several databases to track police use-of-force and disciplinary issues, but much of the information would not be available to the public, like details about which officers have been secretly banned from testifying in court for issues like lying under oath. That information would be available for the first time ever to the state boards that grant or take away the certifications required to work in law enforcement, but would continue to be hidden from the general public.

To quote myself from twitter…This bill is not perfect, but it is substantial progress. The politics on police reform has genuinely shifted in a positive way and real changes are happening. Not as fast or as big as activists would like, but things are getting better.

NC Vaccinations

Saw this NC infographic at the bottom of an N&O article I was reading yesterday.  Was very pleased to see the high rates here in Wake County.  Of course, our hospitals are at capacity because the people in surrounding counties are coming here for their medical care when they get Covid.  

Anyway, the color patterns on the map sure made me think of another map.  

Map shows how North Carolina counties voted in the 2020 presidential election.


Media, Democrats, and Afghanistan

Good stuff from Greg Sargent:

Let’s keep two ideas in our heads at the same time. The first is that President Biden deserves serious scrutiny over the withdrawal from Afghanistan, and congressional hearings should examine it.

The second is that no such accounting will be remotely complete if it doesn’t also examine how the current debacle is the outgrowth of 20 years of catastrophically wrongheaded thinking and decision-making spanning four administrations.

Oddly, many Democrats criticizing Biden over the withdrawal seem stuck on the first, and are dancing gingerly around the second. It’s hard to avoid concluding that they are cowed by Republican criticism of Biden and a relentlessly narrow media framing that lends support to the GOP position…

In some cases, Democrats have gone a bit further and implicated the Trump administration’s resolution with the Taliban, which Biden mostly carried out. But many Democrats have capitulated to a framing that treats the only real failures here as related to Biden’s “botched execution” of the withdrawal.

That framing also implicitly takes a position — in the negative — on whether a very messy withdrawal was an inevitable outgrowth of the situation that was created by 20 years of misguided policy. But this is a contested notion.

It also privileges the position of Republicans, who want the focus narrow for obvious political reasons, since a broader focus would implicate their party. And it privileges the position of those who advocated for this war all along.

Meanwhile, about that withdrawal we could have done so much better?  If only it were so simple.  Really good stuff from David Leonhardt yesterday:

What might a more successful exit from Afghanistan have looked like?

I have spent some time talking with colleagues and experts about that question, and it is a difficult one to answer. President Biden’s exit certainly has not gone well. The “orderly” withdrawal he had promised did not happen, and the world has watched agonizing scenes of Afghans trying to escape.

But I’ve also noticed a naïveté about some of the commentary on Afghanistan. It presumes that there was a clean solution for the U.S., if only the Biden administration (and, to a lesser extent, the Trump administration) had executed it. The commentary never quite spells out what the solution was, though.

There is a reason for that: A clean solution probably did not exist.

The fundamental choice, as my colleague Helene Cooper told me, was between a permanent, low-level U.S. war in Afghanistan — a version of what John McCain once called a 100-year war — and a messy exit. “The pullout was never going to be a simple thing,” says Helene, who covers the Pentagon. “It was always going to be an ugly pullout.” [emphases mine]

My goal with today’s newsletter is to explain what the true options in Afghanistan were, as well as some alternate decisions by the Biden administration that might have worked out better.

It’s important to start with this background: The biggest failure in Afghanistan almost certainly was not anything that happened this week or even in the past decade. It was a decision, early in the 2000s, to seek total victory in a faraway war of questionable relevance to U.S. national interests. As Adam Nossiter, who became The Times’s Kabul bureau chief last year, has written, “The American war, like other such neocolonialist adventures,” was “most likely doomed from the start.” …

In hindsight, the solution may seem obvious: The U.S. should have helped many more Afghans leave the country before the military withdrawal. In reality, there was no easy way to do so.

When Biden and Afghanistan’s then-president, Ashraf Ghani, met for the final time, in the Oval Office on June 25, one of Ghani’s main requests was that the U.S. do the opposite and limit evacuations. As The Times has reported: “He wanted the United States to be ‘conservative’ in granting exit visas to the interpreters and others, and ‘low key’ about their leaving the country so it would not look as if America lacked faith in his government.”

It was an understandable request. A mass evacuation would have amounted to a surrender to the Taliban (for which Biden would have been blamed). The only hope for Ghani’s government depended on avoiding a large, advance evacuation of the Afghans who were helping run the country.

In the end, of course, Afghanistan still fell to the Taliban in a few chaotic days this month.

Now, of course there’s surely things the Biden administration could have done better at the end here, but, honestly, given the many, many constraints they faced, they’ve actually done pretty well.  You’re hearing hardly anything about evacuations now that they are going well and happening in substantial volume.  The most frustrating is all the criticisms that pretend that somehow the Taliban is not a hostile actor with its own agency– as if this were just a one-player game; not one where the Taliban responds tactically and strategically to US policy.  Shame on the cowardly Democrats (I don’t expect much from the Republicans) who just go along with this nonsense.  And, hell, yeah, our mainstream political coverage has been massively lacking in appropriate context.  

Was the FDA right to take this long?

No. But, I wouldn’t be me if I didn’t bring you the strongest argument I’ve found from otherwise via Hilda Bastian in the Atlantic:

The full FDA approval of America’s three available vaccines has long been a foregone conclusion. The shots are impressively powerful, the safety data after hundreds of millions of injections are colossal, and COVID-19 certainly hasn’t lost its teeth. So why wait? The recent push to fast-track full approval for these vaccines is based on two premises. First, the FDA has been taking unreasonably long. The agency has already reviewed the initial data for the vaccines as they rolled in, there have been massive global scientific scrutiny of and consensus about them, and signing off on the latest longer-term data shouldn’t take months, the argument goes. Second, the vaccines’ emergency-use status has been a dam wall holding back a flood of vaccination that could help turn the pandemic around.

We have good reason to be cautious about both assumptions. Let’s start with the FDA. The agency’s full approval is more than just a formality. Yes, the vaccines are a tremendous success. But although early, publicly available data have now been thoroughly scrutinized, the agency has access to enormous amounts of more recent information that needs to be combed over for any surprises or signs of possible undetected issues. On a press call about the approval announcement, Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research, said that the agency reviewed hundreds of thousands of pages of new data from Pfizer. Even for an agency as well resourced as the FDA, thorough analysis and consideration of so much information is a heavy lift, especially for multiple vaccines at once; Moderna’s application for full approval arrived hot on the heels of Pfizer’s, on June 1. (In response to questions on the call, Marks declined to comment on the timeline of a full approval for Moderna.)

And it’s not just a lot of data from the clinical trials of the vaccine. The trials and other studies by the manufacturers established the vaccine’s efficacy and basic safety, along with common and not-so-common possible reactions. Now that it’s been rolled out, though, the regulators have to look for signals of very rare issues that wouldn’t show up even in trials of tens of thousands of people…

We’ve already seen how crucial this effort can be. When Pfizer submitted its application for full approval, the link between the currently available mRNA vaccines and some cases of heart inflammation hadn’t been established. The CDC informed us about this potential risk in mid-May. A safety issue particularly affecting younger people was a serious development in the regulatory process of a vaccine approval that includes 16- and 17-year-olds. The small amount of early data for that age group had been a sticking point back at the emergency-use-authorization stage. Now investigating whether the incidence of this potential side effect might be higher for Moderna’s vaccine than for Pfizer’s is reportedly the reason Moderna still hasn’t received emergency use authorization for adolescents.

Then there’s the quality-control side of the task. One of Pfizer’s drug specialists recently described the company’s earliest attempt at manufacturing a COVID-19 vaccine as an “absolute and utter failure.” By the end of this year, Pfizer will have produced an estimated 3 billion doses, the most of any company. That lightning-fast progress is awe-inspiring—and a little nerve-racking. You really want to be confident that regulators are on top of this. The FDA has to be thorough, especially with the first of a new type of drug with completely new production processes, like this mRNA vaccine. It’s not enough that the vaccine used in trials was safe: We must be assured that the shots we’ll get in the arm have the same quality. That quality is not simply baked in. Last winter, for example, the European Medicines Agency, the European Union’s equivalent of the FDA, reported that the contents of some batches of the BioNTech-Pfizer vaccine they had tested weren’t all the same, and the source of the discrepancies had to be resolved before the agency authorized it for rollout.

There’s more and they are not at all unreasonable arguments.  But, I’m not convinced.  If we were talking about a daily drug, I think she’s have very good points, but vaccines pretty much never create problems months down the road.  It’s just not how they work and we’ve got the history of dozens of vaccines to show this.  And, yes, the millions and millions of doses have been able to show us one in a million side effects to be aware of, but you’re never not going to approve a vaccine over a one in a million side effect.  

Is it reasonable that the FDA took this long?  Probably.  Would it been reasonable and better by being a significant positive benefit to US public health to do if faster?  I say quite likely.  I do really like this point from Drum which Bastian partially, but far from fully, addresses:

Here’s what’s missing from this dispute: actual facts. What we need is either a domain expert or a good reporter to explain exactly what’s involved in giving a drug full approval. Are there parts that could be skipped considering that millions of doses have already been given? Are there things that could be speeded up, or is the timetable hostage to absolute requirements like “12 months of data required from Phase 3 testing”? What kind of danger is there in rushing approval?

That’s what I’d like to see. A detailed rundown of exactly what’s involved, with both the history and science of drug approval explained. That wouldn’t necessarily end the dispute, but at least it would put it on a more factual footing.

Meanwhile, Leonhardt is, unsurprisingly, on team yeah we should have done this sooner:

Why, then, has the F.D.A. been so slow to act?

The short answer is bureaucratic caution. The F.D.A.’s leaders wanted to hew as closely as possible to their normal process for granting full approval to a vaccine. They bestowed “emergency authorization” on the Covid vaccines from Pfizer, Moderna and Johnson & Johnson months ago, so that Americans could begin receiving shots. In the meantime, the F.D.A. spent months reviewing trial results before granting full approval to any Covid vaccine.

F.D.A. officials have defended this approach by pointing out — fairly — that a careful approval process can increase people’s confidence in a vaccine. But officials have also claimed that they had little choice but to follow the cautious path that they did. And that part of their defense is inconsistent with the facts.

‘Met our standards’

There are two basic ways to see that the F.D.A. did have a choice and could have acted more quickly than it did. The first is that the agency has acknowledged that it moved more quickly in this case than it normally does. A typical vaccine approval process takes between eight and 12 months; Pfizer’s Covid vaccine received full approval three and a half months after the company filed its application.

There is nothing magical about three and a half months, however. Once the F.D.A. had already departed from its usual process, it could have done so more aggressively than it did. Multiple medical experts have been urging so for months. No White House official, member of Congress or federal judge was threatening to stand in the way of an expedited process.

After all, the F.D.A. leaders made clear that they had made up their minds long ago about the substantive part of the decision to grant full approval. They publicly endorsed the vaccines, urging Americans to get shots. Dr. Janet Woodcock, the acting commissioner, said three months ago that the vaccines “have met our high standards for quality, safety and effectiveness.” Early last month, Dr. Peter Marks, who oversees the approval process, wrote, “If we truly want our lives to return to normal, the fastest way to do so is simple — get vaccinated right now.”

The wait for full approval, then, was more about process than science.

The F.D.R. approach

The second key point is that American history is rich with examples of government officials doing what the F.D.A. decided not to do in this case: overhaul their process in a time of crisis.

Franklin D. Roosevelt repeatedly broke with tradition — and endured confrontation with the courts — to fight the Great Depression. His administration, working closely with business, also threw out the normal bureaucratic procedures to build World War II ships, planes, tanks, bombs and other matériel with stunning speed. In this century, the Federal Reserve under Ben Bernanke took creative risks that helped keep the financial crisis of 2007-9 from becoming another Great Depression. (The title of Bernanke’s memoir is telling: “The Courage to Act.”)

In each of the instances, officials avoided taking steps that clearly violated the law. Yet they recognized that the law often includes gray areas and gives government agencies leeway to choose one of several approaches. During normal times, taking the cautious route and following procedural precedent tends to make sense. It minimizes chaos and mistakes.

But a national emergency can change the equation. In an emergency — like a depression, a war or a pandemic — government leaders will sometimes decide that the abstract benefits of bureaucratic continuity are smaller than the concrete benefits of preventing a depression, winning a war or saving lives. These leaders refuse to be bound by precedent.

In 1932, Roosevelt described his approach as: “Above all, try something.” In 2021, the F.D.A. took a different approach.

And finally Conor Friedersdorf:

Each time a new weapon emerges in the fight against a deadly disease, the bureaucrats charged with judging its safety and efficacy face a trade-off: Proceed too quickly and a dangerous or useless drug or medical device might be granted approval; proceed too slowly and the sick and dying might be denied a lifesaving intervention. Like Odysseus and his crew, an effective bureaucracy must be as concerned about Scylla as Charybdis, knowing that death is the consequence of tacking too far in either direction.

But public-health officials operate under incentives that distort their judgment. If they approve a drug or medical device that hurts even a tiny number of people, or that proves ineffective, the harms are clear, and those responsible may be pilloried in the press as negligent or corrupt. When the bureaucracy moves too slowly, the harms are harder to see. As the economist Alex Tabarrok put it in 2015, people still die, but “the bodies are buried in an invisible graveyard.”

The coronavirus pandemic has illuminated the costs of a sclerotic public-health agency’s inaction like never before.

But, my favorite is just the points from the AAP:

Of course, approving a vaccine for children is a thornier matter: Injecting a substance into one’s body carries risks that taking a test does not; COVID-19 appears to pose less immediate risk to the young than to adults; and children have more years of life ahead, raising the costs of any downside to mRNA technology that manifests only years later. The American Academy of Pediatrics considered all this and still urged the FDA to speed up its review:

Based on scientific data currently available on COVID-19 vaccines, as well as on 70 years of vaccinology knowledge in the pediatric population, the Academy believes that clinical trials in these children can be safely conducted with a two-month safety follow-up for participants. Assuming that the two-month safety data does not raise any new safety concerns and that immunogenicity data are supportive of use, we believe that this is sufficient for authorization in this and any other age group.

Waiting for an additional four months of data, the group pointed out, will give the virus more time to spread. The academy’s claim is not that the Pfizer and Moderna vaccines carry no short- or long-term risks. The organization acknowledges that extremely rare cases of a heart inflammation called myocarditis have been reported among adolescents and young adults. But it also notes that such cases are most likely to occur within four weeks and not after six weeks. The pediatricians argue that six months of data are highly unlikely to tell us anything about those risks that we don’t know after two months. If your concern is that an mRNA vaccine could have an unforeseen downside that doesn’t manifest for 10 years, delaying the vaccine another four months isn’t going to catch that. Meanwhile, society would incur the cost of delay without the benefit of assurance that there is no long-term risk.

Alright, maybe I’m just motivated reasoning myself all the way through this.  But, the “the FDA really needed to take this long argument” just really doesn’t seem to hold up to these compelling counter-arguments.  

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