Public health’s honesty problem

Definitely one of the biggest frustrations throughout the pandemic has been those in public health trying to perform mass psychology without really knowing what they doing.  A lot of “Oh, we can’t say X (even if it’s the truth) because then people might Y.”  Of course, the end result is not that people do what the public health experts want, but, rather many come not to trust the public health experts because they are, at least on occasion, provably dishonest.  I think a good rule of thumb should be for goverment officials to never, never lie to the public unless it is absolutely necessary (presumably narrow matters of genuine national security) and certainly not in matters of science and health.  

Ryan Cooper with a great take on all this recently:

The United States’ COVID pandemic performance is among the worst in the world — particularly given our unparalleled advantages. We lead the planet in confirmed infections and deaths, and while India probably has had more of both that went uncounted, that’s cold comfort when its population is more than four times larger than ours.

One reason for this tragic failure is the dishonesty of American public health bureaucrats. They have repeatedly lied to the public, playing politics with the pandemic, and in the process undermined both the fight against COVID-19 and confidence in their own credibility. Their deception almost certainly got people killed, and it continues to do so this month, as the Omicron variant spreads and booster shots go unused.


This practice of shading the truth or telling straight-up falsehoods in service of some half-baked political end started from the first moments of the pandemic. Back in February and March 2020, National Institute of Allergy and Infectious Diseases (NIAID) chief Anthony Fauci was all over the media downplaying masks. “If you look at the masks that you buy in a drug store, the leakage around that doesn’t really do much to protect you,” he told USA Today that spring. “Now, in the United States, there is absolutely no reason whatsoever to wear a mask.” In an interview with 60 Minutes in March, he said, “Right now in the United States, people should not be walking around with masks.”

It turns out Fauci almost certainly didn’t believe what he was saying. In an interview with InStyle several months later, he admitted that trying to preserve the mask supply for doctors and nurses was his first motivation. “We were told in our task force meetings that we have a serious problem with the lack of PPEs and masks for the health providers,” he said…

A year later, other public health officials seem to have replicated Fauci’s deception on the subject of booster shots — and the consequences here may be graver still. By August of this year, the Biden administration was extremely alarmed about reports of waning immunity among the vaccinated, and in September, officials started plans to recommend booster shots to all adults.

But key bureaucrats and scientists dragged their feet. The Food and Drug Administration vaccine advisory panel refused to endorse an emergency use authorization, with panel members citing a series of bizarre objections in an interview with CNN. “The stated goal of this vaccine has been to protect against serious illness,” Dr. Paul Offit said. This is false — the point of any vaccine is to reduce negative health outcomes of any kind as far as possible, ideally by stamping out transmission entirely through herd immunity. It’s good that two doses of mRNA vaccine likely still protect against severe COVID from the Omicron variant, but it’s even better to cut the risk of symptomatic infection by about 40 percentage points with a booster. 

FDA officials Dr. Philip Krause and Marion Gruber complained they didn’t have enough science to back boosters yet, which is total nonsense. By September at the latest there was strong initial data from Israel and the U.S. itself. Dr. Cody Meissner of Tufts University School of Medicine argued unvaccinated people should get priority, which is just a non sequitur — those two goals don’t trade off at all, because America has had plenty of vaccine supply for months.

Perhaps these arguments aren’t compelling because they aren’t honest. A more plausible motivation comes through in August comments from infectious disease specialist Céline Gounder, who was a pandemic adviser for Biden. “It’s really inequitable and it’s not in our interest because you’re leaving much of the world unprotected, where you’re going to have the emergence of other variants,” she told Politico, pushing to send vaccine supplies overseas instead of giving boosters to Americans. “I feel like this is very short-term thinking. It’s very individualistic, nationalist thinking.”

[Don’t get me started on Gouder!]

This makes much more sense. Just like Fauci told a noble lie to conserve PPE, officials overseeing booster decisions almost certainly fudged the science in the service of an ulterior motive: getting vaccines to poorer countries.

Just like saving PPE for doctors and nurses, this is a legitimately good goal. Poorer countries should have been getting a larger share of vaccines from the start. But it’s not the business of public health bureaucrats to decide where vaccines are allocated (that’s for elected officials to decide), and it’s especially not their business to try to steer policy by lying to the public.

Fudging the science did not, in fact, help poorer countries get more doses — but it certainly delayed booster distribution here. After weeks of argument and pressure, the CDC finally approved boosters for all adults in late November, yet it only recommended them for people over 50, ignoring research which recommends their universal use.

Anyway, more good stuff in there if you read the whole thing.  I would love for public health officials to learn a lesson about honesty from all this, but, sadly, I don’t actually think that will be one of our big lessons learned. 

What are your “anchor beliefs”?

Really enjoyed this recent post at Clearer Thinking on “anchor beliefs”

There’s an important type of belief most of us have, which we call “Anchor Beliefs.” These beliefs are, by definition, those beliefs we hold that are almost impossible to change. To the believer, an Anchor Belief doesn’t feel like a mere belief – it feels like an undeniable truth. These beliefs are often too deeply rooted to change, and the cost of giving them up may be extremely high (e.g., questioning the belief might cause you to lose your family, friends, livelihood, or your understanding of what reality looks like).

Understanding the role that Anchor Beliefs play in human psychology – and identifying your own personal Anchor Beliefs – can help you make better sense of the world around you. Additionally, such an understanding can help you search for false Anchor Beliefs, those apparently unquestionable truths that make up the foundations of some people’s worldviews, despite being wrong! Challenging your own false anchors is very difficult, but the consequences may be life-changing…

Anchor Beliefs almost never change, yet we still have to make sense of new information that we come across (some of which may strongly contradict our Anchor Beliefs). Our solution is to warp the evidence that we receive such that we can fit it into our worldview AND keep our Anchor Belief intact at the same time. This is how Anchor Beliefs get their name: they are like huge, steel anchors securing boats to the ocean floor – only an enormously powerful current will be able to make them budge; any lesser current will simply swirl around the anchor. In this way, only incredibly powerful evidence can pose a threat to our Anchor Beliefs. And even then, our brains are highly adept at interpreting evidence so that our original Anchor Belief remains steadfast…

Here are some common categories of Anchor Beliefs that could be false:

  • Things that almost everyone you know is taught

  • Certain religious beliefs learned in childhood

  • Perceptions of ourselves (e.g., as good/bad)

  • Views about one’s community

  • Views about “enemy” groups

  • Inferences from viscerally shocking first-hand experiences (e.g., “the world’s unsafe”)

  • Beliefs your social group REQUIRES

  • Claims that the reputation of your most trusted authority figures are staked on

  • Beliefs that, if you stopped believing them, would leave you very confused about what to believe or what to do

The idea of an Anchor Belief is connected to (though not the same as) a number of other ideas, including:

Finding your Anchor Beliefs


It may be valuable to ask yourself: “What are my own Tin Anchors?” If you want to consider what Tin Anchor Beliefs you may have, here are some questions that it might be helpful to ask yourself:

  • “What beliefs did I pick up from those around me that I can’t imagine not believing (yet many people in other social groups somehow manage not to believe)?”

  • “What viscerally shocking experience might I have overgeneralized from that explains my worldview now?”

  • “What might other people from another community claim my Anchor Beliefs are?”

These are pretty safe queries, as you’re very unlikely to stop believing your Tin Anchor Beliefs. And identifying one of your beliefs as a Tin Anchor doesn’t make it change, though it might be useful to know where your Anchors lie. Of course, it might be valuable (though costly) to change an Anchor Belief that you hold, if you want to. This might be something worth considering.

So, how do you challenge your Anchor Beliefs?

Suppose you think that you’ve found one of your own Tin Anchors that you think has important implications for your life and you actually want to examine whether it’s true. One strategy that may help is to try and clearly imagine the world where this Tin Anchor Belief turns out to be false. What is that world like? Can you deal with and accept that world? How would believing that you live in that world change your behavior and relationships? Can you accept those changes? If you DO live in that world (where your Anchor Belief is false), would you want to believe you live in it, or would you rather pretend that your Anchor Belief isn’t false? If the answer is truly “yes” – you really would want to know if the belief is false, and you’re prepared to face the ramifications and consequences of losing that belief – then now you can truly start to put the belief to the test.

So what are my anchor beliefs?  Without putting too much thought into it, probably something like this…

1) The scientific method is absolutely, positively the best way to know things.  When there is near-scientific consensus on a belief, it may not necessarily be true, but the burden of proof should be very high to believe otherwise.

2) Same goes for beliefs about the world based on social science.

3) Strongly related to the above… expertise is a thing and it really matters.  When the experts are in (near) consensus, that does not mean they are right with certainty, but there should be a very high evidentiary bar for believing otherwise.

4) The mainstream media is not lying to me.  They get a lot wrong, but there actual motives are to disseminate true information while making a profit they just don’t always do it very well.  Fox News, in contrast, has a primary motive to disseminate information which helps the Republican Party while making a profit.

5) I believe I am actually open to changing my beliefs through sufficient evidence.  I hope I’m right (the fact that I can point to many examples based on points 1-4 tells me I probably am).  

I could probably come up with more, especially relating to how society and government should operate, but for now, that seems like a good start

Boxing day Quick hits (part II)

1) This is actually from last month from Noah Smith, but it’s really good. “Try Patriotism

So to really execute a popularist strategy, you have to figure out what people will both agree with you and care about a lot. And that’s not easy. David Shor (the political analyst who’s name is typically associated with popularism) thinks Dems should emphasize bread-and-butter economic issues while downplaying their elite cultural values. That might not be a bad strategy, but I think Americans take social and cultural issues very seriously — as evidence by Glenn Youngkin’s recent win in the Virginia gubernatorial race on a platform of opposing critical race theory. The fact is, this is a very rich country, and though people certainly have their economic problems, we care a lot about the upper rungs of Maslow’s Hierarchy of Needs. Who gets acceptance, respect, and status in our society is of great importance to us.

And when it comes to sociocultural issues, one thing that Americans very consistently seem to love is patriotism. That’s something neither of the two main political movements in this country seem to understand.

Americans love America

American pride took a hit during the Trump era. But even in the darkest days of 2020, a solid majority of Americans still said that they felt “very” or “extremely” proud to be an American:

And although American “exceptionalism” isn’t as popular among the younger generations, a 2018 Pew poll found that a whopping 77% of Millennials believed that America is one of the greatest countries in the world…

The anti-patriotism of the Left

Progressives get very touchy if you tell them they’re anti-patriotic. But the reason they get touchy is that they remember (or instinctively realize) how devastating that image was for them in previous eras. Yet although it’s painful to hear, ultimately the progressive movement will be stronger if it realizes how deeply anti-patriotic it has become in the last decade.

Progressives have always been more reluctant than conservatives to express jingoistic sentiments. That remains true to this day. But in the past, progressives have been able to muster a variety of liberal nationalism that acknowledged the country’s shortcomings while believing idealistically in its innate capacity to do better. Bill Clinton expressed this idea best when he declared that “There is nothing wrong with America that cannot be cured by what is right with America.” But patriotism was key to the ideologies of Franklin D. Roosevelt, John F. Kennedy, and Barack Obama as well.

Joe Biden still tries to summon some of that old liberal patriotism. But in the age of social media, the progressive movement is defined less by the President and more by the collection of journalists, professors, and lower-level politicians who dominate Twitter and major publications and news networks. And here I’ve seen a remarkable and pervasive vilification of America become not just widespread but de rigeur among progressives since unrest broke out in the mid-2010s.

This vilification generally takes the form of “history”. The general conceit among today’s progressives is that America was founded on racism, that it has never faced up to this fact, and that the most important task for combatting American racism is to force the nation to face up to that “history”…

Every nation has good and bad in its history, and America has plenty of both. But by insisting — or even just accepting — that a cartoon of American evil is the true “history” and the good parts merely puffed-up propaganda, progressives put themselves on the wrong side of patriotism.

One small example of this is when Nikole Hannah-Jones — the architect of the Pulitzer-winning 1619 Project, which has been practically canonized by progressives despite substantive objections by academic historians — insisted that the U.S. used nuclear weapons in WW2 simply because they wanted to justify the money they had spent on developing the Bomb. Hannah-Jones declared that all other reasons for dropping nukes constituted “propaganda”, while her own represented “history”. This assertion was roundly condemned by progressives and conservatives alike (a good sign!), and people with a better knowledge of the relevant history stepped in to educate the public:

That progressives were willing to push back on Hannah-Jones’ assertions bodes well — it’s a sign that the American left may start to balk at the cartoonish tales of American villainy they’re being urged to proselytize to the young generations. That in turn suggests that progressives may eventually move back toward the liberal nationalism of Obama, Clinton, Kennedy and Roosevelt. But it’s going to be a long road back…

The anti-patriotism of the Right

If this were the 70s again, the conservative movement could capitalize on the progressive movement’s paroxysm of anti-patriotism by waving the flag and singing the praise of ‘Murica. But this is not the 70s, and the Right has been captured by its own form of anti-Americanism — one that’s actually far more dangerous to the country than anything the Left has planned.

The Trumpist conservatives of 2021 don’t hate the idea of America — they hate the America that actually exists. As Anne Applebaum recently wrote in a review of a documentary by Tucker Carlson, the Trumpists have turned hatred of American institutions into their own sort of post-Christian religion. Rightists hate corporations because they’re “woke”. They hate the U.S. Military because it’s “woke” (and because it wouldn’t support a Trumpist coup). They hate universities. They hate schools. They hate the media, of course. They hate essentially every institution that makes America America, except for possibly churches, but if and when those start praising diversity, they’ll hate those too…

The patriotic silent majority

So here we have a situation where most Americans love their country and have no one to represent that love in the political arena. They’re forced to choose between one movement that vilifies the idea of America, and another that vilifies the America that actually exists. The patriotic silent majority is politically and ideologically homeless right now.

Whichever movement can reverse course and tack back toward patriotism first will, I predict, encounter a deep and eager reservoir of positive energy and support. Obviously, being on the progressive side of things myself, I hope Dems come up with the next JFK before Republicans come up with the next Reagan. But someone needs to try patriotism soon, because to not do so would be madness.

And I am sick and tired of madness.

2) Ugh, those damn Q-Anon nuts.  Here’s a free Washington Post story for you, “A QAnon con: How the viral Wayfair sex trafficking lie hurt real kids: An Internet mob wanted to rescue a 13-year-old girl. Instead, they terrified her, derailed real trafficking investigations and incited ‘save the children’ violence.”

3) Good stuff from deBoer, ‘Covid Panic is a Site of Inter-Elite Competition.”  I think deBoer actually downplays Covid risks to a moderate degree, but as to his larger point as Covid seriousness as a form of left virtue signaling, I do think he’s onto something.

Covid is a serious disease that has killed a lot of people, but it does not kill different people at the same rates. Obviously, one of the greatest risk factors is being unvaccinated. But you’d still rather be a child and unvaccinated than be a 50-year-old and vaccinated if you’re trying to avoid Covid. Nor do different adult populations have the same risk profile. The vast majority of those people who have died of Covid have been elderly, immunocompromised, or ill. Those who have been hospitalized by Covid have also been disproportionately obese, to a startling degree. Covid discriminates, and not just against the unvaccinated. I don’t know why our media has decided that reflecting the plain scientific reality that different people have profoundly different Covid risks should be so taboo, but it’s precisely the sort of thing that causes a loss of trust among the skeptical. In any event, I’m not among the highest risk, or particularly close to it – I’m 40 years old, generally healthy, overweight but not obese, and vaccinated. People like me have died from Covid, but they are a very small minority of the deaths. Most who catch it from my demographic profile experience the disease the way I did in April of 2020: as an unpleasant but entirely manageable fever and mild respiratory illness…

Imagine my confusion, then, at the number of vaccinated people, almost all of them educated, liberal, and upwardly mobile, existing in a state of constant anxiety and dread over Covid, despite the fact that these feelings confer no survival advantage at all. While I have no issue with people feeling what they’re naturally feeling, I would argue that those with large platforms have a responsibility not to contribute to panic. Unfortunately many people with huge followings are being remarkably irresponsible, openly spreading fear and engaging in baseless speculation about mass death. This despite the fact that almost all of them fall in demographic slices with low risk. The immense popularity of overstating one’s personal risk from Covid, and of structuring one’s whole life around that exaggerated risk, can’t be explained in logical terms. It can only be understood with the animal logic of the force that dictates the living conditions of our entire elite class: their competition against each other…

Elizabeth Currid-Halkett’s book The Sum of Small Thingslays out the essential psychology brilliantly. As she demonstrates, changing norms among bourgie liberals has made conspicuous consumption crass, declassee. But the urge to compete, to win, trumps all. So our striving castes have developed all manner of other signals through which they subtly assert their superior virtue, their superior lives. Covid now fills such a role. With Covid, you never need an excuse to assert your superior seriousness, never need to wait for the right moment to insist that you’re doing it better than all of your peers. You can just openly tell the world “I am more responsible than you,” and the circumstances seem to justify it, even if the behavior is not in fact justified by The Science. (Like, say, by masking outdoors in regular conditions.) Currid-Halkett calls them the aspirational class. The point is not that they strive – we all strive – but that for this class of people striving is a end itself, not a means to an end. And so something like Covid becomes more grist for the mill.

For some people, it seems, being more freaked out about Covid is quite like an I Voted sticker or a BlackLivesMatter sign in their window. It’s another way to let everyone know that they have the greatest wealth of all, the wealth of superior character, of greater moral standing. They’re fond of pointing out those 5.3 million people who have died, in the midst of their self-aggrandizing diatribes. I would perhaps invoke the dead in a different way: even this, even now, even them, you turn into yet another way to let the rest of us know how advanced you are.

The danger is far from over. But when we got the vaccines case rates decoupled from the rate of hospitalization and death. Therefore if you are breathlessly reporting increases in case rates without reference to those other metrics, you are engaged in, yes, misinformation. For you normal people out there? Get vaccinated. Get boosted. Be smart. Then live your life.

4) Honestly a pretty fascinating first-person essay from a trans-man, “My Penis, Myself I didn’t need a penis to be a man. But I needed one to be me.”  And, OMG is phalloplasty some complicated stuff!  And the recovery!  Also, the thought of having the equivalent of an always-erect penis is not enticing. Super inconvenient!

While I’d been sleeping, two microsurgeons, a reconstructive urologist, a surgical fellow, and a surgical resident had, among other things, cut a seven-by-six-inch rectangle out of my right anterior lateral thigh. They’d taken all the skin and fat, plus one big nerve and some veins attached to the muscle, and connected the skin to itself in the shape of a phallus. Then they slipped the whole thing under two of my thigh muscles, pulled up out of the way with a steel retractor, dragged the phallus across my groin under the skin, and pulled it back out into the world through a hole cut in the skin over my pubic bone. They connected the new penis’s nerve to one of the nerve bundles in my native penis, which some people call a clitoris (embryologically, the cells are the same), which they’d cut free of its ligaments, then skinned, then tunneled up under the skin and out to the landing site of the new penis, the base of which they joined to the base of my pelvis, putting me all together with sutures, some finer than a human hair.

“That penis,” Dr. Bauback Safa, one of the microsurgeons, said when he came by after to see me — to see us — “looks perfect.”

He was talking mostly about blood flow. He did not mean that, with its fresh stitches and a round, bloody hole at the top where the skin would eventually close together, it would look like any other penis at the spa. But also, it was a lovely shape. Dr. Safa had correctly estimated that the width — which can be debulked with further surgery but is initially determined by skin and fat thickness — would land on the very but not spectacularly girth-y side. The length I had been able to pick. Each surgeon I’d consulted with had asked what I wanted, then nodded mildly and written it down, breezy as a waiter. My instinctive answer was long, even though I knew it would be that long all the time: While neophalluses can be implanted with erectile devices that change their stiffness, they do not change their size.

5) Good stuff from Katelyn Jetelina, “Why did the Pfizer young kids trial fail?”

With the pediatric trials, the primary outcome was not efficacy. This is because this was an age de-escalation study. We already know this vaccine biotechnology and RNA formula works; we just need to ensure a smaller dose works as well for younger kids as the full dosage does for older kids/adults. So the pediatric primary outcome is “immunobridging”: Does the smaller dosage (3 µg) mount the same immune response among under 5 year olds compared to the full dosage (30 µg) among 16-25 year olds?

Last Friday we got the answer: No. While the smaller dosage worked for the 6- to 24-month-old population, it did not work for 2- to under 5-year-old population.

What went wrong?

So obviously the 3 µg dosage was incorrect for 2- to under 5-year olds. But why wasn’t this detected in Phase I “dosage finding” stage? I don’t know. No one knows, because this data has not been publicly released or published. I have many questions, which include:

  1. Did Pfizer test another dosage in addition to 3 µg in the Phase II/III trial? Why or why not? If they did, what were those results? If they did not, then what were the Phase I results that made them confident a 3 µg dosage would work?

  2. Was the Phase I age distribution skewed? Because the vaccine dosage worked for 6- to 24-month-olds but not for 2 to under 5 year olds, I’d be curious to see if the sampling was skewed younger in Phase I. If so, then I could see how the suboptimal effectiveness was revealed when this dosage was expanded to a broader, more generalizable group.

  3. What variant did they test? The ever-evolving landscape of this virus makes clinical trials very difficult. May 2021 is when Phase I/II started. This was before Delta. So the pediatric dosage was probably based on the original Wuhan strain and it probably did work. When the clinical trial was moved into the Phase II/III, Delta emerged, and we know Delta reduces neutralizing antibodies by 6-fold. In that case, the vaccine dosage may not have worked.

  4. What was the antibody response? From the Pfizer announcement we know the antibody response was not comparable to the 16-25 year olds’ response. But that doesn’t mean there wasn’t a response at all. So, what was the response? And antibodies aren’t the only story; T cells were likely mounted. Was efficacy also tested in Phase II/III? This may help make the case for their Plan B (see below) and we should start vaccinating the two dose 3 µg series now.

What happens now?

Whatever the reason, though, the clinical trial failed. Our kids under age 5 won’t be getting a vaccine as soon as we had hoped. Because this is an age de-escalation design, they can’t just skip over toddlers and start vaccinating infants either.

So, Pfizer is going to Plan B. The same kids from the Phase II/III trial are going to get a third dose (3 µg) 2 months after the second dose. There are pros and cons to this approach. From Pfizer’s perspective, this is the easiest route— they don’t have to start another Phase III all over again with a different dose. That means they don’t have to recruit more people, it won’t be as expensive, and it won’t take as much time. They will lose money by not having a kids vaccine soon. It’s clear that this 3 µg is the incorrect dosage for toddlers, so I don’t like this messy approach.

A third dose may work, but what if it doesn’t? Starting with another dose would be the most rigorous and scientific path. And I hope they are doing this concurrently so we can compare in the end: How do 2 doses of 10 µg compared to 3 doses of 3 µg for toddlers? But it’s not clear that Pfizer has plans for this. Getting the correct dosage would also prevent kids having to get three shots, which would ease implementation thereafter.

Bottom line

I certainly don’t have answers and was just as surprised as the rest of the country that this clinical trial failed. Needless to say, it’s still going to be awhile until there are vaccines for our little ones. As a mom, I am incredibly frustrated. As a scientist, I am also very frustrated by Pfizer’s lack of transparency. But I weirdly find comfort in the fact that the clinical trials are robust enough to find errors like they should. This is just another example of the realities of science unfolding before our eyes. And sometimes that science is not all good news.

6) Amazing to think that Ovechkin may well surpass Gretzky’s goal total.  That said, I really wanted some more analysis on just what it is about his game that makes Ovechkin (and Gretzky before him), such a prolific goal scorer.  For example, to what degree is he a preternaturally accurate shooter?  To what degree is it his ability to put himself in the right place at the right time (I suspect that is the majority of it for most great players).

7) A little dated, given how fast Omicron moves, but David Wallace-Wells interview with Trevor Bedford last week was really good:

With Omicron, and its initial Rt being three-ish, that same equation should give you something like 90 percent of the population infected. But from what we’ve seen in South Africa, it seems like the wave is crashing well before that. So something is going on.

What do you think it is?
The options that I have been thinking about — there’s five of them. They’re non mutually exclusive. So to go through …

First, there’s the simple limit to testing capacity. As things increase, our testing capacity doesn’t increase as fast, and so we’re missing more and more cases. That can give you a distorted picture — it could look like a plateau in Gauteng, but you could imagine it’s really a much higher crest.

Like the top of a mountain has been chopped off by bad testing.
I also bet we can expect a lot more underreporting of Omicron, compared to previous wave, because it’s more mild, either through existing immunity or through actual reduction of intrinsic severity. And if, on average, you’ve reduced the severity of cases, there’d be a lot of people that don’t bother to come to the hospital or to get tested. And so as a rough guess, you might go from like one in ten cases reported in South Africa to one in 20 or even one in 30 cases — that wouldn’t seem unreasonable to me. And that makes it so that at the same caseload of Delta versus Omicron you could actually have three times as many infections with Omicron.

We could also have a change in generation interval. If we have Omicron kind of doubling at this very fast two- or three-day rate, you don’t actually have to have Rt be three. You could have actually just made the whole thing faster without having the number of secondary infections being much higher. And we don’t have no way of knowing that at this moment.

The last two are, it might not be that the entire population is susceptible to Omicron. Maybe half the population is susceptible. And then, finally, I think there’s a network effect — that as things kind of percolate through the community, you can imagine those transmission chains circling back on themselves and hitting someone that has already been exposed.

Rather than continue to spread outward from the initial case, in other words, the fact of natural social networks and limited niches means that chains of transmission can’t continue indefinitely.
And so that would make these waves slow as they reach some per-capita size, just a natural epidemiological phenomenon. Take something from each of those five categories, and I think you have the answer.

The first three things you talked about are phenomena that are to some degree particular to Omicron and South Africa. The last two are ones that we can also apply to these earlier waves. When we think about the Delta wave in the U.K., for instance, should we assume that when that wave peaked and crested that something like the full vulnerable population had been reached by Delta?
No. With Rt you can actually calculate what proportion of the susceptible population should get this. The way that I was thinking about Delta was that not the entire population was susceptible, because a lot of the population was previously infected or had two vaccine doses and hadn’t yet waned so much. And so that will give you maybe 50 percent of the population that’s actually susceptible. And then an RT of 1.5, which is what Delta was coming in with, will give you maybe a 30 percent attack rates.

One of the fundamentals of this dynamical modeling field is that epidemics crash not when they’ve infected everyone but when your number of secondary infections is less than one, when Rt falls below one. So even if we have an initial Rt of two, the numbers are quite big, but you don’t infect the whole population. You infect almost 80 percent of the susceptible population. With an Rt of three you may infect 90 percent of the susceptible population. But this is without any of those network effects. It’s just a model of free mixing, where people encounter other people at an even rate.

And then how do we account for our experience with Delta in the U.S.? We had a peak, we had a decline, but it didn’t get anywhere near zero. We’re still going through the Delta wave. It was a similar dynamic in the U.K.: Fast rise, a peak, followed by what is at first a rapid decline, sort of symmetrical to the rise, but then it flattens out and keeps going, rather than disappearing to zero.
For Delta, my best guess is that kind of slowing down and then picking back up again was due to a combination of continued waning — where boosters and third doses weren’t being given that rapidly, and we were getting farther and farther out from the initial vaccination — combined with seasonality. That would be my explanation.

Relatedly, going off things that Imperial College has done, we can expect that the AstraZeneca vaccine in the U.K. to have less protective effect than Pfizer. And that can explain the kind of systematically high levels of Delta circulation in the U.K., compared to perhaps the U.S.

8) Why is nobody talking about Fluvoxamine as a Covid treatment?!  This is nuts.  At least Scott Alexander is:

Here’s my pitch for fluvoxamine (Luvox) for COVID.

In the midst of all the hype about ivermectin and hydroxychloroquine, scientists put together the giant 4,000-person TOGETHER trial, intended to test all these exciting COVID early treatments. You know what happened next: ivermectin and hydroxychloroquine crashed and burned.

But a different drug, the SSRI antidepressant fluvoxamine, actually did really well! It decreased COVID hospitalizations by about 30% – not the perfect cure rate the rumors attributed to ivermectin, but a substantial decrease. Given the size and professionalism of this study, and another smaller one that also got positive results, I and many others take Luvox pretty seriously. At this point I’d give it 60-40 it works.

Can you prescribe a medication when you’re only 60% confident in it? There’s some thorny philosophical issues around this, but I think in the end you have to compare risks and benefits.

What are the risks? Like every medication, including Tylenol, aspirin, etc, Luvox has some common minor side effects and some rare major ones. But let’s step back a second. Fluvoxamine is a bog-standard SSRI. Its side effects are generic SSRI side effects. We give SSRIs to 30 million people a year, or about 10% of all Americans. As a psychiatrist, I’m not supposed to say flippant things like “we give SSRIs out like candy”. We do careful risk-benefit analysis and when appropriate we screen patients for various risk factors. But after we do all that stuff, we give them to 10% of Americans, compared to 12% of Americans who got candy last Halloween. So you can draw your own conclusion about how severe we think the risks are.

For some reason the same experts who don’t mind prescribing SSRIs when people have mild depression freak out about prescribing them when they’re the only evidence-based oral medication for a deadly global pandemic. “What about SSRI withdrawal?”, they ask. After a ten day course? On 100 mg imipramine-equivalent dose? Minimal. “What about long QT syndrome?” The VA system took 35,000 high-risk older patients off of an unusually-likely-to-cause-QT-syndrome SSRI in 2011, and were unable to find any evidence that this prevented even a single case of the syndrome, let alone any negative outcome!

I conclude that the risk-benefit calculation probably favors using Luvox. And I’m not alone here. Johns Hopkins University’s COVID treatment guidelines recommend fluvoxamine for appropriate COVID patients. Some leading psychiatrists, especially the Washington University psychiatrists who helped discover the new indication, support fluvoxamine for appropriate COVID patients. Many of the epidemiologists and statisticians most instrumental in debunking the hype around ivermectin have spoken out in favor of fluvoxamine, saying this one is the real deal (12). The National Institute of Health hasn’t quite come out in support, but they have taken the unusual step of not disrecommending fluvoxamine the same as they disrecommend every other oral early COVID treatment, saying that the evidence “provides the sort of flexibility for the treating clinician to go either way”.

Unfortunately, none of these bodies alone or combined are powerful enough to make the average doctor prescribe differently. That’s why all eyes are on the FDA.

9) It’s kind of crazy to me that my local school system is having visiting policies for parents determined on school-by-school basis based on whether any given principal is particularly cautious or not and that given principal’s understanding of Covid transmission.  Whatever the case is, should be county-wide damnit.  Fortunately, for me, I got to go into Kingswood Elementary and talk to 5th graders about US Government pretty recently. 

10) Loved this Yglesias post on human history, the impact of agriculture, and all that, so here’s a fair portion of it:

Of course technological progress is something that’s been happening this whole time. Indeed, human technology long predates our species Homo sapiens, with the Oldowan stone tool technology invented by Homo habilis and later inherited by Homo erectus. Erectus eventually advanced to the Acheulian stone technology, but the move from Oldowan technology to Acheulian took about a million years.

Left: Oldowan stone chopper; Right: Acheulian handaxe

What’s so striking about Oldowan technology’s million-year run is not just that it’s a long time — it’s that this is longer than Homo sapiens have been on the planet (roughly 300,000 years). And Acheulian technology, again, lasts longer than the entire duration of our species. Homo sapiens is just incredibly new, not just relative to geological time or the history of the universe, but relative to the basic practice of upright-walking, tool-using apes roaming the earth in hunter-gatherer bands.

We’re evidently much better at inventing stuff than our Homo predecessors were because in our time on Earth, we’ve done a lot better than one or two upgrades of our basic stone tools. But even within the sapiens era, there is an incredible telescoping of technological progress.

For most of time, not much happened

Our species is about 300,000 years old, and farming and towns started about 12,000 years ago. The vast majority of the history of human technology unfolded before the existence of our species, and the vast majority of our species’ existence was prior to permanent settlements.

And per this Luke Muehlhauser chart, it was really only starting 200 or 300 years ago that we see any kind of sustained upward momentum in living standards.

It’s not really that living standards never changed before the industrial revolution. For the sake of legibility, Muelhauser’s chart covers about 3,000 years rather than 300,000.

If you did go all the way back, you’d find that the neolithic revolution — when people turned to agriculture — was also a big deal. The problem is that, as Jared Diamond and now many other scholars seem to agree, agriculture made living standards lower rather than higher. Or if you want to be fussy about it, you can agree with James Scott that the problem was not agriculture per se but grain.

What’s nuts to me, though, is that this whole agricultural era is just so damn short in the context of human history. Holden Karnofsky made a nice chart of life getting worse and then better, but to make it look nice he puts aggregate lives lived to date on the x-axis rather than something more conventional like time.

It’s a fun move and certainly a much nicer chart than if you’d tried to do it to scale by time. That said, I think the extreme paucity of meaningful technical progress during the majority of human history is an important piece of context. As is the fact that one of our key breakthroughs took us backward.

The pernicious logic of agriculture

The world of anti-farming takes has gotten mixed up with paleo bros and weird crank diets, so it’s worth stepping back to take a broader view of things.

In neoclassical economics, we have two factors of production — capital goods and labor. The original classical economists were wiser and had a third factor — land. Hunter-gatherers didn’t have a lot of capital, so for them, land and labor were the key factors. If you were someplace where there’s fruit, you could get yourself some fruit by deploying a little gathering labor. Similarly, if there’s meat, you could get some meat by deploying some hunting labor.

But because you get the non-metaphorical low-hanging fruit first, your gathering labor has sharply diminishing marginal returns. If you hunt, you kill some animals and scare the others off. The land itself is just not very productive, which is why you’re living in nomadic bands. But the non-productivity of the land also means that you only need to work so hard because there’s really no point in putting in more hours. For analog-era journalists, the number of column-inches of copy the editors would print was constrained by the number of ads that were sold — there just wasn’t that much demand for content. On the internet, there’s no objective limit on the number of articles you can afford to run, so there is a lot of pressure to publish at high volume. Nomads work hard — up to a point — but then they stop.

The point of farming is that you can generate radically more calories per acre than by roaming through the wilderness.

But in general, this just results from the factors being complementary — you can make the land much more productive by working really hard. I don’t think this is true on a strictly uniform basis. I once met a family that owns an olive farm, and they described it as a pretty chill situation outside of peak harvest time. But even though olives are delicious, an olive grove is not generating a lot of calories per acre. A rice paddy, by contrast, has incredibly productive land. Today we’re not limited by our local farming capacity, but the long arm of the past is still with us, and population density is incredibly high where the highly productive rice agriculture was.

But there are two problems. One is you need to work insanely hard to maximize the productivity of that field.

The other is precisely in that population density. If some new farmland opens up, you probably start out on easy street — plenty of places for some orchards, pastureland where the animals can just chill until you kill them, plus a little agriculture. You’re doing great, and you’re having more surviving children than your hunter-gatherer ancestors. But that just means the population grows, so you need to replace the orchards with more productive land use that also requires more work. And then you’re scaling back the pasture too, because a field of wheat can produce a lot more calories if it’s directly consumed by humans than if it’s a field of grass that’s consumed by cows who are in turn consumed by humans. But now you’re working crazy hard and eating worse food than a hunter-gatherer.

The good news is that by having a settled lifestyle, you can accumulate possessions. The bad news is all your stuff can be stolen…

The industrial era

Experts disagree somewhat as to when to date the start of the takeoff, but even though we had steady technological improvements during the agricultural era, it’s not until the mid-18th century (at best) that we see sustained improvements in living standards. Before that, whether we’re talking about inventing ironworking or windmills or whatever else, progress is real. But, it is slow enough that population growth catches up and median living standards collapse back to their sub-hunter-gatherer level. All the gains accrue to the extractive, exploitative elites who are able to confiscate more surplus as the bulk of the population is pushed back to subsistence levels.

The sustained increase in agricultural yields and industrial productivity of the past 250 years hasn’t been like that.

The typical English person in 2021 has higher living standards than the typical English person of 1921, who in turn was better off than the typical English person of 1821, who was probably better off than the typical English person of 1721 (though this last one is a little less clear). The 2021 > 1921 fact is even true for the typical resident of the world. But note that on a global scale, there’s no real sign of sustained progress until the second half of the twentieth century.

The dark portrait that Marx and Engels painted of the industrial revolution as immiserating the working class was completely wrong. But it’s easier to understand why you might have made that call given all prior technological improvements had, at best, led to the growth and enrichment of an extractive elite. There’s even an account from Robert Allen holding that British working-class wages didn’t start rising until around 1840, so the immiseration story was even true as a direct observation of the early industrial revolution.

But stepping back, it turns out that the industrial revolution in the North Atlantic world and then the spread of prosperity due to decolonization and globalization after 1960 or so are basically the best things that ever happened.

11) On the new book about the Boeing 737 Max:

When Boeing designed the long-haul 777 in the early 1990s, the company, Robison reports, invested in “$100,000 IBM workstations for every engineer who tested software.” Around the same time, Boeing completed construction of “a $70 million training center near Seattle for pilots, mechanics and flight attendants who would use the 777 and other Boeing planes.” Well into the 1990s, that proud engineering culture was alive and well.

Then, right around the turn of the millennium, Boeing lost its way. Robison accurately traces the beginning of Boeing’s downfall to the 1997 acquisition of McDonnell Douglas, a rival aircraft manufacturer. At the time, McDonnell Douglas was run by Harry Stonecipher, an unpleasant chief executive who relished cost cutting and had little patience for deliberative engineers. It was an attitude Stonecipher developed during his years at General Electric, where he worked with Jack Welch, the most influential C.E.O. of his generation and the pioneer of a new style of cutthroat capitalism that prioritized shareholder value above all else.


12) Interesting new poll results in Axios:

Nearly a quarter of college students wouldn’t be friends with someone who voted for the other presidential candidate — with Democrats far more likely to dismiss people than Republicans — according to new Generation Lab/Axios polling.

Why it matters: Partisan divides — as each side inhabits parallel political, cultural and media universes —make a future of discord and distrust in the U.S. all the more likely.

By the numbers: 5% of Republicans said they wouldn’t be friends with someone from the opposite party, compared to 37% of Democrats.

  • 71% of Democrats wouldn’t go on a date with someone with opposing views, versus 31% of Republicans.
  • 30% of Democrats — and 7% of Republicans — wouldn’t work for someone who voted differently from them.

 To be fair, though, you could still have a pretty broad college social network without Republicans in it. For an Republican college student to have a social network without Democrats in it would be very limiting.

13) From last year, but just came across it today– heat (and humidity!) for limiting the spread of Covid:


Enveloped viruses such as SAR-CoV-2 are sensitive to heat and are destroyed by temperatures tolerable to humans. All mammals use fever to deal with infections and heat has been used throughout human history in the form of hot springs, saunas, hammams, steam-rooms, sweat-lodges, steam inhalations, hot mud and poultices to prevent and treat respiratory infections and enhance health and wellbeing. This paper reviews the evidence for using heat to treat and prevent viral infections and discusses potential cellular, physiological and psychological mechanisms of action. In the initial phase of infection, heat applied to the upper airways can support the immune system’s first line of defence by supporting muco-ciliary clearance and inhibiting or deactivating virions where they first lodge. This may be further enhanced by the inhalation of steam containing essential oils with anti-viral, mucolytic and anxiolytic properties. Heat applied to the whole body can further support the immune system’s second line of defence by mimicking fever and activating innate and acquired immune defences and building physiological resilience. Heat-based treatments also offer psychological benefits and enhanced mental wellness by focusing attention on positive action, enhancing relaxation and sleep, inducing ‘forced-mindfulness’, and invoking the power of positive thinking and ‘remembered wellness’. Heat is a cheap, convenient and widely accessible therapeutic modality and while no clinical protocols exist for using heat to treat COVID-19, protocols that draw from traditional practices and consider contraindications, adverse effects and infection control measures could be developed and implemented rapidly and inexpensively on a wide scale. While there are significant challenges in implementing heat-based therapies during the current pandemic, these therapies present an opportunity to integrate natural medicine, conventional medicine and traditional wellness practices, and support the wellbeing of both patients and medical staff, while building community resilience and reducing the likelihood and impact of future pandemics.

14) Kind of wild for Trump to now decide he wants to speak forcefully and consistently in favor of vaccines.  What a difference this could have made a year ago!!

15) Speaking of overdue… why in the world are we just now finding out that Remdesivir can dramatically cut down on Covid hospitalizations?!  Shouldn’t that trial have been run ages ago?

Merry Christmas Quick hits (part I)

1a) From Pro Publica, “This Scientist Created a Rapid Test Just Weeks Into the Pandemic. Here’s Why You Still Can’t Get It.: Irene Bosch developed a quick, inexpensive COVID-19 test in early 2020. The Harvard-trained scientist already had a factory set up. But she was stymied by an FDA process experts say made no sense.”

On March 21 — when the U.S. had recorded only a few hundred COVID-19 deaths  Bosch submitted the test for emergency authorization, a process the Food and Drug Administration uses to expedite tests and treatments.

A green light from the FDA could have made a big difference for the many Americans who were then frantically trying to find doctors to swab their noses, with results, if they were lucky, coming back only days later.

But the go-ahead never came.

In the months that followed, Bosch responded to repeated requests from FDA reviewers for data and studies. When the agency finally put out guidance that summer about the performance over-the-counter home tests needed to meet, officials required that such tests be nearly as sensitive as the lab tests used to definitively determine whether a patient has COVID-19.

That standard proved difficult to meet. Rapid tests are usually sensitive enough to detect viral antigens when someone has enough of them to be able to spread the disease. Such tests are not as good at picking up cases in either earlier or later stages of infection, when viral loads are lower.

Bosch’s tests missed the FDA’s high bar. It wasn’t until the spring of 2021 that much larger companies were able to design similar tests — relatively inexpensive, over-the-counter rapid tests — that the agency found acceptable.

“You could have antigen tests saving lives since the beginning of the pandemic,” said Bosch, sitting in her lab at MIT. “That’s the sad story.”

As ProPublica recently detailed, many companies with at-home tests have been stymied by an FDA review process that has flummoxed experts and even caused one agency reviewer to quit in frustration.

While E25Bio’s test didn’t catch quite as many cases as those now on the market, it could have been used to catch superspreaders, with warnings that a negative result wouldn’t rule out infection. Experts told us that the test could have been a vital public health tool had it been produced in the millions in 2020 just as COVID-19 was racing across the country undetected.

“Since we didn’t have other options, it would have been a very good test,” said Michael Mina, an epidemiologist who followed E25Bio’s early progress. “If we were going to war, and somebody was invading us, and we had a bunch of revolver pistols, and we didn’t yet have the shipment of machine guns, hell yeah, you’re going to pick up the revolver pistol. You do what you can when you need to in an emergency.”

Three other experts reviewed Bosch’s submissions at ProPublica’s request and agreed that her test approached what is now considered acceptable for over-the-counter tests.

1b) Michael Mina

2) Chait, “Biden Should Take Manchin’s Deal Right Now”

Sunday morning, Joe Manchin threw a giant twist into the plot of the Biden presidency by announcing his opposition to the administration’s signature domestic agenda. But the new plot had a gaping hole: Biden noted that, a few days before walking away, Manchin had made a counteroffer to Biden at the White House.

What was the counteroffer? And why did Biden reject it?

The Washington Post fills in the answer. Manchin’s proposal included universal pre-kindergarten, an expansion of the Affordable Care Act, and hundreds of billions of dollars in green energy spending, all totaling the promised $1.8 trillion.

The main conceptual difference between Manchin’s bid and Biden’s ask is that Biden is trying to fund more programs with the same amount of money and does it by phasing several of them out after a few years. Manchin opposes this from the right as a fiscally irresponsible scheme to start up programs that will get extended but lack any funding source. The more important argument against it is that these plans won’t be permanent, because a future Republican Congress will happily let them expire, which would mean the hard-won spending Biden negotiated will be for naught.

5) I can’t imagine too many people want to move to Mississippi, but this was quite interesting in the Planet Money newsletter, “Where To Live To Get The Most Bang For Your Buck”

Natchez, Mississippi, is a town of about 15,000 people nestled on the Mississippi River. It’s pretty, pretty enough to be a popular wedding destination. It’s racially diverse. It’s got a college campus, multiple art galleries, good steakhouses and southern eateries, a brewery, and a decent nightlife. Natchez’s tourism agency says the town offers “a taste of true southern hospitality” and “a visit to Natchez feels like coming home.”

But Natchez may hold even more appeal for the roughly 60 percent of American adults who have not graduated from college. A fascinating new study by Stanford University economist Rebecca Diamond and UC Berkeley economist Enrico Moretti finds that Natchez and its surrounding area offers one of the highest standards of living in America for workers without college degrees…

“The big, overall takeaway for college graduates is that expensive cities like New York and San Francisco remain a pretty good deal,” Moretti says. Sure, they’re obnoxiously expensive. But, educated workers have jobs that are so good that their incomes are more than enough to offset higher expenses. “San Francisco, for example, is in the top 20 percent in terms of standard of living across all locations.” New York is not far behind. 

Overall, Diamond and Moretti find that the standard of living for college graduates across America varies much less than it does for other workers. The jobs they get basically offer a cushy cost of living adjustment, so, on average, college graduates are able to afford a relatively similar lifestyle no matter where they live in America.

That said, there are still some significant differences in standard of living. The five places — technically, “commuting zones,” so these places and the area around them — with the highest standard of living for college graduates:

  • McAllen, Texas
  • Houston, Texas
  • Huntington, West Virginia
  • Beamont, Texas
  • Charleston, South Carolina…
Workers With Only A High School Diploma

“For the less educated households, the picture is quite different,” Moretti says. While they still do get paid more in places with a higher cost of living, their incomes do not adjust as strongly as they do for college-educated folks. So living in these areas, if they are not getting outside help from family or the government, makes them financially worse off.  “Expensive cities offer a significantly lower standard of living compared to more affordable communities,” Moretti says.

The five places with the highest standard of living for those with only a high school diploma:

  • Gallup, New Mexico
  • Summersville, West Virginia
  • Natchez, Mississippi 
  • Graham, Texas
  • Marquette, Michigan 

The five places with the lowest standard of living for those with only a high school diploma:

  • Asheville, North Carolina
  • San Diego, California
  • Manhattan, Kansas
  • Medford, Oregon
  • Jacksonville, North Carolina…
The Bigger Picture

It’s worth highlighting that some of the most expensive places in the country, like San Francisco and New York, are not at the bottom of any of these lists for having a low standard of living, even for those without a high school diploma. We asked Moretti about this, and he said the reason is simple: they may be more expensive, but they also offer higher salaries than any of the places that fare worse in their data. 

That said, Moretti says that expensive cities like New York and San Francisco are still low on the list for those who didn’t finish college and those who didn’t finish high school. They offer a pretty low standard of living for these classes of people relative to most of the country. 

As a result of this project, Moretti says, he’s come to believe that big, expensive cities offer significantly lower standards of living than he previously believed. Yes, they remain beacons of opportunity for brainiacs as well as those with fancy pedigrees or good connections. “But my thinking has evolved on less educated workers,” he says. “For them, expensive cities seem to be much less of a good deal than it looks like when you look simply at the higher incomes they earn there.” 

6) So much this, “The Anti-Abortion Movement Could Reduce Abortions if It Wanted To”

Often an abortion happens because a woman is pregnant when she didn’t intend to be. It is true that some women terminate wanted but doomed pregnancies and others face serious health complications. But if abortion opponents are serious about decreasing the need for abortion instead of simply punishing women and doctors, they should be rallying around contraception access. Instead, they’re largely standing in the way.

As of 2019, researchers found that 45 percent of all pregnancies in the United States were unintended and roughly 40 percent of unintended pregnancies were terminated. This makes for very simple math: Decrease unintended pregnancies and you decrease abortions.

The best way to do that is with easy access to modern methods of contraception, particularly long-acting ones (IUDs, for example), coupled with comprehensive sex education. The U.S. abortion rate is at a record low because of a significant decrease in unintended pregnancies, which Guttmacher Institute researchers say “is most plausibly explained by more and better contraceptive use.” Though a large majority of Americans, including those who might identify as pro-life, believe contraception is morally acceptable, many of the powerful anti-abortion lobbyists who shape Republican Party priorities and lead the legal attacks on reproductive health are at best silent about, and at worst hostile to, modern contraception.

Most anti-abortion groups do not publicly favor full and free access to some of the most effective contraceptives, and many adamantly oppose them. Some even claim (contrary to the scientific consensus) that some of the most common methods, including the pill, are “abortifacients.”

On its face, this makes very little sense. Why would groups that want to end abortion not support the most efficient way to make abortions less common? The answer is that their mission extends beyond abortion and into the regulation of sex, gender roles and the family. Contraception and abortion are tied together because both offer women the freedom to have sex for pleasure in or outside of marriage, and both allow women greater control over their lives and futures. The “pro-life” goal isn’t an end to abortion. It’s to establish another means of controlling women.

7) Eric Levitz with a nice reminder on how nuts the Authoritarian Right in America is, “The Authoritarian Right’s 1877 Project”

In a recent column for The American Conservative, Helen Andrews argues that Reconstruction — that brief slice of the 19th century during which Black Southerners enjoyed extensive political rights under the aegis of Northern Republicans — was “objectively bad.” Further, she insists that the “only possible reason for lionizing this traumatic episode,” as today’s mainstream historians do, “would be if you had an ulterior political reason to do so.” She proceeds to suggest that the conception of Reconstruction as “a noble experiment in interracial democracy” is crypto-communist agitprop.

In support of this argument, Andrews marshals two basic contentions:

• Reconstruction governments were uniquely corrupt. In Andrews’s words, Southern corruption during the period was “not just a matter of a little graft here and there,” but rather constituted “the complete subordination of every level of government to the personal enrichment of a few.”

Andrews’s condemnation of contemporary U.S. historiography is almost refreshing for its forthrightness. Unlike some of her ideological bedfellows, Andrews is not trying to veil her wildly reactionary understanding of American racial history behind more respectable concerns; no ill-defined abstractions like “critical race theory” shroud her apologia for white Southern redemption. Yet Andrews is only candid in relative terms. In truth, her column is unrelenting in its refusal to baldly state its most incendiary implications…

In any case, the political dispute that shadows contemporary debates over Reconstruction doesn’t concern the desirability of Bolshevism so much as that of popular democracy. I can’t speak to Andrews’s personal motivations. So it may well be a coincidence that she is reviving rationalizations for Black disenfranchisement at a time when the Republican Party is subverting election administration and working to entrench racial inequality in political representation. But there is certainly an affinity between conservative arguments against Reconstruction and the movement’s contemporary justifications for gerrymandering and election subversion. In both instances, the right invokes the irresponsibility of Black voters and corruption of Black officials to legitimate anti-majoritarian forms of governance. When Donald Trump sought to discredit the integrity of the 2020 election’s results, he concentrated his allegations of impropriety on heavily Black urban centers such Philadelphia, Detroit, and Atlanta — even though Republicans lost far more ground in affluent white suburbs. In 2018, the Republican speaker of the Wisconsin state Assembly justified his party’s decision to transfer various authorities away from the incoming Democratic governor on the grounds that “if you took Madison and Milwaukee out of the state election formula, we would have [won] a clear majority.”

In recent years, conservatives have accused liberals of embracing a moralistic revisionist history that privileges ideological dogma and political expediency above nuance and historical accuracy. In arguing that Reconstruction was “objectively bad,” Andrews ably demonstrates that on this matter, as on so many others, the right practices what it preaches against.

Her column is everything that Republicans have denounced “The 1619 Project” for being. And while the latter was a mere magazine issue, the right’s burgeoning “1877 Project” threatens to become something farmore sinister.

8) How had I not heard about this?! “Maryland’s Wayward Zebras Have Been Captured After Nearly Four Months”

For almost four months, two escaped zebras had built a life for themselves in the suburban terrain of Maryland.

They made surprise backyard appearances, much to the delight of residents, and crossed the streets like every other law-abiding citizen. They grazed on fields and pastures and drank from streams.

They also evaded numerous attempts to corral them. But they were finally captured last week, the Maryland Department of the Environment said in a statement on Tuesday.

The two zebras had been among the most wanted residents of Prince George’s County since they escaped with a third zebra from a farm in August.

The third zebra was found dead in a snare trap a month after the escape, the Maryland Natural Resources Police said in October. All three animals had been living on a farm owned by Jerry Lee Holly, 76, in Upper Marlboro, Md., according to the authorities.

The details of the capture and the circumstances of their initial escape were still unclear. But the zebras have now been “returned to the herd,” the Department of the Environment said in the statement. The department did not respond to questions on Tuesday.

9) Just came across this from almost two years ago, but still highly relevant, “Math scores stink in America. Other countries teach it differently – and see higher achievement.”

American students struggle in math. 

The latest results of an international exam given to teenagers ranked the USA ninth in reading and 31st in math literacy out of 79 countries and economies. America has a smaller-than-average share of top-performing math students, and scores have essentially been flat for two decades.

One likely reason: U.S. high schools teach math differently than other countries. 

Classes here often focus on formulas and procedures rather than teaching students to think creatively about solving complex problems involving all sorts of mathematics, experts said. That makes it harder for students to compete globally, be it on an international exam or in colleges and careers that value sophisticated thinking and data science. 

There is a growing chorus of math experts who recommend ways to bring America’s math curriculum into the 21st century to make it more reflective of what children in higher-performing countries learn. Some schools experiment with ways to make math more exciting, practical and inclusive. 

“There’s a lot of research that shows when you teach math in a different way, kids do better, including on test scores,” said Jo Boaler, a mathematics professor at Stanford University who is behind a major push to remake America’s math curriculum.

Here are some ideas for improving it:

Stop teaching the ‘geometry sandwich’

Most American high schools teach algebra I in ninth grade, geometry in 10th grade and algebra II in 11th grade – something Boaler calls “the geometry sandwich.”

Other countries teach three straight years of integrated math – I, II and III — in which concepts of algebra, geometry, probability, statistics and data science are taught together, allowing students to take deep dives into complex problems.

In higher-performing countries, statistics or data science – the computer-based analysis of data, often coupled with coding – is a larger part of the math curriculum, Boaler said. Most American classes focus on teaching rote procedures, she said. 

Next year, Boaler and a research team plan to recommend that California phase out the algebra-geometry pathway in favor of integrated math for all students – something she pitched to education leaders across the state. 

Some states, such as Utah, have made the switch. The Common Core academic standards, a version of which most states adopted, say high school math can be taught in either format.

I was intrigued to learn the “geometry sandwich” was still prevalent, as my college senior son actually took integrated math in high school here in Wake County.  Anyway, other interesting ideas there, too.

10) Fascinating story about the case of the man falsely convicted of raping the author of the mega-bestseller, The Lovely Bones. “He Was Convicted of Raping Alice Sebold. Then the Case Unraveled.: Anthony Broadwater was exonerated in the 1981 rape of Ms. Sebold, now a best-selling author. When his lawyers saw the trial transcript, they could only wonder what took so long.” (The month is almost out and I’ve done too few free-for-all NYT links, so this one is– read it!)

11) Good stuff from Vox on why movie theaters aren’t actually dead yet.

12) Just read this New Yorker story yesterday and it’s brilliant and devastating and oh-so-sad, “The secretive prisons that keep migrants out of Europe: Tired of migrants arriving from Africa, the E.U. has created a shadow immigration system that captures them before they reach its shores, and sends them to brutal Libyan detention centers run by militias.”

13) Two really depressing pieces of evidence on Omicron:

14) So, let’s finish it off with a great Noah Smith post that rounds up all the more encouraging Omicron evidence or recent days.



If you are not using N95 (or similar) time to up your mask game

1) I find it pathetic that I cannot stop myself from keeping my daily blog posting streak going.  Damnit.  But, here I am, 11p and I’ve just got to write something.

2) With Omicron very transmissible and very ready to break through your vaccination, it’s definitely a good time to consider an N95 for indoor use if you have not yet.  A somewhat problematic NPR article in a few ways, but good on the mask basics:

“Cloth masks are not going to cut it with omicron,” says Linsey Marr, a researcher at Virginia Tech who studies how viruses transmit in the air.

Omicron is so much more transmissible than coronavirus variants that have come before it. It spreads at least three times faster than delta. One person is infecting at least three others at a time on average, based on data from other countries.

“It’s very contagious,” says Dr. Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco. “And the kind of encounter that you could have had with prior versions of the virus that would have left you uninfected, there’s now a good chance you will get infected from it.”

True, a cloth mask can be a “marginally OK to maybe a decent filter,” Marr says. But with something as highly transmissible as omicron, just “OK” isn’t good enough.

Marr notes that preliminary data from scientists at the University of Hong Kong has shown that omicron multiplies 70 times faster inside human respiratory tract tissue than the delta variant does. That study also found that omicron reaches higher levels in respiratory tract tissue 48 hours after infection, compared with delta.

“That would suggest to me that maybe it reaches higher levels and then we spew out more [virus particles] if we’re infected,” Marr says. And while it’s too soon to tell, she says it’s conceivable that omicron is so good at infecting us, we just need to breathe in fewer viral particles of omicron to get infected.

And virus particles from an infectious person can linger in the air indoors for minutes or even hours after they leave a room in some situations, says Dr. Abraar Karan, an infectious disease physician at Stanford University. “I think that people need to realize that transmission here can happen even when you’re not near somebody,” he says.

Why high-filtration respirators are better and how to find a legitimate one

Given all this, you want a mask that means business when it comes to blocking viral particles. Unlike cloth masks, N95, KN95 and KF94 respirators are all made out of material with an electrostatic charge, which “actually pulls these particles in as they’re floating around and prevents you from inhaling those particles,” Karan notes. “And that really is key” — because if you don’t inhale virus particles, they can’t multiply in your respiratory tract.

The material in surgical masks also has an electrostatic charge. But surgical masks tend to fit loosely, and a snug fit — with no gaps around nose, cheeks or chin — “really makes a big difference,” says Marr, who has studied mask efficacy.

KN95s tend to be a bit more comfortable than N95s, but counterfeits continue to be a problem. For safer shopping, check out a site like Project N95, a nonprofit that helps consumers find legitimate personal protective equipment. Or check the CDC’s site for advice on how to spot a counterfeit and a list of trusted sources for surgical N95s.

For maximum protection, make sure your N95 fits snugly as well, creating a seal around your mouth and nose. The CDC explains what makes a good fit and how to test that yours is sealing well.

For the most part, KN95’s have ear loops which can make it harder to get that truly good seal that a two-strap N95 will get you (also, you never get sorer ears!).  Frustratingly, this article doesn’t tell you that both surgical masks and N95’s are very re-usable and thus very cheap. 

I love this tweet from my pandemic twitter friend on just how damn reusable they are:

I wore this pouch “duckbill” N95 all last semester while teaching.  Very comfortable and pretty easy to get a good seal (no glasses fogging), but, damnit, you do look faintly ridiculous.  I saw a lot of smart epi people talking about this 3M one the other night, so I just ordered and am hoping it works as well while looking more normal. 

I may well get Omicron, but, damnit, I’m not going to get it while wearing a mask.


We should change “fully vaccinated” but it’s hard

I think the evidence has been quite clear for quite some time that we should consider three shots of a Covid vaccine to be “fully vaccinated.”  Many vaccinations are a three shot series and with Covid, that third shot 6 or so months later clearly induces greater immunity than the original series– more antibodies and more diverse antibodies.  Even before Omicron this was clear, but the broader antibody response is even more valuable against Omicron (and future variants).  

I’ve been really glad to see that even if the government is not taking any action, many colleges and universities (including my alma mater, whose Covid response has generally been great).  I asked a friend/colleague  who is plugged in if there was any hope for NCSU, but out health administrators are pathologically dependent on whatever the CDC recommends (and as we’ve long known, they are often weeks/months behind in making recommendations based on the best science).

So, yeah, I’ve really been advocating that we redefine “fully vaccinated” but, as the always-excellent Katherine Wu explains, this is easier said than done.  

Sometime in the very, very near future, that status—and the perks that come with it—could evaporate in an instant for millions of Americans. Medical experts and public-health officials have for weeks been calling for the CDC to alter the definition of fully vaccinated to include another dose. Countries such as Israel have already done it; Anthony Fauci has been gunning for the switch. As he told me this summer, “I bet you any amount of whatever” that three shots, spread out over several months, will ultimately be the “standard regimen for an mRNA vaccine.” Even the CDC told me this week that it “may change [the] definition in the future”—a line it’s never used with me before. For a cautious government agency, that’s kind of a gargantuan leap. A new floor for full vaccination, one that firmly requires what we’re now calling booster shots, is starting to look like a matter of when, not if

A change in definition would almost certainly spur some individual action in the short term; it’s maybe the closest the CDC can get to mandating boosters without, you know, mandating boosters. But it would also invite a whole lot of mess. Millions of people would be bumped back into “partially vaccinated” purgatory. Unvaccinated people would have one more hurdle to clear to achieve CDC-sanctioned status; some could be further disincentivized from getting the necessary shots. If Fauci is correct, the amendment is inevitable, and the risks of a logistics and communications tangle are worth taking now. But some other experts aren’t so sure. “We still don’t know what the optimal vaccination schedule is,” Boghuma Kabisen Titanji, an infectious-disease physician at Emory University, told me.

And there’s still no consensus on what our COVID-19 vaccines are supposed to accomplish in the short or long term. Stamp out severe disease? Aggressively tamp down all infections, so that we can squelch viral spread? In deciding what fully vaccinated meansit would help to know “what outcomes we’re trying to prevent, and why,” Céline Gounder, an infectious-disease physician at Bellevue Hospital Center, in New York, told me. That would dictate our dosing strategies—the what, the when, the how many.

Already, in the year since our shots first rolled out and full vaccination against COVID-19 was first defined, the pandemic landscape has shifted. And in this long fight against a fast-moving, fast-morphing virus, we may never actually, truly be fully vaccinated at all. Updating the definition of fully vaccinated is a strong move—hence the push for it at all. But it’s also a reminder of the power of waiting until we’re more sure of what we want our shots to do.

On that last point, oh, I’m sure what we want the shots to do– prevent disease! That’s actually what we seemingly what most vaccines to do is prevent disease, not just severe disease.  

None of this waffling is, to be clear, an indictment of boosters. By this point in the pandemic, it’s quite clear that adding on more shots can come with big benefits, especially now. Months have passed since many people got their shots, leaving antibody levels relatively low. And the heavily mutated Omicron can hopscotch over several of the antibodies that are left, taking hold more easily in vaccinated bodies compared with its predecessors, and perhaps transmitting more rapidly out of them. But a booster’s bump can skyrocket both the quantity and quality of frontline immune defenses, and restore much of the body’s ability to pin the coronavirus in place. Early data suggest that while two doses of an mRNA vaccine deliver kind of meh protection against Omicron infection, tacking on another dose brings the body back to a Delta-like benchmark. Omicron will still spread within vaccinated bodies, and among them. But it will do so less often with a booster. At this point, “I don’t think we can meaningfully interrupt transmission without three doses,” Saad Omer, a Yale epidemiologist, told me. Our viral opponent has clearly upped its offense, and boosters—a bolstering of defense—have never made more sense.

Looping boosters into “full vaccination,” then, could clinch the importance of these shots. “We’ve hit a tipping point,” Jason Schwartz, a vaccine-policy expert at Yale, told me. It’s become essential to “encourage and promote boosters,” and sticking stubbornly to a now-obsolete definition of fully vaccinated could undermine that effort.

A modification wouldn’t be without precedent. The measles/mumps/rubella vaccine first debuted as a single shot, but it became a double-doser in 1989 to better contain outbreaks; the chicken-pox vaccine underwent a similar tweak in 2006…

A definitional conversion for fully vaccinated would also create logistical nightmares for freshly instated mandates that rely on the current definition—one dose of J&J, two of mRNA. In practice, an update to fully vaccinated could completely rejigger who is and isn’t compliant; workers who only just met a two-dose mandate would have to await a third shot at the six-month mark. “You already have a lot of resistance,” Gounder said. Faced with new requirements, some employers might try to do away with mandates entirely; employees might choose to call it quits.

The prospect of three required doses could also raise a barrier for people still trying to decide whether they want to get any COVID-19 shots at all. Right now, a one- or two-dose shot means waiting two to six weeks to hit full vaccination. A three-doser could balloon that to eight months, with potentially three rounds of side effectsOne of the best ways to protect the world is for unvaccinated people to get vaccinated; we could quickly find ourselves in trouble if third doses get pushed at the cost of firsts. Ideally, we’d bring the entire world to three injections—perhaps more if needed. But partial vaccination is still better than none. And the more doses we buy up and urge onto the residents of wealthier countries, the harder it becomes for people around the world to get their initial series, giving the virus more places and chances to transform itself into something even more troublesome.

Well, damn, that’s complicated.  I still think potential benefits of a re-definition outweigh potential costs, but it’s clear there’s potentially very real costs.  That said, this approach sounds great:

With all of these factors at play, experts like Grace Lee, a Stanford pediatrician and the chair of the CDC’s Advisory Committee on Immunization Practices, thinks we might be better off shifting the conversation entirely—asking whether people are “up-to-date” on their shots, rather than whether they’re fully vaccinated. Whereas fully vaccinated implies a sort of finality, and has, to some, even become shorthand for fully protectedup-to-date is more flexible and forgiving. The phrase, which is already used among health professionals when discussing vaccines, might leave more room for individual tailoring, and it accommodates the unpredictability of our circumstances. Up-to-date is also a little more agnostic on the primary-versus-booster distinction. And asking “Did you get your shot this year?” rather than “Are you fully vaccinated?” could be an especially useful framework, Lee told me, if we end up having to retool and readminister our vaccines somewhat regularly, much like we do with vaccines for the seasonal flu.

All that said, whatever we call it, we absolutely should prioritize getting that third shot in as many Americans as possible.  And part of that, presumably, is how we define “fully vaccinated.”  

Keep schools open!

One of my favorite voices on this whole mess, Joseph Allen, “We Learned Our Lesson Last Year: Do Not Close Schools”

As the Omicron variant brings skyrocketing cases, colleges are suspending in-person classes, Broadway shows are canceling some performances, and companies are pushing back return-to-office dates. Most ominously, some politicians are calling to consider closing K-12 schools again, and a district in a Maryland suburb of Washington, D.C., decided recently to shift to remote learning until the middle of January. The dominoes are in danger of falling again. But a new round of widespread school closures would be a tragic mistake and should be off the table as an option.

The argument for keeping schools open rests on two constants ever since the Covid pandemic began: The risk of severe outcomes to kids from coronavirus infection is low, and the risks to kids from being out of school are high.

On risks from Covid: The weekly hospitalization rate for school-age children is approximately 1 in 100,000. This has stayed remarkably consistent throughout the pandemic — through the origin strain, the more transmissible Alpha and last winter’s surge and, yes, even through the summer Delta surge in the South and the fall Delta surge in the North.

As the American Academy of Pediatrics stated in a report released this month, “The available data indicate that Covid-19-associated hospitalization and death is uncommon in children.” There is also promising news regarding long Covid and children: A large meta-analysis published last month shows that kids who tested positive for the coronavirus have rates of persistent symptoms that are similar to those who tested negative, and when there were differences, they were small.

The early evidence from outside the United States suggests that kids will remain low risk during the Omicron surge as well. The latest data from South Africa for the week ending Dec. 12 shows that school-age children (5-to-19-year-olds) had the lowest hospitalization of any age group, and even with the Omicron uptick, the hospitalization rate is four to six per 100,000 — higher than one in 100,000 but still quite low. The latest data from Britain is similar. As of Dec. 12, the hospitalization rate for 5-to-14-year-olds is 1.4 per 100,000 — the lowest hospitalization rate of any age group…

The harms to kids from being out of school, on the other hand, are severe. They are accumulating. And they could last for decades…

Online learning isn’t the same as in-person learning. A report by McKinsey examining Covid-19 effects on the 2020-21 school year found that the pandemic left students five months behind on math and four months behind in reading. Schools with majority Black and brown populations saw deeper losses: six months behind in math and five to six months behind in reading. A separate study analyzing the impact of remote learning found that math and reading passing rates were lowest in poor areas and that going from fully virtual to fully in person counteracted the low math passing rates by 10 percentage points.

And that’s for students who were in school. One million students expected to be in school didn’t show up in person or online at all, with the largest declines in the youngest learners and in families living below the federal poverty line…

The effects of closed schools go far beyond learning loss. We have a full-on child mental health crisis on our hands. The proportion of pediatric hospital visits for mental health reasons increased significantly in 2020 as the pandemic hit and schools closed, and the trend only worsened as 2020 wore on.

Schools are the place where we first detect trouble at home, including neglect and abuse. Even short-term closings have steep consequences. In just the first three months of the pandemic, an analysis of data from New York City found a drop of nearly 8,000 in expected reports of allegations of child maltreatment. When researchers extrapolated that to the rest of the country, they estimated that more than 275,000 cases would have otherwise been reported…

And it’s not only children who suffer when there is no school. Kids doing school at home also meant many parents couldn’t be at work. This additional home work disproportionately fell on women, and differences in labor force participation between women and men, already stark, grew 5 percentage points from 2019 to 2020 in states offering primarily remote instruction.

All of these effects were predictable and, in fact, predicted. And they must not be repeated…

But when it comes to quarantining and masking, many schools should take a less intrusive approach than they currently are. This may seem counterintuitive in the midst of a surge, but because learning has been disrupted so much already, we need to prioritize keeping kids in school as much as possible and making the educational experience when they are there as rich as possible.

To that end, we need to stop quarantining entire classrooms when there is a positive case and instead establish so-called test-to-stay policies as the default. The Biden administration has finally woken up to this. If you test positive — or if you have any symptoms — you stay home. If you test negative, you’re in school.

This approach works. Los Angeles compared schools with test-to-stay policies and those without and found similar case rates across the schools, but the schools that didn’t have such policies lost over 90,000 in-person school days because of overquarantining. The schools that had test-to-stay policies lost zero days. Though we may feel tempted during the Omicron surge to use more restrictive measures, we should resist that urge. Test to stay will still be the best policy for schools, even as cases rise.

If rapid tests are not available, schools should not resort to quarantining entire classrooms. The default still should be keeping kids in classrooms, coupled with more aggressive monitoring of symptoms. This is less optimal than test to stay but preferable to sending entire classrooms home.

No, this is not risk.  What it is is a proper weighing of the many costs that come from closing schools.  And on a societal level, we need to prioritize keeping schools open. 

And Aaron Carroll from earlier this month, “We Opened the Schools and … It Was Fine”

Schools aren’t the problem. They never have been.

One of the frustrating things about the pandemic has been our inability, even at this late date, to understand why surges occur. [emphases mine] They hit communities with mask mandates, and communities without. Last year, we believed that the surge from October through February was caused by seasonal changes. The cold drove everyone indoors, where COVID was much more likely to spread, and therefore cases developed more quickly. This year, though, the surge began long before the weather turned cold. Vaccines are certainly protective and likely mitigate the severity of surges locally. Even so, things may worsen again—the data right now aren’t looking good for much of the country, and many people fear more hardship to come from the emergent Omicron variant—but no predictable pattern has emerged to explain what sets off periods of dramatic increases.

What is pretty certain, however, is that schools are not to blame. They didn’t cause the surges. They didn’t cause the massive numbers of hospitalizations and deaths that Florida experienced this summer and that Michigan appears to be experiencing now. They haven’t done nearly as much damage as bars, restaurants, and indoor events (including kids’ birthday parties), which never seem to receive the same amount of attention.

This doesn’t mean that kids aren’t getting COVID, of course. It doesn’t mean that kids aren’t in danger, haven’t gotten sick, haven’t been hospitalized by the thousands, and even died. Kids catch COVID, and transmission does occur in schools, but it is rare when precautions are taken. Because of this, the level of school transmission is sometimes lower than that of the surrounding community. Most schools are on guard, at least. Many require masks. More are being thoughtful about close contacts and group dynamics, and they enforce isolation and quarantine as much as they can. That may be inconvenient, but it’s hard to argue that it hasn’t made a difference.

It was not unreasonable to close schools before we really understood what we were dealing with and before we had vaccines that could dramatically reduce the risk of severe outcomes.  Given what we’ve learned and given the availability of vaccines for all school-aged children (alas, I sure wish uptake was much higher) schools really should be the last thing we close now.

The next front in the Abortion conflict

With Roe v. Wade about to be either officially overturned next year, or, at minimum, functionally eviscerated, abortion policy is going to be a state-by-state issue.  And, in many states the new front line may well be the issue of medical abortion.  Expect to see lots of political and policy conflict here after the Court decision.  NYT with details:

The federal government on Thursday permanently lifted a major restriction on access to abortion pills. It will allow patients to receive the medication by mail instead of requiring them to obtain the pills in person from specially certified health providers.

The decision, by the Food and Drug Administration, comes as the Supreme Court is considering whether to roll back abortion rights or even overturn its landmark 1973 decision in Roe v. Wade that made abortion legal nationwide.

The F.D.A.’s action means that medication abortion, an increasingly common method authorized in the United States for pregnancies up to 10 weeks’ gestation, will become more available to women who find it difficult to travel to an abortion provider or prefer to terminate a pregnancy in their homes. It allows patients to have a telemedicine appointment with a provider who can prescribe abortion pills and send them to the patient by mail.

Earlier this year, for the duration of the pandemic, the F.D.A. temporarily lifted the in-person requirement on mifepristone, the first of two drugs used to end a pregnancy. The decision to make this change permanent is likely to deepen the already polarizing divisions between conservative and liberal states on abortion. In 19 states, mostly in the South and the Midwest, telemedicine visits for medication abortion are banned, and these and other conservative states can be expected to pass other laws to further curtail access to abortion pills.

Yet other states, like California and New York, which have taken steps in recent years to further solidify access to abortion, are expected to increase the availability of the method and provide opportunities for women in states with restrictions to obtain abortion pills by traveling to a state that allows them.

“It’s really significant,” said Mary Ziegler, a law professor at Florida State University. “Telehealth abortions are much easier for both providers and patients, and even in states that want to do it, there have been limits on how available it is.”

Groups that want to outlaw abortion issued strong statements against the decision.

“The Biden administration today moved to weaken longstanding federal safety regulations against mail-order abortion drugs designed to protect women from serious health risks and potential abuse,” said a statement from the group Susan B. Anthony List. “The Biden administration policy allows for dangerous at-home, do-it-yourself abortions without necessary medical oversight.”

Let’s just pause here for a moment to deride the pro-life’s side completely bad-faith, risible argument that this about protecting women’s health.  Just own it and say “we are in favor of anything that makes it harder to take unborn life” or whatever along the lines. I just hate these completely fallacious arguments that this is in any way about women’s health.  Continuing…

So far this year, presumably in anticipation of such a decision, six states banned the mailing of pills, seven states passed laws requiring pills to be obtained in person from a provider, and four states passed laws to set the limit on medication abortion at earlier than 10 weeks’ gestation, said Elizabeth Nash, the interim associate director of state issues for the Guttmacher Institute, a research organization that supports abortion rights.

Susan B. Anthony List said in its statement that next year, at least seven additional states were likely to enact laws restricting the method.

The current practice is that women who live in states that don’t allow telemedicine for abortion must travel to a state that does — although they don’t have to visit a clinic. They may be in any location within that state for their telehealth visit, even a car, and may receive the pills at any address in the state.

But legal experts said they expected supporters of abortion rights to try to find ways to make the pills available without requiring a patient to travel, including possibly filing legal challenges to state laws banning telemedicine for abortion…

“There’s going to be plenty of people who try to use them in states where they’re illegal without traveling out of state, legal ramifications aside,” said Professor Ziegler. She said such efforts might include clearinghouses that would try to allow “fudging where people’s addresses are to receive it” and a “black market” that might emerge.

In data released last month by the Centers for Disease Control and Prevention, 42 percent of all abortions — and 54 percent of abortions before 10 weeks — occurred with medication in 2019, the most recent year for which C.D.C. data is available. (The report represents most of the country, but does not include data from California, Maryland and New Hampshire.)

In 2020, in some states, including IndianaKansas and Minnesota, the method accounted for a majority of abortions, according to state health department reports.

The C.D.C. also reported that 79 percent of all abortions occurred before 10 weeks’ gestation, suggesting that there are many more women who might choose abortion pills over an in-clinic procedure if they could.

There’s also the fact that these drugs essentially induce a miscarriage.  Sadly, this means in many states the trauma of having a miscarriage will only be compounded.  Jessica Grose:

When you have your first bad sonogram, you fall into an abyss of maternity care. If you haven’t experienced it, you might not know the contours of this purgatory, but I can tell you what it’s like. Almost exactly seven years ago, the face of my obstetrician fell while performing an ultrasound for a very wanted pregnancy, and our collective mood shifted in an instant from buoyant to somber.

I learned that day that it appeared that my pregnancy was not progressing, because my doctor couldn’t find a heartbeat. But he couldn’t be certain; my period was quite irregular, and it was possible that he misdated the pregnancy and that it was still viable. So I had to wait. One week, then two. Dragging myself into the radiologist’s office every few days to see if there was a heartbeat while attempting to work and parent my then-2-year-old and desperately trying not to cry most of my waking moments.

When my doctors were finally certain that the pregnancy would not go forward, I was given three options: I could continue to wait and see if my body would miscarry on its own without intervention, I could take medication and end the pregnancy at home, or I could have a surgical procedure to empty my uterus, known colloquially as a D. and C. (The last two options are the same choices offered to abortion patients.)

I chose the D. and C., mainly because I wanted to get this awful experience over with as soon as possible.

 Years later, I am at peace with the pregnancy loss; the fetus had a chromosomal issue called Turner syndrome, which “may cause up to 10 percent of all first-trimester miscarriages,” according to the National Institutes of Health. I know now that miscarriages are common. An estimated one-quarter of all pregnancies and around 10 percent of known pregnancies end in miscarriage before 20 weeks. Thankfully, I was able to have another healthy child later. But that two-week wait remains painful to think about.

And yet I’m thinking about it in the aftermath of the Supreme Court’s ruling on Friday allowing federal court challenges to Texas’ restrictive abortion law, S.B. 8, but leaving the law in effect, essentially outlawing abortions after six weeks in that state. That’s because in countries where elective abortion is outlawed or extremely restricted, women are not given the choices I had when they miscarry.

Abortion restrictions create a chilling effect on medical professionals who are understandably concerned about being prosecuted for anything resembling elective abortion. And so doctors in countries with restrictive laws “don’t always provide all the relevant information concerning the pregnancy, especially if they see there are complications and they’re afraid women can take drastic measures,” said Irene Donadio, a senior adviser at the International Planned Parenthood Federation.

I asked Dr. Isabel Stabile, a gynecologist in private practice in Malta and an abortion-rights activist, what first-trimester miscarriage care looks like in her country, where there is a total ban on abortion, with no exceptions. “The short answer to this question is in Malta it’s always a wait and see. Women are never given the immediate option of being hospitalized and having a D. and C. nor having pills so we can proceed with a spontaneous miscarriage. The medical and surgical options are never offered as a first line,” she said…

In cases like mine, when there is no detectable heartbeat, the trauma may primarily be to women’s mental health. But when there isa detectable heartbeat and there are other pregnancy complications, there are physiological stakes, including that women can and have died. In Poland, which has some of the strictest abortion laws in Europea 30-year-old woman named Izabela died of septic shock this year in Pszczyna after doctors declined to intervene to save her life. The fetus’s heart was still beating, so physicians may have been afraid to break the country’s laws because the penalty is spending three years in prison, according to reporting in The Guardian

If you think this wouldn’t happen in the United States, think again, because there is evidence that it is already happening. At Catholic hospitals, which are expected to follow directives set by the U.S. Conference of Catholic Bishops to never allow abortion services, women may not be getting the full slate of medical options when they present with an ectopic pregnancy.

In September, Ghazaleh Moayedi, an obstetrician-gynecologist in Texas, sounded the alarm in these pages. “Pregnancies that face complications will now be at greater risk. Under this new law, the only abortion exception allowed is for a medical emergency. That might mean if a woman will imminently lose an organ or die without intervention. But how we judge that risk will play out individually with each hospital’s policy, in each clinic,” she wrote. “I can think of no other area of health care in which we would wait for someone to worsen nearly to the point of death before we offered intervention. It’s just unconscionable.”

I honestly think many and probably most opponents of legal abortion have good-faith religious/moral objections that lead them to this political position.  Heck, I used to hold similar positions myself. But, the sad reality is that trying to implement these particular moral beliefs through public policy is ultimately injurious not only to women’s autonomy, but to women’s health and that’s a tradeoff we should not be making.  

Quick hits (part II)

1) Interesting NYT Review of a new book on the top 10%:

In his new book, “The 9.9 Percent,” Matthew Stewart focuses on the wealthiest one-tenth of Americans, a “new aristocracy” whose aggregate wealth is four times greater than that of everyone else. A minimum of $1.2 million in assets is required to enter this exclusive club and Stewart writes that the threshold will almost certainly rise by the time his book is published. It’s a club to which white people are eight times more likely to belong than people of color.

But what ultimately unites its members is less the size of their bank accounts than a mind-set, Stewart contends. At its core lies “the merit myth,” a shared belief that the affluent owe their success not to the color of their skin or the advantages they’ve inherited but to their talent and intelligence. Under the spell of this conviction, Stewart argues, the privileged engage in practices — segregating themselves in upscale neighborhoods, using their money and influence to get their children into elite colleges — that entrench inequality even as they remain blithely unaware of their role in perpetuating it.

2) And sticking with the book theme, from a review of a new book on Neanderthals:

Sykes explains that Neanderthals were sophisticated and competent human beings who adapted to diverse habitats and climates. They ranged from the shores of the Atlantic to the steppes of Central Asia. They thrived in hot climates as well as in ice age tundra. In addition to iconic large game hunts, Neanderthals also fished in rivers, gathered a multitude of plant species and sometimes stole honey from beehives. They manufactured complex tools, made clothing from animal hides, constructed cozy shelters, occasionally buried their dead and maybe, just maybe, even created art…

Yet Sykes’s convincing arguments about the competence and diversity of ancient Neanderthals lead us back to the inevitable Sapiens question. Scholars always noted the suspicious coincidence that Neanderthals made their exit exactly when Sapiens appeared on the scene. But as long as scholars viewed Neanderthals as simple brutes barely scraping by in ice age Europe, it was easy to give Sapiens the benefit of the doubt. Some scholars said that climate change made conditions more suitable for Sapiens while Neanderthals couldn’t cope with it. Other scholars argued that Neanderthals were already on the brink of extinction even before Sapiens left Africa. Another option was that Neanderthals didn’t go extinct at all — they were assimilated into the expanding Sapiens population.

But Sykes’s new synthesis seems to rule out all these options. For over 300,000 years Neanderthals successfully weathered many climatic cycles and adjusted to numerous habitats. They were capable of innovation and adaptation. They disappeared quite abruptly about 40,000 years ago as a result of what looks more like a sudden shock than a protracted process of decline. And while we now have conclusive evidence that some Neanderthals interbred with Sapiens, the evidence indicates that these were isolated incidents, and that the two populations did not merge.

So what happened? If Neanderthals were so good, why did they disappear? Sykes does not provide a definitive answer, but her findings strengthen the suspicion that Sapiens had a hand in it. Apparently, Neanderthals were sophisticated and innovative enough to deal with diverse climates and habitats, but not with their African cousins.

3) Models of Omicron’s potential impact cover quite the range.  Fingers crossed we get the optimistic edition (though, insofar as that depends on better human behavior, I’m not optimistic):

Among the first omicron-related projections to be made public is one from the UT COVID-19 Modeling Consortium at the University of Texas at Austin. That group has modeled 16 omicron scenarios that cover a range of “how quickly it spreads, how easily it evades immunity and how quickly we’re able to roll out booster shots,” says Lauren Ancel Meyers, who directs the consortium.

According to some of those scenarios, the omicron wave might only intensify the delta surge that’s underway. But in the most pessimistic scenario, omicron could trigger a tidal wave of infections that would be worse than last winter’s massive surge.

By around the end of January, more than 500,000 people could catch the virus every day on average, which is more than double the peak reached last winter, according to the most pessimistic scenario.

In the following weeks, an estimated 29,812 people would be hospitalized with COVID-19 and 3,876 would die every day on average, according to this projection.

“The most pessimistic scenarios are scary. And we need to sort of equip ourselves to make changes — change policies, encourage more cautionary behavior — if and when we start to see hospitalizations tick up in this country,” Meyers says.

But Meyers stresses that the most dire scenarios assume the very worst, including that the U.S. takes no additional measures or behavior changes to slow the spread of the virus, such as more masking and social distancing.

The pessimistic scenario also assumes that omicron is extremely adept at evading our immune systems and that omicron makes people sicker than delta does. Omicron is proving to be good at evading immunity and vaccines. But so far, evidence suggests it may cause milder illness, though that remains the biggest and probably most consequential open question.

The more optimistic projections are far less frightening. In the least pessimistic scenario, the omicron wave peaks around the middle of January and cases are only about double what they are now — reaching 189,069 on average every day. In this scenario, omicron would lead to only a few thousand more hospitalizations and a few hundred more deaths each day — 10,538 hospitalizations and 1,412 deaths on average.

In this hopeful scenario, “it’s just sort of a little bump. It’s not a catastrophic surge that overwhelms our hospitals and leads to record number of deaths,” Meyers says.

But that scenario assumes that omicron isn’t quite as good as it is in the pessimistic scenario at sneaking around our immune systems, that it doesn’t make people any sicker than delta and, importantly, that more people get boosted.

4) This interview makes the optimistic case based on South Africa data:

Let’s talk about what we know right now. There’s been relatively encouraging reports out of South Africa, but then there was this Imperial College report today that was striking a quite different tone, giving a quite different picture. How do you see the basic lay of the land right now? And what do you think is ahead for us in the next month or so?
Well, I think we’re starting to have good data from South Africa. And it looks like the proportion of people hospitalized, given infection, is much lower than in previous waves. Some estimates are as optimistic as 90 percent lower. It looks like, given hospitalization, people are less likely to die, or are less likely to die by respective age groups — a two-thirds reduction of death from infection compared to previous waves. There could be all sorts of reasons why, but that is quite spectacular. If you assume that these numbers are correct, it would mean a 30-times reduction in fatality relative to previous waves, which is really something. That brings us down to seasonal flu.

5) This is also an encouraging take on the SA data:

6) To be clear, the “optimistic” take means not the total disaster that some are predicting.  We are definitely going to have a major Omicron wave.  Almost surely it will lead to way more substantial illness and death and disruption.  So, optimistic is about just how bad within that framework. David Wallace-Wells, “Omicron Is About to Overwhelm Us The new COVID variant has all the makings of a massive wave.”

But right now we don’t need models to tell us that the pandemic is taking a bad turn, and we won’t need to wait to see the projections validated, either. The speed of spread with Omicron is so fast that, when it comes to case growth, at least, the warnings are being validated already.

The relative virulence of the new variant is still clouded by enormous amounts of uncertainty. Only one patient has died with Omicron, thus far, and it is not entirely clear if the coronavirus was even the true cause of death. But in part this lack of severe outcomes reflects just how early in the wave we still are, even in South Africa; the variant was first identified there just three weeks ago, which means many of the early cases are still running their clinical course, and we don’t yet know what the outcomes will be. Hospitalization data comes earlier, and the news has been encouraging there, though experts have warned that what we see as milder outcomes may have less to do with the inherent virulence of the variant and more to do with the fact that more people who’ve caught it are carrying with them protection from vaccination or previous infection. The largest study to date on early South African data — somewhat strangely, it was conducted by an insurance company — found that, overall, those with Omicron were experiencing 29 percent less severe disease than those who got sick in the country’s first pandemic wave. Other, independent assessments have yielded lower — which is to say, more encouraging — estimates: Perhaps Omicron’s severity is lower by two-thirds, perhaps even less.

7) And a moment for abortion.  Even though politicians are completely polarized on abortion, not so ordinary voters. Nate Cohn,  “Some Voters Are at Odds With Their Party on Abortion: Despite decades of partisan fighting in Washington, Americans are not as neatly divided on abortion as politicians and activists.”

Despite decades of partisan fighting, Americans are not as neatly divided on abortion as politicians and activists. There are Republicans who support abortion rights, Democrats who oppose abortion and a surprisingly large group of voters who appear to have muddled or conflicted views. Overall, 26 percent of voters hold a different view on abortion than the presidential candidate they supported in 2020, according to data from an AP VoteCast election survey of more than 100,000 voters.

No issue quite compares to abortion, at least not in its emotional and moral stakes. Yet by some measures, more voters hold views on abortion at odds with those of their presidential pick than on other hot-button issues, including gun control, coronavirus mask mandates or a border wall.

The relatively large number of voters who split with their party on abortion may simply be a reflection of how the Supreme Court’s decision in Roe v. Wade often kept the issue from the center of political debate. But it may also suggest that many voters just don’t feel as strongly about the issue as one might assume.

The findings in the AP VoteCast election survey are a reminder that American politics are not always as polarized as we imagine. The bitterly partisan fight unfolding in statehouses and courthouses, even in the Supreme Court’s split decision on Friday over the Texas abortion law, can obscure how many Americans of all parties struggle with the weighty moral and ethical questions raised by abortion.

As recently as 30 years ago, Democrats and Republicans had very similar views of abortion. In 1991, 42 percent of Democrats thought abortion should be legal whenever a woman sought one, compared with 41 percent of Republicans. Although attitudes about abortion have gradually tracked more sharply along partisan lines since then, there are still many voters who hold a mix of views that diverge from party allegiance or affiliation.

Less engaged and moderate voters are especially likely to hold abortion views at odds with their party. According to the 2018 General Social Survey, 92 percent of college-educated liberal Democrats believe it should be possible for women to obtain a legal abortion if she wanted for any reason, compared with just 55 percent of more moderate Democrats. Similarly, 39 percent of moderate Republicans say abortion should be legal in all or most cases, according to Pew Research.

8) And more good stuff in the NYT Upshot, “Who Gets Abortions in America?” (Lots of cool charts, too, if you follow the link)

The portrait of abortion in the United States has changed with society. Today, teenagers are having far fewer abortions, and abortion patients are most likely to already be mothers. Although there’s a lot of debate over gestational cutoffs, nearly half of abortions happen in the first six weeks of pregnancy, and nearly all in the first trimester.

The typical patient, in addition to having children, is poor; is unmarried and in her late 20s; has some college education; and is very early in pregnancy. But in the reproductive lives of women (and transgender and nonbinary people who can become pregnant) across America, abortion is not uncommon. The latest estimate, from the Guttmacher Institute, a reproductive health research group that supports abortion rights, found that 25 percent of women will have an abortion by the end of their childbearing years…

Six in 10 women who have abortions are already mothers, and half of them have two or more children, according to 2019 data from the Centers for Disease Control and Prevention. “One of the main reasons people report wanting to have an abortion is so they can be a better parent to the kids they already have,” Professor Upadhyay said….

About half of women who had an abortion in 2014 were below the poverty line, with another quarter very close to poverty. Guttmacher surveys show low-income women have been a growing share of abortion patients in recent decadesSeveral smaller studies of abortion patients have shown similar results. Researchers say this shift reflects improved access to effective contraception among higher-earning women, and a recognition of the growing costs of raising children among poorer women. It may also reflect the growing presence of charities that help poor women pay for abortions in states where public programs don’t.

“It’s people who don’t have access to health care, access to contraception, who, when facing an unintended pregnancy, don’t have the resources to have another child,” said Rachel Jones, a principal research scientist at Guttmacher.

9) Not long ago I remember strongly arguing that the NHL needs to stop nullifying goals for an offsides entry that happened long before the goal.  Love this Athletic discussion of potential NHL rule changes including this very one:

I think there should be some kind of time limit on how far back an offside could occur before it could overturn a goal. It’s kind of adding a proximate cause element to offside reviews.

The rule would say that if the offside happened 30 seconds (give or take a few) or more before the goal, then it couldn’t be used to overturn an otherwise valid goal. The benefit is that you focus the offside review on what it should be about: preventing rush goals from occurring offside, not stopping goals that really didn’t have much to do with the offside. — Greg Y

Gentille: Not a huge fan of this one, because “goals that really didn’t have much to do with the offside” kind of … don’t exist. If you gain the zone unfairly, then score on that trip, guess what? You shouldn’t have been there in the first place. Plus, it’d be too much of a judgment call. That’s kind of the whole problem with NHL officiating, yeah? NO

Mendes: I’m in favour of this rule, largely because I hate video review for the offside rule in the first place. I felt like I spent 35 years watching hockey without fretting about zone entries and now I’m watching them like a hawk. I understand catching the egregious mistakes and ensuring nobody scores a goal as the result of a blatantly offside play. But if you’ve been hemmed into your own zone for 30 seconds and then get scored on, I’m guessing that questionable offside call probably had little to do with the goal itself. So I’m OK with a 30-second limit. YES

McIndoe: Hmm. I want to vote yes, because it’s ridiculous that we go back as far as we do to review zone entries. But I don’t think this proposal goes far enough, because 30 seconds is a long time. I’d say 10 or 15 seconds. Or even better, if we can’t just scrap these dumb reviews in the first place, I’ve suggested that we only go back to the last change of possession. If a team is offside on the entry, but the other team gets the puck at some point after that before coughing it up, you had your chance. No whining to the replay official for a do-over.

If I vote for the 30-second limit as a starting point, am I closing the door on something better down the line? Let’s hope not, because I don’t want to let perfect be the enemy of slightly better. YES

10) I will answer the question in this editorial, “More students are bringing guns to school in NC. How do we keep kids safe?”  Hold parents legally accountable, damnit!!

And studies have shown that more than half of U.S. gun owners do not safely store their guns, making it far too easy for children to get their hands on them…

“I’ve heard kids tell me they can get a gun in 20 minutes if they wanted to get a gun,” Charlotte-Mecklenburg Police Chief Johnny Jennings said at a press conference after a student fired a gun outside West Charlotte High School Monday. Of the guns that end up on school grounds, three out of four come from the home of a friend or family member,

11) This “Adam Ruins Everything” on the college loans is just a devastating take on this exploitative industry and damn funny, too.

12) Good stuff on democracy and January 6th, especially Nyhan’s comments:

The problem, of course, is that Democrats have had high hopes that Trump would face a reckoning for his misdeeds before, in the Mueller investigation and in the President’s two sets of impeachment proceedings. Brendan Nyhan, a political scientist at Dartmouth College, praised the work of the January 6th committee, and said that fully uncovering Trump’s role remains vital. But he cautioned that political leaders and journalists should not focus solely on producing a January 6th “smoking gun,” reminiscent of the secret Oval Office recordings that brought down President Richard Nixon. “So much of the media has been obsessed with the idea that a document will emerge that shows everything,” Nyhan said. “I worry that we lose the forest for the trees.”

Nyhan, who is also a co-director of Bright Line Watch, notes that both U.S. politics and the ways in which Americans receive their information have changed radically over the past fifty years, contributing to the current deep polarization. According to opinion polls, seventy-eight per cent of Republicans believe that Biden was not legitimately elected—an increase from seventy per cent in April. Nyhan believes the committee’s findings, like past investigations of Trump, are unlikely to sway his fervent base. Meanwhile, Republican leaders, particularly House Minority Leader Kevin McCarthy, are standing by as Trump purges the G.O.P. of opponents. “He is doing what politicians do,” Nyhan said, of McCarthy. “He is going along with the energy in his party.” Nyhan feels it is equally important for Democrats to immediately enact reforms that will prevent either party in the future from attempting such radically anti-democratic acts as overturning an election—and that they should start building public support for such measures now, rather than wait for a smoking-gun moment to do so. Historically, Nyhan points out, authoritarian regimes have emerged by gradually subverting the independence of rival centers of power—such as the legislature, the courts, and the media—and concentrating power in their own hands. “The story of democratic erosion in other countries is that it happens invisibly, you don’t have this tanks-in-the-streets moment,” Nyhan added. “There are elected governments who operate with impunity, whose opponents don’t have a level playing field to compete upon.”

Observers, however, say it is unlikely that Republicans will support any Democrat-backed election-reform effort. In October, they filibustered the For the People Act, a sweeping Democratic proposal that would have revamped election systems nationwide. Nyhan said that Democrats should consider eliminating or changing the filibuster in order to pass the Freedom to Vote Act, a watered-down election-reform bill endorsed by Senator Joe Manchin, of West Virginia, which currently has some bipartisan support in the Senate. It includes measures that would make it more difficult for state legislators to dismiss election results certified by nonpartisan state officials—a tactic Trump tried to use in 2020. Nyhan also called for reform of the Electoral Count Act—an obscure and poorly drafted 1887 law that describes how Congress should count the electoral votes—before Democrats potentially lose their control of the Senate and House in next year’s midterm elections. “The Electoral Count Act is terrifying,” Nyhan said, referring to the statute’s vagueness. “It’s Chekhov’s gun.”

13) OMG this deBoer take on elite college admissions is so good and so much fun to read:

Here is what I want to say to you: at the end of this process, no matter how you change it, no matter how many statements the schools put out about diversity, no matter how many thumbs you put on all the scales to select for a certain kind of student, at the end of this process are self-serving institutions of limitless greed and an army of apparatchiks who are employed only to protect their interests. That’s it. You can’t make college admissions fair by getting rid of the SAT because colleges admissions can’t be “fair.” College admissions exist to serve the schools. Period. End of story. They always have, they always will. College admissions departments functioned as one big anti-Semitic conspiracy for decades because that was in the best interest of the institution. Guys who the schools know will never graduate but who run a 4.5 40 jump the line because admissions serves the institution. Absolute fucking dullards whose parents can pay – and listen, guys, it’s cute that you think legacies are somehow the extent of that dynamic, like they won’t let in the idiot son of a wealthy guy who didn’t go there – get in because admissions serves the institution. Some cornfed doofus from Wyoming with a so-so application gets in over a far more qualified kid from Connecticut because the marketing department gets to say they have students from 44 states in the incoming class instead of 43 that way, because admissions serves the institution. How do you people look at this world and conclude that the problem is the SAT?

And what just drives me crazy, what I find so bizarre, is that all these PMC liberals in media and academia think they’re so endlessly disillusioned and over it and jaded, but they imagine that it was the SAT standing in the way of these schools admitting a bunch of poor Black kids. What the fuck do you think has been happening, exactly? They’re standing around, looking at all these brilliant kids from Harlem and saying “oh God, if only we could let in these kids. We need to save them from the streets! But we can’t get past that dastardly SAT.” They decide who to let in, and they always have! They can let in whoever they want! Why on earth would you put the onus on the test instead of the schools? You think, what, they would prefer to admit kids whose parents can’t possibly donate? The whole selection process for elite schools is to skim a band of truly gifted students from the top, then admit a bunch of kids with identical resumes whose parents will collectively buy the crew team a new boathouse, and then you find a kid whose parents moved to the states from Nigeria two years before he was born and whose family owns a mining company and you call that affirmative action. And if you look at all this, and you take to Twitter to complain about the SAT instead of identifying the root corruption at the schools themselves, you’re a fucking mark, a patsy. You’ve been worked, you’ve been took. You’re doing the bidding of some of the wealthiest, most elitist, most despicable institutions on earth. You think Harvard gives a single merciful fuck about poor Black teenagers? Are you out of your goddamned minds?

It was in their best interest to use the SAT before, so they used it. Now it’s in their best interest to have even more leeway to select the bumbling doofus children of the affluent, and you’re applauding them for it in the name of “equity.” Brilliant…

“Equality”?!? Harvard only lets in 2000 kids a year! You really think carving out space for 50 more Black kids among them, if that actually even happens, is going to result in some sort of quantum leap forward for the average Black American? Is it not obvious that the whole scheme of fixing our racial inequalities by starting at the top by selecting some tiny number of Black overachievers and hoping the good times trickle down has failed, over and over again, since the start of desegregation? You can’t make Harvard “fair!” You can’t make it “equal!” Thinking otherwise is absolutely bonkers to me. Harvard exists to make sure our society is not equal. That is Harvard’s function.

You get that they just want to make it easier to turn down the poor but brilliant children of Asian immigrants, right? You understand that what Harvard and its feckless peers would like is to admit fewer students whose Korean parents clear $40,000 a year from their convenience stores, right? And you think, what, they’re going to be walking around Brownsville, handing out admissions letters to kids with holes in their pockets and a dream in their hearts? To the extent that any Black students are added to the mix by these policies, it’s going to be the Jaden and Willow Smiths of the world. If you think Harvard has any actual, genuine desire to fill its campus with more poor American-born descendants of African slaves you are out of your fucking mind. Just absolutely unhinged.

14) Interesting piece from Lawrence Krauss.  At first glance, looks like science funding is sexist, but, it turns out that senior scientists have way more success in getting funding and that women are far less of senior scientists than junior scientists.  Now, the latter is certainly a problem we should work on, but, science funding should be based on the most worthy science.

15) So, this sounds great, “New Eye Drops Offer an Alternative to Reading Glasses: Vuity, a once-a-day treatment that can help users see up close without affecting their long-range vision, went on the market Thursday after being approved by the F.D.A. in October.”  Huge caveat… this works by constricting your pupils so don’t use them any time around when you might want to drive at night.  Hmmm.

16) This was good, “The Unseen Side of “Cancel Culture” The threat to free expression goes well beyond high-profile cancellations.”

Shortly before hearing from Karith, I had been privy to similar instances of narrow-mindedness. I’m currently directing a forthcoming feature documentary based on The Coddling of the American Mind, the bestselling book by Greg Lukianoff and Jonathan Haidt. In late 2020, our team took a meeting with a major distributor. The executives liked our angle—focusing on the mental health crisis of Generation Z. But one blanched at the controversy it could ignite, noting it would take just one journalist on Twitter to question why this distributor greenlit the project in the aftermath of the George Floyd murder. I was shocked. Coddling has nothing to do with the Floyd tragedy. And how could one hypothetical Twitter user enjoy so much influence?

Around the same time, a friend of mine emailed me, smarting from a recent tangle at work. He’s a Latino comedic actor who had been courted by a new media platform. He moved across the country, and for years enjoyed a rarity for comedians—steady work. His comedy is sketch-based and addresses current events: a bit like “Saturday Night Live,” except with more eagerness to lampoon the excesses of identity politics. It’s something his employer encouraged, but that quickly changed in 2020. My friend made no outrageous blunder. His style of comedy stayed the same. And yet he was abruptly fired. His comedy had suddenly become taboo, and the once-prized recruit became a problematic liability.

I then received word from a producer at a top nonpartisan news organization. He was working on a television special about race in America, which would feature black experts. He hoped for some viewpoint diversity, and I provided a shortlist, complete with bios and links to televised interviews. My list included entrepreneur and podcaster Kmele Foster, Columbia professor John McWhorter, and George Mason University economist Walter Williams. My friend responded quickly—his bosses declared them all too extreme…

But none of the people in my examples were canceled in the traditional sense. Though fired, my comedian friend’s reputation hasn’t been smeared by a public trial on Twitter. Kmele Foster, John McWhorter, and Walter Williams weren’t disinvited from the television special—they were simply rejected at an earlier stage. Time will tell what happens to people like Karith Foster.  

Even when cancel culture’s most obvious side doesn’t show itself, those involved still feel its chill. The news producer will think twice before suggesting on-air experts that irritate his bosses. The college administrator who booked Foster will also think twice, as will the Latino comedian. I will recalibrate my already low expectations for the amount of viewpoint diversity entertainment executives will tolerate. Distributors and other gatekeepers will use new guidelines to filter out problematic content before it reaches audiences. Colleagues and friends connected to the examples above will note that the unwritten rules have been revised yet again.

Each impact may be small, but imagine them multiplying. Imagine the news media systematically misrepresenting black viewpoint diversity. Or colleges systematically favoring a “common enemy” approach to diversity training. Or entertainment executives systematically bowing to Twitter’s view of the world.

Doesn’t that seem a little bit like our world?

Tiny impacts from cancel culture can accumulate into big problems. It appears that the type of diversity training common on college campuses and elsewhere not only doesn’t work, but can increase bias, and exacerbate anxiety and depression. I’ve recently been speaking with many current and former college students in their teens and twenties. They often don’t realize that there are other ways to achieve social justice goals. Even if they do know, speaking out poses risks. Perhaps knowing the political diversity among Americans of all colors would embolden them, yet the screens they gaze at reinforce conformity.

17) This is some crazy story, “How Ashley Biden’s Diary Made Its Way to Project Veritas”

In the final two months of the 2020 campaign, President Donald J. Trump, his grip on power slipping because of his handling of the pandemic, desperately tried to change the narrative by attacking the business dealings of Joseph R. Biden Jr.’s son Hunter, invoking his name publicly over 100 times.

At the same time, another effort was underway in secret to try to expose the contents of a diary kept the previous year by Mr. Biden’s daughter, Ashley Biden, as she underwent treatment for addiction.

Now, more than a year later, the Justice Department is deep into an investigation of how the diary found its way into the hands of supporters of Mr. Trump at the height of the campaign.

Federal prosecutors and F.B.I. agents are investigating whether there was a criminal conspiracy among a handful of individuals to steal and publish the diary. Those being scrutinized include current and former operatives for the conservative group Project Veritas; a donor Mr. Trump appointed to a political position in the final days of his administration; a man who once pleaded guilty in a money laundering scheme; and a financially struggling mother of two, according to people familiar with federal grand jury subpoenas and a search warrant who spoke on the condition of anonymity to discuss an ongoing investigation.

18) This is really good on not just J&J, but what it takes to be successful in the pharmaceutical marketplace, “The tragedy of Johnson & Johnson’s Covid vaccine

But the CDC panel, unswayed, nonetheless recommended the Pfizer and Moderna vaccines first, and suggested J&J’s vaccine for people who can’t take the others or won’t.

In normal times, a preferential recommendation by the CDC of one vaccine can destroy the business of its rival; a preferential recommendation for GlaxoSmithKline’s shingles vaccine, Shingrix, for example, presaged Merck removing its own shingles vaccine from the market entirely.

The threat of TTS would likely have been enough to limit the J&J vaccine’s use in the U.S. no matter what the CDC said. For many months, the public has been less interested in the shot. 

But J&J was also hurt because, unlike Pfizer, it believed that its clinical trials could be geared to the desires of public health experts – particularly those calling for a one-dose vaccine.

Pfizer-BioNTech is dominant because it completed its clinical trials fastest, smoothed out manufacturing problems, and expanded fastest from adults to children and from emergency authorization to full approval. These are all lessons from commercial drug launches.

J&J, by contrast, had disadvantages from the start. It launched its study later, and it may have chosen a one-dose approach at first because doses of its adenovirus-based vaccine couldn’t be given too soon after one another. (Pfizer’s vaccines are given three weeks apart; for its two-dose study, J&J chose a two-month interval.) Stoffels also thought that in a pandemic, a one-dose shot with lower efficacy would be preferred to a two-dose one. But in the end, people preferred the vaccine with the better efficacy. 

This situation is not ideal, because mRNA vaccines by themselves might not be the best solution for fighting Covid over the long haul. Covid-19 isn’t going away, and it might not be wise to rely so heavily for the world to rely on the first vaccine technology that worked. It might be that, as J&J seems to believe, its vaccine or AstraZeneca’s might give broader protection against still unseen variants. Protein-based technologies like Novavax’s might have fewer side effects if people do need annual boosters. Nasally delivered vaccines might provide different types of protection. 

But, for now, it is not really clear how any of those technologies are going to replace the dominant Pfizer and Moderna shots. Running the right trials is just too difficult. It’s what Pfizer, 20 years ago in its defense of the drug cholesterol drug Lipitor, then the best-selling drug in the world, used to call a wall of data.

Instead of a triumph, the J&J vaccine stands as kind of object lesson, as does Merck, which is said to have passed on Moderna’s vaccine and had its own efforts mothballed, as well as AstraZeneca, which licensed its vaccine from the University of Oxford but was beset by clinical trials snafus. All those companies had seemingly great intentions. But in drug development, it doesn’t always pay to be nice. It’s better to be skilled. And it’s best to be lucky.

19) Interesting take from Drum on conservative influence:

Is 2021 the year that conservatives finally went too far?

Liberals have long griped about how the media treats obvious conservative lies. The list is endless: climate change, Benghazi, Hillary’s emails, tax cuts paying for themselves, and on and on. But these are fairly ordinary partisan disputes, and for better or worse the press is unlikely to take sides. Politics is politics, after all, and political reporters have seen this kind of stuff on both sides for decades.

But then came 2021, and suddenly conservatives went beyond—way beyond—the bounds of normal partisan fights. There have been two in particular:

  1. The “Big Lie” that the 2020 election was stolen and Donald Trump should have rightfully won the presidency.
  2. The refusal of conservative leaders to be aggressively pro-vaccine.

Even for people jaded by decades of partisan cat fights, these were shocking. The Big Lie was not something that was even colorably debatable. It was just a lie. A big one. And it was adopted by practically everyone in the Republican Party, leading to the insurrection of January 6. To this day, Republicans insist the election was stolen even though everyone knows this is Goebbels-level fabrication.

The Republican attitude toward vaccination is, if anything, even more shocking. For one thing, it’s barely even partisan since it doesn’t really harm Democrats in any way. It’s just flat-out pandering that has cost thousands of lives and will cost thousands more. There’s literally no reason for it aside from either pique (Donald Trump); a desire to promote conspiracy theories because it’s profitable (Tucker et al.); or craven capitulation to the mob (DeSantis and other GOP leaders).

I may be fooling myself, but I’ve noticed at least a small change in the media’s treatment of Republicans this year. Even hardened veterans who pride themselves on being cynical toward all sides are stunned by what’s happened. Lying for partisan advantage? Yawn. Everyone does it. But lying in service of destroying faith in democracy? Refusing to promote vaccines just to get a few cheers from the cheap seats? Those are whole different things.

So far, this hasn’t produced a sea change in coverage of Republicans. But I think it’s produced the start of something that might eventually become a sea change—especially if Democrats can lighten up and take advantage of it. We’ll see.

20) Humans are social animals– vaccine edition, “With nearly 800,000 U.S. covid deaths, what’s keeping people from getting vaccinated? Their own social circles.”

Here’s what we discovered: Yes, individuals tend to operate within networks that are polarized by vaccination status. Unvaccinated individuals talk to unvaccinated folks, and vaccinated individuals are chatting with vaccinated friends and families. Furthermore, attitudes about coronavirus vaccines produce social pressure within these groups that may influence personal decisions to receive the vaccine. The vaccination status of an individual’s closest confidants is a great predictor of whether they decide to get vaccinated against covid-19.

Quick hits part I

1) Jonathan Rauch, “The Real Hoax: There is ample evidence that Trump colluded with Russia. Here’s how he convinced people otherwise.”

They have convinced millions of people, including many in non-MAGA circles, that Trump and his campaign did not collude with the Russians in the 2016 presidential campaign; that in fact, if anyone colluded, it was Christopher Steele, the Hillary Clinton campaign, and the FBI—against Trump.

This narrative does seem to have some facts in its favor. It is true that people in Clinton’s orbit commissioned the ex-spy Christopher Steele to trawl for gossip about Trump and the Russians, that they and Steele brought his report to the FBI, that the FBI relied partly on the unsubstantiated dossier to obtain a surveillance warrant, and that two sources for the investigation have been indicted for lying to the FBI. You don’t have to be a master propagandist to weave those facts into a claim that a politicized FBI was in cahoots with Trump’s adversaries.

But you would be wrong. An exhaustive investigation by the inspector general of the Justice Department—and that would be President Trump’s Justice Department—reviewed more than a million pages of documents and conducted more than 170 interviews. The finding? The FBI’s investigation was properly predicated; it was not politicized; it predated the Steele dossier. The bureau did rely on the dossier’s unverified allegations and make some misstatements in its bid to surveil one person, which resulted in the felony conviction of an FBI lawyer. But those failings, while troubling, had no bearing on the outcome of the FBI’s investigation or anything else.

Was the dossier dodgy? Yes, but it was widely understood to be unconfirmed gossip, which is why reputable media outlets declined to publish it until Buzzfeed (improperly, in my view) dumped it all out.

Did Clinton associates and Steele alert the FBI? Yes, but that is what concerned citizens are supposed to do if they have reason to think a hostile foreign power is interfering in our election (as, of course, one was). In fact, as really ought to be obvious, Russia’s efforts to penetrate the Trump campaign should have been reported to the FBI not only by Christopher Steele, Clinton associates, and Australian diplomats, but also, and especially, by the Trump campaign.

As for those two recent indictments of FBI sources, both charge wrongdoing against the FBI, not by the FBI. They imply nothing about the FBI’s intent or conduct—or for that matter about Trump’s.

Ironically, the Steele dossier and the ensuing fiasco benefit exactly one person: Donald Trump. Steele’s material was salacious enough to be irresistible to the media and plausible enough to seem newsy, yet also flimsy enough to set up gullible media outlets for the fall they experienced. The dossier proved the perfect vehicle for Trump to redirect attention from his own misdeeds to the media’s.

The brazenness and success of this counternarrative are remarkable, because what is there in front of our nose, in plain view, is an undeniable and undenied stack of evidence that the Trump campaign and Russian intelligence viewed the 2016 presidential race as a collaborative venture. The facts are these (all according to undisputed reports by special counsel Robert Mueller, the bipartisan Senate Intelligence Committee, and many news outlets):

  • The Trump campaign eagerly and knowingly accepted overtures from the Russian government to provide dirt on Hillary Clinton.

  • Trump publicly asked the Russians to illegally steal and dump Clinton documents, and Russian intelligence promptly did exactly that.

  • The campaign and its associates had at least 100 contacts and probably more with assorted Russians, including (according to the Senate Intelligence Committee’s account) ones with ties to organized crime and Russian intelligence.

  • Trump’s campaign manager provided internal campaign materials to a business associate characterized by the Senate report and the U.S. Treasury Department as a Russian intelligence operative.

  • The campaign team, including Trump, was well aware of potential plans by Russia’s Wikileaks partner to dump stolen documents, kept close tabs on it, and tried to schedule and exploit that possibility.

  • Trump and his fixer Michael Cohen lied point-blank about Trump’s ongoing business dealings with the Russians.

  • Meanwhile, at no point did Trump and his people report Russia’s activities to U.S. law enforcement; instead, according to the Senate Intelligence Committee report, the campaign was “elated” by what it regarded as a “gift” from Wikileaks.

That the Trump campaign did all of those things and more is not seriously disputed. 

2) David Rohde:

The problem, of course, is that Democrats have had high hopes that Trump would face a reckoning for his misdeeds before, in the Mueller investigation and in the President’s two sets of impeachment proceedings. Brendan Nyhan, a political scientist at Dartmouth College, praised the work of the January 6th committee, and said that fully uncovering Trump’s role remains vital. But he cautioned that political leaders and journalists should not focus solely on producing a January 6th “smoking gun,” reminiscent of the secret Oval Office recordings that brought down President Richard Nixon. “So much of the media has been obsessed with the idea that a document will emerge that shows everything,” Nyhan said. “I worry that we lose the forest for the trees.”

Nyhan, who is also a co-director of Bright Line Watch, notes that both U.S. politics and the ways in which Americans receive their information have changed radically over the past fifty years, contributing to the current deep polarization. According to opinion polls, seventy-eight per cent of Republicans believe that Biden was not legitimately elected—an increase from seventy per cent in April. Nyhan believes the committee’s findings, like past investigations of Trump, are unlikely to sway his fervent base. Meanwhile, Republican leaders, particularly House Minority Leader Kevin McCarthy, are standing by as Trump purges the G.O.P. of opponents. “He is doing what politicians do,” Nyhan said, of McCarthy. “He is going along with the energy in his party.” Nyhan feels it is equally important for Democrats to immediately enact reforms that will prevent either party in the future from attempting such radically anti-democratic acts as overturning an election—and that they should start building public support for such measures now, rather than wait for a smoking-gun moment to do so. Historically, Nyhan points out, authoritarian regimes have emerged by gradually subverting the independence of rival centers of power—such as the legislature, the courts, and the media—and concentrating power in their own hands. “The story of democratic erosion in other countries is that it happens invisibly, you don’t have this tanks-in-the-streets moment,” Nyhan added. “There are elected governments who operate with impunity, whose opponents don’t have a level playing field to compete upon.”

Observers, however, say it is unlikely that Republicans will support any Democrat-backed election-reform effort. In October, they filibustered the For the People Act, a sweeping Democratic proposal that would have revamped election systems nationwide. Nyhan said that Democrats should consider eliminating or changing the filibuster in order to pass the Freedom to Vote Act, a watered-down election-reform bill endorsed by Senator Joe Manchin, of West Virginia, which currently has some bipartisan support in the Senate. It includes measures that would make it more difficult for state legislators to dismiss election results certified by nonpartisan state officials—a tactic Trump tried to use in 2020. Nyhan also called for reform of the Electoral College Count Act—an obscure and poorly drafted 1887 law that describes how Congress should count the electoral votes—before Democrats potentially lose their control of the Senate and House in next year’s midterm elections. “The Electoral College Count Act is terrifying,” Nyhan said, referring to the statute’s vagueness. “It’s Chekhov’s gun.”

3) Good stuff here: “We’re Getting Close to ‘Universal’ Vaccines. It Hasn’t Been Easy.”

Then, around 2008, multiple research groups found something surprising in human blood samples: antibodies that could defend against two HA subtypes. “They were H1 antibodies that recognized H5 bird flu, and everyone said, ‘Wait, that’s not supposed to happen,’” James Crowe, the director of the Vanderbilt Vaccine Center, recalls. It turned out that those antibodies were bound to the stalk of the HA proteins, as opposed to the head — and the stalk appears to mutate less than the head between HA-NA strains. “That started the whole revolution of the universal flu vaccine,” Crowe says. “We thought the surface of the flu virus was infinitely variable. But actually, there are some places that rarely change drastically.” Multiple groups now have universal vaccines in various stages of clinical trials. Some of them, including one that the National Institutes of Health is testing for safety in people this flu season, produce more stalk antibodies than traditional vaccines.

Even if a vaccine is broadly effective against different flu strains, it’s unclear how long that protection might last. (A shot that lasts just two or three years would have a big public-health benefit.) There is evidence that, in fact, the immune system can generate a lifelong defense against influenza — but there’s a catch. People appear to be “imprinted” somehow with the HA proteins they encounter in childhood, says Aubree Gordon, an associate professor of epidemiology at the University of Michigan School of Public Health. People respond to flu viruses and vaccines differently based on their past exposure. “It’s not only what you’ve recently been exposed to which is important,” she says. “But we think your very first exposures are incredibly important for determining your response for the rest of your life.”

People imprinted with one HA subtype have a response ready for similar viruses. But when they are infected with one that’s less alike, they may still make antibodies partly geared toward the earlier virus, rendering them less beneficial. A 2016 paper in Science found that your birth year, more than your age, determines your risk of severe disease from a given influenza permutation. As an example, the 1918 pandemic was disproportionately lethal for young people, possibly because the HA proteins for the virus were different from those of the flu viruses circulating during their childhoods; the same cohort fared much better during the 1968 pandemic, caused by a virus that may have matched their early exposure. It’s still a mystery how this imprinting works, but figuring that out will very likely be key to getting a universal flu vaccine that works well for most people, according to Fauci. “There are still a lot of unknowns,” he says.

4) Scott Lemieux on opposition to expanding the Supreme Court:

I haven’t written about judicial reform a lot recently, mostly because of the failure in 2020 to win majorities large enough to make it even a remote possibility. But it’s still a good idea, and the Court’s defenders are still writing nonsense in its defense:

Federal judges are not politicians. They do not identify with political parties or the president who appointed them. Judges are human, though, and some may occasionally fall short of strict political impartiality. But in our experience, the overwhelming majority of judges — who may have different life experiences and different points of view — go to extraordinary lengths to be fair adjudicators.


The impartial judge is the Constitution’s ideal, and from our experiences as federal judges we can happily report that it is also the norm, even if critics of individual decisions might think otherwise. Court-packing would seriously damage that norm. 

The idea that judges are impartial and apolitical if they fill slots that come up at random but not if they’re newly created ones makes no sense if you think about it for more than a few seconds. (Both Carter and Reagan “packed” the circuit courts, so how can those judges be impartial?) The whole idea of apolitical appellate judges is just adults pretending the Easter Bunny is real. If it was true, Merrick Garland would be on the Court today, and everyone knows it.

This, however, takes things to 11:

Term limits, by providing each president with two Supreme Court appointments in every four-year presidential term, would risk enmeshing the appointments in the presidential election cycle, further politicizing the appointment process.

It seems possible, even likely, that presidential candidates would announce their Supreme Court choices as part of the campaign, turning potential nominations into political fodder. 

Donald Trump DID THIS! Very prominently and famously! With no term limits! It probably won him the election! Am I losing my goddamned mind here? Anyway, hoping Santa will be coming by tonight with the mortgage payment.

5) I think deBoer downplays super-serious Republican threats to democracy a little much in this post, but his criticism of the left is very good: 

Sometimes I get people asking me why I don’t write more criticism of Republicans and conservatives. I’ve made the basic point many times before: those with influence within the conservative movement are too craven or crazy for meaningful written engagement to be worth anything, and those who are interesting and honest have no influence within the conservative movement. You can engage with Ross Douthat, who’s sharp and fair but who the average conservative would call a RINO, or you can engage with a roster of interchangeable lunatics who lie and dissemble in defense of a cruel revanchist movement. I tend to train my fire on the broad left of center because, as much as I would sometimes like to wash my hands of the whole damn lot of them, they are the half of American politics that could actually reform, that could improve. I see no positive outcome from going through Breitbart posts and pointing out the lies. But Hayes, and other liberal Democrats who grumble and groan about left on liberal criticism, seem to think that if we just keep talking about how awful Josh Hawley and the Proud Boys are, somehow these problems will all sort themselves out.

They won’t. If you’re obsessed with defeating Trumpism, you should realize that you can only do that through securing a broad multicultural coalition, and you can’t do that when you’re alienating Hispanic voters or failing to challenge people in your political orbit when they insist that white children should be taught that they’re inherently and irreversibly racist. 70% of this country is white, Hispanic voters are not remotely as left-leaning as people assumed, immigrants are far from uniformly progressive, women were never actually a liberal stronghold, and you can’t win national elections by appealing only to the kinds of people who say “Black bodies” instead of “Black people.” This is the simple point David Shor has made for over a year, and for his trouble he gets a columnist in the Nation flat-out lying about him. Imagine a political tendency where popularism – literally, the idea that you should do things that appeal to voters – is immensely controversial. Liberalism is not healthy…

Today, American liberalism wants to tell you not that America can be a place of justice and equality where we all work together for the good of all, even as we acknowledge how badly we’ve failed that ideal. In 2021 liberalism wants to tell you that the whole damn American project is toxic and ugly, that every element of the country is an excuse to perpetuate racism, that those groups of people Hayes lists at the bottom are not in any sense in it together but that instead some fall higher on an hierarchy of suffering, with those who are perceived to have it too good in that hierarchy deserving no help from liberalism or government or the Democratic party – and, oh by the way, you can be dirt poor and powerless and still be privileged, so we don’t want you, especially if you’re part of the single largest chunk of the American electorate…

Conservatives run roughshod over the country, and liberals are powerless to stop them, because liberalism has been colonized by a bizarre set of fringe cultural ideas about race and gender which they express in abstruse and alienating vocabulary at every turn. If anyone complains, liberals call them racist or sexist or transphobic, even when those complaining are saying that we can fight racism and sexism and transphobia more effectively by stressing shared humanity and the common good. Republicans tell the American people batshit conspiracy theories about communists teaching Yakub theory in kindergarten; Democrats fight back by making PowerPoint slides about why resegregating public schools is intersectional. We have reactionary insanity that expresses itself in plain, brute language and an opposition that insists that most voters don’t actually have any real problems, using a vocabulary that should never have escaped the conference rooms of whatever nonprofit hell it crawled out of. I cannot imagine a more obvious mismatch, the gleeful conspiracist bloodletting of the right against the sneering disdain and incomprehensible jargon of the left. I wonder who’ll win politically, an army of racist car dealership owners who have already taken over vast swaths of America’s state and local governments, keening for blood and soil? Or the guy in your anthropology seminar who insisted they were the voice of social justice while simultaneously making every conversation all about them?

6) Two great Omicron threads…

7) The reality for many of is that we actually know few if any people seriously affected by Covid.  Drum:

I tweeted back that the level of COVID deaths wasn’t actually that high, and naturally I’ve been dragged all over Twitter as a result. Maybe I deserved it. But I still think there’s something not quite right about this.

The CDC’s preliminary mortality report for 2020 is here. When you separate out the numbers for working-age adults, here’s what you get: COVID has increased the crude death rate from 0.43% of the population to 0.47%. If this happened in the absence of COVID it would barely even be noticeable.

As before, I want to emphasize that I’m not saying that the deaths of the elderly don’t matter. Or that COVID-19 is no big deal. Or that long COVID isn’t scary. Or that we couldn’t have done better.

All I’m saying is that the lived experience of most people simply doesn’t match the constant rhetoric of “staggeringly” high levels of death. Does this matter? I think it does, though I admit I’m not quite sure how. But it’s something to think about if you’re trying to figure out why so many people have come to accept the COVID death rate as normal and tolerable.

8) The Atlantic article everybody was talking about this week, “Where I Live, No One Cares About COVID: Outside the world inhabited by the professional classes in a handful of major metropolitan areas, many Americans are leading their lives as if COVID is over.” Of course, our level of death and suffering as a nation is way higher than it needs to be because people like this refuse to take it seriously.  I saw a fair number of complaints about the Atlantic running this, but, I found it quite valuable to have a coherent explanation of a perspective so totally different from my own, even though I think it is quite wrong.

9) And speaking of other perspectives, this is good from Drum:

Let’s talk about the demise of democracy and how Republicans are trying to save it.

Wait. Republicans? I meant Democrats, right?

That’s certainly how I see it. It’s also how nearly all of you see it. But it’s not the way everyone sees it. Republicans, in particular, have been convinced for a very long time that Democrats routinely steal elections. I wrote about this ten years ago in “The Dog That Voted and Other Election Fraud Yarns,” and the following ten years have done nothing except cement this belief even further into the Republican psyche.

Do Republicans really believe this? Among party leaders, I don’t know. Some always have. Some have convinced themselves just from saying it so often. And some probably don’t but play along cynically.

Likewise, among the rank and file, some are believers and some aren’t. But as time has passed, and both Fox News and party leaders have unceasingly hammered on this, more and more conservative voters have turned into believers. Trust in elections went down to a dismal 60% in 2008 and stayed there throughout the Obama years even as Republicans won landslide victories in congressional elections. It rebounded a bit during the Trump presidency, but by 2020 trust had already fallen back to about 60%. After the election it fell off a cliff:

The story behind the chart is a simple one: What do you do if Democrats routinely show disdain for fair voting? What if you’ve tried and tried to get them to clean up their corrupt ward bosses, fake voters, and laughable urban vote counts, but none of it has worked? Answer: You fight back harder. Because American democracy is on its last legs and someone has to do it.

So the stage was all set for Republicans to go ballistic after the 2020 election. They’d known Democrats were cheating for a long time, but never had it been this brazen. Never had Democrats managed to steal the presidency. It was time for war.

If the only way to ensure a fair vote was to restrict early voting and mail voting and other easy targets for cheating, so be it. If Democrats refused to get rid of crooked precinct counters, then Republicans would have to dive into local politics and do it themselves. And if even that wasn’t enough, they’d have to reserve the right to let Republican legislatures intervene to make sure that votes were counted accurately.

Naturally, Democrats would fuss and fume and insist that it was Republicans who were playing dirty. But nobody outside their lackeys in the press actually believed that. It was all just pretense. The truth was simpler: Democrats had been all but open about their corruption for years, and in 2020 they finally went too far. Democracy—and America itself—was at stake now. If they wanted war, it was war they’d get.

10) The case for standardized tests (personified through Political Science professor, Mike Munger):

But Duke University economist Michael Munger challenges the notion that the test has nothing to say about a person. 

“The SAT saved me twice,” Michael told me. “First, it brought me to Davidson [College in North Carolina]. Then it made my [college] advisor hold me to a higher standard, saying ‘You can clearly do this.’” 

Michael Munger grew up in rural Florida.

My father worked at a lumberyard, and my mother stayed at home. We lived on an orange farm, so much of my work when I was at home was [on it].

The economist describes his child self as “lazy.” “I attached no value to intellectual things.” He had Cs and Ds in most classes. But a standardized test—a ninth grade state test that all Florida students were required to take—identified him immediately as an outlier. “We took this test, and the principal of the school came in and said, ‘Which one of you is Munger?’ I had the highest grade in the school. And then they said, ‘Why are you in this class?’” 

Michael was immediately transferred to an upper-level class where he promptly did better and received higher grades. “I started doing the homework,” he said. He took the PSAT (the Preliminary SAT) and was awarded a National Merit Scholarship, which put him on the map to recruitment to selective colleges. With an excellent SAT score, Michael was awarded a scholarship to the highly selective Davidson College, where he—the son of orange farmers—would study the great classics and eventually be put on a tenure track as a Duke University professor. 

This is arrogant of me to say…but I, with no preparation, went to Davidson [and] had a mean, terrible person who was my advisor, who said, ‘Looking at your test scores,’ meaning my SAT, ‘you’re just lazy! So you have to take calculus-based physics and calculus.’ And I did, and I ended up majoring in math, because it’s true—I was able to do it. Because I was a math major at Davidson, I was able to get a PhD in economics.

To him, the SAT wasn’t a destructive experience; it was his biggest opportunity yet. The SAT, a nationwide test administered the same way for every student who takes it, forced colleges to seriously consider a boy from a high school that selective colleges never touch. It showed the world that Michael Munger was capable of competing with other students at the highest level. 

11) I did just about average for NYT readers on this famous faces of 2021 Quiz.  My best performance was getting two people that only 19% of readers did and my worst was missing someone 75% got (otherwise, I got everybody down to the 59% level.  I was definitely not so great on pop culture people.

12) Please, please, please more sensible advice from the CDC like this, “Children exposed to covid can safely stay in class with in-school testing, CDC says”

Students who have been exposed to the coronavirus can safely continue in-person learning if they are regularly tested for the virus at school, avoiding disruptive at-home quarantines, the Centers for Disease Control and Prevention said Friday.

The CDC released two studies that show the effectiveness of what’s known as “test-to-stay.” School districts across the country have tried this strategy, though it is not widely used.

“These studies demonstrate that test-to-stay works to keep unvaccinated children in school safely,” CDC Director Rochelle Walensky told reporters Friday. She called it “a promising and now proven practice.”

Typically, students who are deemed close contacts of someone who tests positive for the virus are sent home to quarantine, to make sure that people who may be carrying the virus, even without symptoms, do not infect others. The CDC studied test-to-stay alternative programs in Lake County, Ill., and Los Angeles County.

13) Jesse Wegman, “Surprise! There’s No Voter Fraud. Again.”

For those who spend their days operating within the constraints of empirical reality, the long-running voter-fraud scam peddled by right-wing con artists poses a dilemma: Respond to their claims and give them the veneer of legitimacy they crave. Ignore them, and risk letting transparent lies spread unchecked.

I used to err on the side of responding as often as possible, in the belief that persistent fact-checking and debunking was the best way to inoculate the American public against a virulent campaign of deception. But it became clear to me, probably later than it should have, that this was always a fool’s game. The professional vote-fraud crusaders are not in the fact business. While they pretend to care about real election crimes, their purpose is not to identify whether voters are actually committing such crimes; it is to concoct a world in which the votes of certain people (and it always seems to be the same people) are presumptively invalid. That’s why they are not chastened by data demonstrating — again and again and again and again — that there is essentially no voter fraud anywhere in this country.

Thanks to their efforts, about three quarters of Republicans believe the 2020 election was stolen, and they won’t be convinced by evidence to the contrary.

That evidence continues to grow. Earlier this week The Associated Press released an impressively thorough report examining every potential case of voter fraud in six decisive battleground states — Arizona, Georgia, Michigan, Nevada, Pennsylvania and Wisconsin — where Donald Trump and his allies challenged the result in 2020. Voters in these six states cast a combined 25.5 million votes for president last year, and chose Joe Biden over Mr. Trump by 311,257 votes. The total number of possible cases of fraud the A.P. found? Fewer than 475, or 0.15 percent of Mr. Biden’s margin of victory in those states.

14) Great post from Scott Alexander, “The Phrase “No Evidence” Is A Red Flag For Bad Science Communication”

Every single one of these statements that had “no evidence” is currently considered true or at least pretty plausible.

In an extremely nitpicky sense, these headlines are accurate. Officials were simply describing the then-current state of knowledge. In medicine, anecdotes or hunches aren’t considered “real” evidence. So if there hasn’t been a study showing something, then there’s “no evidence”. In early 2020, there hadn’t yet been a study proving that COVID could be airborne, so there was “no evidence” for it.

On the other hand, here is a recent headline: No Evidence That 45,000 People Died Of Vaccine-Related Complications. Here’s another: No Evidence Vaccines Cause Miscarriage. I don’t think the scientists and journalists involved in these stories meant to shrug and say that no study has ever been done so we can’t be sure either way. I think they meant to express strong confidence these things are false.

You can see the problem. Science communicators are using the same term – “no evidence” – to mean:

  1. This thing is super plausible, and honestly very likely true, but we haven’t checked yet, so we can’t be sure.

  2. We have hard-and-fast evidence that this is false, stop repeating this easily debunked lie.

This is utterly corrosive to anybody trusting science journalism.

Imagine you are John Q. Public. You read “no evidence of human-to-human transmission of coronavirus”, and then a month later it turns out such transmission is common. You read “no evidence linking COVID to indoor dining”, and a month later your governor has to shut down indoor dining because of all the COVID it causes. You read “no hard evidence new COVID strain is more transmissible”, and a month later everything is in panic mode because it was more transmissible after all. And then you read “no evidence that 45,000 people died of vaccine-related complications”. Doesn’t sound very reassuring, does it?


Unfortunately, I don’t think this is just a matter of scientists and journalists using the wrong words sometimes. I think they are fundamentally confused about this.

In traditional science, you start with a “null hypothesis” along the lines of “this thing doesn’t happen and nothing about it is interesting”. Then you do your study, and if it gets surprising results, you might end up “rejecting the null hypothesis” and concluding that the interesting thing is true; otherwise, you have “no evidence” for anything except the null.

This is a perfectly fine statistical hack, but it doesn’t work in real life. In real life, there is no such thing as a state of “no evidence” and it’s impossible to even give the phrase a consistent meaning. EG:

Is there “no evidence” that using a parachute helps prevent injuries when jumping out of planes? This was the conclusion of a cute paper in the BMJ, which pointed out that as far as they could tell, nobody had ever done a study proving parachutes helped. Their point was that “evidence” isn’t the same thing as “peer-reviewed journal articles”. So maybe we should stop demanding journal articles, and accept informal evidence as valid?

Is there “no evidence” for alien abductions? There are hundreds of people who say they’ve been abducted by aliens! By legal standards, hundreds of eyewitnesses is great evidence! If a hundred people say that Bob stabbed them, Bob is a serial stabber – or, even if you thought all hundred witnesses were lying, you certainly wouldn’t say the prosecution had “no evidence”! When we say “no evidence” here, we mean “no really strong evidence from scientists, worthy of a peer-reviewed journal article”. But this is the opposite problem as with the parachutes – here we should stop accepting informal evidence, and demand more scientific rigor…

Is there “no evidence” that King Henry VIII had a spleen? Certainly nobody has published a peer-reviewed article weighing in on the matter. And probably nobody ever dissected him, or gave him an abdominal exam, or collected any informal evidence. Empirically, this issue is just a complete blank, an empty void in our map of the world. Here we should ignore the absence of journal articles and the absence of informal evidence, and just assume it’s true because obviously it’s true.

I challenge anyone to come up with a definition of “no evidence” that wouldn’t be misleading in at least one of the above examples. If you can’t do it, I think that’s because the folk concept of “no evidence” doesn’t match how real truth-seeking works. Real truth-seeking is Bayesian. You start with a prior for how unlikely something is. Then you update the prior as you gather evidence. If you gather a lot of strong evidence, maybe you update the prior to somewhere very far away from where you started, like that some really implausible thing is nevertheless true. Or that some dogma you held unquestioningly is in fact false. If you gather only a little evidence, you mostly stay where you started.

I’m not saying this process is easy or even that I’m very good at it. I’m just saying that once you understand the process, it no longer makes sense to say “no evidence” as a synonym for “false”.

And, then, of course, the very next day I read so many headlines like this, “‘No evidence’ Omicron less severe than Delta, say UK researchers.” So, which “no evidence” is it?  

15) This from Ed Yong hits really close to home, “I Canceled My Birthday Party Because of Omicron.”  I’m turning 50 in early February and was really looking forward to having a party to celebrate.  Things are sure not looking good for early February right now, though.  Maybe I’ll aim for a party this spring.  It’s okay to have a late 50th party– right?

16) I’ve recently enjoyed subscribing to Katelyn Jetelina’s Covid-based substack.  I thought this was a really good post, “The holidays with my family”

Final Thoughts

This isn’t a “no risk” plan. But there is no “no risk” plan. There is risk in everything we do, especially with Omicron uncertainly on the horizon. Importantly everyone has a different risk tolerance—the amount of risk you’re comfortable with may be very different from the risk I’m comfortable with. Also, the value certain activities bring to your quality of life is very different from what they would bring to mine. No one can weigh those benefits and risks but you.

For what it’s worth, my goal this holiday season is to protect my girls and the ones I love while balancing the immense joy I have being with family and at the beach for the holidays. This may mean that I get a breakthrough case but it may not. We can live with COVID19, we just have to do it smartly.

17) Schools need to be open, “Schools Are Closing Classrooms on Fridays. Parents Are Furious.: Desperate to keep teachers, some districts have turned to remote teaching for one day a week — and sometimes more. Families have been left to find child care.”

18) For much of my life, Christmas shopping meant braving the local mall for hours on the weekend (or two weekends before if I were on top of the ball) before Christmas.  Now, of course, it’s all Amazon.  Yes, there’s still malls, but damn has our culture around them changed so much. 

My generation came of age when movies both celebrated and mocked the mall’s cultural primacy: It was the theater of adolescent angst and makeovers and—especially—irony. Malls were sort of for losers, a little bit, but you went anyway. They were a stable signifier of vaguely embarrassing American excess, a place where you could purchase what you were missing—a bit of edge, maybe, or glamor. A better complexion or shape. These missions usually failed, of course. (I frequently settled for being condescended to by the exquisitely be-shadowed clerks working MAC makeup counters.) But as the mall’s hegemony plummeted, its shiny hysterical promises started to seem shabby and worryingly fallible. A mall stripped of its spell—its meandering people on doomed but pleasing quests—becomes not just ugly but uncanny; its homogenized expanses of beige and brown play host not to luxury and perfume counters but to increasingly desperate chains. The teens are mostly gone now. And though in California you can easily find actual ghost towns, with their savage and rusted record of mining detritus and lives lived and lost in the pursuit of gold, even more haunting are these abandoned cavernous halls with foam columns where no one lived or pursued much of anything at all.


19) Good stuff (as always) from David Epstein, “Even Tiger and Mozart Weren’t Tiger and Mozart”

Last week I wrote about how my own interaction with Serena Williams — as well as King Richard, the new film about her father — added nuance to the straightforward tennis-prodigy story I had absorbed.

And while the research is unequivocal that delaying hyperspecialization is the typical path for elite athletes, there is still a tremendous amount of individual variability. There’s no one-size-fits-all answer, which shouldn’t be a huge surprise with something as complex and multifaceted as human development.

In other words, even though they are the exception — not the norm — there are true “Tiger stories” of success, as I’ve come to call the tales of singular focus from a very early age. The literal Tiger story, after all, is the opening of my book, Range. But even that story, I think, deserves a tad bit of nuance.

In 2000, a Golf Digest writer ended an interview with Tiger with this question:

To parents who want to raise the next Tiger Woods, what would you say?

Tiger’s response:

Don’t force your kids into sports. I never was. To this day, my dad has never asked me to go play golf. I ask him. It’s the child’s desire to play that matters, not the parent’s desire to have the child play. Fun. Keep it fun.

Earl Woods didn’t lord over every hour of Tiger’s practice. In fact, when Tiger was four, he would drop him off at a course, and pick him up later in the day — sometimes with the money he’d won from those foolish enough to doubt.

When Earl first gave Tiger a club he was no longer using, it was as a toy, not in an attempt to force him into becoming a golfer.

There is no doubt that Tiger had a very unusual, and very 10,000-hoursy childhood — he was on national television swinging a club at age two, after all. (Once when we chatted about this, Malcolm Gladwell called it a “human cat video,” which I still find hilarious.) Still, according to Tiger, he also played baseball and ran cross-country and track. But it’s Tiger’s response to that Golf Digest question that I want to focus on, because it brings up an important point — one that is also missed in the one story of prodigy that may be as world-famous as Tiger’s own.

Tiger Before Tiger

In a letter to Mozart’s sister in 1792 — the year after Mozart died at age 35 — family friend and musician Andre Schachtner recounted an experience with the young Wolfgang Mozart.

Schachtner and another musician visited the Mozart home to play with Wolfgang’s father, Leopold. Schachtner was supposed to play the second violin part in a trio, but little Wolfgang spoke up and said he wanted to play that part. Schachtner recalled:

But Papa refused him this foolish request, because he had not yet had the least instruction in the violin, and Papa thought that he could not possibly play anything.

Leopold was not yet pushing his son. In fact, he had focused his musical instruction on Wolfgang’s talented older sister, Maria Anna. So Leopold scoffed at the little boy who wanted to join without having been trained. How did little Wolfgang respond? Schachtner:

Wolfgang said: You don’t need to have studied in order to play second violin.

Cheeky! Nonetheless, Leopold refused his son. And then:

…Wolfgang began to weep bitterly and stamped off with his little violin.

To make the boy feel better, Schachtner asked Leopold if he could play with the boy a little.

Papa eventually said: Play with Herr Schachtner, but so softly that we can’t hear you, or you will have to go; and so it was.

And so they began to play together. Schachtner again:

I soon noticed with astonishment that I was quite superfluous, I quietly put down my violin, and looked at your Papa…

Little Wolfgang proceeded to play all six pieces that the adults were set to practice. And then — and I love this line:

When we had finished, Wolfgang was so emboldened by our applause to maintain that he could play the first violin too.

So they let him try — again assuming he couldn’t possibly.

For a joke we made the experiment, and we almost died for laughter when he played this [part] too, though with nothing but wrong and irregular positioning, in such a way that he never actually broke down.

Without formal lessons, young Mozart had made up his technique, but was still able to play the part. His father was astonished.

So here’s the important point I was getting at: In both cases — Tiger and Mozart — the child demonstrated extremely unusual interest and prowess at a very young age in a highly structured activity; only after that did the father facilitate huge amounts of focused practice.

20) Pretty fascinating tale of our times, “A White teacher taught White students about White privilege. It cost him his job.: Amid a growing furor over critical race theory, Matthew Hawn told his high school students in rural Kingsport, Tenn., that White privilege is ‘a fact’”

21) Adam Gopnik with far and away my favorite essay on the Beatles documentary.

Yet the Beatles moved us now, and then, as a metaphor for family. No: as a family, a willed one—and seeing the intensity of their family relations, even when under stress, is what remains moving. Ringo, though chronologically the oldest, is the perfect youngest sibling. The last to join the band, he is everybody’s favorite: the peacemaker, playing piano with Paul, “writing” a song with George. George is a classic neglected middle child, with the bossy older siblings absent-mindedly nodding at him and never taking him entirely seriously; when asked, they’re quick to say that he’s talented and important, but they’re too self-involved to say it when it counts. The sequence in the film that ends with George quietly quitting the band, his eyes clouding over with hurt after he tries to make genuinely sweet and helpful comments while John and Paul ignore him and sing strictly at each other—in a song that is obviously about each other, “Two of Us”—is a study in the damaged feelings of an open heart.

John is the clear oldest, dominating, though unaware even while being so, and Paul a classic second, just as he calls himself (“I’ve been sort of secondary boss”), domineering as well but accustomed to maneuvering rather than forcing his way forward. Far from being actually bossy, he tries to act bossy—and then apologizes for acting bossy. Paul is excellent, too, at an older sibling’s evil skill: feigning distraction in place of what is in fact disinterest. There is a touching bit where George, with younger-brother enthusiasm, generously praises and plays an old Paul song, “Every Little Thing,” and Paul benignly accepts it as no more than his due—with George then adding, sincerely, that he hopes this album can be like the previous one (“the only album, so far, I tried to get involved in”), only to get a minimal response from Paul. (Paul then immediately does an old John song from that previous album, “I’m So Tired.”)…

Throughout the new documentary, Paul’s compulsive musicianship is everywhere evident, taking over even the arrangement of John’s best song, “Don’t Let Me Down.” “It should be different beat and all onto light things and cymbals,” Paul instructs Ringo, and, of the bridge, coolly reminds John: “That’s a weak bit of the song, that.” Yet how gentle the Beatles are with one another, in the pained, semi-articulate way of families! Nobody says a harsh or impatient word. John and Paul, secretly recorded talking about George after he’s quit, do not call him a prima donna but only regret that “it’s a festering wound that we’ve allowed. . . . And we didn’t give him any bandages.” Paul’s talent as a musician does dominate the sessions—but he dominates mostly by cajoling and including rather than by insisting. The now legendary sequence in which Paul, playing full chords on his bass guitar—a difficult thing to do—composes “Get Back” in less than four minutes is still perhaps a bit misunderstood. Paul does it, but he does it for the group. He starts with a keening minor-key wail, interesting in itself, then finds the familiar chord pattern of the song. But Ringo and George are the necessary audience. “It’s good. It’s . . . you know. Musically and that, it’s great,” a till-then bored-seeming George mutters—and, on his Telecaster, instantly answers with a sharp, Steve Cropper-style upstroke riff, one that might well have found a home in the finished song. Ringo starts clapping out the rhythm. Then John walks in, late, and, without saying a single word, immediately finds—as a rhythm guitarist should—the right A dominant-seventh chord on his Epiphone electric and casually starts filling out his part. It’s a movie moment, of the kind that used to happen in forties musicals, when the big band on the sleeper car suddenly finds the song. But here, it just happens. That’s a band.

An Omicron/policy mismatch?

The next couple of months here are going to be interesting.  We are absolutely going to have a huge Omicron wave.  It is clearly ridiculously infectious.  Tons and tons of people with two shots are going going to bet symptomatic cases as will many who have had prior cases of Covid.  Virtually all of these people who are under 65 will, though, avoid severe cases (and the substantial majority over 65).  And, yes, there will even be breakthrough cases of the boosted, but at much lower rates.  Get boosted!

We still don’t know and very much need to know how Omicron, relative to previous strains, impacts an immunologically naïve (i.e., no prior infection or vaccination) population.  It may be just as severe, but there are some encouraging– though very preliminary– signs that we may actually catch a break and that among these many spike protein mutations one result is less severity.  

We can fairly confidently say, though, that the overall severe disease burden relative to caseloads will be much lower than for previous waves since so many infections will be in the vaccinated and/or prior infected.  That said, a small fraction of a huge number is still a big number and we may well see unprecedented numbers of cases from Omicron.  The absolute key remains preventing our hospitals and health care systems from being overwhelmed.

All that said, I’m also really concerned that what may make the next couple months pretty ugly is just how bad many of our Covid policies our based on 2020 Covid (less contagious, nobody vaccinated) in a substantially vaccinated, Omicron world.  I saw yesterday on twitter that Princeton, NJ schools had extended their quarantine for kids exposed– not positive mind you, just exposed– to 14 days!  That is both anti-family and anti-science.  That’s an extreme burden on families with hourly/daily wage incomes and 14 days is extreme overkill.  And totally ignores the efficacy of test-to-stay policies.  Also, this:

Short version: We need public health policies that address the reality that very many of the positive cases are going to be among the vaccinated.  Also, Omicron is so damn infectious that there’s no way we can substantially curtail the spread for non-pharmaceutical interventions.  It’s going to be everywhere and it’s going to be everywhere soon.  We need policies based on Omicron’s realities. Great thread from Ashish Jha, here’s his conclusion which I fully endorse:




Do we need Omicron-specific vaccines?

I’d say so.  So does Yglesias.  But, as he points out, don’t listen to him, listen to Michael Mina. Yglesias:

Omicron has weakened our vaccines

Hannah Kuchler, Donato Paolo Mancini, and Oliver Barnes at the Financial Times did a write-up of data from the UK Health Security Agency that I think really clarifies the vaccine situation.

I’m going to steal their chart because it’s good. The key points are that vaccination works against both Delta and Omicron, but it works significantly less well against Omicron. Boosters work against both variants, but again less well against Omicron. A boosted person has similar protection against Omicron as a non-boosted person has against Delta.

So I’m boosted, you should boost, we all should boost. At the same time, this is telling us we should expect a lot of symptomatic infections even among boosted people.

Pfizer, optimistically, is telling us that its vaccine still offers a 70% reduction in the risk of severe (i.e., you end up in the hospital) Covid-19. And unless something really weird is happening, that should also mean at least a 70% reduction in the risk of death. But while 70% is pretty good, South African health journalist Mia Malan notes it is far less than the 93% protection provided against Delta. Most people naturally tend toward absolutism, so they’ll hear about a large reduction in relative risk and figure “okay, I’m safe.” Then they’ll hear anecdotes about severe breakthroughs and ask, “is it all a lie and nothing works?”

We live in a big country (and a bigger world), so even though a 70% reduction in severe disease is significant, we’re still going to see a lot of vaccinated people end up in the hospital — including some relatively young people with no clear comorbidities.

Variant-specific vaccines

Everybody wants to reassure people that the existing vaccines are still useful against Omicron and that everyone who can take them, should take them. That said, they are clearly less effective than they were against Delta. And they were less effective against Delta than they were against the original strain.

With the flu, we have an established process for creating variant-specific shots for each new flu season and approving them very rapidly. We could set up a process like that for variant-specific boosters, but so far we have not. And that, in turn, has made it unclear to pharmaceutical companies whether developing variant-specific boosters is likely to be lucrative. There’s a good case to be made that we should not be so heavily reliant on the profit motive when it comes to pharmaceutical development. But the fact is that we are dependent. Right now, Pfizer and Moderna are selling every dose of mRNA they can make, so it’s not obvious that there is a super-strong business case for developing new vaccines. If we want to see that happen, we need to put money into it and we need regulatory clarity.

I’m just going to quote an email that Harvard’s Michael Mina sent to Holden Karnofsky, because it’s very smart and also because maybe people will trust a Harvard epidemiologist rather than a “contrarian” on Substack.


We should do the least necessary checks of the new variant vaccines. Put them into 20 people and make sure they elicit the desired immune responses. Do NOT do any sort of efficacy study and these vaccines should be fast tracked like flu shots.

Unfortunately FDA has essentially no ability to balance the cost of slowness and the cost of inaction with the benefit of action. The FDA viewpoint is that inaction and whatever cost comes from that is not on them. They are used to a system where it’s better to do nothing than act with any uncertainty. But that’s Bc the FDA is not designed for emergencies. It just isn’t. It is horribly inefficient and unable to effectively make calculations around public health vs medicine.

To this day we still do not have a regulatory framework for products that have as a base use one of public health. Vaccines elicit ideas of public health but ultimately are evaluated and regulated as medicine. As far as safety this is important. But as far as efficacy and the regulatory approaches and data required, it’s entirely around individual benefit. Which at this point I hope everyone recognizes that’s the wrong angle in a pandemic.

For example, we knew that a single dose vaccine would yield 90% or more protection from severe disease for at least a few months, yet we withheld first doses in order to give people second doses and importantly we have those second doses in a suboptimal manner just Bc that’s the hard data we had. But the soft data (the data from decades of immunology research across the world) allowed us to know that spacing the vaccines months apart would have been better both for individuals and for public health. We didn’t do that.

At this point, we can’t get optimized vaccines off the ground in time to head off an Omicron wave. But we will still be vaccinating (and boosting) people next summer, by which time Omicron will still be kicking around everywhere, so it still helps. More to the point, we’re in a world where different variants are going to be popping up for a while, so we need to be ready to optimize.

There is so much uncertainty about what to expect with Omicron.  Two things are pretty clear, though. 1) There’s going to be an Omicron wave. 2) A 3rd dose is far and away the best thing we can do against this coming wave.  The difference in preventing a symptomatic Omicron infection between two doses (especially waning doses) and a third dose is simply massive and we are crazy not to make this change our public policy.

As for the actual title of this post, though, any vaccine changes are going to be much too late for the coming wave.  But there’s a good enough chance that Omicron is not going to be outcompeted for a good while and it’s kind of nuts that at this point we’re still basing our vaccines off the original Wuhan strain when we know we could get so much of a better immune response with a vaccine much more appropriately targeted to the dominant strain.  

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