Liberty 'Gator

I’ve written a bit about variolation, a sort of poor-man’s version of a vaccine. The idea is you intentionally (or accidentally, I suppose) get a small dose of an infectious disease that hopefully won’t make you too sick but will make you sick enough to develop immunity.

Here’s an intriguing idea: Maybe wearing a mask can act as a sort of variolation device, to reduce one’s exposure to the virus and hence reduce the severity of symptoms. This could help explain declining COVID-19-related deaths. See an article by Web MD (which quotes Amesh Adalja) a study by NEJM.

Denver economist Andrew Friedson thinks the George Floyd protests did not on net cause an increase in COVID-19 cases because they scared other people indoors. What this doesn’t answer, of course, is whether the protests themselves led to any new cases of COVID-19, or how many.

In a phase 1 trial with 45 people, the Moderna vaccine induced an immune response in all participants.

Nell Watson has an absolutely terrifying take on COVID-19. The upshot is that many people who get it are likely to have severe long-term health problems.

So this is an interesting finding: “Black Lives Matter protests increased net stay-at-home behavior, likely among non-protesters, and COVID-19 case growth did not increase.” Of course, we are seeing case growth around much of the U.S., so it would interesting to know how much COVID-19 did spread through the protests, even if there was a stronger offsetting effect. Based on headlines I’m seeing it seems like bars and parties are a big part of the current rise.

Eric Feigl-Ding summarizes, “Children and teenagers are only half as likely to get infected with the coronavirus as adults age 20 and older, and they usually don’t develop clinical symptoms of COVID-19. This lends support to kids returning to school in the fall.” See the related Washington Post story.

An incident in in the U.S. Army suggests that a 14-day quarantine may not be sufficient to prevent subsequent infection.

I think it’s a stretch to say Anthony Fauci “lied” about masks, but he certainly didn’t go out of his way to clarify the matter early on, either.

“Dexamethasone proves first life-saving drug.” Maybe. But, even if this result holds up, it only does so much. “It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth,” the BBC reports.

Julia Marcus recommends creating small social bubbles of a few friends or a couple of households, who limit their other social interactions.

Atul Gawande summarizes that two Missouri hair stylists saw 140 clients while infected with the coronavirus, but, likely because they wore masks, didn’t infect anyone else.

Infectious disease expert Amesh Adalja writes, “There are some values that are worth pursuing, even in the face of risk to oneself and to others whom one may infect. Public health officials who made that case during the protests perhaps should have communicated the message earlier — and they should be more consistent in its application.” Adalja points to the double-standards of many in evaluating the anti-lockdown protests and the Black Lives Matter protests. He argues, “Physicians and policymakers must respect that different people will be willing to risk exposure for different things; such pluralism is at the heart of a liberal society.”

Widespread use of masks, by itself, could reduce the effective reproduction rate below 1.

Tomas “Hammer and Dance” Pueyo is back. He asks, “Should we aim for herd immunity like Sweden?” I’m convinced we shouldn’t. Even Sweden seems convinced now. Granted, I was more open to the idea initially, when I thought Sweden was much further along the path to herd immunity than was the case. But that doesn’t imply that Pueyo’s own lockdown-then-manage (hammer and dance) strategy is optimal either.

Pueyo points out that most countries that “crushed the virus” in fact imposed lockdowns. To his credit, he lists five that did not: Cuba, Japan, Taiwan, Iceland, and South Korea. He writes, “All [are] islands (South Korea is de facto an island since its only ground border is with North Korea and it’s sealed) and all five had advanced methods to deal with the virus. Taiwan and South Korea took all the right preventative measures, as did Cuba. Japan had massive mask wearing and a strong healthcare network with contact tracing experience. Iceland went straight into dancing, testing a massive share of the population (around 17%) and isolating all the positive cases.” He discusses Hong Kong elsewhere, which, notably, is not an island.

Here’s something odd about his Chart 7, though, which shows “countries that beat the coronavirus.” The only thing that matters to Pueyo here is whether a country’s infection line goes up quickly and then comes down quickly; he doesn’t care what the magnitude of the peak is. Hence, he includes countries with almost no COVID deaths, such as New Zealand, with countries with incredibly high COVID deaths, such as Italy, Spain, and Belgium. Indeed, Belgium has the absolutely highest rate of deaths per million. I’m pretty skeptical of any approach that treats New Zealand and Belgium equally as success stories.

This bit is interesting: “For countries that applied very heavy Hammers, their case growth stops around two weeks after the Hammer.” But not so fast. Pueyo’s Chart 8 shows that, in New York and Spain, social mobility declined steadily headed into the lockdown and and pretty much bottomed out around the time the lockdowns went into effect. So there are two ways to interpret this. 1. “The lockdowns themselves didn’t cause the reduction in cases; the lockdowns and the increased social distancing both were caused by public fear of the disease.” 2. “The lockdowns did something important on top of measured social distancing to slow the disease.” (See my May 22 updates for a discussion of some of the causal complexities involved.)

Granted, it’s easier to stop a disease on an island. Given that, the interesting question is, is it possible for other countries to stop a disease without lockdowns? Some people claim that just universal mask wearing can bring the effective reproduction rate under 1. I’m convinced that, if the U.S. had had an effective hygiene-test-trace-isolate strategy from the outset, along with moderate social distancing, lockdowns and intense social distancing could have been avoided. In Pueyo’s terms, you don’t need a hammer to dance.

Pueyo comes close to granting this. He writes, “The Hammer and the Dance was meant for countries that were overwhelmed with cases and didn’t know how to handle the situation, to limit the outbreak while figuring out what to do. But now we know what to do. We can keep the economy open and reduce the caseload, the way South Korea, Taiwan, Vietnam or Hong Kong have been able to. Many measures can be taken to stop the coronavirus, including testing, contact tracing, isolations, quarantines, universal masks, hygiene, physical distancing, public education, sewage testing, travel restrictions and crowds restrictions. All countries should apply these measures, since they’re mostly proven, much cheaper, and can dramatically reduce the epidemic. . . . Whether it’s admitting it or not, the US is pursuing a Herd Immunity strategy. At this point, it’s not realistic to apply new lockdowns everywhere. Thankfully, they’re not needed: States can apply all the measures mentioned above. They’re affordable and doable. Dozens of countries are doing it, many US states are doing it too.”

Eric Feigle-Ding warns, “Cases are rising in nearly half the states. They all had lockdowns lifted. Most have rising percent positivity too. (I.e., it’s not just more testing). Unless governors are insane, lockdowns coming again—not if, but when.” He refers to an AP article. I sincerely hope he’s wrong. I hope that it’s not too late to ramp up mask wearing, testing, contact tracing, and effective isolation of the infected.

Notably, Colorado (largely) reopened and also had extensive protests, and our case, death, and hospitalization numbers look not too bad (although not awesome by Pacific Rim standards).

Much of the conversation in the U.S. has been about the effectiveness of lockdowns, as opposed to doing nothing, to stop COVID-19. I was pleased to see Jennifer Nuzzo remark,”Though I think Sweden’s high case fatality is worrisome, I don’t think the lesson is that total lockdowns are the way to go. Other countries successfully avoided major lockdowns through targeted public health measures—testing, tracing and isolation.”

Max Roser of Our World in Data writes, “There was no difference in the speed of the outbreak between Italy and the U.S. The difference—which is leading to the rapidly rising death toll in the US—is that European countries achieved a much faster decline of the outbreak.” He shows a chart showing a much steeper decline in daily cases per million in Italy versus the United States.