Must Read: Tyler Cowen on VA vaccinations

This is Joseph

Tyler Cowen is (correctly) upset about the rate of vaccination in Virgina:

Total vaccine doses distributed: 388,100

Total vaccine doses administered: 75,288

 This is very slow. Now maybe it will pick up in the New Year. But this is not a reassuring pace of vaccination. At this point I am starting to wonder about Erik Loomis' proposal just to send the vaccines into the medical system and let it sort them out. I still think it is wrong move, but the 2019/2020 flu season had about the same percentage of adults vaccinated at 2018/2019 (52%) and that included children. 

Now, it is 100% true that sending vaccines through the medical system will increase medical inequality, no doubts about it. But we are behind schedule on vaccine production and even more behind on giving these vaccines -- yes, we are seeing this poor rate of utilization under unexpectedly tight supply constraints not as a consequence of a surplus. At some point, I think the increase in epidemic intensity to enforce a complex queuing system might to more harm to vulnerable populations. I loathe using a price mechanism for a vaccine, but I also am in utter shock at the failure to build up public health resources to implement the vaccines. The decision to consider private options happened when investment in resources to vaccinate was neglected. 

I think the next few weeks are critical to see if state governments can step up to the challenge. Israel vaccinated 10% of it's population in 2 weeks using the Pfizer vaccine (the one with tough cold chain) and while it has advantages, they are not different than those of New York City, Chicago, and Los Angeles -- none of whom look anything like that. California is at 1.04% of the population today and Virginia is at 1.05%. Imagine if they gave out 80% of the vaccines instead of 20%? 

Comparing countries is just depressing; the overall rate for the US is currently 1.30%. Canada is 0.27% (not a typo), Portugal 0.26%, Poland 0.10% and France 0%. Even the UK, which authorized the Astra-Zeneca vaccine to speed up vaccinations, is at 1.47%. If B.1.1.7 is as bad as expected, we might regret not being more prepared, given we are running out of capacity in morgues already. 

Happy New Year from Windsor McCay and Little Nemo

Make it a good one.

Watch the body language

This is Joseph

In very early 2019 I remember telling my friends "I am not very worried about this new virus in China, but the one that that concerns me is that the Chinese authorities are acting like they are terrified-- that is really the only thing that worries me". These words came back to haunt me.

Recently we heard about a new mutant strain of covid-19 in the UK. I was initially not super worried, as any new strain that shows up will look like it will have a transmission advantage. Whether it is causal or not is very hard to be sure of.

Then I read the latest draft of "in the pipeline":

We do not know. We don’t know for this vaccine, nor for the Pfizer/BioNTech one, nor for Moderna’s. No studies have been designed to find that out, so all we can do is guess based on what we’ve seen with the interval between doses in the two-dose studies. That’s been encouraging with the two mRNA vaccines, but remember: we don’t know how they are over a longer period, because no one was left without a second dose for that long. It’s certainly possible that without the second booster that the protection seen after one shot starts to wane. We do not know. And we know even less about the Oxford/AZ vaccine’s behavior under these conditions. Giving as many people in the UK as possible a single dose of that vaccine with a longer wait until the booster is a gamble, and you wouldn’t want to do it that way if the alternatives weren’t even worse. It’s the right move, unfortunately, and it’s a damned shame it’s come to this.

The bolding is mine. 

Now it is possible that the UK government is trying to get ahead of cases and end the pandemic quickly. This is still the most likely answer, I think. But maybe they know stuff about the new strain that they are trying new strategies because they are really worried and not because they thought out the science. 

This is likely a situation to keep an eye on, Thankfully it is likely that vaccines will still work on it, but it suggests that getting good with vaccine delivery is important. Early news has shown challenges with TPM reporting that perhaps only 2.1 million of the 14 million doses delivered have been given. But hopefully these vaccine distribution challenges are teething pains and not enduring issues as we gear up to finally end the pandemic. 

Follow-up on one dose vaccine strategies

This is Joseph

As a general follow-up, I have never seen a fun discussion overtaken so quickly by events.  

In Ontario, Rick Hillier has actually requested Health Canada to approve single dose Moderna.

We’ll have the answer from population level data to a high enough precision for public health decisions, as we can limit the bias to low enough for public health decisions by comparing Canadian provinces. Meanwhile, the UK said “why not both”. They approved the Oxford vaccine and allowed a 3 month gap for the Pfizer vaccine, which is basically pushing on both pathways at once (increasing supply via the fast to make vaccine and stretching out the high-efficacy Pfizer one). 

So I suspect we’ll know the answer from observational administrative data in about the same time frame as we would from a clinical trial. It is high time we get to do some fun observational work

P.S. There is a robust discussion over on Andrew Gelman's blog. 

Pólya would have been proud

In addition to the overwhelming cuteness, there's an important pedagogical principle here straight out of How to Solve It.

The little girl is convinced that her sequence of numbers is correct and will not be persuaded otherwise, but when her mother presents her with a related problem, the girl reaches the correct conclusion more or less on her own.

One dose of mRNA vaccines

This is Joseph

I am starting to see the hot take of "why don't we experiment with giving only one dose of an mRNA vaccine". For example, see this. 

So let us count the reasons that this isn't a great idea.

1. The vaccines were tested from phase 1 to phase 3 to find an optimal formulation. People looked at the single dose antibody titers, as compared to two doses, and it was a lot worse. This casts doubt on the durability of the immunity.
2. Vaccine manufacturers look at these subgroups. the main Moderna trial had 30,351 participants and an efficacy of 94.5% (95% CI 86.5-97.8%). In the one dose subgroup there were 996 participants in the vaccinated group, and 1,079 in the placebo group with 7 cases vaccinated group and 39 cases placebo (80.2%; 95% CI 55.2-92.5%). So we know even short term efficacy is less.
3. The Oxford vaccine had more participants in the low-dose/high-dose subgroup, with 3 cases in the vaccinated arm and 30 in the placebo arm (efficacy 90·0%, 95% CI: 67·4 to 97·0)
4. In US dollars and sold in the US, the Oxford vaccine is $4 per shot versus $15/$19.50 for the mRNA vaccines. So it is a lot cheaper.
5. The Oxford vaccine looks able to make 3 billion doses in 2021, whereas the two mRNA vaccines (combined) look to be able to produce 2 billion doses. So there is more expansion in capacity by adding Oxford than splitting the Moderna or Pfizer doses up. 
6. This ignores Sputnik V and Sinovac, which are approved in some countries already/ These vaccines claim > 90% efficacy *(Sputnik V and Sinovac). These are both based on low case counts (bad) but no worse than the one dose sub-group for Moderna. 
7. Oxford can "be stored and transported at normal refrigerated temps of 2 degrees to 8 degrees Celsius (36 degrees to 46 degrees Fahrenheit) for at least six months" whereas Pfizer must be kept at -70 degrees Celsius until six hours before use. That is a huge logistical advantage. Moderna's vaccine is better for logistics, but it is also the vaccine with the lowest production levels. 
8. Even if the Oxford subgroup is due to the Texas Sharpshooter fallacy, the efficacy of the pooled vaccine estimate is about 70% (either you use the sib-groups or you don't). This is likely not significantly different than one dose Moderna and will likely be more durable

So if we want to argue for an ethical imperative to move quickly, the easy way forward is to approve the Oxford vaccine. There is almost no case where the one dose of mRNA vaccine approach is going to be better than just adding in the next tier of vaccines -- which have trials. Now it is possible that the FDA might decide that they are inferior and should not be given an emergency use authorization. But the one dose approach would require trials (timed to measure durability) and would take years to complete (versus actionable data now -- seriously, the Oxford vaccine has a Lancet publication so the data can be scrutinized). 

In a similar vein, the best thing we could do with Modern is . . . make more of it. Solves the one versus two dose problem if there is enough for everyone. If we really wanted to make a difference -- why not pay Moderna to drop the patent and make it universally free? 

Or push out the Oxford vaccine faster? Hilda Bastian has some concerns with the Oxford vaccine, but at least we have the data to make an informed risk-benefit tradeoff with it (and more data is coming soon when the US trial concludes). 

The handling of the Western mega-fires is another reminder we live in a solution-phobic society

We've had some nice showers recently. We're supposed to get more tomorrow (Monday) with winter storm warnings promising snow in the mountains. It is, of course, welcome. The West always needs water and we've had a fairly dry fall which in recent years has meant fire season threatened to stretch into the winter.

But while the rains are bringing a respite from the mega-fire, they are also a tragically wasted opportunity. Despite a virtually absolute scientific consensus as to the steps we desperately need to be taking, almost nothing is being done and very few people seem to care.

Writing for the LA Times, Bettina Boxall has an excellent account of the depressing details.

When COVID-19 blew a hole in California’s spending plans last spring, one of the things state budget-cutters took an axe to was wildfire prevention.

A $100-million pilot project to outfit older homes with fire-resistant materials was dropped. Another $165 million earmarked for community protection and wildland fuel-reduction fell to less than $10 million.

A few months later, the August siege of dry lightning turned 2020 into a record-shattering wildfire year. The state’s emergency firefighting costs are expected to hit $1.3 billion, pushing the California Department of Forestry and Fire Protection’s total spending this fiscal year to more than $3 billion.

The numbers highlight the enormous chasm between what state and federal agencies spend on firefighting and what they spend on reducing California’s wildfire hazard — a persistent gap that critics say ensures a self-perpetuating cycle of destruction.

 ...

Fire scientists have long called for a dramatic increase in the use of prescribed fire — that is, controlled burns that trained crews deliberately set in forests and grasslands during mild weather conditions.

They have urged federal agencies to thin more overgrown stands of young trees in the mid-elevation Sierra Nevada and let nature do some housekeeping with well-behaved lightning fires in the backcountry.

They point to the dire need to retrofit older homes to guard against the blizzard of embers that set neighborhoods ablaze in the most destructive, wind-driven fires.

Yet year after year, state and federal funding for such work remains a pittance compared to the billions of dollars spent on firefighting. 

...

[Jessica Morse, deputy secretary of the California Natural Resources Agency, which oversees Cal Fire] cited an August agreement between the state and the U.S. Forest Service in which they each committed to annually treating 500,000 acres [a fraction of what researchers say we need to be doing. -- MP] of California forest and rangelands by 2025 with a variety of fuel-reduction practices, including prescribed fire, thinning overgrown woodlands, timber harvest and grazing.

Yet this memorandum of understanding is non-binding and includes neither money nor staffing.

Maybe we should state all days as Eve powers

 

Little Nemo Meets Lieutenant Kijé

 A few years ago, I was playing around with the very cool open-source video editor, Kdenlive. It's powerful yet remarkably intuitive and, you know, free.

The images are from Winsor McCay. The music is by Sergei Prokofiev, though you may know it better from the many artists like Greg Lake and Sting who have borrowed it over the years.

Merry Christmas from Little Nemo

 

Twas the night before Christmas...

 

It's the thought that counts

If you've gone through the holidays without hearing "Sugar Rum Cherry"...

 ... you have not had a cool Christmas.

Fifty-two years ago

I was working on a highly critical post on the space colony movement when I happened to channel surf across this Nova episode commemorating the anniversary of Apollo 8. As often happens with that show, I quickly found myself engrossed and watched the whole thing.

Given all the bullshit we've seen in recent years around manned space travel, it's important to remember just how fantastic the story of Apollo was.

Here's the preview:

 

And if you have time:

Even the hitchhiker with the axe is nervous around the hitchhiker with the chainsaw

The crazy Trumpists are turning on the even-crazier Trumpists https://t.co/Nlr8dZLDSl

— Jonathan Chait (@jonathanchait) December 19, 2020

 Complete with Michael Flynn.

At the White House on Friday, President Trump held what may have been his most deranged meeting yet. In it, the president raged at his loyalists for betraying him, and discussed taking extralegal measures to overturn the election.

The meeting, first reported by the New York Times, included lawyer and conspiracy theorist Sidney Powell, convicted felon Michael Flynn, and Rudy Giuliani. One plan floated at the meeting was for Trump to appoint Powell as a “special counsel” overseeing allegations of voter fraud. Powell’s voter fraud claims are so fantastical she has been mocked even by other far-right legal conspiracy theorists. Andrew McCarthy, a former birther and author of one book titled How Obama Embraces Islam’s Sharia Agenda and another calling for his impeachment on multiple counts, has described Powell’s vote-fraud claims as “loopy.”

 ...

 But the election was not close enough for him to pursue either strategy, whatever chance he had for some kind of Bush v. Gore replay has passed. The measures he is now contemplating lie outside the normal framework for resolving election disputes, and would require, at minimum, almost uniform levels of GOP support.

Trump does not have that. Indeed the striking thing is that he is veering to positions so extreme and self-defeating that even his loyalists have blanched. Perhaps the most alarming fact about the Friday meeting is that Giuliani, who has spent months spreading fantastical claims of imagined voter fraud, became a quasi-voice of reason. Giuliani has proposed using the Department of Homeland Security to seize and examine voting machines — a move the Department has resisted — but even Giuliani opposes appointing a nutter like Powell.

We've gotten a lot of use out of this ad over the years.