Perhaps the most powerful man in the world is a narcissistic con artist propped up by a cult of personality (and don't get me started on Donald Trump)

At least if you buy the money is power theory.

New York (CNN Business) Elon Musk edged past Amazon founder Jeff Bezos to grab the title of world's richest person, according to Bloomberg.

A 6% rise in Tesla (TSLA) shares early Thursday lifted the value of its CEO's stock holdings and options by $10 billion, taking his net worth to about $191 billion. A more modest rise of less than 2% lifted Bezos' Amazon (AMZN) shares by about $3 billion, putting his net worth at $187 billion.

Bloomberg's real-time billionaire tracker still has Bezos about $3 billion ahead of Musk. But the tracker doesn't update until the end of the trading day. Bloomberg posted an article confirming Musk's title.

Bill Gates is now a distant third at $132 billion, according to Bloomberg.

 

 

In case the printing is too small on the P/E ratio... 

 

 

We are still the nation that rolled out three liberty ships every two days

Extraordinary story out of Northern California. 

For me, the most depressing aspect of the pandemic, particularly over the past few weeks, has been the lack of urgency and focus. It is bad enough in normal times living in a solution-phobic society where navel gazing and hot takes now pass for public discourse, but in a time of crisis, it's the stuff of madness. 

While thousands are dying each day and a frightening new variant is emerging, we have at least five vaccines ranging from pretty good to exceptional (two from the US, one from Great Britain, one from Russia and one from China). We should be moving as fast as possible, up to a occasionally beyond the bounds of safety to get shots in as many arms as possible and probably go ahead and pull the trigger on AstraZeneca as well.

Ukiah is a poor rural town of about 16,000. They have few resources and lots of challenges, but they responded to a crisis like it was a crisis which these days is sadly the exception rather than the rule.

Anita Chabria writing for the LA Times.

At 11:35 on Monday morning, senior staff at Adventist Health Ukiah Valley Medical Center in Mendocino County were holding their first 2021 executive meeting when the hospital pharmacist interrupted: The compressor on a freezer storing 830 doses of the Moderna COVID-19 vaccine had stopped working hours earlier, and the alarm meant to guard against such failure had failed.

The doses were quickly thawing.

“It was not how my day was planned,” said Adventist spokeswoman Cici Winiger, who was in the executive meeting. “At that point it was all hands on deck, drop everything.”

The Moderna vaccine is shipped and stored at frozen temperatures, and stays stable up to 8 degrees Celsius in a regular refrigerator for up to 30 days. But once it reaches room temperature, as it did in the Adventist freezer, it must be used within 12 hours. By the time the freezer problem was discovered, the vials had been creeping toward warm for some time.

Medical staff estimated they had two hours to use them before they would no longer be viable.

With the minutes ticking down, the medical team made the decision that the goal would be to inject every dose, regardless of state guidelines. The medical team believed that “the more people we vaccinate just brings us closer to herd immunity,” Winiger said.

Winiger got on the phone, trying to give the shots first to those on the priority lists. One local elder care facility took 40 doses for staff, and the hospital’s chief medical officer drove them to the facility himself.

About 200 doses belong to the county and were being stored by the hospital. Winiger said those doses were returned to the county. The county in turn gave 100 doses to the city of Ukiah, county Chief Executive Carmel J. Angelo said.

...

An additional 100 doses hit the fire department about 12:15 p.m., Fire Chief Doug Hutchison said. At first, garbled information he received through phone calls left him fearing all 800 doses were coming his way, leaving him thinking, “There is no way,” he said. His full-time staff of 16 had already been promised to help with other clinics.

Hutchison headed to a city conference center, and his remaining crew “began giving shots as fast as we could sit people down and roll up their sleeve,” he said. Their syringes went into the arms of police, essential city staff and firefighters — including Hutchison, who had declined earlier offerings of the vaccine to make sure his staff got it first.

“I was trying to make sure all my people got shots before I did,” he said.

...

In Mendocino County, Bednar, the sheriff’s lieutenant, was one of those who received the initial dose Monday, though he isn’t yet sure how he feels about it.

“It’s one of those things where I was a little hesitant at first because it’s a new vaccine,” he said. “But I have family that is older, and it’s better that I get it than possibly risk their safety.”

Even as the shots were being delivered to the jail, a big-rig accident on one of the main highways cut the hospital off from its sister facility about 20 minutes away, Winiger said, making it impossible to reach. Ukiah, a town of about 20,000 surrounded by state and national forest, has a population spread through its rural and often difficult-to-navigate territory, creating a daunting challenge to quickly deliver the doses to remote areas.

The Adventist staff turned instead to the local community, with about 600 shots remaining.

First, they sent a text asking every available medical professional to turn out at one of four sites to give the vaccines and monitor those who took them.

“We had nurses, pharmacists, physicians, even those that are not part of the hospital, coming to help,” said Judson Howe, president for Adventist Health in Mendocino County. “It was all hands on deck and a true community effort.”

Then hospital staff blasted out a text to employees letting people know that anyone who showed up could have the shot. “We just wanted to make sure none of this goes to waste,” Winiger said.

By noon, within 15 minutes after learning of the freezer failure, shots were being administered at all four sites. Lines began to form as word spread and some staff was siphoned off for crowd control. At the site Winiger ran, about 30 people were turned away after the doses ran out. At the main site near the hospital, she estimates about 120 people left without the shot.

But by the two-hour deadline, every dose had found a patient, Winiger said.

How we saw it then -- III

 

Tuesday, February 28, 2017

GOP Game Theory -- things are still different

"It's probably better to have him inside the tent pissing out, than outside the tent pissing in."

    LBJ on FBI Director J. Edgar Hoover,

[UPDATE: The conversation continues with The nuclear moose option and The Republicans' 3 x 3 existential threat.]


Let's start with a prediction:

Senate Minority Leader Charles Schumer (D-N.Y.) predicted on Tuesday that Republicans will split with President Trump within months unless the administration changes course.0

"My prediction is he keeps up on this path...within three, four months you're going to see a whole lot of Republicans breaking with him," Schumer said during an interview with ABC's "The View."

Schumer argued while most GOP lawmakers aren't yet willing to break publicly from the White House, they are privately having "real problems" with Trump's policies in his first month.

"A lot of the Republicans, they're mainstream people. ... They will feel they have no choice but to break with him," he said.

GOP leadership are largely dismissing any early signs of discord between Congress and the White House as they slowly try to make progress on an ambitious agenda.

Ed Kilgore, however, points out that Trump may not be as toxic as many people think:

So while it is hard to deny that Trump is amazingly unpopular for a new president, unless his approval ratings trend farther down the way even those of popular presidents typically do, his party may not suffer the kind of humiliation Democrats experienced in 2010. For all the shock Trump has consistently inspired with his behavior as president, there’s not much objective reason for Republican politicians to panic and begin abandoning him based on his current public standing. But in this as in so many other respects, we are talking about an unprecedented chief executive, so the collapse some in the media and the Democratic Party perceive as already underway could yet arrive.

The relationship between the Trump/Bannon White House and the GOP legislature is perhaps uniquely suited for a textbook game theory analysis. In pretty much all previous cases,  relationships between presidents and Congress have been complicated by numerous factors other than naked self-interest--ideological, partisan, personal, cultural--but this time it's different. With a few isolated exceptions, there is no deeply held common ground between the White House and Capitol Hill. The current arrangement is strictly based on people getting things they care about in exchange for things they don't.

However, while the relationship is simple in those terms, it is dauntingly complex in terms of the pros and cons of staying versus going. If the Republicans stand with Trump, he will probably sign any piece of legislation that comes across his desk (with this White House, "probably" is always a necessary qualifier). This comes at the cost of losing their ability to distance themselves from and increasingly unpopular and scandal-ridden administration.

Some of that distance might be clawed back by public criticism of the president and by high-profile hearings, but those steps bring even greater risks. Trump has no interest in the GOP's legislative agenda, no loyalty to the party, and no particular affection for its leaders. Worse still, as Josh Marshall has frequently noted, Trump has the bully's instinctive tendency to go after the vulnerable. There is a limit to the damage he can inflict on the Democrats, but he is in a position to literally destroy the Republican Party.

We often hear this framed in terms of Trump supporters making trouble in the primaries, but that's pre-2016 thinking. This goes far deeper. In addition to a seemingly total lack of interpersonal, temperamental, and rhetorical constraints, Trump is highly popular with a large segment of the base. In the event of an intra-party war, some of this support would undoubtedly peel away, but a substantial portion would stay.

Keep in mind, all of this takes place in the context of a troubling demographic tide for the Republicans. Their strategic response to this has been to maximize turnout within the party while suppressing the vote on the other side. It has been a shrewd strategy but it leaves little margin for error.  Trump has the ability to drive a wedge between a significant chunk of the base and the GOP for at least the next few cycles, possibly enough to threaten the viability of the party.

The closest analogy that comes to mind is the Democrats and Vietnam, but that was a rift in a big-tent loosely organized party. The 21st Century GOP is a small tent party that depends on discipline and entrenchment strategies. It's not clear that it would survive a civil war.

Given that, I suspect the next year or two will prove Schumer wrong. There is some evidence that the president's polling has stabilized, perhaps even rebounded a bit, but even if the numbers go back into free fall, Republicans in the House and the Senate will be extremely reluctant to break from Trump with anything more than isolated or cosmetic challenges.

This isn't just a question of not wanting Trump outside the tent pissing in; this is a question of not wanting Trump outside the tent tossing grenades. 

How we saw it then -- II

 

Wednesday, March 23, 2016

The Wages of Strauss* -- Part II (Josh edition)

[*Joseph (who knows more than a normal person should on these matters) took mild exception to the previous post in this thread, specifically the way I used Straussianism as a crude shorthand for an argument that goes back to Athens. He's right but I don't have the time to do it right. (What do you expect from a blog?)]

A few days ago, I argued that the conservative movement was based on "the assumption that governing must be done by the intellectually superior elite," so they had put in place "strategies and tactics designed to allow small groups to gain and hold power in a democracy" which left them "vulnerable to hostile takeover" such as the one launched by Donald Trump.

If I would have known about this piece by Josh Barro, I definitely would have included the following quotes:

It's not normal for a political party to rent frontrunner status to cranks and charlatans for weeks at a time. Disastrous candidates are supposed to be blocked by validating institutions. Policy experts explain that their proposals do not add up. The media covers embarrassing incidents from their past and present. Party leaders warn that they will be embarrassing or incompetent or unelectable.

The problem is that Republicans have purposefully torn down the validating institutions. They have convinced voters that the media cannot be trusted; they have gotten them used to ignoring inconvenient facts about policy; and they have abolished standards of discourse by allowing all complaints about offensiveness to be lumped into a box called "political correctness" and ignored.

Republicans waged war on these institutions for a reason. Facts about policy can be inconvenient — a reality-based approach would find, for example, that tax cuts increase the deficit and carbon emissions cause climate change. Acknowledging the validity of complaints about racism could require some awkward conversations with racist and quasi-racist voters in the Republican coalition.

Of course, we're now seeing the unintended consequence of the destruction of those institutions and the boundaries they impose around candidate acceptability: In doing so, Republicans created a hole that Donald Trump could fly his 757 through.

Josh Marshall is also making similar points:

If you look around over the last week there are a number of highly sophisticated Republican voices arguing that Donald Trump is the sort of demagogue and potential strongman our political system was designed to prevent from gaining power in our country. ,,, they would be far more credible if so many Republicans - not necessarily the same writers, but countless formal and informal spokespersons including numerous high-ranking elected officials - hadn't spent the last seven years ranting that the temperamentally cautious and cerebral Barack Obama was a 'dictator' who was trampling the constitution.
...

 Trumpism is the product of many things. But a key one of them, perhaps the key enabling one, is years of originating and pandering to increasingly apocalyptic and hyperbolic conspiracy theories, fantasies and fever dreams which put middle aged white men up against the metaphorical wall with a thug, foreign, black nationalist, anti-colonialist Barack Obama shaking them down for their money, their liberty, their women and even their lawn furniture.

How we saw it then -- I

 

Thursday, March 10, 2016

The wages of Strauss are Trump

[Yet another topic that I will have to rush through to get something on the blog -- literally dictated to my phone -- then hopefully come back later and fill in the details.]

If you start from the assumption that governing must be done by the intellectually superior elite and that handing over power to the masses will lead to disaster, you are basically faced with two choices:

You could openly tear down the democratic institutions of the country and replace them with something authoritarian;

Or, you can subvert the democratic processes so that a small, powerful group can hold power even when it entails regularly going against the will of the majority.





How can you accomplish the latter?

-You can make voting less representational, either by suppressing the vote of those who disagree with you or by seeing that it counts less through measures such as gerrymandering.

-You can make sure to control certain strategic points such as K St. or state governments during redistricting.

-You can take advantage of what might be considered inefficiencies in the issue market, finding voters who put so much value on one issue that they consistently undervalue the rest and are willing to trade them away.

-You can create a favorable media environment. For supporters you construct an immersive world of tailored news and opinion. With the mainstream media you undermine, manipulate, and intimidate.



Obviously this is just an outline. Each of these bullet points could be the jumping off point for long discussions, but I am working under the assumption that everyone reading this pretty much knows what would be said.

The point of this post is that, almost by definition, strategies and tactics designed to allow small groups to gain and hold power in a democracy are vulnerable to hostile takeover.

The fact that we just saw such a takeover isn't that remarkable; the fact it caught so many people by surprise is.

David Wallace-Wells has been pushing anti-vaxx talking points for years. When it comes to Covid-19 vaccines, he can keep his damned mouth shut.

I can't think of any 21st century journalist who has more successfully built a career on enemy-of-my-enemy dynamics than has David Wallace-Wells. When he follows the actual research, he is an unexceptional writer, saying nothing you couldn't get from a staff writer at any major publication. When, however, Wallace-Wells veers into hot takes and questionable science (which happens with alarming frequency), he is given a free pass because he is supposedly standing up to climate change deniers and covid skeptics.

There is, of course, no question about the reality and seriousness of man-made climate change and covid-19. The science is unequivocal, leaving no doubt that these are among the most important problems we now face, perhaps the most important, but this very seriousness makes bad reporting even more dangerous. We can no longer afford to tolerated journalists who get these stories wrong no matter whose side they're on.

 

Tuesday, July 18, 2017

David Wallace-Wells, autism and bad science

David Wallace-Wells has been catching a lot of flack (most of it richly deserved) for his recent New York Magazine article on climate change. It is a hugely troubling sign when the very scientists you were claiming to represent push back against your article.

This controversy illustrates a larger problem with science reporting at the magazine. We already have a post in the queue discussing the neutral-to-credulous coverage of topics ranging from homeopathy to magic crystals to Gwyneth Paltrow's goop empire. The Wallace-Wells piece takes things to another level and goes in a very different but arguably worse direction. Rather than giving bad science a pass, he takes good science and presents it so ineptly has to do it a disservice.

I am not going to delve into that science myself. The topic has been well covered by numerous expert and knowledgeable writers [see here and here]. The best I could offer would be a recap. There are some journalistic points I may hit later and I do want to highlight a minor detail in the article that has slipped past most critics, but which is perfectly representative of the dangerous way Wallace-Wells combines sensationalism with a weak grasp of science.

Other stuff in the hotter air is even scarier, with small increases in pollution capable of shortening life spans by ten years. The warmer the planet gets, the more ozone forms, and by mid-century, Americans will likely suffer a 70 percent increase in unhealthy ozone smog, the National Center for Atmospheric Research has projected. By 2090, as many as 2 billion people globally will be breathing air above the WHO “safe” level; one paper last month showed that, among other effects, a pregnant mother’s exposure to ozone raises the child’s risk of autism (as much as tenfold, combined with other environmental factors). Which does make you think again about the autism epidemic in West Hollywood.

No, David, no it doesn't.

I want to be painstakingly careful at this point. These are complex and extraordinarily important issues and it is essential that we do not lose sight of certain basic facts: by any reasonable standard, man-made climate change is one of the two or three most important issues facing our country; the effect of various pollutants on children's mental and physical development should be a major concern for all of us; high ozone levels are a really bad thing.

But the suggestion that ozone levels are causing an autism epidemic in West Hollywood is both dangerous and scientifically illiterate. You'll notice that I did not say that suggesting ozone levels cause autism is irresponsible. Though the study in question is outside of my field, the hypothesis seems reasonable and I do not see any red flags associated with the research. If Wallace-Wells had stopped before adding that last sentence, he would've been on solid ground, but he didn't.

Autism is frightening, mysterious, tragic. This has caused people, particularly parents facing one of the worst moments imaginable, to clean desperately to any explanation that might make sense of their situation. As a result, autism has become a focal point for bad science, culminating with the rise of the anti-vaccination movement. There is no field where groundless speculation and fear-mongering are less welcome.

So, if ozone and other pollutants may contribute to autism, what's so bad about the West Hollywood claim? For that, you need to do some rudimentary causal reasoning, starting with a quick look at ozone pollution in Southern California.

Here are some pertinent facts from a 2015 LA Times article:

EPA Administrator Gina McCarthy selected a limit of 70 parts per billion, which is more stringent than the 75 parts-per-billion standard adopted in 2008 but short of the 60-ppb endorsed by environmentalists and health advocacy groups including the American Lung Assn. The agency’s science advisors had recommended a limit lower than 70 -- and as low as 60.

...


About one-third of California residents live in communities with pollution that exceeds federal standards, according to estimates by the state Air Resources Board.


Air quality is worst in inland valleys, where pollution from vehicles and factories cook in sunlight to form ozone, which is blown and trapped against the mountains.


The South Coast air basin, which includes Los Angeles, Orange, Riverside and San Bernardino counties, violated the current 75-ppb ozone standard on 92 days in 2014. The highest ozone levels in the nation are in San Bernardino County, which reported a 2012-2014 average of 102 parts per billion.

Now let's look at some ozone levels around the region. West Hollywood, it should be noted, is not great.

But just over the Hollywood Hills, the situation is even worse.

Go further inland to San Dimas and the level is even higher…

Higher still in Riverside ...

Though still far short of what we find in San Bernardino.

If you look at autism rates by school district and compare them to ozone levels, it is difficult to see much of a relationship. Does this mean that ozone does not contribute to autism? Absolutely not. What it shows is that, as with many developmental and learning disabilities, the wealthy are overdiagnosed while the poor are underdiagnosed. It is no coincidence that a place like Santa Monica/Maibu (a notorious anti-vaxxer hotspot) has more than double the diagnosis rate of San Bernardino.

The there's this from the very LA Times article by Alan Zarembo that Wallace-Wells cites [emphasis added]:

 Irva Hertz-Picciotto, an epidemiologist at UC Davis, suspects that environmental triggers such as exposure to chemicals during pregnancy play a role. In a 2009 study, she started with a tantalizing lead — several autism clusters, mostly in Southern California, that her team had identified from disability and birth records.

But the hot spots could not be linked to chemical plants, waste dumps or any other obvious environmental hazards. Instead, the cases were concentrated in places where parents were highly educated and had easy access to treatment.

Peter Bearman, a sociologist at Columbia University, has demonstrated how such social forces are driving autism rates.

Analyzing state data, he identified a 386-square-mile area centered in West Hollywood that consistently produced three times as many autism cases as would be expected from birth rates.

Affluence helped set the area apart. But delving deeper, Bearman detected a more surprising pattern that existed across the state: Rich or poor, children living near somebody with autism were more likely to have the diagnosis themselves.
Living within 250 meters boosted the chances by 42%, compared to living between 500 and 1,000 meters away.

The reason, his analysis suggested, was simple: People talk.
They talk about how to recognize autism, which doctors to see, how to navigate the bureaucracies to secure services. They talk more if they live next door or visit the same parks, or if their children go to the same preschool.

The influence of neighbors alone accounts for 16% of the growth of autism cases in the state developmental system between 2000 and 2005, Bearman estimated.

In other words, autism is not contagious, but the diagnosis is.

 

WW84 appears to have lost hundreds of millions of dollars. Just imagine the damage if it hadn't "exceed[ed] box office projections"

A few notes on the opening of Wonder Woman 1984:

1. Some PR firms are definitely earning their money on this. 

 

 

 

 

 

 

 

 

 

 

 

2.  For all the happy talk, it is important to remember that this isn't just whistling past the graveyard; it's whistling from inside the coffin as it's being lowered into the ground. The movie had a North American box office take of less than $17 million its opening weekend despite Christmas falling on a Friday and having the theaters largely to itself. By comparison, the first film had a take of over $100 million for its opening weekend. 

 Streaming alleviated things slightly with WW84 basically acting as a loss leader for HBOMax but because of the size and business model of the service (a topic for another post), the impact was probably trivial. 

Note: if you read about a bump in viewership, make sure to check out the fine print. An increase in subscribers who stay past the free trial would be notable. An increase in short termers or "activated subscribers"? Not so much.

According to AT&T, HBO Max had 12.6 million activated subscribers as of early December 2020. As of September 30, the service had a nominal total of 28.7 million paying subscribers, including HBO pay television customers whose subscriptions make them eligible for free access to HBO Max, but who have not yet activated.

3. When you take into account the budget (considerably more than the first film), marketing, PR and all the other assorted expenses then factor in the complexities on industry accounting, Warners is probably on track to lose around $200 million on a film that was expected to bring in hundreds of million

Under these circumstances and given the mediocre reviews (particularly compared to the first film), the official company line about greenlighting WW3 is plainly bullshit. The company is desperate to put the best possible spin on these numbers, but if there had been any doubt about going ahead with the franchise this reception would not have tipped things in its favor.

Completing the trilogy was a no-brainer. Wonder Woman is one of the DCEU's strongest properties (commercially, critically and with the fans),  Gal Gadot looks to have the makings of a major star, and in an industry rightly criticized for a lack of diversity, this is one of the very few major franchises with a female lead and a female director. The timing of the announcement is just another attempt at downplaying the disaster.

4. Though John Stankey has done lots of stupid things since the merger, this is one of the rare catastrophes that can't be laid at the feet of the executives. The pandemic left them with no good choices and if people are still avoiding theaters a year from now, the effects on the industry will be devastating.

 It's not just the billions in lost box office revenue. There's a whole ecosystem here. Big theatrical releases create IP value and make stars. Every other aspect of the industry feeds off that process. When Netflix offers Gal Gadot $20 million to appear in a picture, it is paying for the boost Wonder Woman gave her career.

For all the hype about streaming, as far as I can tell, none of the services have actually made a star nor produced a franchise with any significant second life. Nothing is on the horizon to take the place of the direct and indirect revenue and IP value creation of theatrical releases. If they go away they will leave yet another huge post-covid hole in the economy. 

For those just joining us...

 

Here was our view of the political landscape back in 2019.There are a few tweaks I might make (and I did fix some typos), but it's still a pretty good framework for how we're approaching the news.

MONDAY, OCTOBER 7, 2019

Out with the Wages of Strauss, in with the Great Unwinding

We have reached a point in the show which always makes the fans a little nervous. we have decided that one of our oldest and biggest storylines is starting to come to a natural conclusion so we need to begin wrapping up the loose ends and introducing the next one.

For years now, when it came to politics, the big recurring story was what you might call the wages of Strauss. we pushed the we pushed the idea that either the main cause or the essential context of almost every major political development over the past couple of decades came from the conservative movement's relatively public conclusion that their agenda, while it might hold its own for a while and perhaps even surge ahead now and then, was destined to lose the battle of public opinion in the long run.

This left them with two choices, either modify their ideas so that they could win over the majority of the public, or undermine the democratic process through a Straussian model, an approach based on controlling most of the money and increasing the influence that could be bought with that money, changing government so that an ever smaller part of the population had an ever-larger role in governing the country and creating a sophisticated three-tiered information management system where trusted sources of information were underfunded and undermined, the mainstream press was kept in line through a combination of message discipline and incentives with special emphasis placed on working the refs, and the creation of a special media bubble for the base which used spin, propaganda, and outright disinformation to keep the canon fodder angry, frightened, and loyal.

For a long time this approach worked remarkably well, but you could argue that the signs of instability were there from the beginning, particularly the difficulty of controlling the creation and flow of disinformation, the vulnerability to what you might call hostile take over, and the way the system lent itself to cults of personality.

We've had a good run with this storyline for a long time now, but it seems to be coming to a resolution and it has definitely lost a great deal of its novelty. (Lots of people are making these points now.)

The next big story, one which we believe will dominate American politics for at least the next decade or so will be how the Republican party deals with the unwinding of the Trump cult of personality. Dismantling such a cult is tremendously difficult under the best of circumstances where the leader can be eased out gently, but you have with Donald Trump someone who has no loyalty to the party whatsoever and who is temperamentally not only capable but inclined to tear the house down should he feel betrayed.

If Trump continues to grow more erratic and public disapproval and support for his removal continues to grow, then association will be increasingly damaging to Republicans in office. However, for those same politicians, at least those who come up for election in the next two to four years, it is not at all clear that any could survive if the Trump loyalists turned on them.

But this goes beyond individual candidates. Trump's hold on the core of the base is so strong and so personal that, if he were to tell them directly that the GOP had betrayed both him and them, they would almost certainly side with him. They might form a third party, or simply boycott if you elections, or, yes, even consider voting for Democrats.. I know that last one sounds unlikely but it is within the realm of possibility if the intraparty civil war got bitter enough.

Obviously, if Trump survives this scandal and is reelected in 2020, all of this is moot, but if not, then how things break will be a story we’ll be glad to have been following.

 

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.