I vaguely remember that bars had a simple and reasonably effective way of checking who was legally allowed to drink. Perhaps we could do something similar.

As mentioned before (until regular readers are sick of hearing it), we have a problem with convergent thinking and solution-phobia. Add to that the journalistic imperative to frame every policy choice as an adversarial contest with no clear winners and you end up with a discussion that not only ignores a number of viable approaches but which often settles on two of the least viable,  a pair of bad choices which go on to dominate op-ed pages and cable news shows. Whether by design or not (and, yes, I do believe antagonism toward solutions is a real thing), the result is a discussion that consists of each talking head listing reasons why the other position won't work.

In addition to the ways defeatism has biased our coverage of vaccine promotion and made precedented compliance levels seem unattainable, it has also largely limited the discussion of compliance checks to two extreme options: a complex and expensive vaccine passport system which raises privacy issues; and an honor system which does not do a goddamn thing. 

We need to open up this discussion starting with ideas like this. 

https://t.co/sB856zssYP

— Mark Palko (@MarkPalko1) May 16, 2021

P.S. Forgery. We need to come back and explain this from a market segment/incentive standpoint (if only there was a blog that covered epidemiology and marketing, that would be perfect), but [spoiler alert] it's probably not that big a concern in this context.

Better than Trump is no longer good enough -- we need to address the CDC train wreck

This is going to be our big thread for the next few days. 

I am trying to think of a case where a federal agency's mishandling of messaging and behavior economics has been this incompetent and this costly, and nothing comes to mind. Back in 2020, it was possible to assume that all of the blame (rather than just some of it) should go to the previous administration but it's mid-May and the fuck-ups just keep coming.

Principles of public communication:

1) Tell them what you’re going to say
2) Say it
3) Tell them what you said

Not applied in this instance, to put it mildly.

— James Fallows (@JamesFallows) May 17, 2021

This is not a question of over- or underreacting (though the CDC has remarkably managed to do both). It's not a matter of taking the wrong positions (they've generally gotten the science right). The problem is that when it comes to crafting messages or setting up incentives or predicting public reactions, they are, to put it bluntly, spectacularly bad at their job.

The tragedy here is that the Biden administration's extraordinarily competent handling of the other aspects of the pandemic have brought us achingly close to our goal. We just have to do a few more things right.



P.S. Nor is this generally a good sign

"In an interview with STAT, Schuchat said she’d been thinking of retirement for a while, but felt she could not leave the agency during a time of crisis."

By @HelenBranswell.https://t.co/InRgzgTV8A

— Matthew Herper (@matthewherper) May 17, 2021

"It's OK to say I'm vaccinated because..." [Why people might not honor the honor system.]

The public discourse is broken part 8,394.

We've had a lot of discussion about whether or not the fully vaccinated can meet without masks and social distancing even though the research is fairly clear on this point. We also talked a great deal about the challenges of requiring verification to enter certain establishments or events even though these problems are likely to be relatively minor (more on that later). 

Instead of the simple and generally effective approach of checking vaccination cards, we're looking at an honor system and we haven't spent nearly enough time going over the reasons that this might be a worse option, such as the way that removing verification and enforceable penalties opens the door for rationalizations.

A very incomplete list:

"I feel fine."

"I already had a mild case. I can't catch it again."

"I'll socially distance."

"I've been careful not to expose myself."

"I'm just stepping in for a little while."

"Everyone else in there is vaccinated."

"It's just this one time."

"The pandemic is almost over."

"If I haven't caught it by now..."

"Everyone else is doing it."

The tragic waste of a sunny day

 It should have been a turning point; it ended up a joke.

William Bryan, acting head of the US Department of Homeland Security's Science and Technology Directorate, outlined the findings at the news conference.

While noting the research should be treated with caution, Mr Trump suggested further research in that area.

"So, supposing we hit the body with a tremendous - whether it's ultraviolet or just very powerful light," the president said, turning to Dr Deborah Birx, the White House coronavirus response co-ordinator, "and I think you said that hasn't been checked but you're going to test it.

"And then I said, supposing you brought the light inside of the body, which you can do either through the skin or in some other way. And I think you said you're going to test that too. Sounds interesting," the president continued.

"And then I see the disinfectant where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning?

"So it'd be interesting to check that."

Pointing to his head, Mr Trump went on: "I'm not a doctor. But I'm, like, a person that has a good you-know-what."

But the blame for what happened next (or failed to happen) did not rest with Trump alone. The ultraviolet light study and the growing evidence of aerosol transmission had perhaps the most important policy implications of any development in the pandemic up to that point. We could, at the same time, reduce transmission of the disease and greatly improve the economy just by moving as much activity as possible outdoors in daylight. 

Some restaurants started offering curbside delivery and a few put in walk-up windows but these were rare exceptions.  Instead, it was another lost opportunity. We could have made things better but we didn't. Yet another sign that we live in a society fundamentally disinterested in solutions. 

Mark's views on the Republican party become more mainstream

This is Joseph.

Mark and I have discussed Donald Trump a lot. One thing that Mark always liked to point out was that Trump's power was his willingness to destroy the party. I was pleased to see that other commentators are starting to see the same issue. Here is Matthew Yglesias in his Slow Boring blog:

The key to understanding GOP leaders’ view of the situation is that Trump has convinced them of the following:

• While he is not a popular or particularly effective face for the party, he’s not so unpopular as to put winning out of reach.
• He is sufficiently deferential to conservative policy goals so that a Trump presidency is highly preferable to a Biden presidency.
• He is sufficiently non-deferential to conservative policy goals so that if he gets angry at the GOP, he will commit his energies to destroying the party.

All pandemic, I’ve been looking forward to the release of the “Dune” movie. Near the end of the book, Paul Atreides scores some tactical military victories but could still easily enough be defeated by his rivals. But he’s able to convince them that he’s crazy enough that he really might destroy a natural resource that the whole universe depends on.

“The power to destroy a thing is the absolute control over it,” he says.

 This is very much Mark's grenade tossing analogy of 2017. Needless to say, it is going to be a complicated and challenging process to reform the GOP away from this pattern. Yglesias suggests the way forward is increasing democratic accountability, which seems overly optimistic but which I hope proves correct. More likely is a long waiting game for the fundamentals to shift. 

Sane Vampires and Unrecorded Votes -- more notes on a defenestration

Writing Tuesday night (we don't actually get up at six a.m. to post these) on the Cheney affair, we pointed out that Republican officials were caught between needing to distance themselves from an increasingly toxic leader and having to appease a cult-of-personality base that will tolerate no sign of disloyalty.

Yesterday, Josh Marshall explained how the sane vampires of the GOP are trying to cope:

The big story is that Liz Cheney was ousted from her leadership position for not supporting the Big Lie of the stolen election and for not endorsing the insurrection. But we knew that was coming. The big story today had to do with how the vote was held. These are usually recorded votes and secret ballots. That was the case last month when Cheney retained her position by a decisive margin. Today it was a voice vote. After the vote, as Tierney Sneed notes here, a request for a recorded vote was denied.

This tells you the real story of what happened here.

To be clear, I’m confident that Cheney would have been defeated in a secret ballot. I’m not saying there’s a secret pro-Cheney or anti-Trump majority. But I’m pretty sure the vote wouldn’t have been as decisive as Kevin McCarthy and Donald Trump wanted. That’s why they didn’t take a recorded vote.

When asked why there wasn’t a recorded vote, Rep. Jim Jordan, a prime mover of Cheney’s ouster, said the voice vote was “overwhelming” and that “you can’t have a conference chair who recites Democrat talking points.”

A recorded public vote would have been a problem too. Even many of those who want Cheney out probably didn’t want to have to commit themselves to it publicly. Many who either oppose Cheney’s ouster or are uncomfortable with it would not want to be put on the spot to go on the record and risk Trump’s wrath.

The great law of legislative politics is safety in numbers. On most divisive issues, most backbenchers just want to stay out of the spotlight. The spotlight is dangerous.

Is Cheney being patriotic? Notes on a defenestration

Read the post from October eighth first. The points weren't original then (they weren't even new to the blog), but they are as or more valid now and they are particularly relevant to today's news.

Is Cheney being patriotic? I don't know. Like her father, she has never put principle before party and it's not obvious she is doing so now. There is a good case to be made that the best option for the GOP is to make the painful break with Trump as soon as possible. As both a loyal and savvy Republican, this could be the most partisan move open to her.

Is Cheney being patriotic? I don't care. The country needs a good, sane conservative party. Instead we have one consisting almost entirely of members who base their positions on increasingly absurd delusions and of "sane vampires" who go along with the believers either out of fear or ambition. Even if Cheney only cares about the GOP, she is still acting in the best interests of the country. 

THURSDAY, OCTOBER 8, 2020

More on the great unwinding -- the post-Trump GOP is probably inevitable but still unimaginable

Just to reiterate a few points we've been hammering for a few years now.

1. Trump has become more and more toxic to a growing majority of the country. If things continue going the way they're headed, he will be the ultimate example of von Hoffman's rat on the kitchen floor for the Republican Party.

2. But unlike with Nixon,  the base is personally loyal to Trump, not to the GOP.

3. It is difficult to describe what we're seeing as anything other than a cult of personality, complete with the Soviet style propaganda images, the assumption of mental and physical perfection and the messianic overtones.

4. Even if the base were to continue to support the party, the Republicans absolutely must broaden its appeal. After 1988, they have won the popular vote for the presidency exactly once and that was the special case of a wartime reelection.

5. But the base will not tolerate disloyalty to either Trump or his message. Keeping them happy while broadening support is impossible, but the alternative is to find a way to go from a minority to a majority party while trying to make up for the loss of around half of your supporters. 

Are there scenarios where this does happen relatively quickly? Sure, but there are no obvious paths that don't require some deus ex machina plot twist. Which leads to the final and most important point.

6. With a handful of possible exceptions like the extraordinarily sharp Josh Marshall, observers are almost all underestimating the chances of profound and unexpected changes to the way American politics works. I'm not saying what's going to fall or which direction it will tip, but things are going to be different.

From Marshall

But don’t take your eyes off this broader calculus – one separate from Trump, his state of mind, one that is above all rational. Yes, everyone should give their 110%. Everybody get out to vote. The stakes for a second Trump term are too high to take anything for granted. But for those gaming out their own moves and post-January realities, Trump’s defeat is starting to look very likely. Under normal circumstances that would lead congressional Republicans to cut Trump loose and pitch their reelection as a check on the power of a Democratic President. That would be a great card to play for a number of endangered Republican Senators at the moment. But it’s all but impossible since loyalty to Trump is now the centerpiece of Republican identity. And any move away from him would trigger a fatal backlash.

I am so goddamn sick of hearing things we've done in the past described as undoable.

Endless articles come out with headlines like "herd immunity is out of reach" even though we have contained even more infectious diseases through vaccination.

From the CDC:

Data are for the U.S.

Morbidity

• Reported number of new measles (rubeola) cases: 375 (2018)
• Reported number of new mumps cases: 2,515 (2018)
• Reported number of new German measles (rubella) cases: 4 (2018)

Source: Health, United States, 2019, table 10 pdf icon[PDF – 9.8 MB]

Vaccination

• Percent of children vaccinated by age 24 months against measles, mumps, rubella: 90.8% (2015)
• Percent of adolescents aged 13-17 years vaccinated against measles, mumps, rubella (2 doses or more): 91.9% (2018)

Source:Health, United States, 2019, table 31 pdf icon[PDF-9.8 MB] and table 32 pdf icon[PDF – 9.8 MB]

From WHO:

An R0 of 2.5 – the absolute maximum the WHO considers likely – would give COVID-19 an infection rate on par with the influenza pandemic of 1918 (2 to 3), at the high end of estimates for the 2014 Ebola outbreak (1.5 to 2.5) and at the low end of estimates for SARS (2 to 5).

Several common infectious diseases have much higher R0s, including measles (12 to 18), rubella (6 to 7) and mumps (4 to 7). Lower R0s were calculated for two recent outbreaks that caused pandemic fears – H1N1 influenza in 2009 (1.46 to 1.48) and MERS (0.3 to 0.8).

 

...

“Containment of COVID-19 is feasible and must remain the top priority for all countries.”

Virus Consulting

 A nice cartoon accompaniment to our recent thread (see here, here, and here)

From XKCD

When it comes to pandemic defeatism, even New York Times Music wants to get in on the act

Picking up from our previous post.

"Epidemiologists say" suggests a consensus, but they base this on quotes from one guy. pic.twitter.com/Z8sY0WLD31

— Mark Palko (@MarkPalko1) May 6, 2021

quick aside. You are currently the subject of dozens of RCTs to determine, among other things, the impact of celebrity endorsements on your purchasing behavior. Take a guess what we found.

— Mark Palko (@MarkPalko1) May 6, 2021

Obviously, stars getting shots will play a very small role in addressing vaccine hesitancy but it's low cost and pretty much all upside, and this is an all hands on deck moment.

— Mark Palko (@MarkPalko1) May 6, 2021

Perspective

This is Joseph

Mark has been on a roll with his covid-19 posts of the last two days. One thing that I really want to reinforce is that we have been successful with previous infectious diseases and vaccination. Consider smallpox -- a disease that changed the destiny of nations. It was highly infectious, around for thousands of years, and even in societies that were experience it killed a third of adults. It was eradicated with a combination of vaccines and public health measures. 

It is impossible to overstate how bad smallpox was when released in a disease naïve population:

After first contacts with Europeans and Africans, some believe that the death of 90–95% of the native population of the New World was caused by Old World diseases. It is suspected that smallpox was the chief culprit and responsible for killing nearly all of the native inhabitants of the Americas.

Like even if this estimate is too high, the size of the death toll was a complete catastrophe for every population that first encountered it. Consider another random example:

In Japan, the epidemic of 735–737 is believed to have killed as much as one-third of the population

Smallpox outbreaks were huge sources of death and suffering, with high levels of suffering. A vaccination and test/trace campaign ended it as a major source of human mortality and morbidity to the point where it is considered eradicated. 

Smallpox is not a unique example. Measles has worse outcomes than covid-19 (one in four hospitalized!), at least in the aggregate and is highly contagious. In fact, both measles and smallpox seem to have a higher reproductive number (R0) than covid-19. This is a little tricky as R0 depends on conditions, and so there is not one single number nor do we really know precisely what the R0 of smallpox would be in modern living conditions. Same with polio, even more famously controlled with a mass vaccination campaign with a four order of magnitude reduction in number of cases. 

[Edit: Mark points out that smallpox is one of only two diseases eradicated. Polio and Measles are both still with us but very minor contributors to mortality at the population level. I am very much in favor of eradicating covid-19 -- and measles, and polio, and other dangerous viruses -- but there is a level of control that also mitigates a lot of the impact that can be achieved with vaccination and epidemiologic surveillance]

But it is clear that a vaccination campaign is likely to be highly successful. This vaccine science is so nondebatable that I can cite sources like wikipedia for just how effective these campaigns have been at improving public health. It is possible that a concerted campaign of public resistance could undermine the use of vaccines and reduce the benefits. But this is a choice. And it is quite clear that we have the technology to greatly mitigate and reduce the impact of covid-19 on everyday life. It isn't free, but the impacts of the pandemic on the economy are not negligible, either.

Now, it is possible that we might decide that this new social pattern is good for other diseases, like influenza. But, again, this would be a choice. But nobody worries about Polio, Smallpox, or Measles when going to a restaurant, a concert, or a haircut. With determination, there is no evidence that covid-19 cannot be added to this list with a vaccination and public health campaign. 

"Well, maybe one will come up"

For some reason over the past year and a half, this clip has come to mind frequently.

Perhaps cultivating learned helplessness is not the best strategy for fighting the pandemic

I'm pressed for time so I'm just going to crack open this topic. While right wing media is spreading anti-vax propaganda and engaging in various acts of journalistic sabotage, the mainstream press has been distorting coverage of the pandemic more subtly but perhaps doing just as much damage thanks to its greater reach and credibility. 

Whether it's overreporting a rare side effect or talking about a 92% return-for-second-shot rate as a crisis or failing to provide useful comparisons like measles for context or misrepresenting one side of the epidemiological debate as the consensus, outlets like the NYT have consistently framed positive news in a negative light and, more seriously, have shown a clear and dangerous bias against solutions. (I could write virtually the same post about climate change, but that's a topic for another day.)

Here's the latest example which Josh Marshall (perhaps our most clear-eyed commentator) calls "needlessly alarmist." 

NEW: The herd immunity threshold for the coronavirus will stay out of reach, because widely circulating variants and persistent hesitancy about vaccines. The virus is here to stay, but vaccinating the most vulnerable may be enough to restore normalcy.https://t.co/q5QOa7IKp8

— Apoorva Mandavilli (@apoorva_nyc) May 3, 2021

Note the use of the word "will." There are no qualifiers here. This is our fate because vaccine hesitancy is an unalterable natural constant. Assuming we use  the standard of containment rather than eradication (which has almost never happened), this level of certainty is absurd.

Consider this story from All Things Considered with the better but still inaccurate title, "Health Experts Disagree On Whether 'Herd Immunity' Can Be Achieved." The segment is an interview with Dr. Ali Mokdad of the University of Washington's Institute for Health Metrics and Evaluation and there's not much evidence of disagreement. 

MOKDAD: Compared to other viruses, it's somewhere between 75 to 85%. We in the United States are not going to get to herd immunity before this winter simply because right now the vaccine is only authorized for adults, not for children...

CHANG: Right.

MOKDAD: ...Fifteen or younger. So you have about 25% of your population not eligible for the vaccine.

CHANG: OK. But down the road, what is your view? Is herd immunity within reach?

MOKDAD: Yes, definitely. Down the road, we can get to herd immunity if we have a vaccine that we can provide to two years or older and if Americans are willing - who are eligible to take the vaccine are willing to go ahead and get the vaccine.

CHANG: You're talking about vaccine hesitancy at the moment. How significant do you think vaccine hesitancy is as an obstacle to ultimately achieving herd immunity?

MOKDAD: It's the only obstacle that we have right now between us and herd immunity simply because we have many Americans who are not willing to take the vaccine. Otherwise, we have vaccines that are safe and effective, and they will provide herd immunity. And we know children are going to get the vaccine. Twelve to 15 is coming very soon and, after that, 6 to 11.

To summarize, Dr. Mokdad says herd immunity can definitely be achieved which directly contradicts the title. 

The mainstream press have badly screwed up all of the truly important stories of the past decade, climate change, the attack on democracy, Covid 19. Perhaps we need a higher standard than "better than Fox."

Josh and the toasty warm take

Following up on a comment by Andrew Gelman, I was going to open this post with a discussion of hot takes, but going through the Twitter feed around this topic, and I saw that lots of mainstream media and political thinkers had the same take, greatly reducing its hotness.

If you'll remember, this started with the following tweet from Josh Barro:

Environmentalism is supposed to be pain and sacrifice. Because Musk offers an environmental vision that is fun, futuristic and coded with all sorts of “bro” aspects, he is deeply suspicious and must be stopped.

— Josh Barro (@jbarro) April 25, 2021

Before we go on, I think it's useful to break down the implicit and explicit points Barro is making. Here's my attempt:

a. Musk is fighting climate change

b. But many environmentalists dislike him

c. Because they disapprove of his style and image

The first two points establish a mystery to be solved; the third offers an explanation. While Barro may have intended this conclusion to be provocative, he treats the premise as axiomatic, as do many others.

Well also he’s very rich, which a small but vocal group thinks is per se bad.

— Matthew Yglesias (@mattyglesias) April 25, 2021

Exactly https://t.co/33kVqRwvlC

— Alec Stapp (@AlecStapp) April 25, 2021

I don't claim to speak for the left, but:
-union busting
-poor workplace conditions/safety
-SWATing whistleblowers
-repeated environmental violations (really)
-market manipulation
-unsafe automated driving development/deployment, even by the standards of an unregulated industry https://t.co/gavkrYrkKV

— E.W. Niedermeyer (@Tweetermeyer) May 1, 2021

And a whole damned essay by James Pethokoukis.

More deeply, Musk is offering an attractive techno-optimist vision of the future. It's one in stark contrast with that offered by anti-capitalists muttering about the need to abandon "fairy tales of eternal economic growth," as teen climate activist Greta Thunberg has put it. Unlike the dour, scarcity-driven philosophy of Thunbergism, Muskism posits that tech-powered capitalism can solve the problems it causes while creating a future of abundance where you can watch immersive video of SpaceX astronauts landing on Mars while traveling in your self-driving Tesla. As journalist Josh Barro neatly summed it up recently, "Environmentalism is supposed to be pain and sacrifice. Because Musk offers an environmental vision that is fun, futuristic and coded with all sorts of 'bro' aspects, he is deeply suspicious and must be stopped."

You'll notice that that these examples include liberals, conservatives and centrists. This is one of the many cases where trying to approach this with an ideological filter not on fails to help, but actually obscures what's going on. The distinction we need to focus on isn't left vs. right but close vs. far.

I don't know of another case where the standard narrative and the story told by reporters on the front lines diverge this radically, and the gap has only grown larger. In one version Musk is a visionary and spectacularly gifted engineer who, though flawed, is motivated only out of a passion for saving the planet. He does amazing things. In the other, he is a con man and a bully who, when goes off script, inevitably reveals a weak grasp of science and technology. Outside of the ability to get money from investors and taxpayers, his accomplishments range from highly exaggerated to the frauulent.

While this view may not be universal among journalists covering the man, it is the consensus opinion. 

The explanations of Barro et al. are not all that reasonable, but they are probably as good as you can get when you start with the assumption that the standard narrative is right.