(2023-01-05) Zvi M Covid010523 Various Xbb Takes

Zvi Mowshowitz: Covid-19 1/5/23: Various XBB Takes. conclusions:

• XBB is the next variant and rapidly taking over, and this is normal.
• XBB is not more deadly.
• Our existing protections against severe disease and death carry over.
• Our existing protections against infection are reduced a lot.
• XBB is not obviously going to result in more infections over time.
• All the standard Public Health recommendations remain in effect.

The Numbers

XBB.1.5 is highly immune evasive and is spreading due to this, it is not more dangerous than previous Omicron variants, and the bivalent boosters and recent other infections (while not ideal) still prevent severe disease – if that’s all you need to know you can skip the section.

Once again, in an adequate civilization this is exactly when we would rush out a new updated booster for XBB.1.5, ideally not bivalent at all, so those who were vulnerable or otherwise wanted to be protected could take it. Needless to say we are not going to do that. We are not talking about it

In practice, our vaccine update plan has utterly failed and is capturing almost none of the available value.

‘No clear evidence’ is an interesting twist on No Evidence. I notice that I very much did not update the way Robert Califf would have liked me to when I saw it, as my brain interpreted it as a Double Weasel and based on what I know I would have expected him to be comfortable saying something far stronger... It is also all but certain that you and the agency (FDA) you head, sir, are the reason we don’t have a more effective updated booster on the way sooner. It is on you that by the time we get a booster that works it will be too late to do much good.

once again, do you need more boosters? No, you need – if you want maximum protections – an updated booster that targets XBB. Which Dr. Califf is keeping illegal.

My model continues to think that vaccination reduces Long Covid risk per infection because it is proportional to severity.

Physical World Modeling

Matthew Healy offers a Google Document aptly called Key Covid Metrics and How to Compare Them. It also explains a bunch of his reasoning and how he thinks about the pandemic. Kudos to him for writing this up.

He then discusses how he thinks about these metrics.

He estimates 50% of America will be infected by Omicron in its first year or so.

He mostly thinks excess deaths are a better measure than reported Covid deaths, since almost all deaths are reported while cause of death is not as reliable, and takes it as relatively safe to say that excess deaths equal Covid deaths.

he cites this study of individual level data in Ohio and Florida, showing excess death rates for Republicans were 76% higher than those for Democrats, widening from 22% pre-vaccine to 153% post-vaccine, concentrated in counties with low vaccination rates, so most of this effect was presumably due to vaccinations. This is a big argument for the value of vaccination, while also being somewhat of an argument against the importance of NPIs. An excellent contrast. I wouldn’t be mandating masks anywhere at this point, but if I did terminals would be near the top of the list.

If you want to make air travel safer, focus on the terminals.

Analysis of latest study on surgical versus N95 filter masks, finds non-inferiority for surgical masks, which in practice performed only slightly worse well within margin of error

In Other Covid News

Bryan Caplan looks back on the libertarian reaction to Covid. I agree with his framing of there being essentially two camps, those who advocated for freedom to protect ourselves from Covid (he calls this ‘tech freedom’) in ways that make sense, and those that advocated for freedom against Covid protections (he calls this ‘personal freedom’ although that doesn’t seem like a clarifying term to me) that didn’t make sense.

I certainly broadly agree that our use of NPIs stayed far too intense for far too long

Bryan cites the freedom-from-interventions cause as more important going forward, because we were exceedingly lucky to get vaccines so fast this time, and without them we risk sliding into years of tyranny.

There are several counterfactuals and potential future scenarios here where we likely disagree on how things work.

Tyler Cowen looks back and finds Covid rapid tests not so important. Certainly they were not in the same league as vaccinations. I think Tyler is selling the tests short here, largely from failing to think on the right margins

In many cases, tests enabled gatherings and events that would otherwise have not happened

This change seems super valuable.

I am confident our children would have been in school far less often without such tests.