Yesterday, I reviewed the first half of Tyler Cowen’s critique of the Great Barrington Declaration. This is the last half. As before, quotes from him are highlighted and my responses are not.
Here are the key words of the Great Barrington Declaration on herd immunity:
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.
And then:
What exactly does the word “allow” mean in this context? Again the passivity is evident, as if humans should just line up in the proper order of virus exposure and submit to nature’s will. How about instead we channel our inner Ayn Rand and stress the role of human agency? Something like: “Herd immunity will come from a combination of exposure to the virus through natural infection and the widespread use of vaccines. Here are some ways to maximize the role of vaccines in that process.”
It means, as the document says, “allow those who are at minimal risk of death to live their lives normally.” I’m not sure why Cowen has trouble understanding. Allowing people to live their lives has nothing to do with passivity. It certainly is consistent with the idea of human agency, even if you don’t go all Ayn Rand on it. When people are allowed to do something, that doesn’t mean they have to do it. There’s necessarily human agency.
He’s right about how herd immunity will come about. But then he says, “Here are some ways to maximize the role of vaccines in that process.” The problem here is, as former Obama economist Austan Goolsbee pointed out in a related context, that this is like the old economics joke where the punch line is “assume a can opener.” We don’t yet have a vaccine, so right now maximizing the role of vaccines gets you to a maximum of zero.
In practical terms, the most problematic paragraph in the declaration is this one:
Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.
In most parts of the Western world, normal openings for restaurants, sporting events and workplaces are likely to lead to spiraling caseloads and overloaded hospitals, as is already a risk in some of the harder-hit parts of Europe. Reopenings, to the extent they work, rely on a government that so scares people that attendance remains low even with reopening.
The middle paragraph is from the Great Barrington Declaration. The paragraphs that bookend it are from Cowen.
I’m not familiar with Europe but Georgia (in the United States) opened without overloaded hospitals. As for spiraling caseloads, that’s part of how you reach herd immunity. And if you follow his link to a Bloomberg article, you’ll see that it says not a word about overloaded hospitals.
Cowen is right that governments have reacted by scaring people. That’s one reason the Great Barrington Declaration is important. It seeks to tell people not to be so afraid unless they’re particularly vulnerable. Notice the statement in the Declaration that “Young low-risk adults should work normally, rather than from home.” The authors are not saying that they should be forced to; they’re saying they should. As I understand the Declaration, they’re trying to talk to young people as well as others and say, in effect, “Come in, the water’s fine.” Does Cowen object? If so, he doesn’t make clear and he doesn’t say why.
Don’t get me wrong: The Great Barrington strategy is a tempting one. Coming out of a libertarian think tank, it tries to procure maximum liberty for commerce and daily life. It is a seductive idea. Yet consistency of message is not an unalloyed good, even when the subject is liberty. And when there is a pandemic, one of the government’s most vital roles is to secure public goods, such as vaccines.
Notice how he jumps from the idea that the message is tempting and seductive (I agree) to government’s role in vaccines. Little problem: WE DON’T HAVE A VACCINE. The Great Barrington Declaration makes clear that it’s addressed to what to do while we’re waiting for a vaccine. Insert can opener joke.
The declaration is disappointing because it is looking for an easy way out — first by taking the best alternatives for fighting Covid off the table, then by pretending a normal state of affairs is also an optimum state of affairs.
Does he care to tell us what “the best alternatives for fighting Covid” are? It strikes me that he has two in mind: (1) vaccines, which haven’t yet been approved, in part thanks to the FDA, which Cowen has earlier said should not approve one from Russia, and (2) lockdowns, which Cowen says aren’t that important and, by the way, we should tighten them.
My worldview is both more hopeful and more tragic. There is no normal here, but we can do better — with vigorous actions to combat Covid-19, including government actions. The conception of human nature evident in the Great Barrington Declaration is so passive, it raises the question of whether it even qualifies as a defense of natural liberty.
I missed the hopeful part. OK, so what are the vigorous actions that include government actions? Blank out, as the aforementioned Ayn Rand loved to say. And how does he know that the authors of the Great Barrington Declaration would not favor those actions? Cowen is fixated on the idea that three non-libertarians produced a libertarian statement. As I mentioned in Part 1, that sends him down a rabbit hole from which he doesn’t emerge.
READER COMMENTS
Kevin Dick
Oct 17 2020 at 6:20pm
Thanks for this analysis. I was pretty disappointed in Tyler’s piece. You did a fantastic job of detailing its weaknesses. That’s why you are somewhat higher on my list of favorite current economists 🙂
David Henderson
Oct 18 2020 at 11:18am
Thanks, Kevin.
Mark Brophy
Oct 17 2020 at 7:12pm
Not only did non-libertarians produce a libertarian statement but Tyler claims that they’re libertarians and work for a libertarian think tank. The non-libertarians produced the statement only because the cost of the lockdowns is much greater than the cost of the virus.
Don Boudreaux
Oct 17 2020 at 7:39pm
How ironic that Tyler accuses the authors of the Great Barrington Declaration of “looking for an easy way out” when it is he who puts his hope in the imminent arrival of a vaccine.
Todd Kreider
Oct 18 2020 at 2:42am
Weird. I replied to someone about a meta study of 14 Randomized Controlled Trials on the effectiveness of masks that I previously put up that concluded masks are not very effective and Scott Sumner seems to have accidently deleted my response…twice!
Benoit Essiambre: Note the word “significant” has a very specific meaning in statistics that does not mean there is no effect. This experiment was consistent with a 49% reduction or a 20% increase in transmission from masks, “CI 0.51–1.20”. All “not significant” tells you is that this particular experiment’s data was too noisy to tell anything.
me: This isn’t correct. Here is part of the abstract:
Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza.
David Henderson
Oct 18 2020 at 11:21am
I remember that Scott Alexander had a long post reviewing a lot of the literature on face masks. I’ve kind of forgotten the bottom line.
Here’s my non-expert take. If the coronavirus is spread by droplets, then it seems that there will be less spread if you emit fewer droplets. I get that there’s an issue of the size of the droplets vs. the size of the holes in the mask. But it seems to me that it will prevent some from getting out. It’s a “think on the margin” thing.
JK Brown
Oct 18 2020 at 12:08pm
There’s a lot of “seems” in there. I don’t disagree. It makes it sensible to encourage mask wearing. The problem comes with mask mandates and their ensuing state violence in the form of fines, business license loss, etc. Not to mention the physical violence from police on those who resist mask wearing or by “concerned” citizens on those not meeting their standards.
Even cloth masks will capture some significant amount of spittle ejected by the wearer. Virus is not thought to be shed as an aerosol, but rather becomes aerosolized when droplets are desiccated in cool, dry air, which is also conditions for long stability of the virus in air (10C at 20% RH is a peak on the stability curve).
Masks provide minimal protection to the wearer. Though a NIOSH rated N95+ mask will reduce the viral load received permitting longer exposure in high viral load environments or while performing procedures likely to cause virus shedding on patients.
Some speculate that a mask will protect the wearer from spittle produced by others. It would stop direct deposit into the mouth, but unless the mask is a medical grade N95+ mask designed to maintain effectiveness while wet the virus is just likely to be inhaled from the collection surface through the mask as the moisture evaporates. Though I have haven’t seen a commercial product, there is a patent based on research for the use of salt, sugar or other crystalizing coatings on masks that will denature the virus as the moisture evaporates thus deactivating the viral load from spittle on masks.
Sadly, the “experts” did not promote the control of where you point your spittlemaker, i.e., mouth and, nose, even when they were recommending against wearing masks. Stop talking into people’s faces. If you must look into their eyes, do it from a distance. Talk past people and preferably while pointing your mouth down. Being cognizant of children and short people.
David Henderson
Oct 18 2020 at 12:15pm
Thanks.
You wrote:
Two, actually. 🙂 But that’s what a non-expert like me should say.
You wrote:
I’m glad we agree. I was discussing whether one should wear masks, not whether the government should use violence on those who don’t. Like you, I’m against such use of violence.
Anonymous
Oct 21 2020 at 10:01am
I believe the government has a role to play in providing law and order (obviously some in libertarian circles disagree), particularly to sanction assault and other violence and coercion. Exposing others to deadly pathogens fits right into this rubric. Going around without taking precautions during the pandemic, potentially exposing others to coronavirus, is an assault on their person and liberty. If someone walks into a store without a mask and starts talking to someone from a few feet away, I want that person to be fined at a minimum.
Jeff Scott
Oct 18 2020 at 10:26am
From Gupta:
Since the declaration last week, the Great Barrington Declaration has come under attack across the media, online (including Wikipedia and Google) from fellow academics as being part of a Libertarian conspiracy (my politics are not remotely libertarian) or being based in “pseudoscience”; others attempting to be less defamatory say that our views are “fringe”.
https://unherd.com/2020/10/matt-hancock-is-wrong-about-herd-immunity/?tl_inbound=1&tl_groups%5B0%5D=18743&tl_period_type=3
Jens
Oct 19 2020 at 4:45am
Some points about Gupta’s article:
She mentions that the SARS-CoV-2 pathogen knows no mechanisms that would fundamentally hinder the development of immunity or a vaccine, both are related. But that also means that the early development of a vaccine is possible and probable. She also mentions that “The situation can be vastly improved through vaccination”.
She wants to protect risk groups and not impair the treatment of other diseases. But aren’t these criteria most likely met when the health system is not overburdened by the SARS-CoV-2 pathogen? Is efficient focused protection possible at all in an environment with a high prevalence of the pathogen?
I miss a statement on the question of how quickly the pathogen should spread in order to achieve herd immunity. Should it spread as quickly as possible? Or are there certain general and boundary conditions that have to be adhered to? What do they look like? What if it gets out of hand? What is the plan B then ? Monster lockdowns with taped doors ?
She mentions that 4 coronaviruses with flu-like symptoms are constantly in circulation and that there are also problematic courses there in risk groups. But SARS-CoV-1 or MERS-CoV are also coronaviruses with symptoms that should not be underestimated. Is SARS-CoV-2 more comparable with the 4 permanently circulating coronaviruses or with SARS-CoV-1 / MERS? Are there perhaps assessment criteria where you should think more about SARS-CoV-1 / MERS, and others where you should think more about the 4 circulating coronaviruses?
This question also applies in part to the long-term consequences. These are also to be expected, but how bad are they exactly? Does it possibly play a role that the genome of the current homo sapiens population is already adapted to the 4 existing coronaviruses (through selection!), while that is not the case with new zoonoses? Do we need more cases for evaluation? Or do we need the time to observe the existing number of cases and their development (*long*-term consequences)?
She mentions that millions of people should not be starved to death because of unavoidable long-term effects. But who wants that and why should a containment strategy be causal for it? Couldn’t a high prevalence situation have similar consequences?
In some places she signals personal involvement (“… those, like me, who caught it …”, “I believe I did!”). How does this affect the recipient? Is she arrogant and lucky? Or does she want to signal understanding for the situation and solidarity? Does she want to establish general validity from her own anecdotal story? As a “survivor”, is she more objective or subjective than others? How does it matter to strategy questions that she had the measles and perhaps some long-term consequences?
To what extent could misinterpretation and incorrect quotations of this strategy proposal lead to individuals no longer feeling bound by hygiene rules or the like? Not everyone will understand or wants to understand that one should comply with the hygiene rule despite the aim of herd immunity, because this lowers the threshold for herd immunity.
And then to play the devil advocate: With a little bad will one could interpret the GBD as an attempt to lure decision-makers into a trap. If they ignore the strategy they will be blamed for ignoring all other issues and costs besides the pandemic. If you try to implement the strategy, which may be associated with high risks because it implies a very high prevalence of a new pathogen, you will be accused of failure and catastrophic loss of human life and health for simply not implementing the strategy *correctly* (there are very few specific suggestions, framework conditions, test criteria that have been proposed after all).
There is also the question of whether a strategic turn is currently particularly useful. It makes no sense to mourn sunk costs, but it also makes no sense to turn around or away before (intermediate) goals.
Please do not get me wrong, i can understand if one is concerned about the side effects of the current policy proposals, wants to analyze or prevent implementation errors or simply has another perspective or other evaluation. I am more interested in the general structure of the debate.
JK Brown
Oct 18 2020 at 12:34pm
The obsession with testing seems to drive a lot of this fear reaction to every suggestion about the virus. Calling a positive test a “case” is even worse. Fits the media and health tyrant narratives, but is not informative for managing risk. Only a small percentage of people testing positive even see a doctor, much less is their case medically-assisted. Of the medically-assisted, a single digit percentage of those are hospitalized. Of the hospitalized, a small percentage are deemed serious cases, of the serious cases a small percentage are deemed critical cases requiring ICU availability and of the critical case, few end up needing a respirator (although current thought is the respirator has negative impact on recovery).
If reporting health departments would stop obfuscating testing positive, with an actual illness and the actual illness with a case requiring medical-assistance, we’d have a much more rational view of the virus.
Testing positive after a low viral load exposure is not a bad thing since that leads to antibodies. The don’t quantify viral load so we can only guesstimate on this eventuality. This virus is going away. Sooner or later, we all will “test positive” and get over it. The virus will join the plethora of viruses we confront daily, but our bodies will have the map to stop it before it gets out of hand.
The current conditions seem to indicate early therapeutic treatment, but the FDA restricts almost all therapeutics to in-hospital care long after a patient has lost the easy battle of limiting viral load growth and has developed life-threatening inflammations from immune system reactions.
Alan Goldhammer
Oct 18 2020 at 6:01pm
This is untrue. There are a number of studies from multiple investigators showing that not all those exposed to SARS-CoV-2 generate an antibody response.
Both remdesivir which may not be a terrific drug based on the data and either the Regeneron or Lilly monoclonal antibody treatments are give by infusion. It’s difficult to see how those can be done outside a hospital setting. Despite getting money to scale up, all three are in short supply right now and could not be used for general early stage therapy. Also, viral load growth appears to be totally unrelated to cytokine storm. In fact patients who get severe COVID-19 have higher titers of neutralizing antibodies than those with mild cases.
Vivian Darkbloom
Oct 19 2020 at 4:27am
“This is untrue. There are a number of studies from multiple investigators showing that not all those exposed to SARS-CoV-2 generate an antibody response.”
I don’t understand the logic of that statement. Your response was that exposure does not *always* lead to an antibody response. I didn’t understand JK Brown’s statement to mean “always”. What percentage of cases of detected exposure do *not* lead some antibody response (keeping in mind, I think, that the antibody response shows up later than the exposure because it is in response to it)?
If a person tests positive for covid exposure but has been exposed to such a low viral load that there is no antibody response, is that a bad thing?
Do vaccinations, which are designed to deliver a low viral load that do not replicate rapidly, *always* lead to antibody response? Are vaccinations therefore a bad thing?
Alan Goldhammer
Oct 19 2020 at 9:38am
I don’t want to get overly scientific here and will state from the outset that I’m not an immunologist. I have seen papers commenting on the surprising lack of antibodies in those exposed to SARS-CoV-2. It is still in the ‘mystery’ category as to why this happens.
We have vaccines against both viruses and pathogenic bacteria. Such vaccines can either be inactivated whole microrganisms, attenuated viruses as is the Sabin oral vaccine, or sub-unit vaccines where only the antigen of the microorganism is administered. Most of the SARS-CoV-2 vaccines are subunit vaccines where the protein from the virus or DNA/RNA coding for that protein make up the vaccine. China appear to be the only country right now working on an inactivated vaccine. In all the cases I am aware of an antibody response is observed.
The big question is which vaccine approach is best for generating a robust AND long lasting response. We do not have an answer for this right now and a vaccine consisting of more than the Spike protein may be a better approach). It may be that booster shots at some interval are required here but the possibility also exists that SARS-CoV-2 mutates to become an endemic but mainly innocuous virus. The decreasing mortality that is being observed right now may indicate this but more genetic research into the virus is required. We do know that the original Wuhan strain is not what is prevalent in the world these days, rather it is the mutated strain that arose in Italy earlier this year.
Vivian Darkbloom
Oct 19 2020 at 11:23am
Thank you for your response, Alan, even though I don’t think you addressed the specific questions I raised. I’m not an immunologist either, but I think I’m fairly well trained to judge whether an argument is on-point and logical. I think you unfairly raised the bar in your response to JK Brown, raising the standard to “not *all* those exposed to SARS-CoV-2 generate an antibody response” which, in context, was not particularly responsive to his argument.
Again, I don’t know of anyone who argues that vaccines are a “bad thing” merely because they are not 100 percent effective. This, I understand, is due to a variety of reasons, among which are that the response by different individuals may vary (that is to say that some individuals may not respond by producing antibodies to fight off the disease while others may). If someone is exposed to the virus sufficiently to test positive for the virus that person is, I think, more likely than not, also going to have an antibody response. If a person doesn’t get sick and doesn’t have an antibody response, I say there is relatively little harm done. In fact, I suspect that a healthy person being exposed to a relatively small viral load of SARS-CoV-2 and who does not become ill is *more* likely to generate an antibody response than those who may have merely been given a vaccine which is not always accurately targeted to the specific strain at hand.
Again, since you’ve read much of the literature, I’m sure that you are in a position to answer my question (and back up your earlier claim) as to what percentage of persons exposed to SARS-CoV-2 do *not* generate an(y) antibody response”.
Thanks.
Viv
Alan Goldhammer
Oct 19 2020 at 12:55pm
Sorry for not addressing the question clearly. The answer is we don’t know and it’s complicated to generate had numbers here as I don’t think most clinicians are looking for this. The number of papers that I’ve read that discuss this is very small.
David Seltzer
Oct 19 2020 at 6:03pm
Miss Vivian. Please allow me a non sequitur. I really enjoy reading your comments. They are well thought out and beautifully argued.
Todd Kreider
Oct 18 2020 at 2:50pm
Someone emailed a lead author of the 6,000 person randomized mask study of the effectiveness against Covid-19 in Denmark asking when the study will be published and got this response:
“When the journal is brave enough to accept the paper.”
I think we have an idea of what the results are.
https://twitter.com/AlexBerenson/status/1317875526997102594
Alan Goldhammer
Oct 18 2020 at 5:54pm
I have not seen this paper on the pre-print servers that I monitor daily. I would love to see what they are calling a RCT of a mask study. Having served on an IRB in the past, I can tell you that this would have a great deal of trouble passing an ethics review.
There are a lot of papers that I have read that show the value of wearing masks. the best one, and perhaps the closest to a controlled trial that we can get is the mask regulation in Jena Germany and how it compared to a comparable city that did not impose their mask regulation until four weeks later. Here is the full paper: https://www.medrxiv.org/content/10.1101/2020.09.02.20187021v2.full.pdf
Jenny
Oct 21 2020 at 6:12am
There are studies on the CDC website that are quite enlightening. I am going to copy and paste the url and excerpts from the CDC conclusions and the studies. Roger Koops also provides a fairly detailed scientific breakdown of masks and their efficacy for the AIER.
https://www.aier.org/article/the-year-of-disguises/
From the CDC:
“Abstract
Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.”
Note the heavy use of the word, “may.”
And from their study:
“Studies of Cloth Mask Efficacy
In 2015, we conducted a randomized controlled trial to compare the efficacy of cloth masks with that of medical masks and controls (standard practice) among healthcare workers in Vietnam (4). Rates of infection were consistently higher among those in the cloth mask group than in the medical mask and control groups. This finding suggests that risk for infection was higher for those wearing cloth masks. The mask tested was a locally manufactured, double-layered cotton mask. Participants were given 5 cloth masks for a 4-week study period and were asked to wash the masks daily with soap and water (4). The poor performance may have been because the masks were not washed frequently enough or because they became moist and contaminated. Medical and cloth masks were used by some participants in the control group, but the poor performance of cloth masks persisted in post hoc analysis when we compared all participants who used medical masks (from the control and the medical mask groups) with all participants who used only a cloth mask (from the control and the cloth mask groups)(4).”
https://wwwnc.cdc.gov/eid/article/26/10/20-0948_article
It is all there in black and white, yet this isn’t the information the media or even the agencies are giving the country. Is it better to wear a mask? Well, maybe…if you never touch them, limit and rotate use, keep them clean, etc. How many people are doing that? And how many people aren’t and are using them as a mental crutch? People and businesses have gotten lax on hygiene and basic cleanliness, not to mention distancing. The problem, in my opinion, is the total lack of trustworthy leadership and a disinformation campaign designed to maintain order and minimize panic, even though that is exacerbating the spread.
Mark Bahner
Oct 22 2020 at 1:51am
Roger Koops is an example of a person who “knows enough to be dangerous” (as the saying goes).
Paul
Oct 19 2020 at 11:57am
First off, the initial modeling was wrong. The flip flopping on masks was wrong. A truly libertarian approach is simple because it would empower people to make decisions on their own and to me it comes down to some answers that are not being provided:
1) How many deaths of the 200+k were in nursing homes?
2) How many deaths were people over 70? How many had preexisting conditions?
3) How many deaths of people not 70 or older had preexisting conditions? This includes, and pardon the example, cases like George Floyd, who obviously didn’t die from the virus but was classified that way for funding purposes?
4) What is the overall hospitalization rate? Sorted by age group.
5) What is the recovery rate of those hospitalized by age group?
The data is there, but there is seemingly deliberate obfuscation. I am not denying anything. It is a new virus. I wear a mask. I limit contact and potential exposure to unknown quantities alot. I use instacart. I don’t go out to eat. But it’s not out of fear it’s out of a lack of information. The declaration was interesting but still DID NOT PROVIDE INFORMATION FOR ME TO MAKE EDUCATED DECISIONS. It’s yet another opinion. I don’t need opinions. I need facts, statistics that should be readily available but aren’t and likely won’t be based on the narratives being pushed as fact from both sides.
Jenny
Oct 21 2020 at 5:59am
Hello! The statistical information you seek is available on the CDC’s website, cdc.org, and clearly indicates that those over 70 are the most vulnerable. There are also statistics on comorbities that break them down by affliction/disease. One of my favorite studies listed on the CDC’s site is on the efficacy of masks. Frankly, a cloth mask provides little to no protection. They did a study where a group of doctors wore cotton masks with directions on washing, which all said that they followed, and the masks did nothing to stop their exposure to the viruses and illnesses they were treating. Another study shows that 71% of infected participants claimed to have worn masks all of the time in public, with the exception of dining. The media chose to focus on the fact that twice as many infected patients had dined out than eaten at home. They ignored the masks. The premise of the GBD is that young, healthy people should resume life as normal, allowing the virus to circulate naturally and that governments utilize target protection for vulnerable populations, but not by force. People should be allowed to make decisions on their own. That means that a 30 year-old man might choose to go on a date to dinner and a movie on Saturday night, maskless, would eat and wash his hands, use the restroom and wash his hands, distance from everyone except his date, see the movie, eat popcorn, and wash his hands. He might also, hopefully, choose not to visit his grandparents for Sunday dinner the day after his date, so as not to potentially expose them to the virus. In turn, his grandparents may adopt the habit of asking relatives to do a self-check for COVID-19 symptoms before coming over and making sure that they hadn’t been to a public event. Or, choose to wait for family visits until a vaccine is available. Obviously, this strategy won’t work for those terrified of the virus because it would need to circulate and infect much of the populace until the vaccine is available.
jj
Oct 19 2020 at 3:26pm
Well put, DH. I’m a fan of Cowen but his article was bafflingly below his usual standards of logic. Allow means allow!
jj
Oct 19 2020 at 3:27pm
I think he committed his own cardinal sin of ‘mood affiliation’. Can’t think of any other reason he wouldn’t take ‘allow’ at face value.
Anonymous
Oct 21 2020 at 10:06am
Actually we do “have” vaccines, we just are not allowed to take them yet. Since the evidence is overwhelming that the harm we are suffering from COVID vastly outweighs any remotely plausible harm from the vaccine, vaccination SHOULD begin immediately.
Dave
Oct 21 2020 at 4:31pm
“Since the evidence is overwhelming that the harm we are suffering from COVID vastly outweighs any remotely plausible harm from the vaccine.”
I disagree with that statement, particularly once we discuss that point in terms of (1) net benefit of vaccine and (2) assessing relative risks for large subgroups of the population who face low risk from COVID.
To the first point, it’s conceivable that a COVID vaccine could be relatively safe but also have very low efficacy. It’s also apparently possible that a vaccine could in fact make COVID infections *worse* in a meaningful number of people due to “vaccine hypersensitivity reactions” (VAH). I’m neither a physician nor a medical researcher, but my limited layman’s understanding is that phenomenon shouldn’t at all be *assumed* as a default likelihood. VAH is, however, to quote a paper on the topic at the Journal of Infectious Diseases “a complex and poorly defined immunopathology”. ( https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa518/5891764 ).
To the second point, the latest CDC information on reported COVID deaths by age shows 448 total reported U.S. COVID deaths among those less than 25 years old. That age group has a total population of ~103 million in the U.S. ( https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm ). Apply some reasonable range to the likely spread of SARS-CoV-2 in the U.S. – perhaps 10% to 25% of the population? – and it’s clear that the denominator for assessing fatality risk for this group is in the millions, most likely tens of millions. Yes, some other fraction of people in this age group have experienced morbidity such as hospitalization, but it’s clear that a COVID vaccine needs to be exceptionally safe to justify that young, otherwise healthy people will themselves benefit from vaccination.
For clear context, I’m overall optimistic about the likelihood of a safe and reasonably effective vaccine. I think that the existing vaccines are probably a net benefit. I’m participating in a Phase III trial of one of the COVID vaccines, and I think that – if I got the vaccine rather than placebo – it’s probably a net benefit and unlikely to be more than a slight net risk. That said, I wouldn’t be comfortable with public health messaging strongly urging that all healthy people *should* – let’s even set aside any question of vaccine mandates – get one of the COVID vaccines based on the degree to which they’ve been studied so far.
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