Why is there no debate on “eradication”? Is the problem that the word sounds icky? Seriously, I don’t get it.
Why don’t we make a list of plans that would be logically sufficient to achieve The Obvious Win Condition and then “SELECT TOP 1, ORDERED BY plan.cost ASCENDING”?
Then the cheapest plan’s costs give a reasonable “way to eradicate covid for a price” against we can compare “the human cost of more sick people from the disease itself plus the potentially years of bullshit costs in the form of mostly-pointless half-measures”?
My hunch is that eradication is cheaper than <gestures> “all of this”. Am I wrong?
To plan eradication you would first need to estimate the effects of your various policies. The most promising policy at the moment is likely vaccines + prophylatic ivermectin. While you might argue that we need more studies to make sure that the prophylatic ivermectin studies replicate but it’s likely still our best bet at the moment. It seems that for ideological reasons there’s little interest in that.
Uttar Pradesh looks like it’s making good progress towards eradication. The price in money in copying Uttar Pradesh’s COVID policy isn’t high.
50 years ago, if a region would have the success at fighting a disease like this, everyone would be willing to copy it. With our present institutions that’s not the case.
Uttar Pradesh has almost a quarter of a billion people. I am very skeptical of claims that ivermectin made much of a difference there. I have been unable to find out how many ivermectin doses were sent out or used—hundreds of thousands? millions? But if we look at vaccination rates, about one quarter of the state have had one shot, and 5%, two shots. That’s not enough to strongly affect infection rates, and I would be surprised if even that many people were using ivermectin.
They did have a severe outbreak in the second wave, like the rest of India, so an unknown fraction of the population would have antibodies. They implemented lockdowns, border control (I read that you can’t enter the state without a negative PCR test), and other public health measures. UP has a BJP government (the chief minister is sometimes mentioned as a successor to Modi), and their supporters have been bragging about UP’s successes compared to “Marxist” Kerala in the south, while their opponents have been saying that the figures are too low to be believed. I don’t know who you should trust there. I notice that across the border in Madhya Pradesh, another mega-state with over 70 million residents, they also report extremely low case numbers.
It’s definitely of interest to understand how things have unfolded in India, but I strongly doubt that ivermectin made much difference. At the very least we would need to know how many people there took it… My expectation is that the course of the pandemic in India is to be explained by a combination of public health measures, private caution, and perhaps natural herd immunity in some populations (like the Dharavi slum in Mumbai).
Ivermectin is relatively easy to produce for India while vaccines aren’t. Them being supply constrained for vaccines doesn’t indicate that they would face the same challenge for Ivermectin.
It’s not easy to get information for Madhya Pradesh but what I get from Google indicates they also use Ivermectin.
border control (I read that you can’t enter the state without a negative PCR test),
Border controls only help you when you have effective measures to reduce the case rate in your country. Them existing makes it more plausible that other measures in the country manage to bring the case rate down.
while their opponents have been saying that the figures are too low to be believed
When people said similar things about China’s case rate being low, the general argument was that it’s very hard to fake a case rate that low in a big country given an exponential disease.
It’s plausible that Ivermectin isn’t the whole story of why we see the numbers in Uttar Pradesh but it’s one scenario that explains it that’s consistent with what we see in the limited amount of prophylatic Ivermectin trials.
When it comes to Western public policy you could argue that we should have run highly powered trials to get certainty about whether or not Ivermectin has those effects after seeing what happened in India in May. If we would have done that we might have run a trial in 30,000 citizens in June/July and now have more reliable data.
However even in the scenario that the numbers from Madhya Pradesh and Uttar Pradesh are true and it’s not due to Ivermectin, there’s a credible scenario that those factors will also lead to lower infection rates in the US and Europe in the coming six months.
It seems part of the personal who measures cases in Uttar Pradesh is WHO personal which should make it harder to fake the case count.
Your link for Madhya Pradesh actually contains no data about ivermectin use there. The date marked on the graph is when India’s national Covid protocols mentioned ivermectin (and various other medications). So far the only Indian states where I’ve seen reference to official use of ivermectin are Uttar Pradesh, Goa, and maybe Uttarakhand. Certainly there may be others.
My understanding is that in Goa, the health minister said they would make it available for all adults, then WHO’s chief scientist (who is Indian) recommended not using ivermectin, and the national government removed ivermectin and other medications from the national protocols; and then Goa denied the policy.
In Uttar Pradesh, apparently ivermectin could be part of 7-day home isolation kits for people exposed to Covid or showing symptoms, but I have no data on how many such kits were issued, how many of them actually contained ivermectin, or how often the ivermectin was used.
Anecdotally, we can say that ivermectin has had widespread use in India in a decentralized way, as part of treatment for mild Covid or as part of a prophylactic regimen. But I remain very skeptical that it was widespread enough to significantly affect the course of the pandemic there.
40% of whitetail deer had a SARS-CoV2 infection by March 2021. https://www.biorxiv.org/content/10.1101/2021.07.29.454326v1 I’d expect it to be predominantly Delta in them too by now. Given the population and reproduction rate of deer, I’d expect the virus to keep circulating in deer indefinitely.
I love this response partly because it addresses something mechanistic about the world. Once the mechanism is raised it suggests things like: maybe the deer need vaccines? Or to be culled?
My central hunch for deer is that they are more exposed to humans (because of our garbage) than vice versa.
But like: listing out the aspects of the problem (deer, air travel, human trafficking, etc) and then listing sufficient sets of interventions to address all the aspects adequately… Is it really THAT expensive, compared with not eradicating?
It will be a different kind of eradication than smallpox eradication then, which is our golden standard for virus eradication. More like rabies management. Not zero cases forever, but small numbers of cases which are managed by vaccination where needed.
The Lancet had a “no-Covid” article, the UK has a “zero Covid coalition”. But these predate the era of mass vaccination and the Delta strain.
Let us consider the known tools for suppressing the virus. One is restriction on human movement—quarantine, border control, lockdown. This worked for Australia and New Zealand before the Delta strain, but not any more.
Then there’s antibodies: natural immunity in those who already caught the virus; vaccination; and herd immunity from a population full of antibodies, making effective transmission difficult.
The major western vaccines were touted as good for preventing transmission and infection. But at this point, their main unequivocal virtue lies in preventing serious illness. To an unknown degree, vaccinated people can still get infected and can still infect others. This, along with reluctance to get vaccinated in a significant portion of the population, is why masks and other such measures have returned.
Given that social resistance to vaccination and to continued restrictions, an optimal strategy cannot assume 100% consent and participation. Perhaps the way it will play out, is that vaccination and other public health measures will play the main role, and the remaining role will be filled by natural herd immunity building up among the unvaccinated.
We could easily update our vaccines to be more effective against Delta. It’s just about swapping the sequence. We could test additional vaccines against targets besides the spike protein and see whether it improves immunity.
We could run highly powered studies for substances such as ivermectin. The same goes for the other six treatments on the FLCCC preventive protocol.
We recently saw cases in states like the UK go down for reasons we don’t fully understand. If we would do more science to understand it that might give us additional ways to fight COVID.
I expect there’s a lot to be gained by improving air quality, both air filters and humidity control.
I assume that most people are imagining eradication plans using [something close to current tools], and see solving the required coordination problems as a non-starter in that context.
I think that for eradication to be a realistic prospect you’d need a plan which a country could implement unilaterally with significant chance of long-term success. That seems to require new tools. I don’t have a good sense of the odds of finding such tools, or the costs involved (either in research or implementation).
It would still be nice to see some informed discussion exploring the possibilities.
Why is there no debate on “eradication”? Is the problem that the word sounds icky? Seriously, I don’t get it.
Why don’t we make a list of plans that would be logically sufficient to achieve The Obvious Win Condition and then “SELECT TOP 1, ORDERED BY plan.cost ASCENDING”?
Then the cheapest plan’s costs give a reasonable “way to eradicate covid for a price” against we can compare “the human cost of more sick people from the disease itself plus the potentially years of bullshit costs in the form of mostly-pointless half-measures”?
My hunch is that eradication is cheaper than <gestures> “all of this”. Am I wrong?
To plan eradication you would first need to estimate the effects of your various policies. The most promising policy at the moment is likely vaccines + prophylatic ivermectin. While you might argue that we need more studies to make sure that the prophylatic ivermectin studies replicate but it’s likely still our best bet at the moment. It seems that for ideological reasons there’s little interest in that.
Uttar Pradesh looks like it’s making good progress towards eradication. The price in money in copying Uttar Pradesh’s COVID policy isn’t high.
50 years ago, if a region would have the success at fighting a disease like this, everyone would be willing to copy it. With our present institutions that’s not the case.
Uttar Pradesh has almost a quarter of a billion people. I am very skeptical of claims that ivermectin made much of a difference there. I have been unable to find out how many ivermectin doses were sent out or used—hundreds of thousands? millions? But if we look at vaccination rates, about one quarter of the state have had one shot, and 5%, two shots. That’s not enough to strongly affect infection rates, and I would be surprised if even that many people were using ivermectin.
They did have a severe outbreak in the second wave, like the rest of India, so an unknown fraction of the population would have antibodies. They implemented lockdowns, border control (I read that you can’t enter the state without a negative PCR test), and other public health measures. UP has a BJP government (the chief minister is sometimes mentioned as a successor to Modi), and their supporters have been bragging about UP’s successes compared to “Marxist” Kerala in the south, while their opponents have been saying that the figures are too low to be believed. I don’t know who you should trust there. I notice that across the border in Madhya Pradesh, another mega-state with over 70 million residents, they also report extremely low case numbers.
It’s definitely of interest to understand how things have unfolded in India, but I strongly doubt that ivermectin made much difference. At the very least we would need to know how many people there took it… My expectation is that the course of the pandemic in India is to be explained by a combination of public health measures, private caution, and perhaps natural herd immunity in some populations (like the Dharavi slum in Mumbai).
Ivermectin is relatively easy to produce for India while vaccines aren’t. Them being supply constrained for vaccines doesn’t indicate that they would face the same challenge for Ivermectin.
It’s not easy to get information for Madhya Pradesh but what I get from Google indicates they also use Ivermectin.
Border controls only help you when you have effective measures to reduce the case rate in your country. Them existing makes it more plausible that other measures in the country manage to bring the case rate down.
When people said similar things about China’s case rate being low, the general argument was that it’s very hard to fake a case rate that low in a big country given an exponential disease.
It’s plausible that Ivermectin isn’t the whole story of why we see the numbers in Uttar Pradesh but it’s one scenario that explains it that’s consistent with what we see in the limited amount of prophylatic Ivermectin trials.
When it comes to Western public policy you could argue that we should have run highly powered trials to get certainty about whether or not Ivermectin has those effects after seeing what happened in India in May. If we would have done that we might have run a trial in 30,000 citizens in June/July and now have more reliable data.
However even in the scenario that the numbers from Madhya Pradesh and Uttar Pradesh are true and it’s not due to Ivermectin, there’s a credible scenario that those factors will also lead to lower infection rates in the US and Europe in the coming six months.
It seems part of the personal who measures cases in Uttar Pradesh is WHO personal which should make it harder to fake the case count.
Your link for Madhya Pradesh actually contains no data about ivermectin use there. The date marked on the graph is when India’s national Covid protocols mentioned ivermectin (and various other medications). So far the only Indian states where I’ve seen reference to official use of ivermectin are Uttar Pradesh, Goa, and maybe Uttarakhand. Certainly there may be others.
My understanding is that in Goa, the health minister said they would make it available for all adults, then WHO’s chief scientist (who is Indian) recommended not using ivermectin, and the national government removed ivermectin and other medications from the national protocols; and then Goa denied the policy.
In Uttar Pradesh, apparently ivermectin could be part of 7-day home isolation kits for people exposed to Covid or showing symptoms, but I have no data on how many such kits were issued, how many of them actually contained ivermectin, or how often the ivermectin was used.
Anecdotally, we can say that ivermectin has had widespread use in India in a decentralized way, as part of treatment for mild Covid or as part of a prophylactic regimen. But I remain very skeptical that it was widespread enough to significantly affect the course of the pandemic there.
Wow. If they eradicate successfully with what they seem to be doing, that would be awesome!
Does Delta version have natural reservoirs in animals?
40% of whitetail deer had a SARS-CoV2 infection by March 2021. https://www.biorxiv.org/content/10.1101/2021.07.29.454326v1 I’d expect it to be predominantly Delta in them too by now. Given the population and reproduction rate of deer, I’d expect the virus to keep circulating in deer indefinitely.
I love this response partly because it addresses something mechanistic about the world. Once the mechanism is raised it suggests things like: maybe the deer need vaccines? Or to be culled?
My central hunch for deer is that they are more exposed to humans (because of our garbage) than vice versa.
But like: listing out the aspects of the problem (deer, air travel, human trafficking, etc) and then listing sufficient sets of interventions to address all the aspects adequately… Is it really THAT expensive, compared with not eradicating?
It will be a different kind of eradication than smallpox eradication then, which is our golden standard for virus eradication. More like rabies management. Not zero cases forever, but small numbers of cases which are managed by vaccination where needed.
The Lancet had a “no-Covid” article, the UK has a “zero Covid coalition”. But these predate the era of mass vaccination and the Delta strain.
Let us consider the known tools for suppressing the virus. One is restriction on human movement—quarantine, border control, lockdown. This worked for Australia and New Zealand before the Delta strain, but not any more.
Then there’s antibodies: natural immunity in those who already caught the virus; vaccination; and herd immunity from a population full of antibodies, making effective transmission difficult.
The major western vaccines were touted as good for preventing transmission and infection. But at this point, their main unequivocal virtue lies in preventing serious illness. To an unknown degree, vaccinated people can still get infected and can still infect others. This, along with reluctance to get vaccinated in a significant portion of the population, is why masks and other such measures have returned.
Given that social resistance to vaccination and to continued restrictions, an optimal strategy cannot assume 100% consent and participation. Perhaps the way it will play out, is that vaccination and other public health measures will play the main role, and the remaining role will be filled by natural herd immunity building up among the unvaccinated.
We could easily update our vaccines to be more effective against Delta. It’s just about swapping the sequence. We could test additional vaccines against targets besides the spike protein and see whether it improves immunity.
We could run highly powered studies for substances such as ivermectin. The same goes for the other six treatments on the FLCCC preventive protocol.
We recently saw cases in states like the UK go down for reasons we don’t fully understand. If we would do more science to understand it that might give us additional ways to fight COVID.
I expect there’s a lot to be gained by improving air quality, both air filters and humidity control.
I assume that most people are imagining eradication plans using [something close to current tools], and see solving the required coordination problems as a non-starter in that context.
I think that for eradication to be a realistic prospect you’d need a plan which a country could implement unilaterally with significant chance of long-term success. That seems to require new tools. I don’t have a good sense of the odds of finding such tools, or the costs involved (either in research or implementation).
It would still be nice to see some informed discussion exploring the possibilities.