I think the points about non-obvious costs are very important to consider and nicely evaluated. Nonetheless, I think your conclusions are a bit too strong. It’s possible that I’m being too conservative and not giving adequate weight to the obvious and non-obvious costs of continued restrictions.
I think that in light of the risks of long covid from mild infections (small sample size but I haven’t seen a larger study contradicting it) and the ongoing risk of vaccine-resistant mutations, saying that young healthy people are protected from overall risk by a factor of 1000x through vaccination is overly optimistic. I’d say that a 100x reduction harm might be a reasonable estimate. This thread by Ruby which you linked to as well has lots of good analysis of vaccine efficacy for healthy young people. If I am interpreting the note at the top correctly, due to the risks of vaccine resistance, he has adjusted his harm reduction estimate from vaccination downward to 10x-100x reduction, from his initial estimate of 100x-1000x reduction. He also mentions long covid in his caveats towards the bottom. It’s not clear to me why you are still saying 1000x in spite of these factors, and I’d be very interested in understanding how and why your assessment differs from Ruby’s in this regard.
It’s also worth considering the possibility of a tipping point. If we hold off a few months longer on full reopening, we might get enough hesitant people and people under age 16 vaccinated to avoid the rise of a highly vaccine-resistant strain in the US.
Furthermore, there’s a big difference between returning mostly to normal and fully to normal. It’s possible that the most extreme potential superspreader events (examples: an indoor rock concert with thousands of people pressed shoulder to shoulder and yelling over the music; a large group indoor choir singing event; a crowded bar indoor bar in Manhattan; Burning Man) are much more risky with regard to covid spread than all the other stuff combined. And at the same time these sorts of crowded and touchy-feely mass gatherings are a very important part of the human experience, and disallowing them has significant costs.
I am now more than 2 weeks past my second Pfizer shot. Considering the factors above, I am not planning to return completely to my 2019 way of life right now, but I am moving substantially in that direction while monitoring covid prevalence, vaccination rates, and new variants for the next month or more.
My current lifestyle that I’ve experimented with for the last several days includes eating indoors at restaurants (but being mindful of how long I spend at indoor restaurants and how often I go); hugging and hanging out indoors unmasked in small groups with some consenting friends and family who are at least one of young/healthy, vaccinated, or have recovered from covid in the past. I’m probably interested in attending large events outdoors such as concerts so long as people are mostly masked and are not crammed shoulder-to-shoulder. And also small indoor parties with an adequate combination of social distancing, ventilation, and vaccine coverage.
But so far I’m avoiding such activities as going to especially crowded restaurants/bars where I would be spending a lot of time within three feet of many unmasked people, riding on a crowded subway at rush hour, attending crowded indoor concerts, attending large indoor conventions, playing Spin the Bottle, or getting anywhere near other people who are sick and who I assign a substantial probability of having covid. I think those types of activities I will continue to wait on as I monitor the prevalence of covid and spread of variants.
I think that for the next few months, we should maintain legal restrictions on very large gatherings such as the potential superspreader type events that I discuss near the top of this post, either forbidding these sorts of gatherings or requiring most or all attendees to be masked or vaccinated or test negative. Setting guidelines that we will return further to normal once enough people are vaccinated, or allowing vaccinated people different privileges from unvaccinated, may coerce people to get vaccinated, to the benefit society. This will give us a chance at actually hitting something resembling herd immunity through vaccination and preventing a new vaccine-resistant strain from spreading while the overall vaccination rate is lower. I agree that it’s problematic to have unenforced regulations. I think the optimal solution to this, both with covid and other unrelated areas of law (though it’s much easier said than done) is to reduce the number of regulations and more strenuously enforce the most critical regulations.
I haven’t fully grappled yet with the numbers around vaccine resistance, given that I was Fermi-ing something like 2-3x different and not 10x different. But my conclusion is mostly meant to hold up in spite of mistakes there; even if the vaccine was less effective than you thought, what does it get us if we keep social distancing for awhile? Unless we get eradication, it seems like the options are almost binary: eradicate it (~impossible) or go back to normal, unless you have a very good plan for threading the needle in some other way.
I’m pretty fine with a few more months of restrictions on superspreader events until we’re more vaccinated, although I still think we have shown through the last year that we’re in a not-very-cautious control system and so we shouldn’t ban much stuff that will hurt some people and then just cause others to be less cautious.
I see a substantial possibility of near-eradication. Not like we eradicated smallpox, but maybe almost as well as we’ve done with measles? It’s not clear yet what percentage immunity we need need to achieve herd immunity. But given the figures from the past month or so, there’s a decent chance we’re heading in that direction. Even if we can achieve herd immunity, that may not be a good enough argument to ban superspreader events for now—we would achieve herd immunity regardless when we get R<1 with respect to normal activity. But there’s the further factor that by continuing to reduce transmission while more people are vaccinated, we reduce the chance of variants.
There’s also the possibility that we can eventually achieve near-eradication through a combination of immunity and good contact tracing, but we may only have few enough cases to do the contact tracing if we can get the case count down to a manageable level through continued social distancing for a while first.
Do those scenarios seem plausible to you? Why do you believe that the options are almost binary?
I think I see a larger possible downside than you do regarding variants. It seems possible that we could get a variant against which our current vaccines are less than 50% effective, and if we can reduce the chance of that happening through continued restrictions, I think it’s worthwhile.
Distributing more vaccines to the rest of the world would be a bigger intervention in that regard, but perhaps through continued travel restrictions combined with some vaccine protection, we can prevent especially bad variants from spreading worldwide the way the original pandemic did.
I think the points about non-obvious costs are very important to consider and nicely evaluated. Nonetheless, I think your conclusions are a bit too strong. It’s possible that I’m being too conservative and not giving adequate weight to the obvious and non-obvious costs of continued restrictions.
I think that in light of the risks of long covid from mild infections (small sample size but I haven’t seen a larger study contradicting it) and the ongoing risk of vaccine-resistant mutations, saying that young healthy people are protected from overall risk by a factor of 1000x through vaccination is overly optimistic. I’d say that a 100x reduction harm might be a reasonable estimate. This thread by Ruby which you linked to as well has lots of good analysis of vaccine efficacy for healthy young people. If I am interpreting the note at the top correctly, due to the risks of vaccine resistance, he has adjusted his harm reduction estimate from vaccination downward to 10x-100x reduction, from his initial estimate of 100x-1000x reduction. He also mentions long covid in his caveats towards the bottom. It’s not clear to me why you are still saying 1000x in spite of these factors, and I’d be very interested in understanding how and why your assessment differs from Ruby’s in this regard.
It’s also worth considering the possibility of a tipping point. If we hold off a few months longer on full reopening, we might get enough hesitant people and people under age 16 vaccinated to avoid the rise of a highly vaccine-resistant strain in the US.
Furthermore, there’s a big difference between returning mostly to normal and fully to normal. It’s possible that the most extreme potential superspreader events (examples: an indoor rock concert with thousands of people pressed shoulder to shoulder and yelling over the music; a large group indoor choir singing event; a crowded bar indoor bar in Manhattan; Burning Man) are much more risky with regard to covid spread than all the other stuff combined. And at the same time these sorts of crowded and touchy-feely mass gatherings are a very important part of the human experience, and disallowing them has significant costs.
I am now more than 2 weeks past my second Pfizer shot. Considering the factors above, I am not planning to return completely to my 2019 way of life right now, but I am moving substantially in that direction while monitoring covid prevalence, vaccination rates, and new variants for the next month or more.
My current lifestyle that I’ve experimented with for the last several days includes eating indoors at restaurants (but being mindful of how long I spend at indoor restaurants and how often I go); hugging and hanging out indoors unmasked in small groups with some consenting friends and family who are at least one of young/healthy, vaccinated, or have recovered from covid in the past. I’m probably interested in attending large events outdoors such as concerts so long as people are mostly masked and are not crammed shoulder-to-shoulder. And also small indoor parties with an adequate combination of social distancing, ventilation, and vaccine coverage.
But so far I’m avoiding such activities as going to especially crowded restaurants/bars where I would be spending a lot of time within three feet of many unmasked people, riding on a crowded subway at rush hour, attending crowded indoor concerts, attending large indoor conventions, playing Spin the Bottle, or getting anywhere near other people who are sick and who I assign a substantial probability of having covid. I think those types of activities I will continue to wait on as I monitor the prevalence of covid and spread of variants.
I think that for the next few months, we should maintain legal restrictions on very large gatherings such as the potential superspreader type events that I discuss near the top of this post, either forbidding these sorts of gatherings or requiring most or all attendees to be masked or vaccinated or test negative. Setting guidelines that we will return further to normal once enough people are vaccinated, or allowing vaccinated people different privileges from unvaccinated, may coerce people to get vaccinated, to the benefit society. This will give us a chance at actually hitting something resembling herd immunity through vaccination and preventing a new vaccine-resistant strain from spreading while the overall vaccination rate is lower. I agree that it’s problematic to have unenforced regulations. I think the optimal solution to this, both with covid and other unrelated areas of law (though it’s much easier said than done) is to reduce the number of regulations and more strenuously enforce the most critical regulations.
I haven’t fully grappled yet with the numbers around vaccine resistance, given that I was Fermi-ing something like 2-3x different and not 10x different. But my conclusion is mostly meant to hold up in spite of mistakes there; even if the vaccine was less effective than you thought, what does it get us if we keep social distancing for awhile? Unless we get eradication, it seems like the options are almost binary: eradicate it (~impossible) or go back to normal, unless you have a very good plan for threading the needle in some other way.
I’m pretty fine with a few more months of restrictions on superspreader events until we’re more vaccinated, although I still think we have shown through the last year that we’re in a not-very-cautious control system and so we shouldn’t ban much stuff that will hurt some people and then just cause others to be less cautious.
I see a substantial possibility of near-eradication. Not like we eradicated smallpox, but maybe almost as well as we’ve done with measles? It’s not clear yet what percentage immunity we need need to achieve herd immunity. But given the figures from the past month or so, there’s a decent chance we’re heading in that direction. Even if we can achieve herd immunity, that may not be a good enough argument to ban superspreader events for now—we would achieve herd immunity regardless when we get R<1 with respect to normal activity. But there’s the further factor that by continuing to reduce transmission while more people are vaccinated, we reduce the chance of variants.
There’s also the possibility that we can eventually achieve near-eradication through a combination of immunity and good contact tracing, but we may only have few enough cases to do the contact tracing if we can get the case count down to a manageable level through continued social distancing for a while first.
Do those scenarios seem plausible to you? Why do you believe that the options are almost binary?
I think I see a larger possible downside than you do regarding variants. It seems possible that we could get a variant against which our current vaccines are less than 50% effective, and if we can reduce the chance of that happening through continued restrictions, I think it’s worthwhile.
Distributing more vaccines to the rest of the world would be a bigger intervention in that regard, but perhaps through continued travel restrictions combined with some vaccine protection, we can prevent especially bad variants from spreading worldwide the way the original pandemic did.