Feb 17, 2022·edited Feb 17, 2022Liked by Jeff Maurer
Great post! I like use an analogy to talk about Covid restrictions for everyone to protect the unvaccinated: there are a lot of people out there who refuse to wear helmets when they ride their bikes. We could forbid people to drive cars in order to protect the helmetless, but we don’t. We rightly recognize that there are limits to the suffering we ought to impose on the general population in order to protect a foolish few.
I write this from Switzerland, where (except for the mask requirement in healthcare settings and on public transportation, which they’re keeping for a few more weeks) the government just lifted all Covid restrictions. All! Yippee! The government’s attitude, quite properly imho, is that vaccines are available and accessible to everyone, and an exceptionally effective treatment is about to become widely available. It’s time to be done.
I went grocery shopping this morning, and I can’t begin to convey how happy everyone (including every worker I saw—about 20 people) was not to have to wear masks.
Feb 17, 2022·edited Feb 17, 2022Liked by Jeff Maurer
Hey Jeff, one question for you - should the orange line in the second graph (the one that looks ~flat) be labeled "estimated fully vaccinated deaths" instead of "estimated unvaccinated deaths"? My read of the chart now (and, pun intended, I might be wrong) is that it seems to display an optimistic case for the unvaccinated, which I don't think is what you're going for...
I have to be honest--I'd always considered myself to be a fairly empathetic individual, but the Covid era has turned that sense of self on my part upside down. I've realized that very simply, I am not. I don't celebrate the deaths of those who are unvaccinated and are now dying of Covid, but yeah, I am not upset by them. I do feel great sympathy for the medical professionals who have to treat them. I do feel badly for their vaccinated family members. But, if you consciously make a decision not to take a lifesaving vaccine because of a political calculus, I honestly don't have sympathy for you. Life may give you the freedom of choice; it does not give you the freedom to be immune from the the consequences of those choices.
I apologize if the tone and tenor of this comment offend anyone; that is not my intention.
Interesting post. You address the question around whether we should protect people who choose not to be vaccinated. What about those who can’t be vaccinated. Should we have NPIs in place to protect them?
This is a really cogent piece. I agree with most of it, but with asterisks.
I was astounded to read that Omicron drove a death rate spike in the United States in the first week of February that was nearly as high as the pre-vaccine high in January 2021. "How is that even possible," I gasped, "isn't everyone vaccinated!?"
Turns out that the answer to that is no. 88.5% of Americans is "fully vaccinated," but only 65% are boosted. And, without a boost, mRNA vaccine protection against Omicron drops to 57% from 90%+. Which is a big deal at the aggregate, especially when you're talking about older people who are uniquely, exponentially more vulnerable.
Basically, we seem to have about 20 million American seniors who are playing Russian Roulette with a plague: they have a 50/50 chance of catching COVID and whose hospitalization and death rates are *many hundreds* of times higher than a person in their 20s. This is, for most of them, a choice. So, morally speaking, their life is theirs, right?
For some, the notion of voluntary choice is more complicated, though (here comes the asterisks...). The history of public health in America is very cursed by racism, sexism, inequality, etc. You can understand many Americans' skepticism against public health authorities (one of the reasons that Black Americans have notably low vaccination rates).
There were times during this pandemic where health authorities *did* lie. For example, why were we continually told that N95 masks weren't recommended (I know the instrumental/practical reason was that we needed to save them for health workers, but just say that, instead). Why, long after should have been clear that COVID was "airborne," did American health authorities keep denying that fact? Why is there still so much focus on surface hygiene rather than ventilation? Why did the WHO just swallow without chewing the official line coming out of China (or the United States, for that matter)? Science is a moving target, of course, and public policy has to balance many considerations (not the least politics leaning heavily on it), but why should Joe Sixpack trust an authority that has been caught in a lie?
You can also understand why structural inequalities make it at least more difficult for many Americans to get vaccines, even if they did want them. It's not always possible to take off work when you suffer post-jab symptoms... or even to just go get a shot. You might not have a healthcare provider close by or have transportation options. These are real barriers that we need to take into account when we assume that all unvaccinated or unboosted people are just "frustrating."
There's also the even more complicated variable of informed reason. If you are hypnotized by Fox News all day, can you really be said to be "of sound mind?" Numerous studies in ideological bias show the capacity for even highly educated and intelligent people to believe dubious things when they're on a not-especially-nutritious "information diet," or when that biased belief furthers social acceptance.
The susceptibility to bias and bullshit is especially strong if you are, like almost all seniors, suffering at least the early stages of cognitive decline. This isn't condescension or a snarky jab at "dumb Boomers," either. It's a real, if taboo, situation. My father had Alzheimer's for over a decade before his death and it caused noticeable cognitive decline and erosion of decision-making in a man who had prided himself in critical thinking and sharp reasoning. By the end, an award-winning investigative journalist was showing extremely bizarre thinking patterns, I can attest to you. Alzheimer's drives paranoia, for understandable reasons: everyone is always telling you things that you cannot independently verify or corroborate, so you start to suspect they are manipulating you. It's terrifying and infuriating for the sufferer! I could easily see him falling for anti-vaxxer misinformation today, if he were still alive.
So, to what degree can we really lay moral agency at the feet of all these frustrating oldsters who refuse to do the right thing to take care of themselves? Are they really free agents the way we think? Is that just a cop-out for younger people who have no idea what it is like?
Except... there is something that we're not measuring that we probably should be measuring: the impact of COVID that does not lead to death or even hospitalization. I have family who are vax'd and boosted, got Omicron, and are suffering from long-term complications after a fairly easy bout with the actual disease. This appears to be a larger problem than the viral impact from a flu.
At least 1 in 5 US Omicron deaths have been of "fully vaccinated" people. Thousands per week, in absolute terms.
I want to lead with that because it's not just an important fact, but also a hard-won fact. My source is Will Stancil (https://twitter.com/whstancil/status/1488401972789133314), who pored over 17 state-level sources to generate the 1 in 5 estimate; the CDC's relevant counts (https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e2.htm#T1_down) only run through the first week of December, so Stancil's digging was necessary. For his pains, Stancil got accused of being anti-vaccine, guilty of the base-rate fallacy, and flat-out innumerate (https://twitter.com/whstancil/status/1491517369864405001). I saw some of those attacks on Twitter, but what I didn't see was any kind of factual rebuttal. Best I can tell, Stancil was absolutely correct.
The AP's 0.8% estimate might have been applicable in the past (though it's far less than the 9% I get from the CDC April-and-May counts, unsure why) but it no longer holds. The inference that Covid's killing vaccinated people more slowly than the average flu season's 200ish per day therefore doesn't hold either. Stancil estimated 500+ per day (https://twitter.com/whstancil/status/1490731951359242241).
That doesn't automatically justify whatever NPIs people have in mind, but it does imply a bigger externality from vaccine refusal (harder to set it aside as a second-order factor), and it does complicate the vaccinated-unvaccinated divide.
Though it's your right to travel back in time and bet on the Rams, the "SCIENCE" shows that the Rams were 4-point favorites, which means you would lose that bet despite having the benefit of hindsight. But hey, who am I to forbid you from doing something stupid?
I reluctantly became more tolerant of the unvaccinated when Omicron hit and it became common for vaccinated people to spread covid. If we can all spread covid, there's not much point in forcing people to get the shot--except for taking petty pleasure in their histrionics, which I admit that I do... but health policy can't be based on my desire to stab annoying people with needles and watch them cry about it.
My main concern with this is that I think it underestimates the continuing risk to the vaccinated.
The vaccines are very effective against hospitalization and death, though we don't yet have good data on how much or how quickly they wane against omicron. (Most estimates for boosters just don't have a lot of data more than a few weeks out.)
Long term Covid issues remain a problem. E.g., the recent paper showing substantially elevated cardiovascular risk in recovered Covid patients, including those with mild illness, for at least a year. Those deaths won't count as Covid deaths when they come, but Covid will still be a but-for cause for them.
Studies keep showing around 50% vaccine efficacy against long Covid, in contrast to 90-odd percent against death. That's still significant, but still points to a lot of disabling events across the population when you have something that spreads almost as effectively as measles.
Prevalence really matters, and the variants keep getting more transmissible. I think if we stop doing anything to control it, especially while antivirals and effective monoclonal antibodies remain in vanishingly short supply, the human cost even to the vaccinated population will be substantial.
I think the immunosuppressed - who are effectively unvaccinated even if they have had the jab - make this calculation slightly different.
The vast majority of people with serious immunosuppression are doing full personal lockdowns because the levels of infection are too high and they are at risk. The reason they aren't dying is that they aren't getting infected, but the lack of adequate NPIs means that they are having to take all of the responsibility for protecting themselves.
Now, the calculus is different; there are many fewer of them, they are people who have to take high levels of health precautions anyway, so the additional burden of full lockdown is pretty modest compared to what it was for non-immunosuppressed people (ie, they never went to bars in the first place). But reducing from "not much human contact" to "none" may actually be worse than going from "lots" to "not much", which was how lockdowns actually worked for most of us - how many people literally went months at a time without seeing a single person who didn't live in their household?
Timothy's missteps were believing a) the grizzlies were his muse, and b) they enjoyed his singing voice. You know the adage: Never try to teach a pig to sing; it annoys the pig and only wastes your time. Turns out this is true for bears too.
Over twenty years ago on a USENET discussion about obligation and coercion I puffed that coercing someone - anyone - to do something against his will and thus deny his individual sovereignty was wrong. Which seems consistent with your conclusion - "But I am saying that we have no ethical obligation to protect people who choose not to protect themselves." In a reply, one of my interlocutors weaponized a thought experiment and pointed it at me: "Well, say your brother or close friend is addicted to cocaine, in a death spiral to overdose. You let it happen and don't intervene, if it means you need to force him into treatment to save him?" I stuck to my guns and said no. 25 years later I'm not so sure.
Not saying it would be ethically right to force a vaccine on someone to protect him from his wrongheadedness. Just wondering if ethical obligations aren't everywhere black & white and where to draw the line.
You touched on this briefly, but I think it needs be emphasized that by making the decision not to protect yourself from a highly infectious disease you lose any right to complain if a private business won’t let you in the door without proof of vaccination.
My wife and I just lost a 20 year friendship over this exact issue. It’s beyond sad.
Timothy Treadwell was like Andy Dick on meth in Grizzly Man. He got into a shrieking diva fight with a fox who stole his hat-all chronicled by Werner Herzog!
I’ll wade in here. First two facts: I’m fully vaccinated, including a booster. Second, I’m Canadian with full “socialist” health care but don’t dismiss me out of hand. Read my comment before calling me names.
The bear analogy seems a bit off the mark. There is no conceivable connection between the bear-man’s actions and me or anyone else living the in the Alaska bush for that matter. So, unless eating the bear-man lengthens the life of said bear resulting in the death next bush walker, no harm no foul. A better analogy than bear-man is a guy with a 10-acre property target shooting in what he thinks is safe manner. But, continuing the basketball references; off the rock, between the trees, skipping across the pond, bouncing off the guardrail, through the window of a passing car and into some innocent’s cranium (nothing but net), the random shooter kills the passerby (please don’t get all second amendmenty me, that’s not the point). Not getting vaccinated potentially harms other, unless the non-vaxed stays in isolation, note that puts the burden on them as it should since it’s their act which imperils others.
Second quibble, wearing a seatbelt it not potentially harmful to the driver. Ya sure the car catches fire and you can’t get out, blah, blah, blah. The good news is without a seatbelt you’re already dead. The cost to society is a fair argument, at least up here. We all end up paying for your hospital care, so click it. On the other hand, there are a lot of dangerous activities which could end up costing our health care system. The difference is of course, those activities do not hurt others in any direct way. Putting a substance into your body which, for all the good science, is a risk and certainly more of a personal preference and therefore a right.
In conclusion (what the heck was my point), stay unvaccinated if you want, but you are the one who must suffer the consequences and I don’t mean your personal health. You shut yourself in and stay away from my grandmother, well if she were alive that is.
Great post! I like use an analogy to talk about Covid restrictions for everyone to protect the unvaccinated: there are a lot of people out there who refuse to wear helmets when they ride their bikes. We could forbid people to drive cars in order to protect the helmetless, but we don’t. We rightly recognize that there are limits to the suffering we ought to impose on the general population in order to protect a foolish few.
I write this from Switzerland, where (except for the mask requirement in healthcare settings and on public transportation, which they’re keeping for a few more weeks) the government just lifted all Covid restrictions. All! Yippee! The government’s attitude, quite properly imho, is that vaccines are available and accessible to everyone, and an exceptionally effective treatment is about to become widely available. It’s time to be done.
I went grocery shopping this morning, and I can’t begin to convey how happy everyone (including every worker I saw—about 20 people) was not to have to wear masks.
Hey Jeff, one question for you - should the orange line in the second graph (the one that looks ~flat) be labeled "estimated fully vaccinated deaths" instead of "estimated unvaccinated deaths"? My read of the chart now (and, pun intended, I might be wrong) is that it seems to display an optimistic case for the unvaccinated, which I don't think is what you're going for...
I have to be honest--I'd always considered myself to be a fairly empathetic individual, but the Covid era has turned that sense of self on my part upside down. I've realized that very simply, I am not. I don't celebrate the deaths of those who are unvaccinated and are now dying of Covid, but yeah, I am not upset by them. I do feel great sympathy for the medical professionals who have to treat them. I do feel badly for their vaccinated family members. But, if you consciously make a decision not to take a lifesaving vaccine because of a political calculus, I honestly don't have sympathy for you. Life may give you the freedom of choice; it does not give you the freedom to be immune from the the consequences of those choices.
I apologize if the tone and tenor of this comment offend anyone; that is not my intention.
Interesting post. You address the question around whether we should protect people who choose not to be vaccinated. What about those who can’t be vaccinated. Should we have NPIs in place to protect them?
This is a really cogent piece. I agree with most of it, but with asterisks.
I was astounded to read that Omicron drove a death rate spike in the United States in the first week of February that was nearly as high as the pre-vaccine high in January 2021. "How is that even possible," I gasped, "isn't everyone vaccinated!?"
Turns out that the answer to that is no. 88.5% of Americans is "fully vaccinated," but only 65% are boosted. And, without a boost, mRNA vaccine protection against Omicron drops to 57% from 90%+. Which is a big deal at the aggregate, especially when you're talking about older people who are uniquely, exponentially more vulnerable.
Basically, we seem to have about 20 million American seniors who are playing Russian Roulette with a plague: they have a 50/50 chance of catching COVID and whose hospitalization and death rates are *many hundreds* of times higher than a person in their 20s. This is, for most of them, a choice. So, morally speaking, their life is theirs, right?
For some, the notion of voluntary choice is more complicated, though (here comes the asterisks...). The history of public health in America is very cursed by racism, sexism, inequality, etc. You can understand many Americans' skepticism against public health authorities (one of the reasons that Black Americans have notably low vaccination rates).
There were times during this pandemic where health authorities *did* lie. For example, why were we continually told that N95 masks weren't recommended (I know the instrumental/practical reason was that we needed to save them for health workers, but just say that, instead). Why, long after should have been clear that COVID was "airborne," did American health authorities keep denying that fact? Why is there still so much focus on surface hygiene rather than ventilation? Why did the WHO just swallow without chewing the official line coming out of China (or the United States, for that matter)? Science is a moving target, of course, and public policy has to balance many considerations (not the least politics leaning heavily on it), but why should Joe Sixpack trust an authority that has been caught in a lie?
You can also understand why structural inequalities make it at least more difficult for many Americans to get vaccines, even if they did want them. It's not always possible to take off work when you suffer post-jab symptoms... or even to just go get a shot. You might not have a healthcare provider close by or have transportation options. These are real barriers that we need to take into account when we assume that all unvaccinated or unboosted people are just "frustrating."
There's also the even more complicated variable of informed reason. If you are hypnotized by Fox News all day, can you really be said to be "of sound mind?" Numerous studies in ideological bias show the capacity for even highly educated and intelligent people to believe dubious things when they're on a not-especially-nutritious "information diet," or when that biased belief furthers social acceptance.
The susceptibility to bias and bullshit is especially strong if you are, like almost all seniors, suffering at least the early stages of cognitive decline. This isn't condescension or a snarky jab at "dumb Boomers," either. It's a real, if taboo, situation. My father had Alzheimer's for over a decade before his death and it caused noticeable cognitive decline and erosion of decision-making in a man who had prided himself in critical thinking and sharp reasoning. By the end, an award-winning investigative journalist was showing extremely bizarre thinking patterns, I can attest to you. Alzheimer's drives paranoia, for understandable reasons: everyone is always telling you things that you cannot independently verify or corroborate, so you start to suspect they are manipulating you. It's terrifying and infuriating for the sufferer! I could easily see him falling for anti-vaxxer misinformation today, if he were still alive.
So, to what degree can we really lay moral agency at the feet of all these frustrating oldsters who refuse to do the right thing to take care of themselves? Are they really free agents the way we think? Is that just a cop-out for younger people who have no idea what it is like?
Except... there is something that we're not measuring that we probably should be measuring: the impact of COVID that does not lead to death or even hospitalization. I have family who are vax'd and boosted, got Omicron, and are suffering from long-term complications after a fairly easy bout with the actual disease. This appears to be a larger problem than the viral impact from a flu.
At least 1 in 5 US Omicron deaths have been of "fully vaccinated" people. Thousands per week, in absolute terms.
I want to lead with that because it's not just an important fact, but also a hard-won fact. My source is Will Stancil (https://twitter.com/whstancil/status/1488401972789133314), who pored over 17 state-level sources to generate the 1 in 5 estimate; the CDC's relevant counts (https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e2.htm#T1_down) only run through the first week of December, so Stancil's digging was necessary. For his pains, Stancil got accused of being anti-vaccine, guilty of the base-rate fallacy, and flat-out innumerate (https://twitter.com/whstancil/status/1491517369864405001). I saw some of those attacks on Twitter, but what I didn't see was any kind of factual rebuttal. Best I can tell, Stancil was absolutely correct.
The AP's 0.8% estimate might have been applicable in the past (though it's far less than the 9% I get from the CDC April-and-May counts, unsure why) but it no longer holds. The inference that Covid's killing vaccinated people more slowly than the average flu season's 200ish per day therefore doesn't hold either. Stancil estimated 500+ per day (https://twitter.com/whstancil/status/1490731951359242241).
That doesn't automatically justify whatever NPIs people have in mind, but it does imply a bigger externality from vaccine refusal (harder to set it aside as a second-order factor), and it does complicate the vaccinated-unvaccinated divide.
Though it's your right to travel back in time and bet on the Rams, the "SCIENCE" shows that the Rams were 4-point favorites, which means you would lose that bet despite having the benefit of hindsight. But hey, who am I to forbid you from doing something stupid?
I reluctantly became more tolerant of the unvaccinated when Omicron hit and it became common for vaccinated people to spread covid. If we can all spread covid, there's not much point in forcing people to get the shot--except for taking petty pleasure in their histrionics, which I admit that I do... but health policy can't be based on my desire to stab annoying people with needles and watch them cry about it.
My main concern with this is that I think it underestimates the continuing risk to the vaccinated.
The vaccines are very effective against hospitalization and death, though we don't yet have good data on how much or how quickly they wane against omicron. (Most estimates for boosters just don't have a lot of data more than a few weeks out.)
Long term Covid issues remain a problem. E.g., the recent paper showing substantially elevated cardiovascular risk in recovered Covid patients, including those with mild illness, for at least a year. Those deaths won't count as Covid deaths when they come, but Covid will still be a but-for cause for them.
Studies keep showing around 50% vaccine efficacy against long Covid, in contrast to 90-odd percent against death. That's still significant, but still points to a lot of disabling events across the population when you have something that spreads almost as effectively as measles.
Prevalence really matters, and the variants keep getting more transmissible. I think if we stop doing anything to control it, especially while antivirals and effective monoclonal antibodies remain in vanishingly short supply, the human cost even to the vaccinated population will be substantial.
I think the immunosuppressed - who are effectively unvaccinated even if they have had the jab - make this calculation slightly different.
The vast majority of people with serious immunosuppression are doing full personal lockdowns because the levels of infection are too high and they are at risk. The reason they aren't dying is that they aren't getting infected, but the lack of adequate NPIs means that they are having to take all of the responsibility for protecting themselves.
Now, the calculus is different; there are many fewer of them, they are people who have to take high levels of health precautions anyway, so the additional burden of full lockdown is pretty modest compared to what it was for non-immunosuppressed people (ie, they never went to bars in the first place). But reducing from "not much human contact" to "none" may actually be worse than going from "lots" to "not much", which was how lockdowns actually worked for most of us - how many people literally went months at a time without seeing a single person who didn't live in their household?
A couple thoughts.
Timothy's missteps were believing a) the grizzlies were his muse, and b) they enjoyed his singing voice. You know the adage: Never try to teach a pig to sing; it annoys the pig and only wastes your time. Turns out this is true for bears too.
Over twenty years ago on a USENET discussion about obligation and coercion I puffed that coercing someone - anyone - to do something against his will and thus deny his individual sovereignty was wrong. Which seems consistent with your conclusion - "But I am saying that we have no ethical obligation to protect people who choose not to protect themselves." In a reply, one of my interlocutors weaponized a thought experiment and pointed it at me: "Well, say your brother or close friend is addicted to cocaine, in a death spiral to overdose. You let it happen and don't intervene, if it means you need to force him into treatment to save him?" I stuck to my guns and said no. 25 years later I'm not so sure.
Not saying it would be ethically right to force a vaccine on someone to protect him from his wrongheadedness. Just wondering if ethical obligations aren't everywhere black & white and where to draw the line.
You touched on this briefly, but I think it needs be emphasized that by making the decision not to protect yourself from a highly infectious disease you lose any right to complain if a private business won’t let you in the door without proof of vaccination.
My wife and I just lost a 20 year friendship over this exact issue. It’s beyond sad.
Timothy Treadwell was like Andy Dick on meth in Grizzly Man. He got into a shrieking diva fight with a fox who stole his hat-all chronicled by Werner Herzog!
The vaxx doesn’t protect others from spread/contraction BY you, it simply protects you-which one would think is common sense.
I’ll wade in here. First two facts: I’m fully vaccinated, including a booster. Second, I’m Canadian with full “socialist” health care but don’t dismiss me out of hand. Read my comment before calling me names.
The bear analogy seems a bit off the mark. There is no conceivable connection between the bear-man’s actions and me or anyone else living the in the Alaska bush for that matter. So, unless eating the bear-man lengthens the life of said bear resulting in the death next bush walker, no harm no foul. A better analogy than bear-man is a guy with a 10-acre property target shooting in what he thinks is safe manner. But, continuing the basketball references; off the rock, between the trees, skipping across the pond, bouncing off the guardrail, through the window of a passing car and into some innocent’s cranium (nothing but net), the random shooter kills the passerby (please don’t get all second amendmenty me, that’s not the point). Not getting vaccinated potentially harms other, unless the non-vaxed stays in isolation, note that puts the burden on them as it should since it’s their act which imperils others.
Second quibble, wearing a seatbelt it not potentially harmful to the driver. Ya sure the car catches fire and you can’t get out, blah, blah, blah. The good news is without a seatbelt you’re already dead. The cost to society is a fair argument, at least up here. We all end up paying for your hospital care, so click it. On the other hand, there are a lot of dangerous activities which could end up costing our health care system. The difference is of course, those activities do not hurt others in any direct way. Putting a substance into your body which, for all the good science, is a risk and certainly more of a personal preference and therefore a right.
In conclusion (what the heck was my point), stay unvaccinated if you want, but you are the one who must suffer the consequences and I don’t mean your personal health. You shut yourself in and stay away from my grandmother, well if she were alive that is.