Sunday, January 24, 2021

Biden's Big COVID-19 Plan

 So now that Joe Biden was sworn in, it was inevitable he would come up with his own COVID-19 plan (PDF). It's not all terrible, but there are a number of troubling signs that he's about to adopt the kinds of stupid, bureaucratic responses that have hamstrung much of the local efforts, particularly with vaccination. An overview:

 The first order of business is to "[r]estore trust with the American people." To do this, he proposes the government "Establish a national COVID-19 response structure where decision-making is driven by science and equity." Okay, let's step back a minute: what the heck is "equity"? As Andrew Sullivan recently wrote in his Substack space,

...[E]quity means giving the the named identity groups a specific advantage in treatment by the federal government over other groups — in order to make up for historic injustice and “systemic” oppression. Without “equity”, the argument runs, there can be no real “equality of opportunity.” Equity therefore comes first. Until equity is reached, equality is postponed — perhaps for ever.

 Biden doesn't name his preferred groups, but I scarcely need to mention they're what the left refers to as People of Color. This was something the CDC tried and was forced to recant weeks ago in a draft vaccine rollout schedule. So once again, we're going to deal with more efforts to inject racialized everything at a time when vaccinations are ponderously slow.

The rest of that point is largely boilerplate and anodyne (although the continued use of "Biden-Harris administration" is a strong Tell that Joe doesn't intend to be around much longer). Perhaps more interesting is the plan to "Mount a safe, effective, comprehensive vaccination campaign."

Central to this effort will be additional support and funding for state, local, Tribal, and territorial governments improved line of ight into supply – to ensure that they are best prepared to mount local vaccination programs.

This legitimately will be a substantial improvement from the Trump administration's leave-the-vaccine-on-the-loading-dock-without-telling-the-hospitals approach. However, in the next graf on ensuring availability of vaccine, the piece once more raises the Defense Production Act as a means to increase vaccine manufacturing capacity. As with N95 masks, the problem isn't the will, but staffing and expertise necessary to build out specialized manufacturing capacity that doesn't yet exist. At best, it might help with simple things like stoppers, vials, or syringes, but the real bottleneck is on the vaccine supply side. With recent news stories of production difficulties with Pfizer (albeit in Europe), AstraZeneca, and newcomers Janssen (Johnson & Johnson) and Novavax, it's hard to imagine how anything else could be the case. (Michael Abramowicz gave a good background in Reason as to why the DPA is a non-solution to most production problems, and why it could actually exacerbate shortages if used incorrectly.)

As to the point to "[a]ccelerate getting shots into arms and get vaccines to communities that need them most", the "Administration will end the policy of holding back significant levels of doses." This is actually pretty funny, because the Trump administration drew significant criticism for doing exactly this over a week ago.

Skipping ahead to the next part, "Implement masking nationwide by working with governors, mayors, and the American people" is surprisingly good news coming from a Democratic president. It implicitly acknowledges, contrary to partisan fears of federal lockdowns and masking requirements, that the ultimate responsibility for such public health measures rests at the local level and not the CDC or FDA. Likewise, so is the emphasis on expanding testing — though the value of this depends heavily on whether the FDA persists in confusing diagnostic and surveillance testing.

As I've already covered the limitations of the Defense Production Act, I pass over Goal Four, "Immediately expand emergency relief and exercise the Defense Production Act". Goal Five, "Safely reopen schools, businesses, and travel, while protecting workers" seems oddly duplicative with prior efforts in this space. As with Biden's 100-day vaccination goal that was nearly met on the day he was inaugurated, his point here seems more expectations management than goal-setting. But Goal Six is a gallimaufry of "don't let a crisis go to waste" thinking, using the pandemic as an excuse to create a "COVID-19 Health Equity Task Force", followed by a call to "[s]trengthen the social service seafety net to address unmet basic needs", and "increasing data collection and reporting for high risk groups" (read: by race). "Ensure equitable access to critical COVID-19 PPE, tests, therapies, and vaccines" reads very like there will be a long list of rules for vaccine distribution of the sort that stalled vaccinations in New York.

The final section, Goal Seven, "Restore U.S. leadership globally and build better preparedness for future threats" is mostly about patching things up with the WHO, despite the latter's well-known failures. What's interesting about the "preparedness" part is that it doesn't even mention PPE stockpiles, a widely-remarked-upon failing early in the pandemic.

On whole, it's a political document more than it lays out a serious plan forward, with much derived from the Trump administration before it. There's some good parts (at least he didn't try to roll out a parallel federal health agency at the county level!), but there's serious risk of the Team Blue hidebound incompetence that has put California and New York near the bottom of arms vaccinated per capita statistics being nationalized. That must be resisted at all costs.

I tweeted about a couple (mostly better) alternative views here, and will eventually get a response to those out the door.

Maybe We're Not Helping? The Public Health Fiasco

An interesting piece in Medpage Today from a few weeks ago: "Op-Ed: Why Did Fauci Move the Herd Immunity Goal Posts?"

Late last week, Fauci told the New York Times that new science had changed his thinking on the herd immunity threshold -- but he also admitted that his statements were influenced in part by "his gut feeling that the country is finally ready to hear what he really thinks."

Specifically, the fraction of people who would need immunity to SARS-CoV-2 (either through vaccination or recovery from prior infection) to extinguish the spread of the virus was initially estimated to be 60% to 70%. In recent weeks, Fauci had raised the percentage: from 70% to 75%, and then to 75%, 80%, and 85%.

The problem with Fauci is his obvious moving of the goalposts and explicit admission that he's playing us:

"When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 percent," Fauci said. "Then, when newer surveys said 60 percent or more would take it, I thought, 'I can nudge this up a bit,' so I went to 80, 85."

Similar sentiments in Bloomberg Opinion: "Pandemic Regrets? Experts Have a Few":

In the last couple of weeks, I’ve asked a number of experts what they know now that they wish they’d known in the spring, and where they think public health got things wrong. Two big trends emerged: lockdowns (too blunt) and testing (too slow). With months left to go before vaccination can curtail the pandemic, 2020’s regrets should be 2021’s lessons.

University of Minnesota epidemiologist Michael Osterholm, a member of Biden’s advisory board, said one March mistake was closing businesses in places in the middle of the country that had seen almost no cases. “Was it appropriate to shut down so many things back then when there was so little, if any transmission? I think you can argue now that probably was not the best use of resources … it clearly alienated the very populations that we needed to have work with us,” he says.

The time was squandered and so was public trust. He compares the situation to hurricane warnings. People take them seriously because they are usually right. In many Midwest states, people went into emergency mode at the wrong time.


Monday, January 18, 2021

The Wish For A Uniform Federal Vaccination Response Is Pure Narcissism

One of the most irritating things to come out of the COVID-19 pandemic is the repeated wish from epidemiological, scientific, and legal circles for a uniform, federal policy regarding vaccination distribution. If only such a policy were around, we are told, the problems of getting shots in arms would magically vanish. But why should this be so? Why should we not inspect the records of some of the allegedly virtuous blue states — like, say, New York, whose sclerotic vaccination policy led to many doses thrown away? His all-stick, no-carrot approach led to this, and his "fix" may still result in wasted doses. So in California. Whether you believe Govex or the CDC (data updated mostly daily, so this may change by the time you read this), California is near the bottom of getting shots into arms on a population-adjusted basis. And then there was the whole fiasco of the CDC being forced to walk back its unscientific early trial balloons that would have prioritized people at least partly on race. Surely, this didn't help to protect the elderly, the group most at risk.

Why should we believe a larger, more hidebound entity would do a better job at this? The reason this belief gets so much traction is pretty simple: because the people making this assertion believe it would be themselves (or like-minded compatriots) running the show. The same thing fuels the endless demand for socialism, and is just as wrong. Instead, we need to look at places that are actually getting things done ­— like, improbably, West Virginia, which state eschewed the federal agreement with CVS and Walgreens, instead favoring local pharmacies with existing arrangements with long-term care facilities. This should be obvious based on outcomes alone, but much that should be obvious never is.

Thursday, January 7, 2021

The Myth Of The "Mostly Peaceful Protests" And Unprovable Counterfactuals

Donald Trump, still pressing the narrative of a stolen election, met with protesters hoping to shut down the formal electoral vote count. These protests later turned into an absurd, theatrical farce, with dozens arrested and four dead. Very quickly, Joe Biden went straight into absurdities of his own, pretending that the kid-gloves treatment afforded the George Floyd protesters of last summer did not happen, and that they were instead somehow manhandled by the police:

Kamala Harris and Michelle Obama made similar statements: This is the purest of self-delusion. In fact, the summer protests are likely to go down as the most expensive in US history, with mayors in, at least, Seattle, Portland (especially), and Minneapolis all taking little effort and/or being slow to suppress the violence. Seattle only finally cracked down on October 3, but Minneapolis continues to have problems, and Portland Mayor Ted Wheeler actually said something mean about violent protesters. Yes, Trump famously (and stupidly) got unmarked federal police (some from the Bureau of Prisons) on the scene in D.C., and also to Seattle, but both dispersed relatively quickly. It's hard to look at this and conclude this is nothing but a narrative in search of its own facts — and that Democrats have no interest whatsoever in an honest accounting of any misdeeds from their side of the aisle.