Thursday , September 23 2021
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Covid incompetence

Summary:
 WWII started badly for the United States. Our tanks blew up. Our torpedoes were duds. Our airplanes were outclassed. Many commanders were incompetent, soldiers green, supplies chaotic. We lost a lot of battles.  But we learned. The lessons of each mistake were incorporated, incompetent commanders sacked, soldiers learned their terrible craft. Delta is the fourth wave ...

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 WWII started badly for the United States. Our tanks blew up. Our torpedoes were duds. Our airplanes were outclassed. Many commanders were incompetent, soldiers green, supplies chaotic. We lost a lot of battles.  But we learned. The lessons of each mistake were incorporated, incompetent commanders sacked, soldiers learned their terrible craft. 

Delta is the fourth wave of covid, and amazingly the US policy response is even more irresolute than the first time around. Our government is like a child, sent next door to get a cup of sugar, who gets as far as the front stoop and then wanders off following a puppy. 

The policy response is now focused on the most medically ineffective but most politically symbolic step, mask mandates. All all-night disco in Provincetown turns in to a superspreader event so... we make school kids wear masks in outdoor summer camps? Masks are several decimal places less effective than vaccines, and less effective than "social distance" in the first place.* Go to that all night disco, unvaccinated, but wear a mask? Please.   

If we're going to do NPI (non pharmaceutical interventions), policy other than vaccines, the level of policy and public discussion has tragically regressed since last summer. Last summer, remember, we were all talking about testing. Alex Tabarrok and Paul Romer were superb on how fast tests can reduce the reproduction rate, even with just voluntary isolation following tests. Other countries had competent test and tracing regimes. Have we built that in a year? No. (Are we ready to test and trace the next bug? Double no.) 

What happened to the paper-strip tests you could buy for $2.00 at Walgreen's, get instant results, and maybe decide it's a bad idea to go to the all night dance party? Interest faded in November. (Last I looked, the sellers and FDA were still insisting on prescriptions and an app sign up, so it cost $50 and insurance "paid for" it.) What happened to detailed local data? Did anyone ever get it through the FDA's and CDCs thick skulls that even imperfect but cheap and fast tests can be used to slow spread of disease? 

Last summer, we were talking about super-spreader events, and the idea that you don't have to have disastrous lockdowns of everything but maybe packed all-night disco parties are a bad idea? (Reopen smart, I wrote at the time, for example here) Today, silence. Masks. Nice big symbolic masks.  Period.

And then we indulge another round of America's favorite pastime, answers in search of a question. Delta is spreading, so... extend the renter eviction moratorium. People who haven't paid rent in a year can stay, landlords be damned. Usually our government mandates A shall give to B because it isn't willing to spend the money directly. Hilariously in this case it's because the government is simply unable to shovel rent money out the door, even to the scammers who have gotten so much unemployment money.  Somehow throwing people who don't pay rent into "the street" is our major source of covid spread, but releasing a wave of illegal undocumented migrants into "the community" in the next story does not, and the same people free to go to all night disco parties is not a danger. (Disclaimer: I'm all for immigration, but not for hypocrisy.) By and large the Administration and commenters can't even bother to pretend that stopping evictions has anything to do with stopping the spread of covid, the only source of government's authority. (One example I just happened to hear as I was writing this, PBS' interview of Secretary Fudge.) The rent is too damn high is all you need to know.

In the talk "pandemic of the unvaccinated," I hear, basically, resignation. We offered you vaccines. If you won't take them, fine, we're done. We're back really to what quite a few people argued for and were pilloried for in March 2020. Let it sweep through, get to herd immunity, it peters out, bury the dead and go on with life. 

The good news. A reproduction rate of 6 means Delta will spread really fast, peak really fast, and decline fast. The bad news: a lot of people will needlessly get sick and quite a few will die. The economy will slow down as people voluntarily pull back. Evolution got one more step ahead of bureaucratic bungling. A variant that transmits even more easily through vaccinated people can't be far behind.  

It did not have to happen.  The vaccine was in hand, the lines were done, anyone could walk in and get the vaccine. All we had left to do was get pretty much everyone vaccinated before the new variant hit, and it would have been pretty much over. Something like $5 trillion dollars of extra debt, the economy closed for a year, thousands dead, thousands unemployed, huge pain and now we lose sight of the ball when all we had to do was pay a little attention, get some small incentives going for everyone to get vaccinated. (Aaron Stupple suggested, just pay people $1,000 to get vaccinated. 100 million people times $1,000 is $100 billion. Couch change in what the pandemic has cost us, or the upcoming $3.5 trillion "infrastructure" bill. That's not much more than rail and transit subsidies alone. ) 

Just walk over the finish line and don't get distracted by that puppy -- or, in the case of our politics, get distracted by whether extending the wonderful job the public schools are doing to free pre-k for every toddler in the country is a good idea and counts as "infrastructure,"  whether we should refer to global warming as a climate "emergency" or "catastrophe,"  just how many trillions of dollars the government should print and spread around, and all the other brouhahas that keep Washington busy and distracted from basic governance, like stamping out the embers of a pandemic.

Yes, we are now, in the middle of it, slowly getting serious about vaccination. But, as my best post from last year pointed out, if you react to the level of disease, it's like turning the shower from hot to cold when it gets cold, and vice versa. You end up with waves. We ended up with waves. The fight against a virus has to anticipate the next wave, stamp out the embers during the lull. This is not new knowledge. You don't stop taking antibiotics when you feel better. Serious efforts to stamp out infectious diseases -- small pox, polio -- put huge effort in to the dwindling cases. 

Were anyone watching, it was easy to see that getting full vaccination was not going to be a cake-walk. Delta was known by spring, and its high reproduction rate was known. That pushes up the limit for herd immunity. And it was known that after around 60 or 70% of the population vaccinated, it gets really hard. As Stanford's Robert Kaplan reports in WSJ

A poll completed in August 2020 showed that about 20% of the population reported they were very unlikely to take a vaccine even if the evidence suggested it was safe and effective. Another 15% said they were unlikely to take it.  

It's a fun narrative that refusers are all troglodyte Republican anti-vaxxers influenced by crazies spreading "mis-information" on the remaining uncensored bits of the internet. That's not the whole or even major story.  Other countries are maxing out at 70% or so too. And here, straight from the CDC, look at the ethnic breakdown. 

Covid incompetence

Not a lot of Hispanic/Latino or Blacks are Trumpers! Last spring the standard  narrative went on about the tragic racial injustice in vaccine "access." That narrative is now weirdly silent. Well, it just won't hold when anyone can now drop in and get a vaccine, free, fast. Beating the anti-Trumper narrative is so much more convenient. But, folks, these are the people who are going to die. Interviewed on NPR, many quickly cite  Tuskeegee. I guess we reap the reward of  CRT taking over public health history in the public schools. Everyone knows about Tuskeegee. Nobody has heard about smallpox, polio, measles, mumps, and just how many people used to die like flies.  

The internet is awash with misinformation about the vaccines. But data distortion seems to have little effect on vaccine uptake. Well over a year ago, 35% told us they wouldn’t take the vaccine, and they have kept their word. The recent increase in vaccine uptake appears to be among people who initially said they would “wait and see.”

This isn't "misinformation" cured by even more internet censorship. Indeed, it is the opposite. People know that the internet is censored, that public authorities have been lying to them all along.  After mask/no mask, Wuhan lab/no Wuhan lab, FDA explicitly trying to manipulate public psychology in delaying approval and the J&J pause, and so on, people have lost trust. CDC flip flopping on masks clearly under political pressure did not help. And none of them present facts.  The cry of wolf falls on deaf ears.  

Even the vaccine discussion now hews to the joke that everything must be either mandatory or banned. We jump to vaccine mandates, cops coming to your door to hold you down and jab you. That was not necessary and still is not. But not until this week or so is anyone talking about allowing even minor incentives to get vaccinated. Allow cruise ships to say, you're free not to get vaccinated, but you're not free to step on this private property without a vaccine! That's slowly happening, but way way too late. This needed to happen before the wave. 

Of course, only a few weeks ago did the FDA even think that maybe it's time to speed up full approval of the vaccine. The anti-vaxxers have a point. It's mighty hard to talk about vaccine mandates when it only has an emergency use authorization. 

What's going on with the Great Forgetting? Well, as with so many other things, it is to nobody's institutional interest to remember just how many mistakes were made the first time, how much better things could have been. To learn from the mistakes, and institutionalize better responses would mean to admit there were mistakes. One would think the grand blame-Trump-for-everything narrative would allow us to do that, but the mistakes are deeply embedded in the bureacracies of the administrative state. Unlike bad admirals in WWII, nobody less than Trump himself has lost their job over incompetent covid response. The institutions have an enormous investment in ratifying that they did the best possible job last time. So, as in so many things (financial bailouts!) we institutionalize last time's mistakes to keep those who made them in power in power -- which means we do not learn from mistakes. 

Delta will blow through in a couple of months. It looks like it takes about 6 months for immunity to die out, and the same for a new variant to adapt. See you in February or so, and let's see just how many more basics of public health our government can forget in the meantime. Yeah, Grumpy is grumpy today. 

More: A spectacular piece on the FDA by Scott Alexander, which I plan to blog shortly. (HT Russ Roberts) But worth it now. The piece is particularly good for diagnosing the FDAs awful incentives, which is how good people get wrapped up in a dysfunctional institution.  Zeynep Tufekci  and separately Jeneen Interlandi on the CDC, in the NYT no less (HT marginal revolution). MR on the NIH in the pandemic:

● Of the $42 Billion 2020 NIH annual budget, 5.7% was spent on COVID-19 research

* On masks. Of the many things we don't know, just how much masks help or don't help is one of them. You think with $42 billion dollars one could find out. Of the studies I have read and seen cited, I see a guesstimate of 20% reduction in reproduction rate. So if Delta has R0=6, masks might reduce that to 4.8. Even if a vaccine is only 50% effective in stopping transmission, then R0 among the vaccinated is 0.25. 

Masks do much more to stop you from giving it to someone else than to protect you. Cloth masks are close to useless. Well-fitting N95 masks work much better in both directions. Neither comes close to vaccination. Wearing cloth masks outdoors, far from other people, in the wind, as is the fashion in Palo Alto, is just part and parcel of the pointless virtue-signaling so prominent here. If you do go to that crowded all-night disco, wearing an N95 mask might be a good idea. Of course if you’re even thinking about wearing a mask, you’re not going in the first place, which is why the whole mask-mandate business is a bit silly.

I welcome comments pointing to good numbers on this question. 

Update: Tweeters seem to think I argue here that masks do no good. No. For the record: Masks work a bit. Not getting in contact with other people works better. And vaccines work a lot better. 

Update 2: On the effectiveness of masks, a good summary of evidence. Note mask mandates may "work" where masks themselves don't, because forced to wear masks many people choose not to go out in the first place. But mandatory dunce caps would work as well for that. 



John H. Cochrane
In real life I'm a Senior Fellow of the Hoover Institution at Stanford. I was formerly a professor at the University of Chicago Booth School of Business. I'm also an adjunct scholar of the Cato Institute. I'm not really grumpy by the way!

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