Notes on Trump 62 – covid-19 and Biden

Biden got more votes than Trump largely because of Trump’s catstrophically bad leadership on covid-19.

Trump was very good at provoking enough insanity from deranged liberals that he looked like getting a second term simply based on being hated by deranged people rather than having actually delivered anything.

The Democrats were so hopeless that despite running against a Trump who could be blamed for many of the 400,000 deaths they nearly lost in the Electoral College and there are serious doubts as to whether their victory was lawful.

The Biden administration has just released a 200 page strategy for covid-19:

Click to access National-Strategy-for-the-COVID-19-Response-and-Pandemic-Preparedness.pdf

I have only skimmed the first half. I could not bear to even skim the second half which had chapters on “equity” and “US leadership” plus the full text of Executive Orders to implement the strategy.

As far as I can see the strategy document adequately highlights the fact that the current wave is spreading uncontrolled across the USA and will get worse, with hospital systems already starting to be overwhelmed. That is better than Trump and a necessary preliminary to having a strategy.

But I did not notice any plausible strategy. As with Trump the focus is largely on the vaccine. Various measures are proposed to accelerate delivery but I did not notice any that could achieve even a parabolic acceleration, let alone catch up with exponential infection. For example great stress is placed on delivering 6 doses from each vial originally intended to ensure 5 doses with allowance for wastage. That is merely an insignificant blip, not even a plan for constant linear, let alone parabolic acceleration.

The target of 100 million doses in 100 days is comparable to the current level of bungled delivery (900,000 per day). Proportional to population it is substantially slower than what the UK is currently delivering. That is probably realistic and reflects how disfunctional the US health system is. If achieved it could substantially reduce mortality both by protecting many of the most vulnerable and by keeping most of the health and aged care workforce functioning so that staff sick, dead or in quarantine are not the main bottleneck on health and aged care.

But I did not see any calculation suggesting that vaccination of less than 1 in 6 Americans could avoid continued exponential increase resulting from the more infectious strains becoming dominant with the current levels of shutdown. Continuing at that rate would take more than a year to reach herd immunity if it was not reached by infection first.

Instead of plans to tighten lockdowns what I did see was a goal to open up kindergartens and schools within the same 100 days and focus on “testing” to open up rather than immediate mobilization for more severe lockdowns.

In other countries that opened schools too early so as to get parents back to work too early, the pretense that children do not transmit infection has been dropped and schools are being closed as an emergency measure to help keep hospitals open.

The USA is still headed in the same direction as Trump, the opposite to what is needed. So is the UK and so is most of Europe.

A worse disaster can be expected in most of the developing world. Hopefully they may get enough vaccines to protect their relatively small healthcare workforce. But they won’t receive vaccines before Europe and North America so herd immunity will take much more than 1 year with no realistic prospect of overtaking the exponential growth of new strains.

On December 2 I wrote:

This is not just a half baked, but rather a quarter baked article on the current situation with covid-19.

My guess is that Australia is about half way through the state of emergency that began in mid-March.

Current indications are that a vaccine will start to be available here from about March or April, with full availability and likely herd immunity by the end of next year.

That should mean Australia goes to the back of the queue for vaccination. There is currently no urgent need here and major disasters elsewhere, so it should take much longer than the end of next year to vaccinate Australia.

But its far more likely the poorer countries that are likely to eventually get hit very hard will come last and Australia will be in the middle. I would be surprised if the production plants in Europe and North America divert supplies from the disaster unfolding around them until they have that under control. So the initial vaccinations here could also be later than March and April.

Anyway there is plenty of time before next March to analyse the recent news re vaccines.

A lot more information will be available in a few weeks so I am not attempting to analyse this further now. The disasters in Europe and North America are still unfolding and far worse is to come in the rest of the world, but it will be a lot easier to analyse in a few weeks than it is right now.

I am just dashing this off quarter baked because I expect to be paying more attention to US politics over the next few weeks.

A few weeks later there is no doubt a lot more information available. But I am still focussed on US politics and have not caught up on covid-19.

We are still in the silly season and a lot of things are up in the air and have not yet landed – both for US politics and covid-19 (of my three main topics last year, only Brexit has “landed”, with the expected whimper not bang).

As far as I am aware covid-19 has developed pretty much as I expected. But the new virus strains could make things considerably worse than I was expecting. Anyway here’s another “quarter baked” update.

The UK hospital system has now been in crisis for several weeks. The explosion in case numbers was inevitable due to catastrophic government failure (worse than in USA) but it has been confirmed that new virus strains are indeed significantly more infectious and are pretty certain to spread worldwide.

Report 42 – Transmission of SARS-CoV-2 Lineage B.1.1.7 in England: insights from linking epidemiological and genetic data

That is not an unexpected development. Natural selection favours survival of those viral strains that are more infectious.

Unexpectedly there is now preliminary data from the UK indicating that the strains expected to become dominant worldwide are also more deadly. Natural selection does not usually favour survival of viral strains that kill their hosts more quickly since dead people spread infection less than when alive. It is suggested that the mechanism which makes some new strains more infectious is stronger attachment between the virus spikes and host cells, which results in both a higher viral load that is more infectious and a more intense immune system response that is the main cause of death.

It is tempting to speculate that greater mortality could instead simply be due to collapse of the UK hospital system with government announcements naturally preferring to blame nature. But there is no doubt the preliminary data is based on serious statistical analysis by authoritative sources, not from Public Relations spokespeople.

Here is some commentary from outside experts followed by link to the technical paper that was just released:

expert reaction to suggestion made in Downing Street press conference that the new UK variant may be linked to higher mortality than the old variant (NERVTAG paper also now published)

I am not competent to evaluate any of this, but it seems likely to be important.

Both the US and UK are engaged in a race to vaccinate as many people as possible as fast as possible to get their hospital systems back under control.

That seems to me an inherently implausible strategy. We know that the new strains still grow exponentially under the levels of lockdown imposed so far. A plausible strategy would move immediately to a severe enough level of lockdown to actually stop transmission despite the greater infectiousness. That would require only really essential workers allowed out of their homes to work on delivering food, electricity and other essential supplies and services direct to households (as in Wuhan).

We also know that the rate of manufacture and delivery of vaccines cannot grow exponentially as vaccinations do not produce more vaccinations in the way that infections produce more infections. Extreme acceleration of vaccination can only be parabolic, like the acceleration due to gravity, not exponential, like a “viral” epidemic or a nuclear “chain reaction”.

Of course it is possible that even a constant linear delivery of vaccinations could reach herd immunity before the virus infects everybody. But it is very much a short term race with unfavourable odds.

The emergency already justified “emergency use” authorizations without the length of studies usually required and accelerated parallel development of manufacturing facilities. There are health as well as financial risks in both. These are now compouded by lengthening the period between initial and follow up doses so as to maximize short term numbers and permitting use of untested combinations of different vaccines for first and second doses when supplies of the vaccines initially available (mRNA) cannot keep up and manufacturing plants for others (eg AstraZenaca) do come on stream.

One risk already visible is that those for whom vaccination is most urgent – frontline health and quarantine workers – are also the most aware of the risks and about a quarter of healthcare workers in the UK are already hesitant about getting vaccinated.

That will presumably be met by media campaigns and lots of reassuring pronouncements by authorities that could induce actual panic given the perceived trustworthiness of authorities and the media.

Another risk strikes me that I have not read any technical papers about. Partially vaccinated people could be an ideal breeding ground for new strains that are harder to get rid of. My understanding is that people given a course of antibiotics are required to complete the full course to avoid the survival of those more resistant bugs that were not completely killed off by the initial dose.

I gather the effects of triggering the immune reaction are sufficiently unpleasant (nausea, fever, headaches etc in a small but not negligible proportion) that the dominant reason for two doses is to reduce that impact. Indeed recent evidence from Norway suggests that enough frail elderly people are getting killed by the effect of the vaccine to make it possible that the more frail residents of aged care facilities are better off just relying on the vaccination of staff, visitors and other residents rather than getting vaccinated themselves.

If the severity of those effects is the main reason for two doses, it seems possible not enough attention would be paid to the danger of breeding new strains by delaying a second dose in an emergency situation where there really is desperation to outrace collapse of the hospital system. I would of course not be capable of becoming competent to make that judgment.

So far the level of blithering incompetence in Australia has been less fatal than elsewhere. It remains to be seen whether Australian governments will act quickly enough to prevent the new strains escaping from quarantine. I have no way to judge whether they will or won’t. So far they have not. But things are already desperate enough elsewhere that it is reasonable to expect that they will.

I am not commenting on the dispute about whether AstraZeneva should be paused in Australia because it is unlikely to deliver herd immunity. As far as I know the simple fact is that mRNA plants in Europe and North America are not going to deliver supplies needed in a race to save their hospital systems to countries that are worse off, let alone countries that are better off, no matter how selfishly the Australian government demands it and how high it bids up the price. My impression is that even Paul Kelly makes more sense than the competent virologists who started and then backed away from that dispute. That unfavourable impression of competent virologists is not an endorsement of Paul Kelly. But it does strengthen my lack of confidence that people who should know what they are talking about actually do.

6 thoughts on “Notes on Trump 62 – covid-19 and Biden

  1. OK resident deluded pseudo leftist here. I read the opening of this thread and I say what? Democrats nearly lost the electoral college. You mean the voting system that is rigged against them. Well lets see. In 2016 Trump won 304 electoral college votes and he described that as a landslide. In 2020 Biden won 306 and you describe that as democrats nearly lose the electoral college. Really not a landslide.
    Then you say that there are serious doubts that the victory was lawful. Really what does that mean. Do serious people have doubts I mean serious people within the American system. The guy that Trump appointed to monitor cyber security said it was clean. Trumps attorney general Bill Barr had the DOJ run an inquiry which came up with no evidence of illegality. Votes in several states got re counted and recounted but never came up with an inaccuracy that mattered. The votes got counted and checked against the electronic record and no disparity was found.
    So who has serious doubts, well Trump but sore losers dont count, the guy who draws Dilbert cartoons so I guess that counts and the guy who wore the horn hat inside the Capitol he must count but apart from those serious dudes who? Rudy doesnt count hes getting paid 20K a day to say that, hell for 20K a day I would dispute the results and argue that the Qanon shaman deserves a pardon.


  2. The prompt AHPCC decision responding to a single case of South African strain outside of quarantine suggests that they are at least trying and might act fast enough to prevent escape from quarantine into renewed community here.

    Given repeated escapes from less infectious strains the new strains are both far more likely to escape and far more likely to spread fast given current levels of social distancing and contact tracing.

    Extreme measures of total isolation are needed to prevent escape at least until everyone quarantined or involved in quarantine can be vaccinated.

    Actual escape should be met with prompt widespread full lockdown until certain of no further transmission. I still haven’t seen any indication of such plans but it would be even more inconsistent than usual to be reacting to a case in NZ that way but not be doing what else is required.


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