Last chopper out of Dallas

So, two weeks ago we had desperate people fleeing the exultant entry of misogynistic religious extremists into Kabul:

Not Texas

This week we had desperate people fleeing another group of misogynistic religious extremists in Dallas:

Texas

Salesforce CEO Mark Beinoff said the company will help employees move out of Texas if they so choose after the state’s Republican governor signed a strict ban on abortions. “Ohana if you want to move we’ll help you exit TX,” Beinoff tweeted Friday, sharing a link to a CNBC article about the company’s decision.

Obviously, the suffering of Afghan women under the Taliban is vastly more than that of Texan women under the Republicans. But I hear the US Air Force has some C-17s that are currently between missions…

Possibly we misheard Michael Gove

From The Guardian today:

Gove has been subjected to a lot of mockery for supposedly having dismissed the value of (economic) expertise during the Brexit referendum campaign, but perhaps he was misquoted. Maybe what he really said was

people in this country have had enough of exports.

Industrial heritage

There’s a tiny lake in Oxford, Hinksey Lake, between a park and the railway tracks, somewhat used for recreation. I was there recently for the first time since the start of the pandemic. I found there were new signs warning people away from swimming — too little avail, as far as I could see — because of the danger of industrial waste dumped below the surface. I could think of many things you might call such a location, such as a “hazardous waste site” or “industrial trash dump”. But in Oxford they call it a “site of industrial heritage”. Sounds like something you might want to make a point of visiting.

Neanderthals and women

The article seems to have good intentions, but this headline in today’s Guardian is the most sexist I’ve seen in some time. It sounds like the men were hard at work “creating language”, and some women helped out with some testing, and maybe brought snacks. Also some Neanderthals came by and lent a hand. And apes.

Transferable skills

The US federal government has ordered that all nursing home personnel need to be vaccinated against Covid, which seems like an absolute least-you-could-do sort of measure, given the extraordinary risk of outbreaks among the frail elderly. But there’s a problem.

The American Health Care Association, a nursing home lobby, said it appreciated the order but that the mandate should apply to other healthcare providers as well so that workers who refuse vaccination won’t have a reason to change jobs within the industry.

Surely there can’t be that many openings for medical staff who aren’t willing to take minimal steps to protect their patients? Well…

David Grabowski, a professor of healthcare policy at Harvard Medical School, said that, because many nursing home aides are paid only the minimum wage or slightly higher, they would be more likely to seek out work at retail establishments. “The risk isn’t that they go to the hospital down the street—the risk is they go to Starbucks or Target,” he said in an interview. “It’s great if you want to mandate the vaccine, but you also want to make sure these workers are making a living wage.”

Hmm… if Starbucks is hiring unvaccinated care-home nurses to sling lattes for the same salary, there must be some vaccinated baristas who want to transfer in the other direction. What’s that you say? You can’t just hire any bored 20-year-old to care for the elderly? You need training and experience to do the nursing job, and it’s a far more gruelling job!

Then why are they earning the same salary? Low salaries are not immutable constants of nature, however much employers would like to suggest they are. Like

Jon Green, CEO of Pinewood Manor Nursing and Rehabilitation in rural Hawkinsville, Georgia, said the “vaccines are necessary for control of the virus,” but “if we would have mandated it ourselves, it would have caused [many workers] to leave.’’

Anglophone exceptionalism

Guardian film reviewer Peter Bradshaw does not like the new French film Deception, directed by Arnaud Desplechin, based on one of Philip Roth’s many pseudo-autobiographical novels. And one of the things he really doesn’t like about this French film is that… it’s French.

Desplechin doesn’t change any nationalities. His Roth is still supposed to be American, and the object of his love is still English. But Desplechin casts French people, speaking French. Denis Podalydès plays Roth and Léa Seydoux is the English actor.  So the fundamentally important, dramatically savoury difference between them is obliterated.

C’est pas vrai! A French director cast French actors in his film, and let them (I’m trying not to hyperventilate here) speak FRENCH! How could this be allowed to happen? He seems to have gotten the Hollywood rule, that European characters (of whatever nationality) are always supposed to be played by British actors, exactly backward!

Could you imagine a critic commenting on a film by a British or American director set in a non-English-speaking country, that complains that the director cast British or American actors speaking English, which completely misses the nuances of dialect differences?

Spielberg doesn’t change any nationalities. His Schindler is still supposed to be Moravian, and his antagonist Amon Göth is still Austrian. But Spielberg casts British people, speaking English. Liam Neeson plays Schindler and Ralph Fiennes is the Austrian Nazi.  So the fundamentally important, dramatically savoury difference between them is obliterated.

I mention this particular example because I do recall seeing a German review of Schindler’s List that did complain about the dialect issue, but only as an issue about the dubbing by the regular German representatives of those particular British actors, speaking their regular high German. No one would have suggested that an American director really should have made his film in German to begin with.

Thinking about exponential growth and “Freedom Day”

The UK government is holding fast to its plan to drop all pandemic restrictions as of 19 July, even in the face of rapidly increasing infection rates, hospitalisation rates, and Covid deaths — all up by 25-40% over last week. And numerous medical experts are being quoted in the press supporting the decision. What’s going on?

To begin with, Johnson has boxed himself in. He promised “Freedom Day” to coincide with the summer solstice, and then was forced to climb down, just as he was from his initial “infect everyone, God will recognise his own” plan last March, on realising that his policies would yield an unsustainable level of disruption. The prime minister has, by now, no reputation for consistency or decisiveness left to protect, but even so he probably feels at the very least that a further delay would undermine his self-image as the nation’s Fun Dad. At the same time, the the new opening has been hollowed out, transformed from the original “Go back to living your lives like in pre-pandemic days” message to “Resume taxable leisure activities, with the onus on individuals and private businesses to enforce infection-minimisation procedures.” Thus we have, just today, the Transport Secretary announcing that he expected rail and bus companies to insist on masking, even while the government was removing the legal requirement.

But what are they hoping to accomplish, other than a slight reduction in the budget deficit? The only formal justification offered is that of Health Secretary Sajid Javid, who said on Monday

that infection rates were likely to get worse before they got better – potentially hitting 100,000 a day – but said the vaccination programme had severely weakened the link between infections, hospitalisations and deaths.
Javid acknowledged the risks of reopening further, but said his message to those calling for delay was: “if not now, then when?”.

“Weakened the link” is an odd way of putting a situation where cases, hospitalisations, and Covid deaths are all growing exponentially at the same rate. What has changed is the gearing, the chain and all of its links is as strong as ever. In light of that exponential growth, what should we make Javid’s awkward channeling of Hillel the Elder?

I’ll talk about “masking” as synecdoche for all measures to reduce the likelihood of a person being infected or transmitting Covid. We need to consider separately the questions of when masking makes sense from an individual perspective, and from a public perspective. The individual perspective is straightforward:

On the societal level it’s more complicated, but I do find the argument of England’s Chief Medical Officer Chris Whitty… baffling:

“The slower we take it, the fewer people will have Covid, the smaller the peak will be, and the smaller the number of people who go into hospital and die,” he said.
By moving slowly, he said modelling suggested the pressure on the NHS would not be “unsustainable”.
Prof Whitty said there was less agreement on the “ideal date” to lift restrictions as there is “no such thing as an ideal date” .
However, he said a further delay would mean opening up when schools return in autumn, or in winter, when the virus has an advantage and hospitals are under more pressure.

We may argue about how much effect government regulations have on the rate of the virus spreading, but I have never before heard anyone argue that the rate of change of government regulation is relevant. Of course, too rapid gyrations in public policy may confuse or anger the public. But how the rapidity of changing the rules relates to the size of the peak seems exceptionally obscure. To the extent that you are able to have any effect with the regulations, that effect should be seen directly in R0, and so in the weekly growth or contraction of Covid cases. If masking can push down the growth rate its effect is essentially equivalent at any time in terms of the final infection rate, but masking early gives fewer total cases.

To see this, consider a very simple model: With masking cases grow 25%/week, without masking they shrink 20%/week. So if we have 1000 cases/day now, then after some weeks of masking and the same number of weeks without masking, we’ll be back to 1000 cases/day at the end. But the total number of cases will be very different. Suppose there are 10 weeks of each policy, and we have four possibilities: masking first, unmasking first, alternating (MUMU…), alternating (UMUM…). The total number of cases will be:

StrategyTotal cases
masking first57 000
unmasking first513 000
alternating (MU…)127 000
alternating (UM…)154 000

Of course, the growth rate will not remain constant. The longer we delay, the more people are immune. In the last week close to 2 million vaccine doses have been administered in the UK. That means that a 4-week delay means about 4 million extra people who are effectively immune. If we mask first, the higher growth rate will come later, thus the growth rate will be lower, and more of the cases will be mild.

The only thing I can suppose is that someone did an economic cost-benefit analysis, and decided that the value of increased economic activity was greater than the cost of lives lost and destroyed. Better to let the younger people — who have patiently waited their turn to be vaccinated — be infected, and obtain their immunity that way, than to incur the costs of another slight delay while waiting for them to have their shot at the vaccine.

The young were always at the lowest risk in this pandemic. They were asked to make a huge sacrifice to protect the elderly. Now that the older people have been protected, there is no willingness to sacrifice even another month to protect the lives and health of the young.

Update on Delta in Germany

The Robert Koch Institute produces estimates of variants of concern on Wednesdays. My projection from two weeks ago turns out to have been somewhat too optimistic. At that point I remarked that there seemed to be about 120 delta cases per day, and that that number hadn’t been increasing: The dominance of delta was coming from the reduction of other cases.

This no longer seems to be true. According to the latest RKI report, the past week has seen only a slight reduction in total cases, compared to two weeks ago, to about 604/day. And the proportion of delta continues to double weekly, so that we’re now at 59%, meaning almost 360 Delta cases/day. The number of Delta cases has thus tripled in two weeks, while the number of other cases has shrunk by a similar factor. The result is a current estimated R0 close to 1, but a very worrying prognosis. We can expect that in another two weeks, if nothing changes, we’ll have 90% Delta, around 1100 cases in total, and R0 around 1.6.

Of course, vaccination is already changing the situation. How much? By the same crude estimate I used last time — counting single vaccination as 50% immune, and looking back 3 weeks (to account for the 4 days back to the middle of the reporting period, 10 days from vaccination to immunity, and another 7 days average for infections to turn into cases), the above numbers apply to a 40% immune population. Based on vaccinations to date the population in 2 weeks will be 46% immune, reducing the R0 for Delta to around 1.5. In order to push it below 1.0 we would need to immunise 1/3 of the remaining population, so we need at least 64% fully immunised. At the current (slowed) rate of vaccination, if it doesn’t decelerate further, that will take until around the middle of September, by which point we’ll be back up around 10,000 cases/day.

Delta may not mean change

Germany is in a confusing place with its pandemic developments. Covid cases have been falling as rapidly here as they have been rising in the UK: More than 50% reduction in the past week, dropping the new cases to 6.6 per 100,000 averaged over the week, under 1000 cases per day for the first time since the middle of last summer. At the same time, the Delta variant is rapidly taking over. Last week the Robert Koch Institute reported 8%, this week it’s 15%. Virologist Christian Drosten, speaking on the NDW Coronavirus podcast this week (before the new Delta numbers were available) spoke of the 80% level in England that, he said, marked the watershed between falling and rising case numbers.

I think this is the wrong back-of-the-envelope calculation, because it depends on the overall expansion rate of the virus, and the difference between Delta and Alpha, which is likely particularly large in the UK because of the large number of people who have received just one AstraZeneca dose, which seems to be particularly ineffective against Delta. There’s another simple calculation that we can do specifically for the German situation: In the past week there have been about 810 cases per day, of which 15.1% Delta, so, about 122 Delta cases per day. The previous week there were about 1557 cases per day, of which 7.9% Delta, so also about 123 Delta cases. That suggests that under current conditions (including weather, population immunity, and social distancing) Delta is not expanding. This may mean that current conditions are adequate to keep Delta in check, while Alpha and other variants are falling by more than 50% per week.

This suggests a very optimistic picture: that total case numbers will continue to fall. Within a few weeks Delta will be completely dominant, but the number of cases may not be much more than around 100 per day. And that ignores the increasing immunity: The infections reported this week occurred in the previous week, and the immunity is based on the vaccinations two weeks before that. With about 1% of the population being vaccinated every day, we should have — relative to the approximately 70% non-immune population* 20 days ago — already have about 15% reduced transmission by the first week in July. And at current vaccination rates we can expect, by the end of July that will be 30% reduced, providing some headroom for further relaxation of restrictions without an explosion of Delta cases.

That does raise the question, though, of why the general Covid transmission rate in Germany seems to be lower than in the UK. I don’t see any obvious difference in the level of social-distancing restrictions. Is it just the difference between single-dose AZ versus Biontech? If so, we should see a rapid turnaround in the UK soon.

* I’m very roughly counting each dose as 50% immunity.

“Like lepers”

From yesterday’s Guardian:

Contentious advice will be removed from the government website, a spokesperson confirmed on Tuesday evening. It had advised against all but essential travel to and from eight areas of England where the Covid variant identified in India has been spreading. Instead, people will be advised to “minimise travel”.

This gets to something that I observed last spring when I (like many people) decided to immerse myself in the literature of epidemics — The Last Man, La Peste, Journal of the Plague Year, Pale Horse Pale Rider: In an epidemic, people can’t help but think of contagion as a moral failing, and so, thinking of themselves as blameless, underestimate the possibility that they could unwittingly infect someone else. This makes it socially uncomfortable to insist that others practice necessary hygiene, because it sounds like you’re accusing them of secret turpitude. Strangers should wear masks, but “we’re friends”, or even — much too casually — “you’re in my bubble”.

Thus two Bolton residents, whose hotel reservations on the Isle of Wight had been cancelled purely from abhorrence of their municipal origins, complained to the press: “Bolton people are being treated like lepers”.

On a literal level we have here people who are feared to be at high risk of carrying an explosively contagious infection that produces an acute disease with no very good treatment, that is often rapidly fatal; complaining that they are being unjustly shunned as though they might be carrying a different, mildly contagious infection, that produces a chronic disease that can be completely cured with medication.

But, of course, what they really mean is, we’re being treated like morally culpable potential disease carriers. This is a status that has traditionally been conferred on carriers of leprosy, something we do not question, but that only highlights our moral — hence also virological — purity.