(CNN) Fauci’s new 2022 timeline for Covid fight could be a political disaster for Biden and Democrats.

This is about Fauci’s prediction, for spring 2022. In my book, relative to the evolving state of knowledge along the timeline of this epidemic,  Fauci’s handling of the epidemic has been unimpeachable.  Quoting,

“As we get into the spring, we could start getting back to a degree of normality, namely reassuming the things that we were hoping we could do — restaurants, theaters, that kind of thing,” Fauci told CNN’s Anderson Cooper.

For a steward of public health, this is the right thing to say. If  this blog had broad readership, I would not want to undermine Fauci’s hopeful message. Relative obscurity releases this blog from the obligations of a steward. There has to be hope – in a reasonable time frame.

The principal obstacles to the timeline are:

• Current vaccines, while tremendously beneficial to the individual, even with the Delta variant, are inadequate to suppress community presence. See Delta Strain; the Rough Ride Begins.
• Israel experience indicates that a non-Delta specific Pfizer booster is still not sufficiently protective to suppress community presence of Delta.
• The school age population will become a tremendous reservoir of Delta, in constant contact with the more susceptible adult community. (For the math inclined: This is the driving term of an equation for adult infection, so powerful that even for adult R < 1, it can drive infection in the adult community  all by itself.)
• The school-age reservoir will not drain until late June ’22.
• Although social distancing suppressed the winter 20-21 flu season, Delta may compromise resistance to secondary infection, to the point that co-infection with Delta is common, bringing lethality up to 2020 levels.
• All of the troublesome COVID variants have come from outside the vaccinated world. All of them have traveled well. While vaccination in the U.S. has a suppressive effect on domestic mutation, this is like rearranging the deck chairs on the Titanic.
• Some 100 -140 million recalcitrant U.S. adults may never vaccinate. This group will be ravaged. Survivors will be slow to change their minds. The rest of us have need for protection from this reservoir.

From (CNN) Fauci: You get vaccinated… Smouldering Epidemic or Western Wildfire?,

A sociological argument renormalizes this epidemic:

• • • People tend to cluster with others of similar attitudes.
    • The U..S. is in a state of deep division which accentuates clustering.
    • Antivaxers comprise such a group, with social interactions biased to stay within this group.
    • This group of perhaps 140 million moves through a vacuum in which groups with other attitudes do not socially exist.
    • This is in effect an unvaccinated nation of 140M, as was the U.S. in February 2020, except the virus is much worse.
    • Fulmination is possible.

Crash production of a Delta-specific variant could avert some of this, possibly leading to a decent summer ’22. From (CNN) White House frustrated with Irresponsible Delta Variant Coverage…Napkin Calculation #4,

It is possible that a Delta specific booster would both

• • • Reduce the relative risk, which stands at 20-40%
    • Reduce the viral load of breakthroughs.

Time relevant delivery of  boosters and strain adjustments requires a policy tweak that is actually baked into seasonal flu vaccines, and was the crux of Operation Warp Speed, production in advance of proof.

A decade ago, there were DARPA programs for rapid vaccine production to defend against biological warfare. The  programs were successful in rapid production of vaccines of variable quality, for deployment against dire threat. But the loop was never closed; identification  of dire need was never pursued. The process infrastructure for identification of dire need remains vacant.

So we may be in dire need of a Delta-specific booster, with no established process or criteria to establish it. If epidemiology were a mature science, if it could predict with some confidence, that X00,000, or X000,000 people will die this winter, it would be an easy decision. Since epidemiology is not on track for this kind of predictive power, is there another course of action? Yes.

Produce a Delta-specific booster in advance of proofs of need/efficacy. Defer the decision to deploy until more decidable. In the meantime, work at occupying the vacancy of decision infrastructure.

At worst, it’s a waste of money.

 

 

 

 

 

 

 

 

 

From (August 2017) Trump Wants to Fire U.S. Commander in Afghanistan,

The bare-bones boiled-down essence of modern government is just a few things:

• • • Raise revenue by taxation.
    • Use at least some of the taxes to provide services.
    • Facilitate commerce.
    • The services provided justify the taxes enough for popular acquiescence.

You can add all the bells and whistles. But it’s the irreducible minimum. Anything less, and it becomes a protection racket.

Afghanistan has no legitimate economy. Mullah Omar’s gang used to joke that the country couldn’t even make glass. The only trade is underground, opium, immune to civil taxes. But opium makes money for the Taliban. Indirectly, they can tax it, by shaking down the farmers.

This is the essence of the debacle. An even more compact criteria:

• A state with a history of strong government embodies possibility of restoration by foreign intervention.
• A state without a history of strong government lacks even the possibility.

Afghanistan did not have an indigenous central government until the 1747 appointment of Ahmad Shāh Durrānī. It did not resemble a modern state. It was a brief imitation of ancient empire builders, sustained by plunder.

From Biden: Leaving Afghanistan,

I have grave certainty that they [Taliban] won’t uphold. This will be a slaughter of the good. The   future reeks of the fall of Saigon, when our friends were falling off helicopter skids as they begged for rescue. I suspect that the slaughter of innocents bothers H.R. McMaster even more than the strategic retreat.

To remain would only delay the inevitable. Afghanistan is caught in the gyre of a primitive cultural ocean.  Eventually, China, and perhaps India will, in exploitation, bring some measure of humanity.

Do I feel bad? Yes. We spent our blood and treasure unwisely. Venezuela has much better prospects for catalyzed change.

More Afghanistan articles here.

 

 

 

 

Have a look at (CNN) White House frustrated with Irresponsible Delta Variant Coverage…Napkin Calculation #4. I’ll drop in some text.

So let’s try another intervention, vaccine+masks. (PNAS) Face masks considerably reduce COVID-19 cases in Germany. Quoting,

…Weighing various estimates, we conclude that 20 d after becoming mandatory face masks have reduced the number of new infections by around 45%.

This approximates a relative risk reduction of 1/2 = 0.5.  In combination with 100% vaccination,

• • • For Pfizer and Delta, R_mask = 9*( 0.2 to 0.4)*0.5 = 0.9 to 1.8.

This is a bad number. If napkin calculations have credibility, it implies disaster. Though not fact,  it should not be dismissed. It is the result of high viral load of Delta breakthroughs.

The implication  is that R remains above 1, implying runaway, forest fire growth. This glum observation is based on the typical public-use mask, which is derived from the fluid barrier procedure mask, which is not designed for infectious disease control. This class of masks is relatively comfortable to wear; it reduces transmission by about half. In the above calc, it’s the factor 0.5.

Healthcare workers in infectious disease wards use far more effective and uncomfortable N95 masks, which are designed to protect against most aerosols. Experimental factors for transmission reduction may not exist; let’s guess 0.1, a tenth.

So substitute 0.1 for 0.5:

• For Pfizer and Delta, R_mask = 9*( 0.2 to 0.4)*0.1 = 0.18  to 0.36

Less than 1, these are good numbers! If everyone in the U.S. wore N95 masks and practiced perfect aseptic  technique, COVID would vanish. Given the political climate,  unreasoning resistance to masks, and general impracticality, why have I written this?

Many people might be eager to make limited use of N95 masks, in situations they perceive as hazardous. Mask receptivity may jump in those who meet Delta up close and personal. So this is a proposal for the White House task force:

• Subsidize N95 production.
• Make the masks widely available.
• Possibly be surprised at the uptake.

As for refusniks, you do what you can; they do what they will. They may soon become more receptive.

 

 

(CNN) How safe is it for vaccinated people to return to in-person work? An expert weighs in. Quoting,

However, the chance of actually contracting Covid-19 is greatly reduced if you’re vaccinated. According to Dr. Anthony Fauci, you have an estimated eight-fold reduction in risk of having coronavirus if you’re vaccinated compared to if you’re not – and an estimated 25-fold reduction in risk of having severe enough disease to cause hospitalization and death, which is truly remarkable.

This is a boo-boo. Fauci knows what he’s talking about; a statistician knows the true meaning of 8X risk reduction, but the statement is missing context for the typical reader.

Relative risk is not a simple number; it does not mean what it appears to. It is the expectation value of a random variable, which means it has value only in the context of a trial with some group, and the exposures of that group, as in,

“We did vaccine trials on a group, shot versus placebo, and this is the risk ratio for this group.”

You probably aren’t into math, so I’m going to make it real for you. Consider these types of groups of fully vaccinated people, in which there is initially one contagious Delta individual. Our sample has 10 Type A groups, 10 Type B groups, and 10 Type C groups.

• Type A: 8 college students jammed into a payphone booth.
• Type B: 8 employees doing phone sales out of a 10×10 room in a converted residence.
• Type C:  Skeleton crew of 8 in a large ventilated newsroom with forced air HEPA filtration.

The 8X risk reduction of Fauci, or the 2.5X – 5X  I previously computed in Delta Strain of COVID — We’re in for a Rough Ride; Napkin Calculation #3 are based on different groups. Provincetown tourists are a healthy bunch. Both numbers permit these results:

• Everybody in every one of the 10  Type A groups (payphone booth) get  Delta.
• 9 out of 10 Type B groups (small room)  get 6 or more Delta cases.
• 3 out of 10 Type C groups (newsroom) get 3 or more Delta cases.

This is completely compatible with an 8X risk reduction, because random variables do not follow ordinary arithmetic.

Are there  fatalities in A, B, or C? With extreme exposure, as in the payphone booth,  and Type B with the windows shut, it’s possible.

Is this anti-vaccine? No! You might even pick up a few new advocates. 14% of people have intelligence in the range of “bright.” The paradox exposed above makes bright people uncomfortable about something that doesn’t make sense. They are important  to the rest of us as trusted peers and guides.

In (CNN) Covid news coverage needs to start from this fact: ‘The vaccines work’, Brian Stelter is down on media fear-mongering and CDC messaging.  He states, almost true for the moment, that Delta is a disease of the unvaccinated.

That implies unjustified optimism. COVID-19 is not static. It has a huge tendency to mutate. There is already Delta+; virologists cannot set a limit.  We don’t yet know the consequence, in vaccinated individuals, of simultaneous infection with influenza and Delta.

Will vaccine uptake be maximized by hand-holding, with inaccurate, anodyne medical journalism? Something to think about.

Lay it all out.

 

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