GOOD NEWS, EVERYONE!

Although the hospitalization rate in Houston is still high, it’s pretty clear now that we passed a peak and it’s going down. This means my predictions were, fortunately, wrong.

The daily new positive cases are still pretty high.

What’s going on here? I wish I could tell you that people are being more careful, but my small, careful outings into the community reinforce my bleak view of human nature. We, as a whole, are not being particularly careful.

As a refresher, why do I care about/harp on hospitalizations so much? For two reasons: The first is because they are predictive of deaths, so less hospitalizations means less people will die. The second is because, after a threshold, they have compounding bad effects. If the hospitals get saturated enough, people die of milder cases because they can’t get help, and people with other conditions die as well. And the healthcare personnel get sick and/or burn out, further compounding the problem

What IS going on, then? It’s a combination of things. I credit two factors. Both of them are, or would be (if I got it right), genuinely good news.

Factor one, and this one isn’t a guess: we are relentlessly getting better at figuring out who is in danger of immediate serious complications^* or not, and admitting people who truly need it to the hospital, letting milder cases play out at home.

Factor two, an educated guess: the vaccines are having an effect already. The vaccination strategy is fractured and frustrating, leaving people who want them scrambling for shots. However, the vaccines do work, and we’ve -haphazardly, but correctly- prioritized the most vulnerable, and the healthcare personnel who are both necessary, and at risk of being vectors. Aside: under the same logic, please vaccinate the teachers NOW.

As of this writing, 11 doses of vaccine per 100 people have been distributed in the US. This doesn’t mean 11% of people are fully vaccinated, because the vaccines require two doses. Most people have one shot in them, which confers some protection, and a few already have both.

In Harris County, approximately 9% of the eligible population already has received one shot (click on the image below to access an interactive dashboard). If this was a randomly-distributed 9% of the population, the impact would be minimal; but it’s a selected group of vulnerable individuals, with the most likelihood of getting very sick or dying. This likely makes a big difference in hospitalization rates, so I expect them to continue falling.

(Note that the doses allocated/shipped above are for all of Texas, and the Harris County data is in the small popup)

The strategy of allocating vaccines to vulnerable people first poses an ethical question, which is should I get one if I’m not at immediate risk but somehow get on a list? I agree with this NY Times opinion piece: get it. On one hand, gauging your own risk is not that easy. On the other, getting more people vaccinated is a net good. On the gripping hand, there are no guarantees it’ll go to someone who needs it more than you do. Barring genuine counter-indications, we should all get vaccinated if at all possible. You’re arguing timing in marginalia.

Finally, I leave you with a counterargument to one of the dumbest antivaxx conspiracy theories.

*By “immediate serious complications” I mean things that will kill you quickly. All available evidence on long-term complications (“long-haul COVID”) shows that they can be very, very bad, and we have -so far- no way of knowing who’ll have or not. If you prance about the community without a mask on and act carelessly, thinking the doctors will save you if necessary, you’re a selfish dumbass.

Happy new year! The new COVID “British” variant (UK B117 strain) isn’t, of course, British. It was merely detected there first. See this thread by Dr. Gurdasani on Twitter, and the linked report from the Imperial College London: https://twitter.com/dgurdasani1/status/1344774555718590464

The TL;DR version is that this virus is
A. Apparently more transmissible in children, and
B. Has a higher R_t (the coefficient of transmission in real-time^*).

While the R_t for the OG COVID is 0.92 IN LOCKDOWN^** (i.e., on average, one person gives it to 0.92 other people, so the number of infected tends to go down, IN LOCKDOWN)… the UK B117 strain’s R_t is 1.45. IN LOCKDOWN. Which means exponential spread, and (given time), everyone gets sick. Even in lockdown (see footnote ^** again). Collapsed hospitals, etc. Which means we would need much, much, much more stringent measures to control it.

Before your eyes glaze over, this just means that people give the new variant to each other much more than the original one.

It has already been detected in Colorado, with no discernible connection to the UK. It’s a good bet that wherever you are, it’s also already there. We didn’t know how to look for it, or that we should. Now that we will start looking for it, we’ll probably find it everywhere. And since it’s more contagious, it may even become the dominant strain.

For the nerds in the audience, the mechanism for increased transmissibility is still unknown. There is a mutation in the spike protein (yes, the same one targeted by the vaccine) that makes it bind tighter to human cellular receptors. This is a reasonable hypothesis as to why it’s more contagious, but we don’t actually KNOW yet. We don’t know whether the vaccine is equally effective against this strain, either. The people who make the vaccine think it’ll be effective. How much, we don’t know yet.

Therefore:

• Get vaccinated as soon as you can (I’m scheduled for Tuesday, thank my employer!)
• Keep social distancing measures in place. Masks. Masks. Masks.- For the love of everything that is sane, avoid parties, enclosed bars and restaurants, gatherings, etc.
• Yes, this means avoid “outdoors” fully enclosed spaces. That’s dumb as rocks.
• In fact, avoid restaurants and bars other than carryout, period.
• In case you don’t think I’m serious about the above: I’M AN INVESTOR IN TWO DIFFERENT SMALL RESTAURANTS. Sucks to be me.
• Seriously consider switching the kids to distance learning. I KNOW this is a heartbreaking decision for a lot of families, and many have incredible difficulties re: work. Also, kids don’t learn as well. I know. I know. Do it anyway if you can.
• The vaccines are not yet approved for use in children; they won’t be for weeks-to-months. Do you want your kids to catch a lethal disease, or one that will give them lifelong disabilities? Of course you don’t.
• Do all of this even AFTER getting both doses of the vaccine. We need to know more before we let our guard down.
• Yes, I’ve been fantasizing about traveling and going to dinner once properly vaccinated. No can do, for now.

* R₀ is an inherent property of the virus. R_t is the transmission coefficient in real-time, as observed. R_t can and does change over time. We don’t actually know R₀ for either variant, although there’s a proposed range for the OG COVID. It stands to reason that UKB117 R₀ > OG R₀, but we don’t know yet.

** The UK’s lockdown measures SUCK, because they include in-person school… and this variant seems to affect children more. Chicken or egg problem there: children are more exposed, so maybe that’s why they’ve been more affected? Hopefully actual distancing might help.

*** Originally posted on Facebook. The formatting was improved here.

**** Sorry, this came out a lot longer and ramblier than expected.