Benjamin Mueller reports in the New York Times that while "pausing" vaccines due to concerns over rare blood clots may have only a minor effect in rich countries, it's having a massive effect in poorer countries:
In Malawi, people are asking doctors how to flush the AstraZeneca vaccine from their bodies. In South Africa, health officials have stopped giving the Johnson & Johnson shot, two months after dropping the AstraZeneca vaccine. And in the Democratic Republic of Congo, 1.7 million AstraZeneca doses have gone unused.
....And even as American health officials stressed that they paused use of the Johnson & Johnson vaccine on Tuesday in “an abundance of caution,” they forced global health officials to begin crafting the difficult case that shots that might not be safe enough for the world’s rich were still suited to its poor.
“It’s sending vaccine confidence into a crater,” Ayoade Alakija, co-chair of the African Union’s Africa Vaccine Delivery Alliance, said of rich countries’ actions. “It’s irresponsible messaging, and it speaks to the selfishness of the moment that there wouldn’t be more consultation and communication.”
This isn't surprising, especially after the hit that vaccines took ten years ago when we learned that the CIA had been faking a vaccine campaign in Pakistan in order to obtain DNA from members of Osama bin Laden's family. We quickly forgot all about that, but the rest of the world didn't.
More broadly, it's not surprising that we don't have a good idea of how best to communicate about vaccine safety. We've never been faced with anything of this magnitude before and it's all virgin territory.
To state the obvious up front, nobody thinks that real problems with vaccines should be hushed up simply because they might reduce confidence in the vaccination program. But what's the right threshold for sounding an alarm? It sure seems as if a minuscule number of bad reactions is too low, but does anyone want to put a number on it? One death out of a million? Two? Three?
At the risk of suggesting something stupid, I wonder if a better idea is to be more transparent about side effects. Suppose we had something like a dashboard for each vaccine that showed every reported side effect more consequential than a sore arm. It would be updated daily and you could follow it in real time. Something like this might get people used to the idea that there are always a few rare reactions to vaccines and there's no preset limit where a vaccine suddenly goes from good to bad.
It's just a thought. Right now we have no nuance in the way we treat vaccines. They're either approved or halted. That's it. But that's not the way medicine works in the real world, and we might be better off educating people about that.
The blue trendline is just my eyeball guess, but I don't think it's very far off from reality. What's remarkable is the slope of the line. None of us would be surprised if red states were a little lower than blue states in vaccine acceptance, but they're way lower. Recent polling shows that among Democrats vaccine resistance has dropped to about 10%, but among Republicans it's held steady for months at about 40%.
Forty percent! And another 15% are unsure. In all, less than half of all Republicans have either gotten the vaccine or say they will.
This is a public health disaster. How do we ever get to herd immunity if a quarter of the country has already decided to never get vaccinated?
For what it's worth, I agree with most of the critics of the Afghanistan withdrawal. The Taliban will almost certainly overrun the country in short order. It will be a disaster for women. It will provide a safe haven for terrorists. We are abandoning everyone who fought along with us. It will be a humanitarian disaster beyond reckoning.
If anybody could provide me with even a sliver of hope that we know how to prevent this without a permanent military presence in Afghanistan, I'd jump at it. But it's been 20 years. If there were any way we could win this war, we would have figured it out by now. We haven't. And we never will.
But the consequences of our failure will be enormous. It's best to face up to that.
I went out over the weekend to stock up on new wildflower pictures, but it was slim pickings. No rain, you see. But I took pictures of a few, including this red thing that I can't identify even though it looks very familiar. Anyone know what it is?
April 10, 2021 — Laguna Coast Wilderness Park, Orange County, California
Via my old stomping grounds I see that Puerto Rico statehood is once again on the congressional agenda. I oppose statehood for a simple reason: it's not popular enough with Puerto Ricans themselves. Let's review the evidence of half a century of referendums:
1967: Given a choice of statehood, independence, or remaining a commonwealth, only 39% chose statehood.
1993: Statehood received 47% of the vote.
1998: This one had a controversial set of options, but the statehood option was pretty clear and received only 47% of the vote.
2012: Statehood received 61% of the vote, but 500,000 ballots were left blank as a protest.
2017: Statehood received 97% of the vote, but only because the referendum was boycotted by every party that opposed statehood.
2020: Finally, a straight up or down vote produced 53% in favor of statehood.
Over the course of half a century, Puerto Ricans have voted six times on statehood. It has never received a clear majority until 2020, when it won in a bare squeaker.
Compare this to Hawaii and Alaska, the last two states to be admitted. Alaskans voted 85% in favor of statehood and Hawaiians voted 94% in favor.
I don't believe that statehood should be something that's only narrowly supported by the residents of a territory. Puerto Ricans have had a very long time to consider whether they want to become the 51st state and it's clear by now that it's the choice of only the barest majority—and maybe not even that. If it can't muster even a two-thirds majority—and it's never come close to that—it suggests that statehood has grudging support at best. That's a recipe for contention and potential disaster down the road.
But if not a state, then what? The most obvious option is for Puerto Rico to remain a territory, especially since independence has always fared poorly when offered up for a vote. But in the 21st century that strikes me as a poor option too. The colonial era is over and we should all say good riddance to it.
There's no great solution here. Personally, I think the best answer is independence, but with a special relationship with the US. However, the vast majority of Puerto Ricans disagree with me about this, which leaves us right where we started: Puerto Rico as a permanent territory because it's too scary to consider breaking the status quo.
Vaccines should be required for health care workers and for all students who plan to attend in-person classes this fall — including younger children once the vaccine is authorized for them by the Food and Drug Administration.
Employers should also be prepared to make vaccines mandatory for prison guards, E.M.T.s, police officers, firefighters and teachers if overall vaccinations do not reach the level required for herd immunity. Short of a mandate, these workers should be reminded that these vaccines have proved safe and are important not only for their health, but for the health of those they deal with in their jobs.
Let me be clear. If I were your benevolent overlord I would create a huge army of jackbooted thugs who would go house to house and vaccinate everyone whether they wanted it or not. Then they'd tattoo your forehead to make sure everyone knew.¹
Short of that, though, I think mandates are a fine idea. At the federal level, I suppose it could only affect federal employees, but at the state level it could affect everyone. The Supreme Court has said so. Red states wouldn't do it, of course, but that's their problem. Here in blue state territory I'd support a vaccination mandate in a heartbeat. Basically you'd have a choice: Either prove that you have a legitimate medical exemption or pay a $1,000 fine if you refuse to get vaccinated. Don't like it? Tough.
So there I am, channel surfing in the living room, when Lester Holt tells me that the cost of groceries is "soaring." He throws to Stephanie Ruhle, who reports that there's "sticker shock" in the grocery aisle and then interviews a guy who says his grocery bill has doubled. That's followed immediately by a graphic showing that the price of eggs and hamburger has gone up 7%.
"Soaring food prices" is an evergreen staple of the nightly news, but this is sure an odd time to focus on it. Here is the inflation rate of food adjusted for overall inflation:
Last summer, the cost of food really was soaring: prices were up 4.8% above the overall rate of inflation. But that's been falling ever since. In March, the cost of food was only 0.7% above last March after you adjust for overall inflation—surely no one's idea of "soaring." What's more, wages have been increasing right along with prices. As a percent of the average wage, the cost of food is lower than it was last year.
(And in case you think I'm cheating by not showing the 2-year average inflation rate that I extolled this morning, it's the gray line in the chart above. If you use that, food inflation in March was essentially zero.)
Bottom line: By almost any measure you can think of, food inflation is quite moderate. Maybe that will change in the future, as many are predicting, but there's really no excuse for pretending that grocery prices are soaring right now.
Last week I had lunch with my friend DF and the conversation turned to the general subject of the CDC. Stripped to its basics, the question was: Are they idiots? Or are they just doing their best to follow the science at a time when the science is evolving quickly?
The specific subject we chose as a test case was the CDC's advice about disinfecting surfaces in March 2020. I agreed to look into this, which turns out to be a little tricky. I need to go back in time and figure out (a) what the CDC's advice was at the time, and (b) what the best science said at the time.
So here we go. As near as I can tell, the CDC's advice in early March was pretty straightforward: You should clean high-touch surfaces daily, but the risk of catching COVID-19 from surface contact is very low. Here's a typical media report from March 12:
Coronavirus mostly spreads from person to person within about six feet, according to the CDC.
The CDC said it hasn’t seen transmission of this virus from surfaces to people....The CDC said the best thing to do is clean visibly dirty surfaces in your home and then disinfect them.
The problem is that a few days later a study was released that said the coronavirus was stable on some surfaces for quite a long time:
The scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.
This did not change the CDC's advice, but it did get a huge amount of media attention. People started fretting about disinfecting every surface they touched, leaving groceries in the garage for several hours after you brought them home, and quarantining mail for days. But here's Dr. Fauci in mid-March at a CNN town hall:
I think if you start thinking about money and mail and things like that, you can almost sort of immobilize yourself, which I don’t think is a good idea.
“I don’t think we need to get completely obsessed about packages that come in because those types of surfaces — the virus might live there for a very short time," Fauci explained. “But people say ‘Should I get a package from a grocery store that says made in China?’ I wouldn’t worry about that. That’s not the issue.”
The CDC itself was pretty consistent throughout all of this: There was little danger of contracting COVID-19 from groceries or packages or from food. You should clean things like doorknobs frequently, but that's probably enough. Mainly, you should practice social distancing and wear a mask. Much of this got drowned out by media coverage of the coronavirus surviving for days on common surfaces, but you can't blame that on the CDC. They pushed back on that and maintained their more moderate advice.
But there's one more thing. DF was especially dismayed by the closure of outdoor playgrounds even though there was evidence that sunlight kills the coronavirus very quickly. And that's true. Here's a media report from late April:
"Our most striking observation to date is the powerful effect that solar light appears to have on killing the virus, both surfaces and in the air," he said.
....The virus's half-life—the time taken for it to reduce to half its amount—was 18 hours when the temperature was 70 to 75 degrees Fahrenheit (21 to 24 degrees Celsius) with 20 percent humidity on a non-porous surface.... In the presence of sunlight, this dropped to just one and a half minutes.
Half the virus may be killed in as little as two minutes if it’s on a surface exposed to sunlight and high humidity at room temperature.... Under drier, shady conditions, the virus’s half-life is far greater — around 18 hours.
“It doesn’t make it safe to go out to the beach because the time it takes for the sun to kill the virus is exceptionally long,” Armani said.
A coronavirus’ outer layer weakens as the temperature rises, Armani said....But the sun won’t make much difference in spots where shade or clouds reduce the optical intensity of sunlight. Nor will sunshine prevent the virus from spreading from person to person through droplets of saliva or mucus in the air.
Karin Michels, chair of the epidemiology department at UCLA’s Fielding School of Public Health, said there was “no good data” to support the idea that the UV in sunlight would make any difference in the coronavirus infection rate.
In any case, I couldn't find any evidence that the CDC said anything about playgrounds one way or another. The National Recreation and Park Association advised closing playgrounds, and many local communities followed that advice. Most experts quoted in the media advised the same thing, partly because surfaces could retain the virus but mainly because kids are kids and are unlikely to maintain six-foot distances all the time. So yes, this became common advice, but it had nothing to do with the CDC.
This is all tentative since my trip back in time might have missed some important statements. And it's certainly true that, in general, the CDC tends to be very conservative in its advice and is slow to change it in the face of new evidence. You may decide for yourself whether that's good or bad.
That said, my tentative conclusion is that the CDC did a perfectly decent job on the subject of surface infections. The problem is that there were lots of other voices too, and it wasn't always clear to everyone what advice was coming from who. That's led to unfair recollections like this one in the New York Times last week:
When the coronavirus began to spread in the United States last spring, many experts warned of the danger posed by surfaces. Researchers reported that the virus could survive for days on plastic or stainless steel, and the Centers for Disease Control and Prevention advised that if someone touched one of these contaminated surfaces — and then touched their eyes, nose or mouth — they could become infected.
Americans responded in kind, wiping down groceries, quarantining mail and clearing drugstore shelves of Clorox wipes.
That's just not right. The CDC, I think, was pretty clear that you could become contaminated from these surfaces (which was true) but that it was pretty unlikely. When Americans went crazy for disinfecting their houses, it was because of advice from other media talking heads, not the CDC.
Other views are welcome. Let me know if you have media reports from last year that show the CDC providing different advice about the risk of getting COVID-19 from surface infections.
This is your periodic reminder that the coronavirus rescue bill passed last month is a boon for middle-class families that buy health insurance on the private market.
In the past, a family that made, say, $100,000 per year got no subsidy from Obamacare. For a family of three or four, that meant premiums of $15-20,000 per year.
But the coronavirus bill limits premiums to 8.5% of income. That means you pay $8,500 instead, a savings of $10,000 or so.
For an older family it's even better. If you're in your 50s, premiums for two people can reach upwards of $20-30,000. Cutting that to $8,500 represents a savings of $15,000 or more.
