COVID COVID-19 Coronavirus Containment Efforts

[.Scott]

What's wrong with these numbers?

Below is a screen shot from Covid Act Now for New Hampshire.

The screen shot was taken after selecting the popup that shows the detail for each of the ten counties - and there are exactly 10 counties in New Hampshire.

Of interest is the "Daily New Cases per 100K".
The value reported for the State (shown to the left of the popup) is 10.2.
One would expect this to be the weighted average (by population) of the counties.
The county populations are shown in light gray under the county name. For example, it reports Hillsborough County as having a population of 420,000.
Notice that the range of "Daily New Cases per 100K" for the counties is 11.4 to 21.3.
So we have a weighted average that is less than the minimum value (?).

 

[collinsmark]

What's wrong with these numbers?

Below is a screen shot from Covid Act Now for New Hampshire.

The screen shot was taken after selecting the popup that shows the detail for each of the ten counties - and there are exactly 10 counties in New Hampshire.

Of interest is the "Daily New Cases per 100K".
The value reported for the State (shown to the left of the popup) is 10.2.
One would expect this to be the weighted average (by population) of the counties.
The county populations are shown in light gray under the county name. For example, it reports Hillsborough County as having a population of 420,000.
Notice that the range of "Daily New Cases per 100K" for the counties is 11.4 to 21.3.
So we have a weighted average that is less than the minimum value (?).

View attachment 283234

Something is definitely wrong. The site claims that "Over the last week, New Hampshire has averaged 139 new confirmed cases per day."

But then when you add up all 10 counties, of their individual claims (e.g., "Over the last week, Hillsborough County, New Hampshire has averaged 63 new confirmed cases per day"),

63
35
18
18
10
13
8
6
6
7
----------
Total: 184

(As of 2021-05-18)

 

[collinsmark]

Something is definitely wrong.

What's wrong with these numbers?

Ok, I've dug into the source data a little, and I don't think the discrepancy is the fault of the Covid Act Now site.

Rather the discrepancy seems to be found in the New York Times raw data, as far as I can tell. (The data files are too big to attach in this post, but here's a link to the data: https://github.com/nytimes/covid-19-data). I haven't double checked the calculation for each and every county, but I have checked the first couple, and it seems consistent with what Covid Act Now is reporting.

The figure from New Hampshire's new confirmed cases seems to come from us-states.csv, while the individual counties seems to come from us-counties-recent.csv. So the discrepancy seems to be a matter of how the New York Times is populating these data (.csv) files.

(Edit: removed edit)

 

[nsaspook]

The official 'interim' mask rules for Oregon. Status will be verified for indoors without masks. So I guess we get to see how that works now as I think Oregon is the only state with this check status requirement for fully vaccinated 'No Mask'.

https://www.opb.org/article/2021/05/18/oregon-health-officials-release-new-rules-for-masks/

The Oregon Health Authority added some clarification Tuesday about new mask rules that were announced last week. As health officials announced last week, people who are fully vaccinated will no longer be required to wear a mask indoors, but officials clarified that only applies in situations where individuals’ vaccination status is checked.
...
All businesses, places of employment, and faith institutions are required to enforce the state’s mask mandate unless they establish a new policy of checking for proof of vaccination status for every individual who enters.

Customers, employees, or congregants who can show proof of vaccination would then be allowed to enter without a mask.

 

[.Scott]

In New Hampshire, not only has COVID resulted in an inability to count, but this infection seems to have spread to other counts.

Earlier today, I posted NH county COVID case numbers with the odd property that the weighted (by population) average of the numbers (hence the State number) yielded a number that was less than any county.

But one town in NH has had another counting problem. After the November election, a State Representative candidate in Windham, NH asked for the towns votes to be recounted. That recount didn't chance the results for that representative, but the recount numbers were very different that the original machine counts. The difference was enough for the NH Legislature to unanimously vote to audit the result (and that's a lot of representatives to find themselves in unanimous agreements).

That audit is about half-way through the data collection phase - where the ballots and the machines are examined and the results recorded.

But an explanation seems to be coming into view. The voting machines are not COVID-tolerant.

The ballots are printed on thick paper - a bit larger than letter size. Depending on the number of candidates, offices, and ballot questions for that particular town and year, there may be anywhere from about 2 to 4 of these sheets.

Normally, when a voter shows up at the polling place, their registration is checked and then they are given a the ballot sheets. They take them to a private booth, mark the ballots, and place them into the voting machine on their way out.

But absentee ballots are a bit different. The ballots are marked by the voter, then folded in three so that the will fit into a standard size envelope. Then they are feed into the voting machines by the voting officials.

Normally, the number of absentee ballots is something like 2%.
Because of COVID, this year it was a lot more.

Because of the placement of the candidates on the ballot
1) The presidential results are not affected.
2) The Governors race may be affected, but there would have been no bias that would have resulted in a change to the winner (Gov. Sununu).
3) The Legislative votes may be very interesting.

 

[Vanadium 50]

Got Dose 2 today, and asked some questions and kept my eyes and ears open.

I asked if it was mostly Dose 1 or Dose 2, and the answer was it was a mix, and they didn't know which was more. "Around 50-50".

The place was pretty empty. But they seemed to have a steady stream of customers. Not many people waited the 15 minutes. There was one walk-in who was turned away. I stopped by the grocery store on the way back, and their pharmacy was jammed.

Individual sites have only one kind of vaccine. The minimum order is ~1200 doses, which may be an issue in rural areas.

 

[nsaspook]

What happens when businesses are required to check for vaccine status? The state requirement to check fully vaccinated status, as was expected, is causing trouble and is reducing the number of locations the fully vaccinated can enter without a mask. Some of the larger chains are ignoring the check requirement.

https://www.kptv.com/news/business-owners-say-mask-guidelines-creating-tension-between-customers-and-employees/article_48c9de30-b9d8-11eb-9c43-9380cca9565f.html

Bolander says Oregon’s additional requirement that businesses check vaccination cards has only fueled more rage toward staff.

https://www.oregonlive.com/coronavi...ed-meyer-stores-still-require-face-masks.html

Kroger stores across the country are going maskless, but not in Oregon and Washington.

 

[Ygggdrasil]

The state requirement to check fully vaccinated status, as was expected, is causing trouble and is reducing the number of locations the fully vaccinated can enter without a mask.

I think the intended effect of the regulation is to keep masking requirements at most businesses for the reasons discussed in this thread (problems with unvaccinated individuals who lie about their status).

 

[nsaspook]

I think the intended effect of the regulation is to keep masking requirements at most businesses for the reasons discussed in this thread (problems with unvaccinated individuals who lie about their status).

If true then why did the state government even bother with changing the state regulations to allow indoors without masks per CDC guidance? If this is a slight of hand move it doesn't help with improving trust in government by pretending to follow the science of the CDC.

https://www.nber.org/system/files/working_papers/w28804/w28804.pdf

During the first four months of 2021, the United States distributed approximately 250 million doses of COVID-19 vaccinations, which resulted in the complete vaccination of nearly 45 percent of the adult population. In the midst of this mass vaccination effort, Texas became the first state to abolish its statewide mask mandate and fully lift capacity constraints for all businesses. Governor Greg Abbott’s order was met with (i) concern by public health officials that an early reopening would lead to a resurgence of COVID-19, and (ii) assertions by Texas politicians that a reopening would generate short-run employment growth. This study provides the first empirical evidence on these claims. First, using daily anonymized smartphone data on social mobility from SafeGraph, Inc. — and synthetic control and difference-in-differences approaches — we find no evidence that the Texas reopening led to substantial changes in social mobility, including foot traffic at a wide set of business establishments in Texas. Second, using daily data on new COVID-19 cases from the New York Times, we find no evidence that the Texas reopening affected the rate of new COVID-19 cases during the five weeks following the reopening. Our null results persist across more urbanized and less urbanized counties, as well as across counties that supported Donald Trump and Joe Biden in the 2020 presidential election. Finally, we find no evidence that the Texas reopening order impacted short-run employment. Together, our null findings underscore the limits of late-pandemic era COVID-19 reopening policies to alter private behavior.

 

[Vanadium 50]

problems with unvaccinated individuals who lie about their status

Why is this a problem? According to the CDC, "Only unvaccinated people are at risk by unmasking." Are we following the CDC guidance or not?

 

[JT Smith]

Why is this a problem? According to the CDC, "Only unvaccinated people are at risk by unmasking." Are we following the CDC guidance or not?

Why would you? Early in the pandemic they told us wearing a mask wasn't effective, that it could actually be worse than not wearing one. They did that because they were concerned about the limited availability of masks for front line medical workers. But they didn't say it that way. They lied to the public.

 

[Ygggdrasil]

If true then why did the state government even bother with changing the state regulations to allow indoors without masks per CDC guidance? If this is a slight of hand move it doesn't help with improving trust in government by pretending to follow the science of the CDC.

For some businesses, it would be feasible to ensure that all people at the business are vaccinated.

Why is this a problem? According to the CDC, "Only unvaccinated people are at risk by unmasking." Are we following the CDC guidance or not?

Presumably because Oregon still wants to protect the unvaccinated.

 

[Vanadium 50]

Why would you?

Because science!

presumably because Oregon still wants to protect the unvaccinated.

Then they should say so. You shouldn't have to presume, and it shouldn't be implied that this is for the health and saefty of everybody else.

 

[Ygggdrasil]

Then they should say so. You shouldn't have to presume, and it shouldn't be implied that this is for the health and saefty of everybody else.

From the article posted above:

“Masks continue to save lives and protect people who are not vaccinated,” OHA director Patrick Allen said on Tuesday.​

https://www.opb.org/article/2021/05/18/oregon-health-officials-release-new-rules-for-masks/

 

[jack action]

According to the CDC, "Only unvaccinated people are at risk by unmasking."

OK, someone will have to update my knowledge about vaccines.

Isn't the concept of vaccines that they are never 100% efficient? i.e if a vaccine is 75% efficient, it means that 25% of the vaccinated people are NOT protected by the vaccine, partially or totally?

We want everyone in a group to be vaccinated such that the unprotected (not unvaccinated) number of people is as low as possible. The lower this number is, the more chance the pathogen will die on its own, incapable of reproducing itself. Once this is achieved, we have herd immunity, i.e. everybody is protected, with or without a vaccine, efficient or not.

And herd immunity is an unavoidable ending, with or without a vaccine. The difference is that without a vaccine some people (maybe a lot) may get very sick and possibly die. But once a majority has gotten the pathogen and has survived, herd immunity will be achieved.

So isn't it a false statement - giving a false sense of security - to say that all vaccinated people are protected? Or have I misunderstood how vaccination works?

 

[mfb]

Isn't the concept of vaccines that they are never 100% efficient? i.e if a vaccine is 75% efficient, it means that 25% of the vaccinated people are NOT protected by the vaccine, partially or totally?

It's never a binary thing. For a given exposure you reduce the risk of an infection for essentially everyone. How much depends on the person, the virus variant, the exposure, the timing of vaccination and exposure, random chance and so on. We know that the widely used vaccines are pretty good at reducing infections overall, and really good at avoiding severe infections.
If you take a bath in virus particles it's probably going to kill you with or without vaccine, but an infected person coughing near you is less likely to infect you. As the latter case is more common vaccinated people will be far less likely to get infected, far less likely to carry an infection, and far less likely to infect others (these three directly cause each other). It's not 100%, but it's pretty good.

And herd immunity is an unavoidable ending, with or without a vaccine.

Influenza has been around for a very long time.

 

[Ygggdrasil]

One issue with many of the discussions around re-opening is that people treat "safe" vs "at risk" as a binary whereas in reality, there are some judgement calls here. Driving a car is not a safe activity (auto accidents cause ~40k deaths per year in the US). Eating red meat is not a safe activity (red meat consumption is linked with an increased risk of cancer). Even not wearing masks and refraining from social distancing during normal pre-COVID times was not safe (there are ~12-61k deaths/year from influenza in the US). However, many people participate in these activities daily as they deem them to be acceptable risks.

So, the question to consider is, what level of risk is acceptable to society from COVID-19? This is a physics forum, so let's be quantitative with our answers.

Clinical trials and large-scale observational studies of the COVID-19 vaccines show that the vaccines are highly effective at preventing severe illness and death (many of the clinical trials recorded no deaths in the vaccinated population). A large scale study of the vaccine rollout in Israel estimated a 96.7% protection from death (95% CI 96.0-97.3) (Haas et al. 2021). Currently, the US has recorded ~590k deaths from COVID. Were everyone vaccinated (but still experience the same extent of spread of the disease), the number of deaths would be cut to ~24k (even assuming the protection is on the lower end of the estimate at 96% protection). This level of deaths is within the typical number of deaths from seasonal influenza. Is that an acceptable level of risk?

(note that this is a back-of-the-envelope calculation, and there are many other factors that would need to be considered, such as whether immunity might wane over time or whether we would need to aim for lower numbers because that level of COVID-19 disease combined with a normal influenza season could threaten to overwhelm hospital capacity).

 

[jack action]

So, the question to consider is, what level of risk is acceptable to society from COVID-19? [...]

[...] Is that an acceptable level of risk?

Aren't these questions for individuals, not society as a whole?

Once informed, am I not the one who should decide if I want to use a car or not, eat red meat or not, or wear a mask or not?

If one thinks people are crazy drivers, or farmers don't take care of cows in a healthy way, or people walk carelessly in the streets spreading germs; isn't this just new information for one's risk analysis and act according to what one thinks is the proper limit? Is it OK to set a common limit for everyone? (Is it really common if it is imposed?)

 

[nsaspook]

From the article posted above:

“Masks continue to save lives and protect people who are not vaccinated,” OHA director Patrick Allen said on Tuesday.​

https://www.opb.org/article/2021/05/18/oregon-health-officials-release-new-rules-for-masks/

https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le3727.pdf

So the solution is to change to this confusing state of affairs of show us your papers that results in unnecessary (Oregon being the only state with this requirement) tension on the part of unmasked users and potential mask card checkers?
California is actually honest about it. They didn't follow CDC guidance for indoors.

https://www.littler.com/publication...g-your-face-mask-duties-list-statewide-orders

 

[Vanadium 50]

So isn't it a false statement - giving a false sense of security - to say that all vaccinated people are protected?

Yes. But that's what the CDC said. And the CDC is the Truth.

One issue with many of the discussions around re-opening is that people treat "safe" vs "at risk" as a binary

True, but can they be forgiven when the CD tells them that? (BTW, fair point on Oregon) "Only unvaccinated people are at risk by unmasking." They could have said "Unmasked people are putting themselves more at risk than others" which is less black-and-white and probably closer to the truth.

 

[Vanadium 50]

show us your papers

Masks provide two functions. A medical one, and a social statement. They say "we are with our Tribe and not those filthy, smelly, diseased, wrong-way voting stinkers". While I would never suggest that the social aspect is driving the decision...well, it's hard to keep these factors out of the back of one's mind when officials make public health decisions.

The reason for "papers, please" is to prevent people who are not fully vaccinated from claiming they are. The thinking seems to be that they are liars, but I suspect that most of the people that will be caught up in the net will be people who think they are fully vaccinated. So, I looked at the pile of papers I got after Dose 2. Nothing says two weeks. The closest is on the back of a slip of paper that looks like it only has one side (and is stapled in between other forms) and says "may not fully protect you until a week or two after the second shot."). I also got an "I'm vaccinated" sticker.

If they really want to keep unvaccinated folk masked up, a cheaper way to do that would be clearer messaging. Instead of "a week or two" they could say "the CDC recommends two weeks". Instead of a sticker then and there, they could mail me one in two weeks.

Of course these only help with the public health aspect. They don't do beans about the social statement.

 

[mfb]

Aren't these questions for individuals, not society as a whole?

Both.

You are not free to use a car in any way you see fit. You need a license, you need to follow traffic rules, your blood alcohol content needs to be below some limits, and many more requirements. Similarly, the risk to infect others makes some behavior a risk to everyone, not just the person being infected. Things like mask requirements are "pandemic traffic rules".

 

[russ_watters]

Masks provide two functions. A medical one, and a social statement.

To me the social statement is somewhat vague/overlapping with the medical issue. I definitely feel shame if I forget to put on my mask in a situation where I feel I should/would have two weeks ago. As if my fly is down. But that feeling also overlaps with a feeling that the mask guidance is ill-conceived...and I feel less sorry because of that. And I'm also having a hard time thinking of good/well-meaning reasons why it has been so badly bungled.

The reason for "papers, please" is to prevent people who are not fully vaccinated from claiming they are. The thinking seems to be that they are liars, but I suspect that most of the people that will be caught up in the net will be people who think they are fully vaccinated.

I lean more toward the "liars" angle, but I must admit since getting the second dose I've relaxed my own standards quite a bit. I suppose the difference is that my hypocrisy only lasts two weeks whereas an anti-vaxxer's malfeasance lasts forever.

 

[nsaspook]

Both.

You are not free to use a car in any way you see fit. You need a license, you need to follow traffic rules, your blood alcohol content needs to be below some limits, and many more requirements. Similarly, the risk to infect others makes some behavior a risk to everyone, not just the person being infected. Things like mask requirements are "pandemic traffic rules".

The rules in Oregon are the equivalent of having to stop at every stores parking lot to show them your drivers license before you can park in their lot after the government has sent a easy to fake license to those that passed a anonymous (no public records) test of driving.

 

[atyy]

They don't do beans about the social statement.

https://www.npr.org/sections/health...axed-mask-rules-to-get-more-people-vaccinated

Not exactly what you meant by "social statement", but still a discussion on social aspects

 

[mfb]

The rules in Oregon are the equivalent of having to stop at every stores parking lot to show them your drivers license before you can park in their lot after the government has sent a easy to fake license to those that passed a anonymous (no public records) test of driving.

No one is required to show anything anywhere. You are not even required to have a vaccination.
The new rule is an alternative route that might be more convenient to drive but can come with a higher accident risk to everyone, so you can only drive there if you show that you can do so safely. You don't need to use that new option. You can just ignore it completely if you like.
I don't know how easy it is to fake the documentation of the vaccination, if that's too easy it's a concern, but you seemed to be more concerned about new extra requirements (which don't exist).

 

[nsaspook]

No one is required to show anything anywhere. You are not even required to have a vaccination.
The new rule is an alternative route that might be more convenient to drive but can come with a higher accident risk to everyone, so you can only drive there if you show that you can do so safely. You don't need to use that new option. You can just ignore it completely if you like.
I don't know how easy it is to fake the documentation of the vaccination, if that's too easy it's a concern, but you seemed to be more concerned about new extra requirements (which don't exist).

The main risks are unlicensed drivers hitting other unlicensed drivers using the driver license analogy, licensed drivers have very low risks.My concern is the loss of incentives (to the remaining not vaccinated) to be vaccinated by reducing the ability to go mask free indoors. My concern is getting more people vaccinated instead of keeping people wearing masks because the risk reduction from getting the shot is so much higher than mandated masking. Most businesses here are defaulting to not checking and keeping the defacto must have mask rules no matter your vaccination status because they can't check up to 10's of thousands of people entering a typical grocery store a week for a hand written paper vaccination card. Large chains like Walmart that use the CDC guidance locally are just ignoring the check requirement because the rule is impracticable and IMO counterproductive.

From the link posted above.
https://www.npr.org/sections/health...axed-mask-rules-to-get-more-people-vaccinated

"What the CDC is betting on is that people care about their own health and they're going to be nervous" about living in a maskless world if they aren't vaccinated, she says. So Milkman predicts that this will spur more people to get their shots.

During a situation without historical precedent, the CDC's move is a gamble. The risk of loosening mask guidelines, of course, is that unvaccinated people will no longer feel compelled to wear masks at all.

But Milkman says the CDC's guidance puts the incentives and the risks largely on the unvaccinated, which is where it should be. She says that the people most likely to be hurt by the change in rules are "the people who aren't doing the right thing and aren't getting the vaccine."

 

[Vanadium 50]

I suppose the difference is that my hypocrisy only lasts two weeks whereas an anti-vaxxer's malfeasance lasts forever.

Well, it lasts until the pandemic wanes. I guess the question is how badly you want these people punished. (For making legal, and possibly even rational, choices that you and I did not) "Peace will come when they love their children more than they hate us", and all that. I mentioned the walk-in who was turned away. Isn't he the guy we should be directing resources towards?

"Flatten the curve" morphed into "crush the curve", and when the policies intended to flatten the curve flattened the curve and didn't crush it, they were often viewed as a failure. Now we're in the mode where "make a vaccine available" is morphing into "stick a needle in everyone, whether they want to or not".

Maybe a better question is "how much vaccination do we need?"

I estimate the number of adults who refuse vaccination to be 10%. We know that 85% of 65+ people (who were first in the queue) have received at least one dose, so presumably intend to receive the other (and 87% of them have done so). This is a lower bound, as this group contains a higher fraction of those who shouldn't be vaccinated. We also have four states with >90% vaccination and seven more close to it. So we will end up with:

• 7% of the population under 12, no change
• 9% of the population refusing vaccination, no change
• 9% of the population getting J&J, transmission risk reduced by 4
• 75% of the population getting Pfizer or Moderna, transmission risk reduced by 20

Altogether, the transmission risk is down by about 4.5. With a no-intervention R of 2-3, we're done. R becomes 0.5 or 0.6 and we just have to wait out the exponential tail. Sure, we still have kids giving it to other kids, but lining up all the Jenny McCarthys and forcibly vaccinating them won't change that.

If you managed to give all the Jenny McCarthys J&J, the 4.5 moves up to 6.6. If you revaccinated the J&J folks with Pfizer or Moderna (assuming that this works and provides the same efficacy as "regular" folks) the 4.5 moves up to 5.0. The absolute maximum is 14.3. (A vaccine with 100% effectiveness given to 100% of the over-12s)

Where are we today? It's hard to tell, partly because finding out who got what when is difficult, and because immunity is not instantly conferred, but it looks like somewhere between 1.8 and 2.1. It's not 1.5 and it's not 3. It will be above 2 in two weeks, if it isn't already.

 

[Dale]

This is a lower bound, as this group contains a higher fraction of those who shouldn't be vaccinated

I wouldn’t make that claim. It may not be a lower bound because that group may systematically have a different rate of vaccine hesitancy or vaccine access.

I estimate the number of adults who refuse vaccination to be 10%.

Do you have a reputable source for that number?

 

[atyy]

• 7% of the population under 12, no change
• 9% of the population refusing vaccination, no change
• 9% of the population getting J&J, transmission risk reduced by 4
• 75% of the population getting Pfizer or Moderna, transmission risk reduced by 20

The transmission risk reduction for Pfizer could be by 4. The 95% reduction in cases for Pfizer is for symptomatic cases, but asymptomatic cases can still transmit (probably not as well as symptomatic cases). Estimates for the reduction in asymptomatic cases range from 50-90% (depending on the study). Overall, the reduction in total infections (symptomatic and asymptomatic) may be about 70%. That number will get lower as viral variants evolve. Unless borders remain closed for much longer, it may not be feasible to have prevention of infection as a goal. Maybe the goals should be prevention of severe disease for those who want the vaccine, and making sure those who don't want the vaccine don't fall sick at such high rates that medical services are overwhelmed and everyone can't get good care.

https://www.medrxiv.org/content/10.1101/2021.04.22.21255913v1
Impact of vaccination on SARS-CoV-2 cases in the community: a population-based study using the UK’s COVID-19 Infection Survey
Emma Pritchard, Philippa C. Matthews, Nicole Stoesser, David W. Eyre, Owen Gethings, Karina-Doris Vihta, Joel Jones, Thomas House, Harper VanSteenHouse, Iain Bell, John I Bell, John N Newton, Jeremy Farrar, Ian Diamond, Emma Rourke, Ruth Studley, Derrick Crook, Tim Peto, A. Sarah Walker, Koen B. Pouwels, Coronavirus Infection Survey team

 

[mfb]

My concern is the loss of incentives (to the remaining not vaccinated) to be vaccinated by reducing the ability to go mask free indoors. My concern is getting more people vaccinated instead of keeping people wearing masks because the risk reduction from getting the shot is so much higher than mandated masking. Most businesses here are defaulting to not checking and keeping the defacto must have mask rules no matter your vaccination status because they can't check up to 10's of thousands of people entering a typical grocery store a week for a hand written paper vaccination card. Large chains like Walmart that use the CDC guidance locally are just ignoring the check requirement because the rule is impracticable and IMO counterproductive.

There are a couple of changed incentives and it's hard to tell how important which one will be. What do you mean by reducing the ability to go mask free indoors?

* People could interpret the return of unmasked indoor stays as sign that the pandemic would be over -> smaller incentive to get vaccinated
* Infection risk could go up in places that don't check -> larger incentive (probably a small effect for people who are not interested in a vaccine already)
* When vaccinated they can stop wearing masks in places that check (without faking a card) -> larger incentive

 

[Vanadium 50]

Do you have a reputable source for that number?

Nope.

I gave the basis. 85% is based on the 65+ population. The 90% is based on 4 states that are at the 90+% level for eligible adults.

A data point i did not use is that the number of people at my place of employment (which is overweighted by eds and meds, but it is not exclusively so - a surprisingly large number of support people are required) answering "disagree" to the question "I would want to be vaccinated as soon as possible" is 8%. It's probably biased high by the eds and meds, and asks a different question: "right away" does not mean "ever". I waited my turn, even though I had a chance to cut in line. Where does that put me?

But from a public policy perspective, I don't think this matters. Sure, we'd like to take Janny McCarthy and tar, feather and force-vaccinate her (probably not in that order) but it's an expensive proposition, and even at 10% of adults, that's still 30 million people.

I'm arguing that we should spend less effort of punishment and "prevenge" and instead use that effort in places where it would do more good, even if less emotionally satisfying. The walk-in who was turned away? That's the guy we should be helping.

 

[nsaspook]

There are a couple of changed incentives and it's hard to tell how important which one will be. What do you mean by reducing the ability to go mask free indoors?

* People could interpret the return of unmasked indoor stays as sign that the pandemic would be over -> smaller incentive to get vaccinated
* Infection risk could go up in places that don't check -> larger incentive (probably a small effect for people who are not interested in a vaccine already)
* When vaccinated they can stop wearing masks in places that check (without faking a card) -> larger incentive

What I mean is most small business operators here are choosing not to allow indoor unmasking under any vaccination status even if it's allowed by the state of Oregon rules. They don't want to check people at the door so the ability to to go mask free indoors is reduced by the binary choice of, check everyone to allow the fully vaccinated to unmask if they want or don't check anyone and prevent the fully vaccinated from making a allow choice under state rules.

 

[Vanadium 50]

binary choice of, check everyone to allow the fully vaccinated to unmask if they want or don't check anyone

Additionally, the card - at least my card - isn't really suitable for constant checking. It's 20% longer and 50% wider than a credit card so doesn't really fit anywhere. I was instructed not to laminate it. There is no procedure for getting a duplicate. And, since we're talking about no-goodniks, it's trivially forged, and for that matter, nobody checked my for an ID. I could have paid a homeless guy $20 and a bottle of ripple to get a shot for me and got a card that way.

 

[mfb]

What I mean is most small business operators here are choosing not to allow indoor unmasking under any vaccination status even if it's allowed by the state of Oregon rules. They don't want to check people at the door so the ability to to go mask free indoors is reduced by the binary choice of, check everyone to allow the fully vaccinated to unmask if they want or don't check anyone and prevent the fully vaccinated from making a allow choice under state rules.

Then how does that change the incentive of people to get vaccinated?

 

[Dale]

I gave the basis. 85% is based on the 65+ population. The 90% is based on 4 states that are at the 90+% level for eligible adults.

I don’t think I would characterize that as a “lower bound”. It is at best merely an estimate with a lot of uncertainty. It is not clear that the 85% of the 65+ will generalize to other age groups and it is not clear that the 90% for 4 states will generalize to other states. So to assume that the generalization must go one way is suspect.

I am not getting into the politics, but just challenging your estimate. I would characterize the uncertainty as large and without specific evidence to the contrary would assume that it is approximately symmetric (in the log odds scale).

 

[Ygggdrasil]

Masks provide two functions. A medical one, and a social statement. They say "we are with our Tribe and not those filthy, smelly, diseased, wrong-way voting stinkers". While I would never suggest that the social aspect is driving the decision...well, it's hard to keep these factors out of the back of one's mind when officials make public health decisions.

The reason for "papers, please" is to prevent people who are not fully vaccinated from claiming they are. The thinking seems to be that they are liars, but I suspect that most of the people that will be caught up in the net will be people who think they are fully vaccinated. So, I looked at the pile of papers I got after Dose 2. Nothing says two weeks. The closest is on the back of a slip of paper that looks like it only has one side (and is stapled in between other forms) and says "may not fully protect you until a week or two after the second shot."). I also got an "I'm vaccinated" sticker.

If they really want to keep unvaccinated folk masked up, a cheaper way to do that would be clearer messaging. Instead of "a week or two" they could say "the CDC recommends two weeks". Instead of a sticker then and there, they could mail me one in two weeks.

Of course these only help with the public health aspect. They don't do beans about the social statement.

Refusal to wear masks and comply with masking mandates is just as much if not more of a political statement than wearing a mask. Indeed, when masking became a politically divisive issue, it's hard to say that people following CDC directives and state/local laws to wear masks were the ones making a political statement.

Do politics play a role in the current masking regulations? Of course, given that political figures are making these choices, the disparity in masking regulations between "red" states vs "blue" states, and the relative weighting of values (social responsibility vs individual liberty) at play in the debate. However, I would caution in assuming the "tribal" explanation as is a main reason many individuals would choose to continue wearing masks in public.

What I mean is most small business operators here are choosing not to allow indoor unmasking under any vaccination status even if it's allowed by the state of Oregon rules. They don't want to check people at the door so the ability to to go mask free indoors is reduced by the binary choice of, check everyone to allow the fully vaccinated to unmask if they want or don't check anyone and prevent the fully vaccinated from making a allow choice under state rules.

State rules allow men to appear in public without shirts or shoes, but stores are within their right to refuse service to people without shirts and/or shoes. Businesses can and do restrict peoples behavior, which is fine, in part, because consumers are able to choose which businesses they patronize.

 

[nsaspook]

Then how does that change the incentive of people to get vaccinated?

Because humans judge risk by their peers and possibly modify their behaviors during interactions with peers. If we limit (by restrictive business checking rules) positive unmasked interactions with peers who have followed the previous non-vaccinated masking rules and gotten fully vaccinated in social settings, to me, that's a disincentive.

Vaccination is what's important now to reduce sickness and death in the US, not masks. The CDC guidance is an obvious incentive to get vaccinated using the masked and unmasked as examples.


I go to the local Joe's bar with Tom (a person I know and trust) and see fully vaccinated Tom without a mask laughing and talking to fully vaccinated Sally without a mask with little or no risk to COVID-19 but I'm not vaccinated. Sure, I could lie or fake a card but there is a peer based incentive to actually get fully vaccinated for my personal safety.

The state of Oregon thinks incentives are a useful tool because they are using the Lottery to push vaccination.
https://www.opb.org/article/2021/05/21/oregon-covid-19-lottery-briefing/

Oregon to offer $1 million lottery drawing for COVID vaccine recipients​

 

[Vanadium 50]

Refusal to wear masks and comply with masking mandates is just as much if not more of a political statement than wearing a mask. Indeed, when masking became a politically divisive issue, it's hard to say that people following CDC directives and state/local laws to wear masks were the ones making a political statement.

I never said otherwise.

However, I would caution in assuming the "tribal" explanation as is a main reason many individuals would choose to continue wearing masks in public.

Never said that. Never even meant that. I did intend to suggest that when governments adopt policies that tend towards the punative/coercive and do not involve policies that are less so and (I've argued) more likely to help, the policy makers might have the tribal aspect in the back of their minds.

And I think @nsaspook nailed it: "Vaccination is what's important now to reduce sickness and death in the US, not masks."

I am not getting into the politics, but just challenging your estimate.

Feel free to come up with your own. I outline what went into mine. I think it is better than the (as far as I can tell) evidence-free default position that the number of vaccine refuseniks is large and that they are coming from a certain place in the political spectrum.

You mentioned politics and the four states. I think people have been too quick to go there. It is true that these states are blue. Ranked #2, #3, #9 and #17. But it's a mistake to think of New England as homogeneous. You get out of eyeshot of water in Maine and it gets very rural, very poor and very red very fast. Even Massachusetts is relatively red between Worcester and Springfield.

People - like the NYT - are pointing out states like Alabama, Mississippi and Georgia as cases where their political redness is causing the low vaccination rates. (#48, 49 and 50). But I see at least two other reasons. One is that these states are very rural. (Rank #4, 9 and Georgia is #28 with one large city), and we previously discussed the challenges rural areas face. Another is that these states have a large African-American population (#1, #2 and #6), and African-Americans are being vaccinated at 3/4 of the rate of the population as a whole.

Scapegoating our political foes might make us feel better, but won't solve the problem. (And indeed, the places where Africa-Americans lag the most in vaccination are DC, NYC and Maryland. Hardly bastions of redness)

 

[Dale]

Feel free to come up with your own. I outline what went into mine.

My main objection is the claim that it is a lower bound.

 

[mfb]

I go to the local Joe's bar with Tom (a person I know and trust) and see fully vaccinated Tom without a mask laughing and talking to fully vaccinated Sally without a mask with little or no risk to COVID-19 but I'm not vaccinated. Sure, I could lie or fake a card but there is a peer based incentive to actually get fully vaccinated for my personal safety.

That's the second positive incentive I mentioned in my earlier post. Such a situation cannot happen without a rule "if you are vaccinated you can remove your mask in some places".

You mentioned politics and the four states. I think people have been too quick to go there. It is true that these states are blue. Ranked #2, #3, #9 and #17. But it's a mistake to think of New England as homogeneous. You get out of eyeshot of water in Maine and it gets very rural, very poor and very red very fast. Even Massachusetts is relatively red between Worcester and Springfield.

It's not just four states. It's an obvious correlation across all of them. It also holds on the county level within states. Correlation does not mean causation, but it's a notable pattern.

 

[nsaspook]

That's the second positive incentive I mentioned in my earlier post. Such a situation cannot happen without a rule "if you are vaccinated you can remove your mask in some places".

That's exactly my point, we need to increase the chances of that happening even if it means some small percentage of cheating. We are long past worrying about the level of mask wearing, mask cheating and mask virtue signaling at this stage if we can increase vaccinations because cheating is very unlikely to cause a uptick in serious COVID-19 cases due to vaccinations being so much more effective than masks.

Restriction elimination is linked directly to the vaccination percentage metric in most states because cases have been dropping at a rate that has eliminated most case based metrics to the point that Portland Oregon (in Multnomah County) is due to be in the lowest state risk category this week.

https://www.kgw.com/article/news/he...y-26/283-ee2dba6e-5cec-479b-bc3d-2c1f881e8928

The other requirement to move to lower risk is that at least 65% of a county's residents 16 or older must have received a first dose of the vaccine. Multnomah County reached that target last week. On Friday, five Oregon counties — Benton, Deschutes, Hood River, Lincoln and Washington — moved to the lower risk level.

Having submitted its vaccine equity plan, the county will now be eligible to move to lower risk on Friday, May 28, which will allow the county to significantly reduce its COVID-19 restrictions. The lower risk level allows a maximum of 50% capacity indoors at restaurants, theaters, gyms and other indoor entertainment spaces. It also expands retail store capacity to 75%.

 

[russ_watters]

Well, it lasts until the pandemic wanes.

No, they just have until the pandemic wanes to reverse the hypocrisy. After that it isn't an option anymore.

(For making legal, and possibly even rational, choices that you and I did not)

It's definitely legal, maybe rational, but usually selfish. Most of the pandemic mitigation efforts have been that way. Vaccines, masks, Thanksgiving dinners, protests, personal information sharing...heck, even toilet paper. Much of the story of the pandemic has been the push-pull between making choices that are viewed as best for ones-self vs what is best for society -- and governments' attempts to shape that.

Maybe a better question is "how much vaccination do we need?"

Yes, and to be fair the question may already be moot. The 70% threshold is mythical and doesn't include those who have already been infected and are carrying some immunity. Seeing how fast the infection numbers are dropping right now tells me we may already be at the threshold, whatever it is. But still...

I estimate the number of adults who refuse vaccination to be 10%. We know that 85% of 65+ people (who were first in the queue) have received at least one dose, so presumably intend to receive the other (and 87% of them have done so). This is a lower bound, as this group contains a higher fraction of those who shouldn't be vaccinated.

To me, the elderly represent an upper bound -- or maybe both at the same time because they are simultaneously the group with the most who shouldn't be vaccinated (<10%?) and the most who should (everyone else). And they are the group with the easiest access the vaccine. For those frail enough to live in congregate care but not frail enough that vaccination itself presents a high risk, the vaccine was literally delivered to their kitchen table. For such people, there wasn't even an opportunity to be ambivalent about the vaccine, it was a binary choice; get it or don't, right now.

The "should I get a vaccine" calculus is entirely different for a 20 year old than for a 75 year old. For the rest of the population, the choice is not binary. The options include:

• Yes, immediately.
• Yes, when I have time.
• Maybe, if it is made easy enough for me.
• Maybe, eventually, if it is made easy enough for me.
• I don't know = not right now and maybe never
• No, never.

We also have four states with >90% vaccination and seven more close to it. So we will end up with:

Others have pointed out the political association, but New England is also very white. This isn't just a political issue, it is a demographics issue; vaccine hesitancy is high among blacks and Hispanics as well. And that's definitely not related to rural living, as those groups are concentrated in cities.

I'm arguing that we should spend less effort of punishment and "prevenge" and instead use that effort in places where it would do more good, even if less emotionally satisfying.

We're just talking here. I don't see policies in action to actually punish the hesitant/refusers. Really, I see the policy change as letting them off the hook. Maybe the CDC was hoping it would provide an incentive to get vaccinated, but for the refusers I don't think it does.

But I see at least two other reasons. One is that these states are very rural. (Rank #4, 9 and Georgia is #28 with one large city), and we previously discussed the challenges rural areas face.

Well...you speculated about the challenges rural areas might face. If such challenges did exist and were a significant factor behind the sharp drop in new vaccinations, I'd think it would be demonstrable and all over the news. While I know we're all speculating here, I think it's unlikely to be a significant issue. There's 14,000 McDonalds in the US and 40,000 chain pharmacies (not sure if Walmart is counted in that number), plus doctors' offices and hospitals. One would need to be really, really rural to lack easy access to a vaccine and I can't see that there would be enough such people to affect the uptake statistics.

The minimum order is ~1200 doses, which may be an issue in rural areas.

That's for Pfizer. The minimum Moderna order is 100. I didn't check J&J because who wants a J&J vaccine.

Just for the heck of it, I went looking for a random small town in Alabama, and stumbled on Russellville (pop: 10,000), my new favorite place:
https://www.google.com/maps/search/pharmacy/@34.5070437,-87.7453479,14z
It has four pharmacies in town with COVID vaccines.

 

[atyy]

We're just talking here. I don't see policies in action to actually punish the hesitant/refusers. Really, I see the policy change as letting them off the hook. Maybe the CDC was hoping it would provide an incentive to get vaccinated, but for the refusers I don't think it does.

Unmasking may not let them off the hook, because with viral mutations, herd immunity becomes less likely, even with 100% vaccination. So if the vaccine is mainly to prevent severe disease, then those who aren't vaccinated will have higher sickness and death rates (until we reach herd immunity against the variants). Of course, the policy is probably not out to get them, it's just that there may be a practical limit to how much some people can be persuaded. Then the policy would be to try to live with their views, as long as the higher rates among unvaccinated don't take up so much resources that others cannot get good care. The people who are punished are those who would like to be vaccinated, but cannot for one reason or other.

 

[russ_watters]

Unmasking may not let them off the hook, because with viral mutations, herd immunity becomes less likely, even with 100% vaccination. So if the vaccine is mainly to prevent severe disease, then those who aren't vaccinated will have higher sickness and death rates (until we reach herd immunity against the variants). Of course, the policy is probably not out to get them, it's just that there may be a practical limit to how much some people can be persuaded. Then the policy would be to try to live with their views, as long as the higher rates among unvaccinated don't take up so much resources that others cannot get good care. The people who are punished are those who would like to be vaccinated, but cannot for one reason or other.

I agree with pretty much all of that. I'm going to continue wearing a mask indoors in many circumstances for a little while at least (even though officially "fully vaccinated" today), because of a combination of concerns, which you pretty much list. Where the rubber meets the road, what government policy should be focused on is minimizing overall deaths/serious illnesses and what I am personally concerned with is minimizing risk while balancing against freedom*. Or from the other direction; wearing a mask to the supermarket means nothing to me personally, so there is no reason not to keep doing it. The more vigilant we are, the faster the disease numbers drop and the safer it is for all of us.

*Like V50 I don't like government gamesmanship (even if we set aside the politicizing). I think it is counter-productive/ineffective, especially in this case. The people the government is trying to game are the ones already primed to distrust government and detect/reject the gamesmanship. Oh -- and unethical/corrupt too. Yeah, there's that.

 

[atyy]

*Like V50 I don't like government gamesmanship (even if we set aside the politicizing). I think it is counter-productive/ineffective, especially in this case. The people the government is trying to game are the ones already primed to distrust government and detect/reject the gamesmanship. Oh -- and unethical/corrupt too. Yeah, there's that.

Maybe there's no gamesmanship - this is the endgame. Let's say there are no anti-vaxxers, then the endgame could still be all vaccinated can be unmasked, while those who are not vaccinated (for medical reasons) should remain masked to protect themselves (here I'm assuming the vaccinated might be asymptomatic carriers). Of course these same people should also be careful when they interact with their vaccinated relatives (since they can be asymptomatic carriers).

 

[morrobay]

Covid vaccine compulsory in this Thai province.https://www.bangkokpost.com/thailand/general/2115995/buri-ram-makes-covid-vaccinations-compulsory

 

[morrobay]

https://www.bangkokpost.com/thailand/general/2115995/buri-ram-makes-covid-vaccinations-compulsory Vaccines compulsory in this Thai province

 

[russ_watters]

Maybe there's no gamesmanship - this is the endgame. Let's say there are no anti-vaxxers, then the endgame could still be all vaccinated can be unmasked, while those who are not vaccinated (for medical reasons) should remain masked to protect themselves (here I'm assuming the vaccinated might be asymptomatic carriers). Of course these same people should also be careful when they interact with their vaccinated relatives (since they can be asymptomatic carriers).

If everyone were vaccine urgent-ers, we would not have seen the drastic drop-off in the vaccination rate over the past few weeks. People would still be lined-up around the block to get their first dose (actually, by now we'd be starting to run out of people eligible/able if that were the case).

But more to the point, we know there's gamesmanship. There has been from the beginning, and it hasn't been unique to a political persuasion - the original 'masks don't help' position is an example. Governments are trying to coerce the actions they want to see, for the benefits they are trying to produce. Even today, democratic governments think it is ok to lie if they have the best interests of their people at heart. That position/reality should terrify us. It's exactly the opposite of what democratic governments are supposed to be about.

 

[atyy]

If everyone were vaccine urgent-ers, we would not have seen the drastic drop-off in the vaccination rate over the past few weeks. People would still be lined-up around the block to get their first dose (actually, by now we'd be starting to run out of people eligible/able if that were the case).

What I mean is that the reasonable endgame may be the same regardless of how enthusiastic people are to get vaccinated. If so, the question is whether now is too early to be playing the endgame.