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IM Doc pt 28
Dec. 19th, 2021 10:33 amVaccine-Only Mandates as a Manifestation of the Bizarre Civil War-Stoking Impulses of the Professional-Managerial Class in the US
Never in my worst nightmares did I imagine I would ever want Bernanke and Geithner back in charge. Yes, vast swathes of the public at least dimly recognized that the financial crisis bailouts were designed to preserve the banking system at their expense. Yes, no executives went to jail or even had their feathers ruffled. Yes, the Fed, the Treasury, and central bankers all over the world refused to believe that the derivatives-leveraged debt bomb was aimed at the heart of the financial system, even though they had warning in the form of three acute phases before the big Lehman-triggered blow up.
But compared to the clown show we have managing the Covid crisis, the Fed-Treasury team was a paragon of managerial virtue. There is every reason to loathe their banking system friendly, cognitively captured priorities, backed by Obama’s fundamental conservatism and personal reluctance to cross anyone in the clubs he’d just joined. But they were bloody well competent at pursuing those bad objectives.
By contrast, most readers are all too familiar with the sorry conduct of public health establishment in the US over the course of the Covid crisis, from the initial denial of the possibility that it could become a pandemic,1 to advising against masks, to ending lockdowns too early, to imposing too few restrictions on international air travel, to refusal to impose quarantines with teeth, to the premature May “Mission Accomplished, take off your masks” pronouncement.
Today, we’ll discuss the vaccine mandates as a perverse example of the “othering” that has become a prominent and not-productive element of the official response to Covid. It as if this focus designed to serve the emotional needs of those in charge, in particular reaffirm their claim to authority and assertion of special privileges, rather than prevent death and suffering. And the “others” are responding in kind to the open hostility, starting with Biden saying he’s lost patience with the unvaccinated.
Vaccinations Alone Insufficient to Combat Delta….
A Covid strategy that relied pretty much exclusively on vaccinations could conceivably have worked with the original “wild type’ or “Wuhan” variant, where experts estimated that a ~65% vaccination level would reduce the replication rate to less than one, so the pathogen would fizzle out. There might still be outbreaks in low-vaccination areas, but Covid would be reduced to an intermittent, low-level problem.
But with Delta being far more contagious, or as the experts would say, having a higher unmitigated R0, it would take a correspondingly much higher level of vaccination to lower the R0 to below one, with most experts pegging it at 85% if not higher.
Getting to 85% would be daunting when you factor in not merely vaccine resistance/hesitancy and legitimate economic reasons to avoid vaccination (the risk of miss a day or two or work due to a routine reaction leading to a catastrophic economic downspiral) but also the fact that being vaccinated or getting Covid confers less than a year of immunity. The best guesstimates seem to be eight months for Moderna and contracting Covid, and close to that long for J&J, versus five to six months at best for Pfizer.3
Despite efforts to impugn data out of Israel showing declining efficacy of Pfizer vaccine4, confirmed by a large-scale study out of Mayo, it appears that the current vaccines do very little to reduce contagiousness. The CDC study of the Provincetown outbreak found similar nasal viral loads among the vaccinated and unvaccinated; other studies tried to claim the vaccines still reduced Delta propagation. To the extent it does, it ain’t much, on the order of 2.0
Moreover, waning vaccine effectiveness among the vaccinated translates into not merely more breakthrough cases, but also an increasing number of those with breakthrough cases winding up mighty sick. And all those cheery claims that virtually all of those hospitalized for Covid are unvaccinated is composed from anecdata since that information does not exist on a national level. From IM Doc:
I was informed today by the Health Dept that they have absolutely zero way of tracking correctly vaccinated cases. In that they do not have the ability to retrospectively find out which vaccination the person has had. So there is no way the CDC will be having this kind of detail, unless other states are doing this.
Readers have said California and some other states do have proper vaccination tracking systems, but in aggregate, they represent a minority of the population.
The reason we suspect the official-sounding anecdata is we are hearing from readers and medically-connected sources of specific instances of fully vaccinated individuals winding up in the hospital with Covid and some dying. IM Doc has even sent obits of medical professionals he knew who died of Covid, fully vaccinated, with no mention in the text, while the press makes relishes reporting on Covid deaths of the unvaccinated. Even though there is every reason to believe that deaths and hospitalizations are still significantly skewed towards the unvaccinated, the press hyping by how much is undermining confidence among the fence-sitters.
You might say, “But the booster program is starting! The virtuous vaccine-takers will be protected.” Um, not to the degree you’d like to think. Even for Moderna, the most effective vaccine against Delta, the neutralizing antibodies generated against B.1.351 by a third shot were only 40% of the level of the earlier jabs agains the wild type, per Moderna’s own research. Yet the booster program is now focused on Pfizer, the least effective vaccine against Delta. There’s a reason Israel is now talking about fourth booster shots.
You might say, “Well, the drug companies will soon have a booster that targets Delta.” Notice that they are instead offering boosters that are the same as the original shot, as in is designed to combat the Wuhan variant. The lack of any apparent plan to develop Delta or other variant-specific shots does not appear to be due to development or approval delays, but instead the span of variants. As GM explained:
It has been noted for some time that the mutations in Delta/B.1.617.2, on one hand, and B.1.351/Beta and P.1/Gamma, on the other, are orthogonal to each other. And there have been other mutational paths too, but those did not rise to significant prominence.
Which is essentially evolution into distinct serotypes, and is one big reason why we are still injecting the original Wuhan strain vaccine into the arms of people instead of a variant-specific one — the antigenic distance between the Wuhan strain and each of these variants is lower than the antigenic distance between some of them, thus the original vaccine gives the best breadth of coverage.2
Tellingly, even without necessarily having plumbed these or similar details, the media has started to abandon vaccine cheerleading. Notice the start of the segment, the host is clearly frustrated with the lack of sufficient vaccine success and probes Scott Gottlieb about therapeutics as a possible remedy:
And mind you, we haven’t even mentioned the elephant in the room, that of children as a contagion vector. The regular very large-scale tests by Imperial College established in 2020 that elementary school kids are twice as likely as adults to bring Covid into a household as adults, and older children, seven times as likely. Yet children have been omitted from the Covid computation until they started getting visibly sick with Delta and some dying.
And despite the full court press for adolescent vaccinations and enthusiasm for childhood jabs, it’s extremely unlikely that the uptake would get within hailing distance of adult levels. IM Doc lives in a very blue pocket in flyover. A report from early August:
We were at the parent meeting for the new school year this week. An informal vote was taken about this issue so the parents’s feeling could be gaged. There were 114 kids whose parents were there. The vote was 112-2. 112 kids will not be vaccinated.
What started off as an informational meeting turned into a screaming match between about 10-15 parents and the principal/school board. Massive standing ovations when these parents were stating that they will pull their kids and home school them before they would consent for them to be vaccinated.
And perhaps more relevant, with his area having a Covid upsurge, despite an 80% vaccination level in his county, to the degree that the National Guard are in his hospital, the local schools have contained infection among children:
Front page news story today – One of the largest school districts in the state – XXXX – now has almost 500 kids out in quarantine.
Schools up and down the mountain ranges in Montana are having similar issues.
All kinds of parents freaked out about masks and refusing to have their kids wear them, etc.
And yet in my kids’ district, a few here and there with COVID – and then appropriate measures taken.
A heavy community spirit.
All kids and teachers wearing masks. No communal cafeteria. We were asked last week to pack 2 lunches for each kid because they are trying to keep kids in their classroooms for lunches – and wanting no kids to have to eat cafeteria food. So some of the parents are sending 2 lunches with each kid to cover the other kids whose parents cannot afford (or whatever) to bring food. All windows in the class wide open with fans blowing. And they had installed fan filters in each room for when the winter comes. If a kid even has sniffles – they are called to be home – and for 7 days. No exceptions even if they are negative. The cold weather will start here very soon – will see how this all goes then.
We will skip over children for the rest of this discussion, but bear in mind that they create even more problems for viability of the Biden Administration vaccine-fixated response.
….Yet Biden Administration Doubles Down on Vaccines and Resorts to Coercion
Yet with that sorry fact set, here is where we are: With an 80% vaccine effectiveness against serious disease, a lot less than that against infection, the US is effectively doing the same as allowing 20% of people to be infected without any vaccine even if we vaccinated everyone, and it is a lot worse than that if we are far from that target.
And the official response is even worse. The vaccinated were told they could abandon precautions like masking, distancing, avoiding going to restaurants and bars. Due to the summer upsurge, the CDC has tried partially walking this hare-brained May guidance back and now recommends that the vaccinated mask up indoors. But the damage has been done. I see very little masking save at venues that require it, and readers across the US report report broadly similar behavior.
Rather than try to get the public to again adopt low-cost protective behaviors like masking, with soft measures like jawboning the major broadcasters to have all their on camera reporters wear mask, the Biden Administration instead is doubling down on its failed strategy of shaming by escalating and adding coercion into the mix, via vaccine mandates.
Remember, we can see that name-calling the unvaxxed has not worked well in the US data. We were early to start vaccinating the public and have had adequate supplies, yet as Lambert points out in Water Cooler, our vaccination levels are unimpressive by world standards.
As much as I don’t like the punitive glee too often visible in the discussion of the vaccine mandates, what is disconcerting is the strong-form of “vaccine only,” as opposed to the original formulation of “get the vaccine or get tested weekly.” Ahem, given breakthrough infections, why is regular (free) testing made into a punishment and not an incentive? If I could get weekly free testing at my workplace, I’d be all for it. And given the discussion of why vaccines alone are insufficient to tackle Covid, frequent testing would speed identification and isolation of the infected5.
And the reason the doubling down on a failed vaccination strategy via coercive mandates isn’t that the absolute levels of refusals will be all that high, but that they are almost certain to hit the already staff-starved hospitals, who have had a steady bleed of personnel due to burnout and reluctance to take even more exposure to Covid under Delta. Hospitals simply can’t afford to lose more staff. As we have pointed out, despite this recent Covid wave being less deadly than its predecessors, hospitals in many locations are closer to breakdown due to staff attrition.
It is touching to see Rochelle Walensky so concerned about the impact of mandate-triggered departures on already-strained hospitals. From The Hill:
CDC Director Rochelle Walensky on Monday said she backed vaccine mandates for health care workers, but admitted that resulting staff shortages could present a challenge.
We’ve pointed out that a big group that is reluctant to get vaccinated is reproduction-aged women, who’ve heard, often from women they know personally, reports of whacked-out menstrual periods, including cases of their cessation. The CDC has refused to take this seriously and is late to look into the issue. The lack of investigation allows these worries to fester and grow.
New York City is at risk. From New York hospitals brace for mass staff shortages as vaccine deadline looms:
Maxine Carrington, the personnel chief for Northwell Health, said she has had personal conversations with each staff member who is not vaccinated in order to try to increase vaccinations. “I’ve had personal conversations with team members, and I was asked by one: ‘Are you really going to fire us on the 27th?’ And I said, ‘let’s put that aside for a minute and let’s talk about saving your life. Why don’t you want to get vaccinated?’” Carrington said
Mind you, these hospital workers are regularly the antithesis of Southern-state Bubbas, but you’d never know that from the likes of the New York Times. Morning Newsletter, which ran a story today on how only 60% of Republicans had gotten one jab versus 86% of Democrats (hhm, poor follow through in both groups, Lambert’s Water Cooler shows the national vax level at 55.3%) with the headline, Covid’s partisan pattern is growing more extreme, which a reader translated as “Time to put redneck whiteys in concentration camps.”
So how can narratives like these co-exist?
Hochul considering deployment of National Guard to address health care worker shortage https://t.co/pfK2n1SlNp pic.twitter.com/FAUDDbEbdM
— The Hill (@thehill) September 27, 2021
For health systems that have passed their employee vaccine deadlines, this chart show the total number of employees and the number of employees released due to not vaccinating or receiving an approved exemption. pic.twitter.com/0sJakF3rgG
— Steve Edwards (@SDECoxHealth) September 24, 2021
There are two factors that are missing in the computation of raw numbers. First is that the officialdom has incentives to minimize the impact of these policies. For starters, the chart above is about firings. It’s not hard to imagine that “retirements” are not counted.
Second is that most people who object, or were pushed over the edge by this requirement after all of the Covid stress, would resign before the deadline and find another job. Why burn bridges by being forced out? Particularly for low-level workers that are the backbones of hospitals, like CNAs, cleaners, and cooks, there are other jobs in this staff-short economy for workers who aren’t very highly paid. CNA pay is appalling and they’d be likely to find new work quickly.
There are signs of resistance among other modestly-paid workers; whether they’ll follow through and work only for vaccine-tolerant employers remains to be seen. From Detroit’s ABC station:
“I’ve met a lot of resistance, I’ve had two people get quite angry with me to be honest with you,” said Gail Smith, staffing manager at Snelling Staffing Services in Roseville.
Smith said some of her employers are now requiring the vaccine, and applicants are not happy.
“It’s been 100 percent of the candidates I’ve spoken with. Nobody has said, ‘sure no problem,’ they all had hesitations,” she said.
Many of those interviews were for custodial positions in hospital or school settings, where vaccines have been required. But now, since the majority of the agency’s clients have more than 100 employees, Smith expects to face that pushback more often….
“They’re getting really uncomfortable. They don’t want to miss out on the job, but they’re torn. They’re very torn,” said Smith.
Again, most of these applicants are likely to fall into line, but note that the open positions include those for hospitals and schools, which are already short-handed.
Brunches with Cats pointed out in comments that other strategically-placed workers, like transport workers, weren’t keen about mandatory vaccinations and enough in her state of Washington (which has a vaccine-only mandate) are already resigning so as to affect service levels. As she observed:
Yep. Inslee and staff don’t believe that state employees threatening to quit over his mandate will actually do it. We’ll find out shortly, as they have to have both shots (or one J&J) by Oct. 4 to be “fully vaccinated” by Oct. 18 or be fired.
Whether or not it’s for political points, it could backfire big time if personnel shortages cause cutbacks in public services. It’s already happening within the ferry system, in part due to workers out sick with the virus, but there have been rumors that some are calling in sick in protest or refusing to accept overtime to cover for sick coworkers. As a result, many sailings are being cancelled, leaving passengers stranded on the dock for hours.
State troopers also are in an uproar over a reported blanket refusal to grant religious exemptions within the division, on the grounds that there’s no way to accommodate them. The gov’s proclamation includes the legally required exemptions for medical or religious reasons, but even if granted, they have to pass the “reasonable accommodations” test.
Because they’re truly delusional, they’re requiring employees to register with a third-party vaccination verification program, which means signing an odious 50-page EULA before sending personal and medical data off to the Microsoft cloud. According to one of my ferry contacts, union reps responded to their concerns by saying they had been “addressed” with management, period, and BTW could they help out HR by uploading their documentation by the end of this week.
The regular abuse by anti-vax parents of school vaccine requirements by getting cooperative doctors to send in notes claiming that Johnny can’t be vaccinated is now making it difficult for the few who work for employers like United that have implemented a strong-form vaccine mandate do have bona fide health issues to request an accommodation via weekly testing.6 The law firm representing six United employees as part of a class action suit succeeded in obtaining a temporary restraining order. Most anti-vax suits are terribly drafted so I don’t anticipate that many of the legal challenges to the vaccine mandates will prevail in the end. However, United’s position that six years of unpaid leave amount to a reasonable accommodation for plaintiffs who have (potentially bona fide) medical reasons not to take the vaccine seems like a stretch.7
And even though the press reports that vaccination rates among blacks and Hispanics are rising, there are doctors who object to mandating the vaccines.
But there is one cohort that does fit the “Bubba hatred” stereotype, and that is some hard-core evangelical sects in flyover. However, at least for the one described below, their opposition is not to vaccines; many have taken them and the unvaccinated among them would be amenable to “doing your patriotic duty” exhortations….which are utterly in absence as far as Team Biden is concerned.
From a regular reader immediately after the Biden Administration extended its vaccine mandate from Federal employees to private businesses with more than 100 workers in early September:
This is very serious – I think these Biden people have no idea what they are about to unleash. They have seriously underestimated how common these feelings are in large swaths of this country. Places that grow the food and drill the oil. They have underestimated how many minorities feel the same way. .
Their worst prophetic nightmares are coming true daily before their eyes. They have been told these days were coming all their life and have been steeling themselves for it. They are not anti-vax in any way shape or form. This passport, get fired, lose your life and livelihood is the Rubicon to them – and as of today it has officially been crossed.
An-email from a close relative’s religious leader:
Effective today, the government of the United States of America has cast its lot completely and totally with the evildoers. There is now no going back. The lot has fallen. They come after our jobs and livelihood now. Tomorrow, will come the passports and the Mark of the Beast. It is on the way. We are a fallen and deluded country. We are deceived. God will not be mocked.
None of the chosen will take the Mark in any way shape or form. To do so would lead to hellfire for eternity.
Brothers and Sisters in Christ, war has been declared today. We must fight the Evil. We must fight the Beast until the day of the Glory of the Lord. We must begin to look after one another. We must fight the use of the Mark in our affairs. If we do not fight with all our hearts, souls, and minds before the coming of the Glorious Day, all will be lost.
We will all be getting down on our knees tonight at 7PM. We will need to get ourselves spiritually prepared. They have declared war on us today. We will respond in kind until the day that He arrives to take us up into the clouds.
Needless to say, this is the sort of development that the mainstream media is not keen to report. And in fairness, neither they nor I have a ready way of determining how many believers have reacted this way. How significant this response turns out to be will be largely a function not of their numbers, since they are clearly a minority, but whether they are strategically placed via their employment. But the US is already up to its eyeballs in supply chain disruption, so even if evangelical opposition added to this picture in a serious way, it would be hard enough to parse out so as to facilitate it being minimized.
By contrast, some white collar workers are being handled with care. The Verge reported that Apple is implementing a mandate-lite, requiring regularly testing of unvaccinated employees but not pressing them to take the jab.
In other words, the harder you look at it, the more difficult it is to find any logic for vaccine coercion without a parallel hard push for non-pharmaceutical interventions. Is it desperation and denialism? Blind belief in their own authority and self-perceived moral superiority? Sheer laziness, because a multi-pronged approach would be hard?
I can’t fathom it save perhaps deep-seated cynicism in action. The best-informed recognize the US lacks the will and the institutional capacity to manage the pandemic, and so the vaccine mandate is just another Pharma-enriching approach that also pre-positions the blame cannons squarely at Bubba. In reality, the adopted a “let-er-rip” strategy and the vaccines are at best an effort to protect the health care system…but they aren’t succeeding at that either under Delta.
It’s already obvious that the results will not be good unless the officialdom gets lucky and Covid evolves into a more contagious yet wimpier variant. And so far, the gods have not been kind.
____
1 Contrast with Nassim Nicholas Taleb’s January 26, 2020 warning.
2 Continuing from the same e-mail from GM:
But how big is the antigenic distance exactly?
Here is a new preprint:
https://www.medrxiv.org/content/10.1101/2021.09.14.21263564v1
They also had a strain isolated from an HIV patient after 190 days of infection, which is a bit of a mix of P.1/Gamma and C.37/Lambda — R190K, K417T, D427Y, F490S, N501Y. That’s called “D190” in the preprint
Figure 2 shows the results for the neutralization reductions:
Baseline
— B.1.351/Beta on ancestral strain serum: 7.2x reduction
— B.1.617.2/Delta on ancestral strain serum: 2.0x reduction (in their assay it is low, others show it to be 5-6x; it varies a lot)
— D190 on ancestral strain serum: 8.8x reductionCross-strain:
— Delta on Beta serum: 12.4x reduction
— Beta on Delta serum: 33.6x reduction
— Delta on D190 serum: 27.1x reductionA reduction of 33x means essentially no immunity — the protective threshold is less than 10 on that scale.
So it will be very interesting to see if some non-Delta serotype survives and rises in poorly vaccinated populations that have been swept by Delta.
C.1.2 in South Africa is a good candidate, maybe even B.1.621/Mu could have caused another wave in India if it got there in significant numbers and could establish itself before it goes extinct.
But long-term, unless the Delta advantage is unique to this particular structure and the fitness landscape turns out not to be flat but with a sharp peak, we will likely end up in a situation with multiple serotypes for which cross-immunity does not work.
3 Even these estimate may be generous in practice. Recall that we flagged official data from Israel in early July that showed that infection rates, even when stratified by age, were proportional when comparing the vaccinated to the unvaccinated. That meant that 5-6 months from when most Israelis were vaccinated, the vaccine (in Israel almost exclusively Pfizer) conferred no protection against contagion.
Other evidence of the vaccines offering only limited reduction in Delta spread. From GM:
Useful example of what happens in an contained population, in this case a prison
https://www.cdc.gov/mmwr/volumes/70/wr/mm7038e3.htm
80% vaccination, and relatively recent too — half were 4-6 months from second dose, the rest less than that — resulted in 70% attack rate among the vaccinated (and 93% in the unvaccinated)
Attack rates in the 4-6 months groups — 89%
Moderna held the best — 40% attack rate. Pfizer at 81%, but it’s not clear if those are matched by time from second dose.
4 Don’t even try Simpson’s Paradox. One of my very plugged in economist colleagues said as soon as Israel started publishing official data showing declining vaccine efficacy, Pfizer was all over them to try to get them to change it. They didn’t. And as GM said:
There were lot of people talking about Simpson’s paradox and how in Israel they did not properly age match, and how VE was not properly calculated. Israel has some of the most competent statisticians in the world, and they did in fact properly age match, but more importantly, whether we got the percentages right does not matter, what matters is whether hospitals are overrun with vaccinated patients. If they are, and they are, then the vaccine has been broken through to an extent that makes it a failure.
5. But oh, no, that isn’t necessarily happening either. Due to this post already going into the over-long territory, I have not tracked down the prevalence of another anti-public-health measure, that of requiring only the unvaxxed who have been exposed to a positive Covid case to isolate.
6 I fail to understand why school systems have been so chickenshit over vaccine evasion. Why didn’t they require anyone who sought a medical exemption to submit evidence from their health records to substantiate the claims? Oh, and threaten to pursue the suspension of licenses of MDs who had clearly fabricated? The AMA is pro-vaccine and they’d be keen to rout out anti-vax MDs. If that approach had been developed and de-bugged, it would not be hard to implement a similar scheme for Covid vaccines. But that horse left the barn a very long time ago.
7 The niceties of employee rights in this area are over my pay grade. However, generally speaking, it appears that employers normally don’t have offer many/any concessions are far as vaccinations are concerned. However, in this case, some flavors of the Federal mandate and most state and local implementations allow for frequent testing as an alternative, which could conceivably allow the plaintiffs to contend they are entitled to testing as an accommodation.
re: booster shots. I haven’t seen any info that indicates that they are any different from the original vaccines. That they are basically the same thing and the booster shot just refreshes the original vaccine as it declines in efficacy. Is that correct?
From my (uninformed) point of view, the mix-and-match strategy makes lots of sense, especially if the same-brand boosters are just more of the same.
What do we know about the Novavax vaccine? – Expert Q&A
I’m going to be paying a lot of attention to this one.
This has been becoming more and more obvious over the past few weeks. It may indeed be directly responsible for the terrible numbers coming from Israel – where the relative risk reduction for the vaccine (They pretty much only used Pfizer) is now down to 16%. And cases after large swaths have received the 3rd booster are now going parabolic. Once an RRR is below the 25% level – we begin to approach the level of worthless.
https://news.yahoo.com/big-gap-between-pfizer-moderna-034719881.html
I have been carefully counting the exact vaccination information on every single one of the breakthrough cases I have been seeing ( assuming if they actually know).
I work in an area that was predominantly Moderna for the first several months because that was all we had.
It has been interesting to note that since August 1st, precisely 72.7% of the breakthroughs have been vaccinated with Pfizer. (Remember the large predominance of Moderna in my area – making the number all the more striking). All but 2 of the vaccinated admissions that I have had since August 1st have been with Pfizer.
Fascinating.
Either the dosing schedule, the dosing amount or something about the freezing/delivery is causing them to fail more rapidly. Or it could be something with the actual biochemical mechanics of the vaccine itself. Above my pay grade.
However – this has been a topic of conversation for weeks among colleagues both local and far away. Being noticed everywhere. Not that the news media would say a word for months – somehow the flood gates are being opened right now.
FYI – the discussion in the past few weeks at the FDA to only booster the Pfizer patients was most decidedly NOT because Moderna and J&J were tardy with the paperwork and Pfizer got theirs done first as multiple media stories put forth. Tardy paperwork for a multi billion dollar pharmaceutical my ass. Use your brains.