Vinay, Excellent summary of endless idiocy, much of which is still ongoing. Looking forward to adding it to the upcoming boosting column and disseminating widely.
These are all great points Vinay and you are brilliant to point them out.
Just that…
At this point, pretending all this theater by our government and public health officials was just “bad policy” or “innocent mistakes” is equally naive and stupid as believing vaccines can “end the pandemic”.
None of these policies were innocent mistakes. It was all on purpose! All planned for. That is why they never back off. They keep pushing in-spite of knowing they are wrong.
At this point we should seek to answer “why”? What is their ultimate goal?
That’s the only way we may be able to prevent similar catastrophic policies in future .
Plus, the insanity of prioritizing vaccines for people who had recently recovered, purely because of their careers, while ignoring those at higher risk...
Oh...and claiming those with previous infections still needed shots because presence of antibodies didn't mean anything...while also using presence of antibodies to claim vaccines are working.
Excellent summaries and a welcome breath of fresh air as we have come to expect from Dr Prasad. Thank you!
I read this after arriving home from a nursing home that I visit weekly as a psychiatric nurse practitioner. While there, I was stopped in a hallway by a nursing assistant (who is tested in the facility twice weekly) and reminded that my surgical mask -required for building entry-was insufficient in that general skilled unit, and I would have to go locate an N95 before I saw patients.
Whoops, I didn’t tell her I’d already finished rounding on all these older folks (who had received their 4th booster).
Re: school closures, you say "Enough data had accumulated by then to know it was a fools errand". However, on other topics, you are constantly beating up on the reliability of observational studies and saying we should run RCTs. One recent quote from you: "Observational studies are hypothesis generating". I could be wrong, but I am not aware of any RCTs that were run regarding school closures. Presumably, "enough data" in your "fools errand" quote refers to observational analysis. There's little doubt that there were significant negative impacts on education, but you also seem highly confident that school closures prevented ~0 covid deaths. I don't see how this confidence could be based on anything other than observational studies. I think it would be illuminating for you to explain why you have high confidence in your apparent belief that school closures did not save lives, given your general skepticism towards observational studies and inclination to call for RCTs.
School closures would have to prevent far more than ~0 COVID deaths to be justified on a cost-benefit basis. We could almost certainly save more than ~0 lives (of children and adults) annually from school closures just based on avoiding accidental deaths from people traveling to and from schools.
Here's one way to get a rough estimate of the cost of school closures. U.S. public K-12 education spending is $760 billion per year. (Source: https://nces.ed.gov/fastfacts/display.asp?id=66) So the revealed preference of society at large is that the benefit of K-12 schooling is *at least* that much per year. Because why spend the money unless it provides at least that much benefit? Across a 9-month school year, that implies *at least* ~$85 billion per month of value from K-12 education.
How much was the quality (i.e., value) of education degraded by use of remote rather than in-person schooling? That's tough to quantify. A study from American Institutes for Research, Dartmouth College, Harvard, and the educational-assessment nonprofit NWEA found that, for districts that remained remote throughout the 2020-21 school year: "Students at low-poverty schools that stayed remote had lost the equivalent of 13 weeks of in-person instruction. At high-poverty schools that stayed remote, students lost the equivalent of 22 weeks." (Source: https://www.theatlantic.com/ideas/archive/2022/05/schools-learning-loss-remote-covid-education/629938/) There's also a babysitting / childcare value from K-12 schooling that's independent of learning achievement. ~50% loss of value from remote schooling seems reasonable as a rough estimate.
That implies ~$380 billion loss of value for K-12 remote vs. in-person schooling across the U.S. for 1 school year, or ~$40 billion per month of the school year.
As for the benefit side, there's quite a lot of literature attempting to estimate value of a life saved. It's frequently used as part of various cost-benefit calculations. In the U.S., recent numbers are in the range of $7.5 million to $10 million. ( https://en.wikipedia.org/wiki/Value_of_life#United_States )
Another common metric used is "value per year of quality life". The above shows numbers in the range of $50,000 to $130,000 for the U.S, which seem to map to somewhat lower values of a statistical life than in the paragraph above. This approach is consistent with the common intuition that, while it's always sad when a person dies, a young person dying with a full life ahead of them is a tragedy that's very different than an 80 year old dying after having lived a full life.
So, at a rough value of $10 million per life saved, nationwide U.S. school closures would have to save more than an incremental 4,000 lives per month (or 36,000 per school year) to be justified on a cost-benefit basis.
We should also look at the sensitivity of the above assumption to the age of those whose lives are saved. That's consistent with the idea of value per year of quality life.
If we're saving the lives of school-age students, the value per life perhaps increases to something like $20 million, meaning benefits exceed costs if more than 2,000 lives are saved per month of school closures.
If lives saved are among an elderly population with fewer years of life remaining, a reasonable estimated value per life saved is perhaps more on the order of $1 million to $2 million per life. That would mean that benefits exceed costs if more than 20,000 to 40,000 elderly lives are saved per month of school closures.
The age-adjusted IFR of COVID implies, of course, that any lives potentially saved from school closures would primarily be from indirect effects like preventing transmission of SARS-CoV-2 to others from children. The cost-benefit of school closures is clearly negative for school-age children themselves.
So it's not just a question of whether we think, based on observational studies, that school closures "saved lives" by preventing COVID deaths. We'd want to see evidence that school closures would save large numbers of lives.
For sure, the number of lives saved by school closures would matter when judging the cost-benefit tradeoffs. I did not mean to imply that closures were justified so long as they saved any lives at all, although I can understand if you took my comments that way. My main point is that I don't see how Dr. Prasad can claim with high confidence that school closures did not save e.g. (to pick one figure from your comments) 36,000 lives per year, given his inclination to distrust observational studies.
Even if closures did not save quite enough lives to justify the costs in educational harms, if they saved some lives, that would at least imply that critics of school closures should dial down the intensity of their criticism of proponents of school closures. In that scenario, school closures may have been a mistake, but a more understandable mistake. It would be a mistake which had some upsides, but upsides which were not sufficient to justify the policy. It seems to me, though, that most people who are mad about school closures are led via motivated reasoning to the questionable belief that we know school closures had little or no benefit at all, just because they are really angry about the downsides.
I agree that it would at least behoove Dr. Prasad to link to some of his prior commentary on this topic, where, IIRC, he laid out his reasoning in far more detail.
Perhaps because such an RCT would be quite difficult to run. OTOH, every RCT is difficult to run. And it's only Dr Fauci that insists on RCTs usually because of the funding required.
On one hand, Long COVID is likely a much bigger problem than you think. In science, observations matter. We can observe things long before we understand them. The Curies didn't start out with Geiger counters when they figured out radioactivity. So it will be with Long COVID: Eventually, we'll figure out what causes this - in fact, I think we may be pretty close. (See Canadians MRI + Xenon technique published this week.)
However, I agree that The Church of Fauci the Preventer needs to burn to the ground. Obviously, nothing was prevented, and arguing over "Degrees of Delay" misses the point. The POINT is that some people have sequelae. The severity of Long COVID loosely tracks the severity of infection, but importantly, it isn't 1:1. A similar observation would be that 50-year-old women did get myocarditis from the Moderna vaccine. Yes, the odds were much lower, but when you multiple low odds by millions of people, you will get lots of examples like this.
When I was vax injured, I enjoyed your musings as a voice of real science. However, as someone now on the Long COVID train (a train I would love to get off at the next stop, pls), I would appreciate you pushing us toward RESEARCH and TREATMENT. It's not enough to stop the insanity of PREVENTION, but it must be replaced with the next steps of treatment. Fauci openly said he didn't want treatments or therapies because, in his fertile imagination, millions of people wouldn't get vaccinated if there was a treatment. Well, that ship sailed, burned, and sank.
If this thing is endemic, and every wave that comes around hits millions of people, and every way wave has some unknown 0.7% - 6.0% of them are have sequelae ... then we need to start funding treatments.
And I want you to vet them! I want Dr. Vinay Prasad's take on those studies. I'm still going to be here waiting for your take on the treatments, because I'm skeptical that "black seed oil," Ivermectin, and Vitamin D are going to make the final cut on Long COVID therapeutics. (Note: I don't care what ends up being effective. But right now, I feel like the answer is "take these 18 placebos and see which one works for you." Yet, when I go to lift a bag of cement, I still can't really breathe, so ...)
I really appreciate your clear reasoning in #7. Unfortunately, I've seen a lack of this reasoning coming from Catholic bioethicists - one of whom was trying to argue that mandatory vaccination is like the draft. You've very clearly articulated why such a "draft" is only moral when your weapons actually work.
Dr. Prasad, as usual you make good points, but I can't share this post (e.g. on FB or Twitter) for two reasons.
(1) Your point 8. is too strong to be defensible. A blanket condemnation of *every* personal precaution, once a person has been vaccinated? This just makes you sound extreme. (And way too confident in the actual effectiveness of the vaccines.) If a person has a big work event coming in 10 days, and getting covid (and hence having to miss the work event) would be a big problem, are they crazy or stupid if they avoid restaurants and wear an N95 on public transport? Of course not.
(2) Proofread your essays before posting, please! Or get someone to do it! Sloppy writing is easier to dismiss, so if I shared this essay on FB, many of my academic colleagues (some of whom tend towards covidianism), would treat it like a bad student paper. Your thoughts deserve the *best* packaging, so try to make sure your posts are error-free; they will have more impact if you do!
Last line reads "It seems reasonable to provisionally prefer ivosidenib -azacytidine until a confirmatory trial of venetoclax -azacytidine involving patients with untreated AML with IDH1 mutations has been conducted."
And just saw you are co-conspirator on the next correspondence letter. I guess that's how much you hv inspired me - I wanted to let you know RIGHT AWAY that I smell BS.
I’m thinking testing is just another delaying tactic. Michael Mina made a pretty convincing case for it as a way to end the pandemic in 2020, but clearly it didn’t have that effect. The ladies who clean my house knew to test last winter, because one of their kids had a scratchy throat. Because they tested positive, they didn’t come over, so that may have saved me an infection at the time, but not forever. Similarly, some performing arts organizations require testing for their workers. I think the point is to spread out infections, so everyone doesn’t get sick at the same time, thus creating the need to cancel events. So, there’s some use to it, but it definitely doesn’t “get control” of the virus.
Vinay, Excellent summary of endless idiocy, much of which is still ongoing. Looking forward to adding it to the upcoming boosting column and disseminating widely.
Nice summary. Next our good doctor will need to address the growing evidence of OAS - the vaccinated being more susceptible to the latest variants. What have we done to ourselves? How corrupt can our officials be? Dr Birx admits https://justthenews.com/politics-policy/coronavirus/asked-if-government-was-lying-or-guessing-about-covid-vax-data-birx.
These are all great points Vinay and you are brilliant to point them out.
Just that…
At this point, pretending all this theater by our government and public health officials was just “bad policy” or “innocent mistakes” is equally naive and stupid as believing vaccines can “end the pandemic”.
None of these policies were innocent mistakes. It was all on purpose! All planned for. That is why they never back off. They keep pushing in-spite of knowing they are wrong.
At this point we should seek to answer “why”? What is their ultimate goal?
That’s the only way we may be able to prevent similar catastrophic policies in future .
Plus, the insanity of prioritizing vaccines for people who had recently recovered, purely because of their careers, while ignoring those at higher risk...
Oh...and claiming those with previous infections still needed shots because presence of antibodies didn't mean anything...while also using presence of antibodies to claim vaccines are working.
So many opportunities to call out the madness!
Excellent summaries and a welcome breath of fresh air as we have come to expect from Dr Prasad. Thank you!
I read this after arriving home from a nursing home that I visit weekly as a psychiatric nurse practitioner. While there, I was stopped in a hallway by a nursing assistant (who is tested in the facility twice weekly) and reminded that my surgical mask -required for building entry-was insufficient in that general skilled unit, and I would have to go locate an N95 before I saw patients.
Whoops, I didn’t tell her I’d already finished rounding on all these older folks (who had received their 4th booster).
Good grief.
time to rid our world of "public health" because "public health" just reduces our health. Everyone who pushed this shit needs to spend time in a cell
Wise words.
Re: school closures, you say "Enough data had accumulated by then to know it was a fools errand". However, on other topics, you are constantly beating up on the reliability of observational studies and saying we should run RCTs. One recent quote from you: "Observational studies are hypothesis generating". I could be wrong, but I am not aware of any RCTs that were run regarding school closures. Presumably, "enough data" in your "fools errand" quote refers to observational analysis. There's little doubt that there were significant negative impacts on education, but you also seem highly confident that school closures prevented ~0 covid deaths. I don't see how this confidence could be based on anything other than observational studies. I think it would be illuminating for you to explain why you have high confidence in your apparent belief that school closures did not save lives, given your general skepticism towards observational studies and inclination to call for RCTs.
(1/2)
School closures would have to prevent far more than ~0 COVID deaths to be justified on a cost-benefit basis. We could almost certainly save more than ~0 lives (of children and adults) annually from school closures just based on avoiding accidental deaths from people traveling to and from schools.
Here's one way to get a rough estimate of the cost of school closures. U.S. public K-12 education spending is $760 billion per year. (Source: https://nces.ed.gov/fastfacts/display.asp?id=66) So the revealed preference of society at large is that the benefit of K-12 schooling is *at least* that much per year. Because why spend the money unless it provides at least that much benefit? Across a 9-month school year, that implies *at least* ~$85 billion per month of value from K-12 education.
How much was the quality (i.e., value) of education degraded by use of remote rather than in-person schooling? That's tough to quantify. A study from American Institutes for Research, Dartmouth College, Harvard, and the educational-assessment nonprofit NWEA found that, for districts that remained remote throughout the 2020-21 school year: "Students at low-poverty schools that stayed remote had lost the equivalent of 13 weeks of in-person instruction. At high-poverty schools that stayed remote, students lost the equivalent of 22 weeks." (Source: https://www.theatlantic.com/ideas/archive/2022/05/schools-learning-loss-remote-covid-education/629938/) There's also a babysitting / childcare value from K-12 schooling that's independent of learning achievement. ~50% loss of value from remote schooling seems reasonable as a rough estimate.
That implies ~$380 billion loss of value for K-12 remote vs. in-person schooling across the U.S. for 1 school year, or ~$40 billion per month of the school year.
So that's one way to estimate the cost side.
I often tell people that if you truly want 0 deaths from schools then just close them down forever and switch to Zoom in perpetuity.
Car accidents
School shootings
spread of flu
Fights
(2/2)
As for the benefit side, there's quite a lot of literature attempting to estimate value of a life saved. It's frequently used as part of various cost-benefit calculations. In the U.S., recent numbers are in the range of $7.5 million to $10 million. ( https://en.wikipedia.org/wiki/Value_of_life#United_States )
Another common metric used is "value per year of quality life". The above shows numbers in the range of $50,000 to $130,000 for the U.S, which seem to map to somewhat lower values of a statistical life than in the paragraph above. This approach is consistent with the common intuition that, while it's always sad when a person dies, a young person dying with a full life ahead of them is a tragedy that's very different than an 80 year old dying after having lived a full life.
So, at a rough value of $10 million per life saved, nationwide U.S. school closures would have to save more than an incremental 4,000 lives per month (or 36,000 per school year) to be justified on a cost-benefit basis.
We should also look at the sensitivity of the above assumption to the age of those whose lives are saved. That's consistent with the idea of value per year of quality life.
If we're saving the lives of school-age students, the value per life perhaps increases to something like $20 million, meaning benefits exceed costs if more than 2,000 lives are saved per month of school closures.
If lives saved are among an elderly population with fewer years of life remaining, a reasonable estimated value per life saved is perhaps more on the order of $1 million to $2 million per life. That would mean that benefits exceed costs if more than 20,000 to 40,000 elderly lives are saved per month of school closures.
The age-adjusted IFR of COVID implies, of course, that any lives potentially saved from school closures would primarily be from indirect effects like preventing transmission of SARS-CoV-2 to others from children. The cost-benefit of school closures is clearly negative for school-age children themselves.
So it's not just a question of whether we think, based on observational studies, that school closures "saved lives" by preventing COVID deaths. We'd want to see evidence that school closures would save large numbers of lives.
For sure, the number of lives saved by school closures would matter when judging the cost-benefit tradeoffs. I did not mean to imply that closures were justified so long as they saved any lives at all, although I can understand if you took my comments that way. My main point is that I don't see how Dr. Prasad can claim with high confidence that school closures did not save e.g. (to pick one figure from your comments) 36,000 lives per year, given his inclination to distrust observational studies.
Even if closures did not save quite enough lives to justify the costs in educational harms, if they saved some lives, that would at least imply that critics of school closures should dial down the intensity of their criticism of proponents of school closures. In that scenario, school closures may have been a mistake, but a more understandable mistake. It would be a mistake which had some upsides, but upsides which were not sufficient to justify the policy. It seems to me, though, that most people who are mad about school closures are led via motivated reasoning to the questionable belief that we know school closures had little or no benefit at all, just because they are really angry about the downsides.
You make fair points.
I agree that it would at least behoove Dr. Prasad to link to some of his prior commentary on this topic, where, IIRC, he laid out his reasoning in far more detail.
Perhaps because such an RCT would be quite difficult to run. OTOH, every RCT is difficult to run. And it's only Dr Fauci that insists on RCTs usually because of the funding required.
https://twitter.com/VPrasadMDMPH/status/1425074891502411778
👍👍👍
On one hand, Long COVID is likely a much bigger problem than you think. In science, observations matter. We can observe things long before we understand them. The Curies didn't start out with Geiger counters when they figured out radioactivity. So it will be with Long COVID: Eventually, we'll figure out what causes this - in fact, I think we may be pretty close. (See Canadians MRI + Xenon technique published this week.)
However, I agree that The Church of Fauci the Preventer needs to burn to the ground. Obviously, nothing was prevented, and arguing over "Degrees of Delay" misses the point. The POINT is that some people have sequelae. The severity of Long COVID loosely tracks the severity of infection, but importantly, it isn't 1:1. A similar observation would be that 50-year-old women did get myocarditis from the Moderna vaccine. Yes, the odds were much lower, but when you multiple low odds by millions of people, you will get lots of examples like this.
When I was vax injured, I enjoyed your musings as a voice of real science. However, as someone now on the Long COVID train (a train I would love to get off at the next stop, pls), I would appreciate you pushing us toward RESEARCH and TREATMENT. It's not enough to stop the insanity of PREVENTION, but it must be replaced with the next steps of treatment. Fauci openly said he didn't want treatments or therapies because, in his fertile imagination, millions of people wouldn't get vaccinated if there was a treatment. Well, that ship sailed, burned, and sank.
If this thing is endemic, and every wave that comes around hits millions of people, and every way wave has some unknown 0.7% - 6.0% of them are have sequelae ... then we need to start funding treatments.
And I want you to vet them! I want Dr. Vinay Prasad's take on those studies. I'm still going to be here waiting for your take on the treatments, because I'm skeptical that "black seed oil," Ivermectin, and Vitamin D are going to make the final cut on Long COVID therapeutics. (Note: I don't care what ends up being effective. But right now, I feel like the answer is "take these 18 placebos and see which one works for you." Yet, when I go to lift a bag of cement, I still can't really breathe, so ...)
I really appreciate your clear reasoning in #7. Unfortunately, I've seen a lack of this reasoning coming from Catholic bioethicists - one of whom was trying to argue that mandatory vaccination is like the draft. You've very clearly articulated why such a "draft" is only moral when your weapons actually work.
Dr. Prasad, as usual you make good points, but I can't share this post (e.g. on FB or Twitter) for two reasons.
(1) Your point 8. is too strong to be defensible. A blanket condemnation of *every* personal precaution, once a person has been vaccinated? This just makes you sound extreme. (And way too confident in the actual effectiveness of the vaccines.) If a person has a big work event coming in 10 days, and getting covid (and hence having to miss the work event) would be a big problem, are they crazy or stupid if they avoid restaurants and wear an N95 on public transport? Of course not.
(2) Proofread your essays before posting, please! Or get someone to do it! Sloppy writing is easier to dismiss, so if I shared this essay on FB, many of my academic colleagues (some of whom tend towards covidianism), would treat it like a bad student paper. Your thoughts deserve the *best* packaging, so try to make sure your posts are error-free; they will have more impact if you do!
DID YOU SEE THE NEJM just released CORRESPONDENCE
Last line reads "It seems reasonable to provisionally prefer ivosidenib -azacytidine until a confirmatory trial of venetoclax -azacytidine involving patients with untreated AML with IDH1 mutations has been conducted."
I am sure you 100% concur lololol.
And just saw you are co-conspirator on the next correspondence letter. I guess that's how much you hv inspired me - I wanted to let you know RIGHT AWAY that I smell BS.
Wow! I was 20/21🙌🏻
I’m thinking testing is just another delaying tactic. Michael Mina made a pretty convincing case for it as a way to end the pandemic in 2020, but clearly it didn’t have that effect. The ladies who clean my house knew to test last winter, because one of their kids had a scratchy throat. Because they tested positive, they didn’t come over, so that may have saved me an infection at the time, but not forever. Similarly, some performing arts organizations require testing for their workers. I think the point is to spread out infections, so everyone doesn’t get sick at the same time, thus creating the need to cancel events. So, there’s some use to it, but it definitely doesn’t “get control” of the virus.