The Politics of Covid 19, mask wearing and the vaccination process

[Defiant]

I'll be honest with you El Guapo. I don't understand your position. Just as in law, medicine and vaccines have a protocol. They are following it. Just like in law, maybe Trump thinks that the election was stolen. That doesn't make it stolen legally right? We as Americans trust our law process and you as an attorney understand that trust and work to continue that trust. Why do you now want a corresponding profession to throw out the trust and instead consider how people feel? In neither profession does it matter how people feel right? So let's have the FDA do the right thing by following its protocols, just as our judges did the right thing by requiring Trump to produce evidence, no matter how people felt.

I'm fine with following procedure. Sometimes, however, there's more to consider. When it came to the election, I supported going above and beyond procedure in order to try to address concerns about the election, until it was clear that those concerns from the right weren't in good faith. I'm fine with following procedure and pausing J&J, but I'd probably feel differently if it were the only vaccine we had available and we were seeing the number of cases and deaths we saw at the height of the pandemic.

[Lorini]

Vaccines aren't even addressing the current surges in the Midwest and the Northeast, as I said they are not a solution for today's pandemic. They are a solution down the line. That is why the CDC turned down Michigan's request for more vaccine.

[Carpet_pissr]

My hot takes:
1. According to the Biden admin, we have enough vaccine to hit targets WITHOUT JNJ, I can't help but to think this was a HUGE factor in the decision to pause JNJ.
2. I heard more than one Dr. on various media say that the reason they are metaphorically jumping up and down about these blood clots, is that they are not typical blood clots, and if you treat them as such, you can cause serious problems for the patient. Apparently Heparin is the go to drug to treat typical clots, but would create a world of hurt if administered for THESE clots. They were worried that without the publicity, GP's (or whoever) would just treat them per normal.
3. IMVHO, the pause is an overabundance of caution and I worry muchly about the cultural impacts of the pause in *cough* certain populations.

To wit, anecdotally, take my Dad (please! ha!). For months I tried to convince him to go get a vaccine (he's 81), and he gave me every excuse you could think of. Finally, I guess after the badgering got to be too much for him (I assume my brother and sister were also helping to badger) he reluctantly agreed to get the JNJ vaccine when it was available since he had a buddy who worked at a place where they produced them (questionable), and said buddy told him ONLY to get the JNJ for some Fox News reason. So he intentionally waits for the JNJ to be out in the wild for a month or two, before signing up (again, IMO due to MUCH pressure from immediate family to do so, since we are all vaccinated, and wanting to plan get togethers, etc).

So he gets it last week. You can imagine the text when he heard the news. He had not even looked at ANY of the details (how many cases, how many administered, etc), like I assume most Americans would not, but just saw a headline (again, probably on Fox). VACCINE PULLED DUE TO (and it doesn't even matter for someone like that, what you put here....because they've already stopped reading). Apparently he read those 4 words and immediately texted me to show that he was right, and this was EXACTLY what he was afraid of.

I actually did engage at that point (something I am loathe to do based on previous experience), and tried to pinpoint the ACTUAL reason he was so wary of COVID vaccines. He gets flu shots, for instance. Every year! WTF. I really think that THIS particular disease, and resulting vaccine, have been SO politicized (something that the flu has never had to worry about...to this extent), and so blasted by Fox talking heads and Trump, as a fake news situation, or worse, some kind of global political hit job, that it's become ingrained in him to be suspicious AND/OR sulky since I assume "they" blame "it" in part, for Trump's defeat. That's what I sussed out at least.

Had this news come out 3 days before he got his shot, I can promise you he would NEVER have gotten it, or any other COVID vaccine.

[Zaxxon]

Because we don't know. We don't know how many cases there actually are because doctors don't know to look for them in vaccinated people. Now they do! So let's see what happens in the next couple of weeks and then we can continue on with our vaccine process which has gone so well.

Vaccines aren't even addressing the current surges in the Midwest and the Northeast, as I said they are not a solution for today's pandemic. They are a solution down the line. That is why the CDC turned down Michigan's request for more vaccine.

Totally agreed on your first reply. On the second, I think you're again conflating the non-conflatable. No one is arguing that the J&J vaccine is a solution for the present surges. But it is a required piece of the medium-term solution, and slowing our roll does have a known, significant impact on the longer-term expected case/death count.

That's why I'd like a better risk/reward explanation from the powers that be--because while the answer to why we're stopping seems to be that we don't know the risk of this clotting issue, we do know the risk from pausing J&J, and it's quite a significant one (orders of magnitude higher than the thus-far-known clotting damages). So again, 'we don't know' doesn't seem like a sufficient answer on its own--the answer must be 'we don't know, but we suspect with a high degree of confidence that the true clotting risk is at least orders of magnitude greater than known,' or else the math on pausing entirely doesn't jive.

That's what I'm wanting to hear from the folks running the show, and it's something that I have not seen said. And perhaps it's not been said because that, too, could foment more vaccine hesitancy from the usual suspects. Thinking about this, that may be the best explanation--that the group of folks in my camp (who trust those in charge but would love to see a bit deeper into the weeds) is greatly outnumbered by the group of folks itching for any excuse to kneecap the vacccination effort, and therefore getting into the weeds is seen as something to be avoided by the powers-that-be.

I'll admit I don't know the particulars for a EUA here and whether or not it mandates broad suspension or if it allows for targeted suspension. I don't know that I'd take the position that the EUA skirts safety requirements. What we've traded is short-to-medium term safety for unknown long term health impact. I have to trust the scientists here and believe the short to mid-term benefits of the vaccine outweigh the risk of some negative health condition emerging in Smoove_B 10+ years from now as a result of being vaccinated.

Your whole response is super-helpful; thanks. Perhaps a targeted suspension isn't an option, in which case that would also explain the full-stop decision.

If an EUA isn't in some manner reducing safety testing, then what differentiates an EUA from a normal authorization? What are we giving up in exchange for the faster approval (since by definition we are giving up something, else an EUA would just be a UA)?

However, even if it did allow for targeted suspension, I think I still agree with the current path and the reason is scale. We really have no modern analogous comparison to what's happening right now with mass vaccinations. The closest I can think was for polio in the 1950s, but that wasn't anywhere near the same scale in terms of the number of people vaccinated.

Any other more "modern" vaccination would be provided to targeted cohorts. So trying to find a comparison with a Shingles vaccine or the HPV vaccine wouldn't work - we're giving those to seniors and teens. If we found issues when they were released, the scale of the "pause" would be much smaller. Just like the example provided by Dr. Sharfstein that I shared yesterday - a vaccine for infants and children.

So, given the fact that we're now vaccinating all people in America (broadly) over the age of 16 and for the last month we've been (broadly) vaccinating people ages 40+ nationwide it makes sense to look at all the data we have so far and verify there aren't issues with the data that's been collected (in terms of finding patterns).

The closest example I can craft would be for an annual flu vaccine. If for some reason doctors and pharmacists noted some type of new medical issue seemingly associated with the annual shot for people ages 25-35 ("severe edema in the legs"), I'm pretty confident they would suspend all flu shots to figure out what's happening. It's not exactly the same as flu shots aren't new, but generally the same idea.

That makes sense. Part of my issue (and at this point I'm fine admitting that this seems to be a hangup localized to me, and it's my problem to resolve it ) is that we don't have a good comparison, so we're using the usual much-lower-stakes criteria and halting roll-out, when the negative impact of that halt is much higher than it would be in the recent comparisons.

If you focus on the risk for clots, broadly the risk seems to be ~1 in a million (right now). However, as was pointed out this morning by people way smarter than I am, the only way to get the true risk is to look at all the data. For everyone receiving the shot it might be 1 in a million. But for women age 20-25 and taking a specific type of medication, their risk might be 1 in a 10,000. If that's the case, that should be part of the information we're providing for advisement.

Fully agreed--I just don't see that the data we have warranted a full halt given the extremely narrow risk profile suggested by that data. Which is fine, as I'm not the one in charge. But I don't hear good explanations of that risk profile from those who are in charge, either.

Again, it's not that we're not considering the risk of clots vs the risk of dying from COVID. Instead, we're looking at the bigger picture - what's the risk to the trust in the process overall? What's the risk to how we operate outside of this pandemic? There's been a 20+ year war on vaccines in America and imho we haven't been aggressively pushing back against the anti-vaccination community. They've been chipping away at trust and undermining the message for why vaccines are important and it's not helping the current effort. If the CDC and FDA dismissed concerns here that there was potential for a health condition associated with vaccination, it would absolutely feed into the anti-vax narrative. What is happening now dismantles it.

As was pointed out earlier, the impact of this decision isn't nearly so cut-and-dry IMO. Checking things out definitely is required, and can bolster faith in the process. But the halt has known negative impacts, as well. Those, too, are being noticed and have an impact on faith in the system. To bring another bad analogy in, maybe the hangup for me is that this halt decision feels like a peacetime move when we're in the middle of D-Day. Yes, evaluating the risks is worthwhile. But the context of the larger worldwide situation also matters. We wouldn't make the same decisions relating to likely minor safety risks in our beach-storming boats in 1936 as we would in June of 1944.

Appeals to authority are never a great argument.

Is this an appeal to authority though? If it is, are all "trust the process" appeals really appeals to authority? Also at that point is it on you to learn the process if you don't want to trust it or is it on them to make sure you understand the process because you don't want to trust their authority.

Yes, it's absolutely an appeal to authority. We are taking the experts at their word that this is the right decision, without seeing the math. That's the definition of appeal to authority.

it looks like a pretty Karen attitude to want insight provided for the way things are done when you learn you may not like the way things are done after putting in no effort to learning why things are done the way they are.

That sound like an attack but I don't know any other way to put it.

No insult taken--I am well aware that I sound like the Karen in this discussion, and I don't like it. But I have put in (some level of) effort to learn why things are done the way they are, and I'm not finding answers that are sitting well with me. It may just be that our experts are not used to putting out data-based defenses to the masses on decisions like these (narrator: they are not, and they do not), and also that they are not used to having such decisions be so widely-followed and impactful. And therefore the sort of deep dive that I'm looking for isn't easy to find.

At the same time, I get where you are coming from. When the last president tells me perhaps Pfizer is paying off the FDA, I can't exactly trust his authority on the subject and his track record for process following that leads to a better today and tomorrow.

Obviously this is not analogous to Trump's ridiculousness, but your point is well-taken: the CDC, EPA, and other government institutions did lose significant appeal-to-authority cred under the Trump administration. While I'm not suggesting that the CDC or FDA is wrong in this case, and certainly not that they are putting out bad-faith or politically-constrained bad info like they were under that admin, it's good to want a better answer whether your government is Trumpalos or not.

[LordMortis]

Yes, it's absolutely an appeal to authority. We are taking the experts at their word that this is the right decision, without seeing the math. That's the definition of appeal to authority.

I guess I'm not seeing that. That might just be because I'm not doing my diligence. I haven't gotten the sense of shut up and do as your told, maybe if I did, I might be see the same appeal to authority you do and discover there is no process, only the word of experts that this is how it is.

https://www.logicallyfallacious.com/log ... -Authority

[Zaxxon]

Yes, it's absolutely an appeal to authority. We are taking the experts at their word that this is the right decision, without seeing the math. That's the definition of appeal to authority.

I guess I'm not seeing that. That might just be because I'm not doing my diligence. I haven't gotten the sense of shut up and do as your told, maybe if I did, I might be see the same appeal to authority you do and discover there is no process, only the word of experts that this is how it is.

https://www.logicallyfallacious.com/log ... -Authority

There need not be a shut up and do as you're told in order to have an A2A. All of the explanations [that I've seen] have come down to 'because this is what the experts say' rather than an explanation of the specific risk analysis. That's what makes an A2A.

Perhaps the idea is that the pause will be over by the time we hit the significant J&J line slant on this graph?



I appreciate everyone indulging my likely-misplaced concerns on this topic. I will stop Karening the thread now.

[LordMortis]

I appreciate everyone indulging my likely-misplaced concerns on this topic. I will stop Karening the thread now.

If I believed I knew it was misplaced, I'd be sarcastic. (That's a bad habit of mine I need to break) I'm exploring because I believe your concerns are mis-placed but belief in something is the second lowest bar you can hit only pegging barely above feeling. I could very well be way off the mark. I don't know if the FDA is or isn't relying on 'because this is what the experts say'. The talking heads who interview people with credentials I don't understand are telling me 'because this is what the experts do' and I see a difference there.

[Smoove_B]

If an EUA isn't in some manner reducing safety testing, then what differentiates an EUA from a normal authorization? What are we giving up in exchange for the faster approval (since by definition we are giving up something, else an EUA would just be a UA)?

Time. I am not sure what the average time is from start to release for a vaccine, but it's likely north of 24 months. The EUA made sure the actual vaccine was safe (short and mid term) and that the method for production was also safe - which would be done anyway. What I'd normally expect to see is additional follow up at 6month, 1 year and maybe 18 month intervals prior to approval for general use. However because of the emergency the FDA essentially said knowing it doesn't cause harm in the short (i.e. the days after we've injected it) and mid term (months following injection) we need to weigh that against potential harm in the long term 12+ months vs the potential harm in allowing the virus to continue to spread.

In truth, there aren't any established long term health issues associated with vaccinations that have been widely established (that I'm aware of). Meaning, no one has demonstrated an increase risk of cancer or stroke 2 or 5+ years after a particular vaccine. I have seen some studies suggesting a link to obesity, diabetes and high blood pressure but nothing widely regarded as concerning when you compare to the risk of whatever the vaccine is working to prevent.

Either way, the level of "crowdsourcing" and community involvement (private sector, government, research, academia) that went into all the vaccines is unprecedented - that's really the story here. Write this down because it's only going to happen once - Trump and his administration did one thing right, they cut through red tape and it was absolutely important because without it, all that other effort would have been wasted.

Fully agreed--I just don't see that the data we have warranted a full halt given the extremely narrow risk profile suggested by that data. Which is fine, as I'm not the one in charge. But I don't hear good explanations of that risk profile from those who are in charge, either.

So (for me) this is what's so impressive. The system that's been designed picked up 6 cases of a specific condition after 7+ million vaccinations were provided. Where are my Six SIgma Black Belts? That is some impressive fidelity (if you ask me) - that we're so closely monitoring things and able to quickly pick up on and respond to a potential "blip" in the delivery. Again, I find this extremely reassuring - the demonstration that monitoring and detection is happening, as designed.

As was pointed out earlier, the impact of this decision isn't nearly so cut-and-dry IMO. Checking things out definitely is required, and can bolster faith in the process. But the halt has known negative impacts, as well. Those, too, are being noticed and have an impact on faith in the system. To bring another bad analogy in, maybe the hangup for me is that this halt decision feels like a peacetime move when we're in the middle of D-Day. Yes, evaluating the risks is worthwhile. But the context of the larger worldwide situation also matters. We wouldn't make the same decisions relating to likely minor safety risks in our beach-storming boats in 1936 as we would in June of 1944.

To build on your analogy, if during D-Day we had the options of bullets (Moderna / Pfizer ) and flame throwers (J&J) to kill Nazis as part of the landing, let's pretend that right before the invasion we determined that soldiers carrying flamethrowers were at increased risk for death in comparison to the soldiers using bullets. We decide to not use flamethrowers as part of the initial invasion and give additional review to their overall use in combat; we're pausing their use as part of the invasion for now. We can do this because we still have bullets and the Nazi threat isn't stopping. If we only had flamethrowers in our toolbox we might not have the choice and we'd be forced to live with that increased risk overall. Thankfully we have options. I'm not sure if my analogy is any better, but I'm trying to work with it.

The hope (I think) is that broadly people can understand that while they're doing the same thing (boosting immunity), they don't work the same way and that not all vaccines work the same. This goes back to the nuance. My impression is that anti-vax people are broadly against all vaccination types. Vaccine hesitant (in my experience) don't realize there are different types and different strategies for immunization. Generally they don't understand basic immunological principles (understandably) or what vaccines are trying to do (and how). I'm able to say, "Ok, let's pause on J&J and get as many people the Moderna and Pfizer shots in the short term" because I know they aren't the same; the concern isn't over Moderna, Pfizer or any other vaccines - just the J&J (and AZ use), which might be tied to their use of adenoviruses - the method;it's unkown. Will that help here? Can we message that element? I don't know.

I'm still not convinced this will move the uptake needle very much. Or maybe I'm just hopeful. I already think we're going to fall short and it has nothing to do with pausing J&J.

EDIT: Mega post; mega edits

[Zaxxon]

This analogy is getting out of control. Next you'll tell me we can't fight in the War Room.

To build on your analogy, if during D-Day we had the options of bullets (Moderna / Pfizer ) and flame throwers (J&J) to kill Nazis as part of the landing, let's pretend that right before the invasion we determined that soldiers carrying flamethrowers were at increased risk for death in comparison to the soldiers using bullets. We decide to not use flamethrowers as part of the initial invasion and give additional review to their overall use in combat; we're pausing their use as part of the invasion for now. We can do this because we still have bullets and the Nazi threat isn't stopping. If we only had flamethrowers in our toolbox we might not have the choice and we'd be forced to live with that increased risk overall. Thankfully we have options. I'm not sure if my analogy is any better, but I'm trying to work with it.

Thankfully, my understanding of the relative importance of J&J on our current rollout was a bit off--I thought it was already a much larger piece of the pie, when it looks (based on my tweeted source above) that the big J&J expansion isn't scheduled for a few weeks yet. So that could be the lion's share of where the data wasn't lining up for me.

While I still have concerns about the impact the 'idea' of the halt will have on the populace, it seems my fears over the immediate negative health outcome impacts were off. So long as we're unpaused in the next couple of weeks (and the longer-term impact is a small target--eg women of a certain age with a certain set of pre-existing conditions), it seems like this won't actually impact the # and timing of shots in arms all that much.

[El Guapo]

So I would say that the strongest arguments for the suspension seem to be: (1) trust the FDA's expertise (though I'd like to be sure that they have people whose expertise is studying impacts of various things on vaccine hesitancy); (2) risk that the blood clot becomes a bigger deal than we currently think and that impact on vaccine hesitancy; and (3) people are gonna do what they are gonna do on vaccines mostly no matter what we do, so might as well be safe.

One kicker for me is that presumably the pause is going to delay some people getting vaccinated, and that some of those will get COVID during the delay, and pass it along to at least some other people. Given that the mortality rate from COVID is so much higher than the mortality rate seems to be from any blood clot issue, that unless the blood clot issue is many, many times more dangerous than we currently think, the simple math suggests that more people will die with the pause than if there was no pause (even assuming no impact on vaccine hesitancy).

Also I can't help but feeling shades of the Comey letter on this. Like, from Comey's perspective he was just updating Congress on an additional check that he was doing in light of new evidence. But like...he should've known how people would react to it. This feels similar in that the likely general reaction from any pause for any reason is lots of people freaking out about vaccine safety.

I guess we'll see. And fortunately we have lots of Pfizer and Moderna as well, so that helps a lot.

I'll be honest with you El Guapo. I don't understand your position. Just as in law, medicine and vaccines have a protocol. They are following it. Just like in law, maybe Trump thinks that the election was stolen. That doesn't make it stolen legally right? We as Americans trust our law process and you as an attorney understand that trust and work to continue that trust. Why do you now want a corresponding profession to throw out the trust and instead consider how people feel? In neither profession does it matter how people feel right? So let's have the FDA do the right thing by following its protocols, just as our judges did the right thing by requiring Trump to produce evidence, no matter how people felt.

You are one of my favorite people here, El Guapo, so I'm not coming after you or anything like that. I just want you to see Smoove and others' perspectives or at least address why in this case we should care about how people feel vs in Trump's stolen election claims we didn't.

So, a couple points on this. First, I don't care about people's feelings on this except insofar as it impacts their behaviors on vaccinations. Like, if someone gets vaccinated I really don't care if they're only doing it because they genuinely think it will allow themselves to access the Microsoft Hive Mind. Similarly, if this pause causes 5% of people in the "vaccine hesitant" group to decline vaccination (to pick a number), that's bad, and I don't really care what those people's feelings are, I just care about the causal impact of the pause.

Second, on the protocols, yes in general the FDA should follow their protocols, which presumably are the way they are for a reason. At the same time, though, this is such an incredibly unique situation that the protocols applicable in general carry less weight - like, what the FDA should do on a vaccine applicable to a random disease that impacts 50,000 people a year that most people haven't heard of doesn't tell us much about what to do in a high media environment where we need hundreds of millions of people to vaccinate.

Lastly, I 100% get Smoove's perspective on this. I asked him about this specifically because he's the essentially resident OO expert on this stuff, so his perspective is super valuable, and the odds that I'm right on something here and he's wrong are not great. I'm just saying FWIW that the argument that this general pause decision was bad seem pretty compelling to me overall, vs. even a smaller tweak (like pausing it just for women 18 - 49 or the like).

[stessier]

I like the trend!

President Biden @POTUS · 3h
United States government official

In less than three months, we’ve more than tripled the number of daily vaccinations.

That’s progress.

[Zaxxon]

[Daehawk]

Why would she get a fake Government tracking shot for a fake disease and tell the world about it?

Shes up to something.

Good thing the nurse hit her arm or she would have deflated.

[Smoove_B]

Lastly, I 100% get Smoove's perspective on this. I asked him about this specifically because he's the essentially resident OO expert on this stuff, so his perspective is super valuable, and the odds that I'm right on something here and he's wrong are not great. I'm just saying FWIW that the argument that this general pause decision was bad seem pretty compelling to me overall, vs. even a smaller tweak (like pausing it just for women 18 - 49 or the like).

I'm always hesitant to wear the mantle of expert (the time I was declared one in court was probably one of the most uncomfortable experiences of my adult life so far), so instead I'll just say that once again I find myself taking the opposite position of Nate Silver and Tucker Carlson. You can take that for whatever it's worth to you, but to me it's everything.

[Zaxxon]

once again I find myself taking the opposite position of Nate Silver and Tucker Carlson. You can take that for whatever it's worth to you, but to me it's everything.

Goddammit, I haven't paid attention to either of them this week but if I've been on 'their side' lately, I take it all back.

[Zaxxon]

More detail, data, and rationale: https://www.washingtonpost.com/health/2 ... ood-clots/

[malchior]

If you want a quick gauge on how bad the media takes on this are, two different news program segments today had a doctor on and they used a tweet by Nate Silver as the 'other side' of the debate about the pause. The natural problem is there is no real debate here. Since there isn't any actual meaningful thing to debate here they trotted out a non-expert opinions by an attention seeker to manufacture it.

[Smoove_B]

He got a little hot earlier today when one of my people called him a pollster - to reinforce why whatever he's blathering on about needs to be disregarded.

I totally get that he's a number whiz. But to think that an ability to run statistics makes him a policy and communication expert is downright insulting - to the degree that he gets on social media and pontificates endlessly about the field and how things are done. It's like there's a total lack of self awareness that there are people that have dedicated their entire lives to understanding health communication or emergency response. And yet somehow, he has a hot take that no one's considered. And to be clear, I'm neither a whiz with the numbers or a policy/communication expert by any means. But I do listen to those that are and amplify the message.

[malchior]

I totally get that he's a number whiz. But to think that an ability to run statistics makes him a policy and communication expert is downright insulting - to the degree that he gets on social media and pontificates endlessly about the field and how things are done.

This is actually a hot ethics/professionalism topic in data science...and its why I've become a fierce critic of Nate Silver. He is committing 'crimes against data science' at the moment. Stats and models are often pretty useless without *expert* guidance to interpret the outputs. If I throw together some predictive or explanatory mathematical model I have to be able to interpret if the result is good, bad, and/or needs refinement. And the current 'state of the art' way to do this is to have a SME from the domain in question on hand to temper these type of hot takes. That being said, he's clearly a smart guy but his expertise is in polling. I'm sure he can get to 80% mastery in other domains relatively quickly just to put some Paredo bounds on it. However it probably is important to recognize that the last 20% is crucial for policy making especially when it impacts public health.

It's like there's a total lack of self awareness that there are people that have dedicated their entire lives to understanding health communication or emergency response. And yet somehow, he has a hot take that no one's considered. And to be clear, I'm neither a whiz with the numbers or a policy/communication expert by any means. But I do listen to those that are and amplify the message.

Right, this is why I label him an attention seeker. People have been yelling at him about this for a year now. He isn't going to change. Worse he is enabled by media outlets holding him up as some pseudo-expert which is just irresponsible.

[Isgrimnur]

He is committing 'crimes against data science' at the moment. Stats and models are often pretty useless without *expert* guidance to interpret the outputs. If I throw together some predictive or explanatory mathematical model I have to be able to interpret if the result is good, bad, and/or needs refinement. And the current 'state of the art' way to do this is to have a SME from the domain in question on hand to temper these type of hot takes.

Thank you. I spend my days trying to solve business problems for our company. I can flip bits in a lot of ways, but that doesn’t mean I understand accounting voodoo or can suddenly determine policy based on a cool report I threw together.

[Smoove_B]

Once again, Texas:

These two paragraphs. Wow.

The two paragraphs:

[Governor Abbott] added, “I don’t know what herd immunity is, but when you add that to the people who have immunity, it looks like it could be very close to herd immunity.”

Michael Osterholm, an epidemiologist and director of the University of Minnesota’s Center for Infectious Disease Research and Policy, said, “There is no way on God’s green earth that Texas is anywhere even close to herd immunity.”

[Isgrimnur]

Can we trade our governor and LT for some draft picks? Please?

[Holman]

I'm really interested in the position my mother (born 1941) is taking.

I grew up suburban-conservative Evangelical in Atlanta and Birmingham. After I went out on my own, my parents retired to the lovely coastal Gulf town of Fairhope (AL), where they helped to build and support a not-quite-megachurch. I've attended their services a few times when I've visited, and it's the kind of place where some members would be die-hard Trumpist anti-vaccers (because Government is bad) and some other members would not (because the Gospel is more personal).

I've been heartened to hear from my mom that she is getting all the required shots and keeping herself safe. She has had one or two upper-60s friends actually catch COVID and suffer terribly from it, and that's enough to persuade her that the risk is serious. She has now had both shots of Moderna, which I'm glad to hear.

[Little Raven]

Experts are not of one mind.

To federal health officials, asking states on Tuesday to suspend use of the Johnson & Johnson coronavirus vaccine until they can investigate six extremely rare but troubling cases of blood clots was an obvious and perhaps unavoidable move.

But where scientists saw prudence, public health officials saw a delicate trade-off: The blood clotting so far appears to affect just one out of every million people injected with the vaccine, and it is not yet clear if the vaccine is the cause. If highlighting the clotting heightens vaccine hesitancy and bolsters conspiracy theorists, the “pause” in the end could ultimately sicken — and even kill — more people than it saves.

With coronavirus cases spiking in states like Michigan and Minnesota, and worrisome new variants on the horizon, health officials know they are in a race between the virus and the vaccine — and can ill afford any setbacks.

“We are concerned about heightened reservations about the J&J vaccine, but in addition to that, those reservations could spill over into public concerns about other vaccines,” said Dr. Paul Simon, the chief science officer for the Los Angeles County Department of Public Health.

...

The repercussions could be more dramatic than federal officials are bargaining for, just as they were in Europe, where a similar clotting issue has turned the AstraZeneca vaccine into something of a pariah. There, too, officials stressed that blood clotting in people injected with the AstraZeneca vaccine was extremely rare. Yet according to a YouGov poll published last month, 61 percent of the French, 55 percent of Germans and 52 percent of Spaniards consider the AstraZeneca vaccine “unsafe.”

“It’s a messaging nightmare,” said Rachael Piltch-Loeb, an expert in health risk communications at the N.Y.U. School of Global Public Health. But officials had no other ethical option, she added. “To ignore it would be to seed the growing sentiment that public health officials are lying to the public.”

[malchior]

Experts are not of one mind.

I'm not so sure. The experts quoted talked about impact in a fairly consistent way and essentially said they had no choice but to pause. It was the non-experts who were all over the place.

[ImLawBoy]

Can we trade our governor and LT for some draft picks? Please?

Oh, please. You know you'd just waste them on WRs when you don't have a QB or a functional OL.

[Isgrimnur]

[El Guapo]

Have their been studies of vaccine hesitancy, and what increases it / decreases it? I would assume so, curious what the results would indicate.

[YellowKing]

Have their been studies of vaccine hesitancy, and what increases it / decreases it? I would assume so, curious what the results would indicate.

It's hardly what I'd call a scientific study, but I seem to recall CNN (?) doing a focus group session with some vaccine-hesitant people and they were able to flip a significant portion of them through simple education.

Anecdotally, the folks I know who do not want to get it are victims of misinformation.

Can you imagine the number of lives saved and the vaccination rates if Fox News and other right-wing media outlets used their propaganda for pro-vaccination drives instead of nonsense?

[Smoove_B]

Have their been studies of vaccine hesitancy, and what increases it / decreases it? I would assume so, curious what the results would indicate.

Quite a few, mainly focused on parents as it relates to giving vaccines to their children. I'm not aware of studies on dealing with adult-specific vaccine hesitancy, though I'm sure they exist.

Generally the key is education and communication from a trusted source - the attending pediatrician. However, even before the child is born, the Ob/Gyn should be educating and communicating what the parents should expect when the child is born (HepB vaccine) and then in the weeks and months ahead.

The problem for everything Covid (I think) is that (1) it's new and (2) adults (largely) aren't calling or meeting with their PCP to get advice on vaccines. If they're older and being advised on the shingles vaccine or pneumococcal pneumonia, maybe. But for most healthy adults with or without grown children? I can't imagine they're calling their doctor to get general advice on the COVID vaccine (how it works, is is safe, etc...).

We struggle to get healthy adults to buy into the annual flu shot, so for the large majority of adults, the idea of a vaccine is unusual - they haven't thought about it since they had kids (or if they don't have kids) likely when they were a kid. We've messaged how important vaccines are in protecting children, but there isn't (in my experience) a greater understanding of how the vaccines actually protect everyone. I think that really has been the core missing element for the COVID vaccines and that if people understood better how the vaccines work, that would help to bridge the hesitancy.

So here they're reliant on information from the FDA, the CDC and local/state health agencies. Oh, and Facebook and Youtube.Can you guess where I think they're likely getting most of their info from?

[Smoove_B]

Oddly enough, a little help from The Atlantic:

In pockets of the country, vaccination rates could stay low, creating little islands where the coronavirus survives and thrives—sickening and killing people for months after the pandemic has ebbed elsewhere. In a worst-case scenario, the virus could mutate, becoming a highly transmissible and much more lethal version of itself. Eventually, the new variant could leak from these islands and spread into the broader population, posing a threat to already-vaccinated people.

This is the future that keeps some public-health experts awake at night. Right now America is in the simplest stage of its vaccination campaign: getting shots to people who want them. But many Americans are still reluctant to get a vaccine—especially those living in rural areas, who tend to be politically conservative and are among the most fervently opposed to inoculation. Public-health leaders will soon have to refocus their efforts toward the next and more difficult stage of the campaign: persuasion. Over the next few months, “the number of willing individuals to get vaccinated will be depleted,” says Timothy Callaghan, a rural-health researcher and professor at Texas A&M University. “Then the work begins.”

What I mentioned earlier:

Vaccine hesitancy is now the chief focus for rural-health experts like Morgan. They have an obligation to change minds, and fast. But persuasion works only with trustworthy messengers, such as local leaders, physicians, and pharmacists—people who already have relationships and friendships with community members, who share similar values, and whose children go to school together. “Rather than have these mass-vaccination sites through government-funded health departments with the National Guard” overseeing operations, health officials need to send vaccines straight to places such as doctors’ offices, churches, and familiar local clinics, Michael Meit, the research director at East Tennessee State University’s Center for Rural Health Research, told me. “It’s those relational pieces that are so, so important in our rural communities.”

[El Guapo]

Have their been studies of vaccine hesitancy, and what increases it / decreases it? I would assume so, curious what the results would indicate.

Quite a few, mainly focused on parents as it relates to giving vaccines to their children. I'm not aware of studies on dealing with adult-specific vaccine hesitancy, though I'm sure they exist.

Generally the key is education and communication from a trusted source - the attending pediatrician. However, even before the child is born, the Ob/Gyn should be educating and communicating what the parents should expect when the child is born (HepB vaccine) and then in the weeks and months ahead.

The problem for everything Covid (I think) is that (1) it's new and (2) adults (largely) aren't calling or meeting with their PCP to get advice on vaccines. If they're older and being advised on the shingles vaccine or pneumococcal pneumonia, maybe. But for most healthy adults with or without grown children? I can't imagine they're calling their doctor to get general advice on the COVID vaccine (how it works, is is safe, etc...).

We struggle to get healthy adults to buy into the annual flu shot, so for the large majority of adults, the idea of a vaccine is unusual - they haven't thought about it since they had kids (or if they don't have kids) likely when they were a kid. We've messaged how important vaccines are in protecting children, but there isn't (in my experience) a greater understanding of how the vaccines actually protect everyone. I think that really has been the core missing element for the COVID vaccines and that if people understood better how the vaccines work, that would help to bridge the hesitancy.

So here they're reliant on information from the FDA, the CDC and local/state health agencies. Oh, and Facebook and Youtube.Can you guess where I think they're likely getting most of their info from?

Thanks. Have there been studies of the effects of vaccine pauses on vaccine hesitancy? I'm just thinking about it because the debate on this seems to be "any safety-based pause is going to raise people's assessment of the risk of the vaccine" vs. "people's faith in the vaccines is dependent on FDA testing, so the pauses will help with vaccine hesitancy in the long run". As you know I tend to find the former materially more persuasive, but what do I know, so I'm curious whether there's data / science on this specific issue.

The other data point on this is supposedly polling on public views of the safety of the AstroZeneca vaccine went sharply down in continental Europe (where AZ was paused) but didn't in the UK (where it wasn't), which I've seen raised as a data point on this, but not sure if there's any issue with that claim or not.

[malchior]

What I mentioned earlier:

Vaccine hesitancy is now the chief focus for rural-health experts like Morgan. They have an obligation to change minds, and fast. But persuasion works only with trustworthy messengers, such as local leaders, physicians, and pharmacists—people who already have relationships and friendships with community members, who share similar values, and whose children go to school together. “Rather than have these mass-vaccination sites through government-funded health departments with the National Guard” overseeing operations, health officials need to send vaccines straight to places such as doctors’ offices, churches, and familiar local clinics, Michael Meit, the research director at East Tennessee State University’s Center for Rural Health Research, told me. “It’s those relational pieces that are so, so important in our rural communities.”

This seems wise to me. This is why I'm skeptical of attacks on public health experts as bad communicators. Maybe they could have done better but the political climate and the past works against them here. And in the present they are being nitpicked to death by non-experts who have outsized voices. Getting beyond that to something effective that is out of the box is probably the only way to potentially succeed.

Thanks. Have there been studies of the effects of vaccine pauses on vaccine hesitancy? I'm just thinking about it because the debate on this seems to be "any safety-based pause is going to raise people's assessment of the risk of the vaccine" vs. "people's faith in the vaccines is dependent on FDA testing, so the pauses will help with vaccine hesitancy in the long run". As you know I tend to find the former materially more persuasive, but what do I know, so I'm curious whether there's data / science on this specific issue.

The other data point on this is supposedly polling on public views of the safety of the AstroZeneca vaccine went sharply down in continental Europe (where AZ was paused) but didn't in the UK (where it wasn't), which I've seen raised as a data point on this, but not sure if there's any issue with that claim or not.

My problem with this line is that it is a one off. This is again another place where I think Nate has lost it. He bangs on this point over and over to justify the damage he is doing when he should know that N=1 situations aren't a justification. They are something to consider. He in particular keeps making it sound like a cold, hard fact.

[Smoove_B]

Thanks. Have there been studies of the effects of vaccine pauses on vaccine hesitancy? I'm just thinking about it because the debate on this seems to be "any safety-based pause is going to raise people's assessment of the risk of the vaccine" vs. "people's faith in the vaccines is dependent on FDA testing, so the pauses will help with vaccine hesitancy in the long run". As you know I tend to find the former materially more persuasive, but what do I know, so I'm curious whether there's data / science on this specific issue.

I'm not sure; I'd need to look. I'd also need to figure out exactly how to search on it because (oddly enough) "vaccine pausing" is also a phrase associated with what some vaccine hesitant parents do/did with their children, spacing out a series of vaccines instead of offering multiple shots all at once during a single visit.

The other data point on this is supposedly polling on public views of the safety of the AstroZeneca vaccine went sharply down in continental Europe (where AZ was paused) but didn't in the UK (where it wasn't), which I've seen raised as a data point on this, but not sure if there's any issue with that claim or not.

I'll admit here I haven't been following anything related to AZ. In my current world, my brain can only rotate through so much info and keeping track of a vaccine I'll never need to deal with seemed like a good way to make mental space.

If there is info about how people respond to pauses, that might be a good place to look though, yeah, just based on what you've said.

[El Guapo]

My problem with this line is that it is a one off. This is again another place where I think Nate has lost it. He bangs on this point over and over to justify the damage he is doing when he should know that N=1 situations aren't a justification. They are something to consider. He in particular keeps making it sound like a cold, hard fact.

Look, I don't really care what Nate Silver is or isn't saying on this. And even assuming that the factual premise is correct (that public views of AZ safety declined after the pauses in Europe) doesn't mean that that will always be the case, but it is relevant. That's why I asked about studies of vaccine pauses in general - obviously what we're facing is kind of a unique / special case, but the effects of other pauses would surely tell us something about what the likely effects are.

[Smoove_B]

This seems wise to me. This is why I'm skeptical of attacks on public health experts as bad communicators. Maybe they could have done better but the political climate and the past works against them here. And in the present they are being nitpicked to death by non-experts who have outsized voices. Getting beyond that to something effective that is out of the box is probably the only way to potentially succeed

Public health communication is its own specialized field and it's not easy. There's significant internal debate over how to communicate things (which is all part of the process), so hearing random talking heads pontificate about specific things is very strange (for me) to watch. When a public health expert is speaking about an issue, they're not free-styling a response. It's measured and intentional. Case in point, I've been getting a document at least 1x a week (sometimes twice) from the State, filtered through the CDC - talking points on Covid. Very specific things to say and how to address questions/concerns from the public. Why? Because it's important that we're all saying the same thing in the same way; it's important we're all on the same (literal) page.

But yes, unfortunately a "Nate Silver" or "Tucker Carlson" is more respected/trusted than a state health official. I said it early on, public health has a PR problem; we're invisible. So now our efforts need to focus on working with local gatekeepers to try and have them convince the vaccine hesitant that what we're trying to do is important and that we should be trusted. We should be doing that normally, but in my experience in local health, it's not happening (at least here in the Jerz).

[malchior]

I said it early on, public health has a PR problem; we're invisible. So now our efforts need to focus on working with local gatekeepers to try and have them convince the vaccine hesitant that what we're trying to do is important and that we should be trusted. We should be doing that normally, but in my experience in local health, it's not happening (at least here in the Jerz).

Is it invisibility or broken politics? We both know NJ politics enough to know that we are our own special kettle of dysfunctional fish here but this seems widespread. If health is driven at a state level with Federal oversight...where did the breakdown happen? Is it funding? Competing theories? Lack of leadership?

[malchior]

My problem with this line is that it is a one off. This is again another place where I think Nate has lost it. He bangs on this point over and over to justify the damage he is doing when he should know that N=1 situations aren't a justification. They are something to consider. He in particular keeps making it sound like a cold, hard fact.

Look, I don't really care what Nate Silver is or isn't saying on this. And even assuming that the factual premise is correct (that public views of AZ safety declined after the pauses in Europe) doesn't mean that that will always be the case, but it is relevant. That's why I asked about studies of vaccine pauses in general - obviously what we're facing is kind of a unique / special case, but the effects of other pauses would surely tell us something about what the likely effects are.

I'm just picking him out of the sky because he spent last night on a tirade about this. He got challenged about this and went ballistic. It is fresh of mind. It was more wondering to the point Smoove_B just talked - why do we listen to this guy who is a non-expert. Why does the media use him as an invisible proxy for experts on the other side who don't exist, etc.

[Smoove_B]

Is it invisibility or broken politics? We both know NJ politics enough to know that we are our own special kettle of dysfunctional fish here but this seems widespread. If health is driven at a state level with Federal oversight...where did the breakdown happen? Is it funding? Competing theories? Lack of leadership?

Politics are a factor, but as a profession we're largely invisible. Up until 2020 when people would ask what I did or what my background was, I needed to explain it. Now? I need to make sure they know it's not just COVID.

In my decade+ of local public health work, not once did I meet with community members in any type of formal or informal setting. Overwhelmingly my contact with a resident was related to disease follow up, a complaint about mosquitoes or rats or a septic system that was blowing out of the ground. I had more relationships with business owners because of regulatory compliance than the average tax paying resident. So here,I can appreciate why there's little to no trust - I'm a stranger. Currently I serve on a local public health board (and in 2020/21 "serving" means connecting to a Zoom meeting every month). In the ~16 months since I've been appointed, there hasn't been a single member of the public that has attended. It's technically easier than ever but there's nothing the board is doing to demonstrate value or build trust. That is likely political, but it's not insurmountable.

Funding (nationally) is a problem. The trend over the last ~15+ years has been a mass exodus in the field overall and there's some real concern it's about to get worse. There's more interest in the field now but there aren't jobs to match the interest - that's a problem. If there's another exodus, there will be more jobs but a loss of collective knowledge; that's also a problem.

Leadership is an issue to a degree, yes. There are some amazing examples of state and local leaders, but they're not widely known. More importantly, their stories aren't being shared nationally - promoted as what's possible when a community values public health.

I think the biggest issue is that public health is a state issue; it's not in our federal Constitution (explicitly) . So depending on the state you live in, your services are going to vary wildly from another. This was made clear with how the pandemic unfolded and how it continues. This is likely political as well - how the state and the state's residents view and prioritize public health. Maybe that will change now. I really don't know what to expect.

There has been a push for prominent state and national public health figures to start getting more political - start running for office. I don't know how that will work out either.

In short; we've got problems.

[malchior]

Politics are a factor, but as a profession we're largely invisible. Up until 2020 when people would ask what I did or what my background was, I needed to explain it. Now? I need to make sure they know it's not just COVID.

In my decade+ of local public health work, not once did I meet with community members in any type of formal or informal setting. Overwhelmingly my contact with a resident was related to disease follow up, a complaint about mosquitoes or rats or a septic system that was blowing out of the ground. I had more relationships with business owners because of regulatory compliance than the average tax paying resident. So here,I can appreciate why there's little to no trust - I'm a stranger. Currently I serve on a local public health board (and in 2020/21 "serving" means connecting to a Zoom meeting every month). In the ~16 months since I've been appointed, there hasn't been a single member of the public that has attended. It's technically easier than ever but there's nothing the board is doing to demonstrate value or build trust. That is likely political, but it's not insurmountable.

This is a real ugly problem and even as a layman I can sense that getting the public's interest is pretty daunting even in ideal conditions. Even after this. I deal with this in my world (cybersecurity) as well. We can try to drive as much awareness as we want but it only takes one careless jabroni clicking a link to let malware into the company. Back to the health word, I imagine you've got all sort of vectors to worry about that are driven by complex human behavior. Ugh.

Funding (nationally) is a problem. The trend over the last ~15+ years has been a mass exodus in the field overall and there's some real concern it's about to get worse. There's more interest in the field now but there aren't jobs to match the interest - that's a problem. If there's another exodus, there will be more jobs but a loss of collective knowledge; that's also a problem.

Right despite spending inordinate amounts on health care maybe we aren't targeting dollars correctly to expand awareness. Also, if I'm getting this right essentially the workforce is aging and not being refreshed. So maybe a wealth of insular thinking/lack of new ideas is also in the mix.

I think the biggest issue is that public health is a state issue; it's not in our federal Constitution (explicitly) . So depending on the state you live in, your services are going to vary wildly from another. This was made clear with how the pandemic unfolded and how it continues. This is likely political as well - how the state and the state's residents view and prioritize public health. Maybe that will change now. I really don't know what to expect.

Yeah this makes sense. And the main road to improvement (guessing universal healthcare or national standards) is impossible here.

There has been a push for prominent state and national public health figures to start getting more political - start running for office. I don't know how that will work out either.

This one doesn't make much sense to me. We've seen public health narratives undermined by political considerations. I can't think of a worse medicine. It isn't like politicians are more trusted. If invisibility is the problem become more visible. I don't get layering in a new layer of distrust. Still I get folks are just trying different ideas out.