Coronavirus

[muscleman]

Today’s big news was not entirely unexpected: There was never any plan for a federal response to the coronavirus pandemic. "What we're inheriting is so much worse than we could have imagined," said President Biden's coronavirus response coordinator Jeff Zients in a call with reporters. Another official said: “There is nothing for us to rework. We are going to have to build everything from scratch."

 

https://heathercoxrichardson.substack.com/p/january-21-2021

 

https://www.foxnews.com/media/cnn-debunked-biden-inherited-vaccine-distribution-plan-47-times

 

[cwericb]

Heather is an oaf. Typical academic liberal elite hack.

 

Otherwise, good to see we are gettihttps://www.cornerofberkshireandfairfax.ca/forum/Themes/default/images/upshrink.pngng excuses on day 1.

 

Shoot the messenger, ignore the message? 

[ERICOPOLY]

How about keeping right wing vomit off of the posts?

[Gregmal]

Heather is an oaf. Typical academic liberal elite hack.

 

Otherwise, good to see we are getting excuses on day 1.

 

Politics is banned right?

 

Supposedly. Which is why I found it odd Liberty posted a partisan opinion piece by a partisan clown...so I just wanted to make sure everyone was aware of the context. Thankfully, muscleman beat me to the fact check.

[ERICOPOLY]

Heather is an oaf. Typical academic liberal elite hack.

 

Otherwise, good to see we are getting excuses on day 1.

 

Politics is banned right?

 

Supposedly. Which is why I found it odd Liberty posted a partisan opinion piece by a partisan clown...so I just wanted to make sure everyone was aware of the context. Thankfully, muscleman beat me to the fact check.

 

So you posted like a partisan clown in response to it?  What is this?  Eye for an eye?

 

 

[Read the Footnotes]

Regardless of what the perfect solution is, two things are true:

1) Distribution has failed relative to the goals and promises of the Trump administration. Last I calculated it was roughly 10% of what had been promised. The shots were manufactured and left the manufacturing facility on time, but it seriously goes off the rails after that.

2) The USA has seriously under-performed its ability. The USA should have been the gold standard, and it has not been.

 

Many experts are repeating that vaccine distribution is going to be the most complicated logistical challenge since WWII and some are going so far as to say that it is the most complicated logistical challenge in the history of the USA.

 

It doesn't make sense to me to have a hands off approach at the federal level. It would make more sense that you would want to take advantage of economies of scale, and efficiencies of scale. It also make sense that you would want to tap in to those with expertise, even if that requires a greater federal response.

 

What is unclear is what the future holds as a result of the proposed changes. Fauci and others certainly seem very happy about the ability to follow the science in the future, but the results may not produce a clear referendum on any one decision or policy because of a long list of confounding variables, such as:

1) Misinformation and conspiracy theories

2) New more transmissible variants

3) Multiple variables changing simultaneously

 

Judging by the response of certain sectors (oil and gas, small banks, and others) in the past couple of weeks, I believe the market is also indicating that it believes that small businesses and economic activity will fare better in the future as a result of better management of the virus.

 

I am sure there will be people who try to find evidence to prove that masks don't work for example. There will undoubtedly be people who pick and choose data to try to prove a point using models that are too simplistic to be useful.

 

I personally am hopeful regarding the direction of the response.

 

As an anecdote, I saw today someone I see basically on a daily basis who has been a staunch anti-masker. He was wearing a mask for the first time I've ever seen. It was early in the morning and no one was around. Maybe he was hoping no one would see him looking so weak with a mask on?  ;) Maybe he was feeling self-conscious and wanted to try it out when no one was looking? Whatever the reason, I take it as a good sign. A year late, but a good sign.

 

 

[Read the Footnotes]

IHME is basically projecting for infections to fall off a cliff given rapid vaccine roll out changes, and universal masking.

 

https://covid19.healthdata.org/united-states-of-america?view=infections-testing&tab=trend&test=infections

 

It will be an interesting test of policy to see if it comes true, but it is far from a laboratory test with many ways in which the real world could disrupt any experimental value.

[Liberty]

Today’s big news was not entirely unexpected: There was never any plan for a federal response to the coronavirus pandemic. "What we're inheriting is so much worse than we could have imagined," said President Biden's coronavirus response coordinator Jeff Zients in a call with reporters. Another official said: “There is nothing for us to rework. We are going to have to build everything from scratch."

 

https://heathercoxrichardson.substack.com/p/january-21-2021

 

https://www.foxnews.com/media/cnn-debunked-biden-inherited-vaccine-distribution-plan-47-times

 

Good if that's true that they had more of a plan than it sounded, but clearly it can't have been that much of a plan, as the feds haven't really been doing much to help distribution and it's in a pretty pitiful state, and already we're seeing a lot of things being activated that should've been months ago (defense production act, mask mandates, increasing resources for vaccination, coordination between states, using more federal resources like FEMA, etc).

[ERICOPOLY]

IHME is basically projecting for infections to fall off a cliff given rapid vaccine roll out changes, and universal masking.

 

https://covid19.healthdata.org/united-states-of-america?view=infections-testing&tab=trend&test=infections

 

It will be an interesting test of policy to see if it comes true, but it is far from a laboratory test with many ways in which the real world could disrupt any experimental value.

 

It doesn't hurt that from here on out we getting beyond the pig in the python that is Thanksgiving/Christmas/NewYear.  You could implement just about any policy starting now and claim relative success.

[cubsfan]

^ Yup - this rollout is being completely botched. Amazing after all the screaming for the vaccine. Local doctors tell you

that you are eligible, but can't help you get the vaccine. It's a circus here in Illinois.

Facts-motivated post submitted for 'analysis'.

First dose given as % of total population in Illinois: 4.3%

First dose given as % of total population in USA: 4.5%

These %s are more than twice what is being achieved in Canada (and in my area where state, free markets, communities and individuals try to cooperate).

You (or the ones to whom your collective trust has been allocated) must be doing something right during this challenging ramp-up phase.

 

If looking for a circus, take a look at the comments on a site i've been following (with some participation):

https://wirepoints.org/illinois-covid-19-crisis-daily-data-update-wirepoints/

Do you realize that (forgetting sunk costs) that Illinois is turning the corner (at least as far as Covid and herd immunity are concerned)?

 

Cigarbutt - thanks much for the link, very helpful.

[Spekulatius]

In terms of Vaccine rollout, the US doesn't look that bad actually.

 

USA 5% vaccinated

Germany ~2%

UK ~8%

France ~1%

Israel: ~38%

 

The reason why Europe is so far behind is lack of vaccines. they have only the BioNtech/Pfizer vaccine approved while the UK as Pfizer, Moderna and Astra Zeneca approved.

 

https://ourworldindata.org/covid-vaccinations

[Liberty]

In terms of Vaccine rollout, the US doesn't look that bad actually.

 

USA 5% vaccinated

Germany ~2%

UK ~8%

France ~1%

Israel: ~38%

 

The reason why Europe is so far behind is lack of vaccines. they have only the BioNtech/Pfizer vaccine approved while the UK as Pfizer, Moderna and Astra Zeneca approved.

 

https://ourworldindata.org/covid-vaccinations

 

Relative valuation sucks. What you want is to see where you are vs your potential. Right now, "49% of the shots distributed to states have been administered", and more shots could probably have been available if the Feds had taken up Pfizer's offer last summer.

[ERICOPOLY]

In terms of Vaccine rollout, the US doesn't look that bad actually.

 

USA 5% vaccinated

Germany ~2%

UK ~8%

France ~1%

Israel: ~38%

 

The reason why Europe is so far behind is lack of vaccines. they have only the BioNtech/Pfizer vaccine approved while the UK as Pfizer, Moderna and Astra Zeneca approved.

 

https://ourworldindata.org/covid-vaccinations

 

Relative valuation sucks. What you want is to see where you are vs your potential. Right now, "49% of the shots distributed to states have been administered", and more shots could probably have been available if the Feds had taken up Pfizer's offer last summer.

 

The opportunity cost to the economy of not purchasing those extra shots is very, very high.

[Read the Footnotes]

 

Relative valuation sucks. What you want is to see where you are vs your potential. Right now, "49% of the shots distributed to states have been administered", and more shots could probably have been available if the Feds had taken up Pfizer's offer last summer.

 

Yes, this is the right approach. The problem is that it is more difficult to do and potentially less mathematically precise so some people will default to doing what is easy. It's basically the same rant as when Buffett and Munger have complained that academic finance is drawn to elegant math even when it is not sensible.

 

The real standard should be what it should have been or was expected to be. The fact is that many countries who were trained by the US CDC have been outperformed the US response. So the master is outperformed by the "students", and those students are completely mystified and horrified by the outcomes in the USA. Many of those trained by the US CDC in other parts of the world have given interviews to say exactly that.

 

To me when you have a country that should have been the absolute gold standard for the whole world that comes in average at best, we should be asking why did the country fail to meet expectations, and why did it under-perform previous experience.

 

Here's a sport analogy.

 

Let's assume that you have a football team, something like the University of Alabama. This football team has the biggest budget by a significant margin of all football teams, many times larger than it's nearest competitors. It has a long track record of winning national championships, which given the long history of investments and the high current investment top performance should basically be expected. In fact the biggest risk to continued championships is that so many other teams try to copy their playbook and learn from the gold standard team.

 

Now assume a new head coach comes in to this best in class football team, he fires half of the coordinators or coaching staff and refuses to allow those positions to be filled because he doesn't think they are needed. Then when game day comes, the new coach tells the team they can continue to use the defensive playbook, but not the offensive playbook. In addition, he tells them that some of the defensive playbook he really doesn't like and it will be trouble if they call any of those plays, but since he hasn't read the playbook, he can't tell them which ones yet.

 

So in this case, if this team with a long history of championships comes in mid-pack, shouldn't we be questioning why? In football, it seems like when you spend a lot on a program and suddenly don't get good results when there's a history and culture of winning, there's usually a price to be paid.

[Read the Footnotes]

In terms of Vaccine rollout, the US doesn't look that bad actually.

 

USA 5% vaccinated

Germany ~2%

UK ~8%

France ~1%

Israel: ~38%

 

The reason why Europe is so far behind is lack of vaccines. they have only the BioNtech/Pfizer vaccine approved while the UK as Pfizer, Moderna and Astra Zeneca approved.

 

https://ourworldindata.org/covid-vaccinations

 

Relative valuation sucks. What you want is to see where you are vs your potential. Right now, "49% of the shots distributed to states have been administered", and more shots could probably have been available if the Feds had taken up Pfizer's offer last summer.

 

The opportunity cost to the economy of not purchasing those extra shots is very, very high.

Placing most of your bets on one tool was also not a good strategy. If anything goes wrong, even a delay will cost lives and billions of dollars unnecessarily, and delays should have been expected.

[Liberty]

https://www.ft.com/content/2b0dbba3-6fe8-4c2d-8cca-90e87261d436

[Cigarbutt]

https://www.ft.com/content/2b0dbba3-6fe8-4c2d-8cca-90e87261d436

That was interesting. Thank you.

-----

In case somebody's interested, here's a non-investment-related comment. An interesting (and critical) part of what the person went through is a very frequent phenomenon (anywhere between 40 and 80% of people going to (through) intensive care units, depending on diagnostic criteria used): ICU psychosis, now labeled ICU delirium. Sadly in a way, the condition still goes mostly under-recognized both during the ICU stay (people then are focusing on a larger issue, saving the person's life) and after discharge (people tend to under-report related symptoms and the condition is often ignored or downplayed during follow-up). Survivors of ICU, when leaving units, typically (physically) look like astronauts who come back to earth, in the hours following landing. Even if 'healed', the physical trauma is very real and, for the mental part, even if most 'recover', the consequences are very real and sometimes very significant. The ICU world is a victim of its success in a way but it is a very artificial environment (noise, intensity of activity, Times Square 24-hr type of environment). It is thought that people who develop 'psychosis' (anxiety, hallucinations, delusions, paranoia) during their ICU stay may have had some kind of predisposing risk factors but most of these people did not show any such symptoms before and would have likely never developed such symptoms absent the ICU visit.

This is something to consider (past, present and future) in terms of using age cutoffs for 'protection' or using the 99.9% of people 'recover' argument for Covid. Even if absolute numbers are lower, the CDC has shown that relative odds of younger cohorts to run into trouble (using relative death rates as a strongly correlated proxy for ICU stay) to have been running something like 30 to 50% higher for significant time periods.

 

-----

The above post is quite useless for investments but here's possibly a relevant investment 'lesson'. When involved in decision making in the ICU, it's no time for existential thinking or 'academic' discussions, it's time for action. To deal with this aspect, most thinking has been made beforehand and most decisions are results of pre-defined checklists. So when dealing with an investment that's becoming distressed or during a real market crash, it's probably best if the some of the thinking (moat, margin of safety, range of outcomes, what is value investing etc) has been made beforehand and most decisions come as result of pre-defined checklists (entry point(s), position sizing etc). It's (slowly) being shown that the best strategy to avoid PTSD after ICU is prevention.

[Castanza]

https://www.ft.com/content/2b0dbba3-6fe8-4c2d-8cca-90e87261d436

 

One mans experience is not the majority’s. This is a bit fear “mongerish” and covertly political.

 

My uncle a 65 year old brick layer who has had two back surgeries, one knee replacement, a heart stent and Rheumatoid Arthritis for the past 10 years has covid last month. Kicked it in 6 days with no lasting effects (known to him). Lost his taste and smell and had a migraine most of the time. He was a checkbox for many co-morbidities but seemingly wasn’t phased.

 

I guess the scariest part is there is no way to know how it will affect you personally.

[Spekulatius]

In terms of Vaccine rollout, the US doesn't look that bad actually.

 

USA 5% vaccinated

Germany ~2%

UK ~8%

France ~1%

Israel: ~38%

 

The reason why Europe is so far behind is lack of vaccines. they have only the BioNtech/Pfizer vaccine approved while the UK as Pfizer, Moderna and Astra Zeneca approved.

 

https://ourworldindata.org/covid-vaccinations

 

Relative valuation sucks. What you want is to see where you are vs your potential. Right now, "49% of the shots distributed to states have been administered", and more shots could probably have been available if the Feds had taken up Pfizer's offer last summer.

 

Yes, relative valuation sucks, but it also provides perspective.

 

FWIW, I looked at Canada and the vaccination rate is at ~2% on part with Germany and far behind the USA.hat is going on there?

 

I know what is going on in Europe.

1) Europe has decided to do the vaccination purchase on an EU basis, but their ordered only 250M doses which is not enough for everyone in Europe obviously.

2) Europe has decided to give no emergency authorization for any vaccine. Which probably causes a 1-2 month delay. So far only BioNtech/Pfizer is approved , Moderna is due soon and Astra has 1-2 month more to go. The reason why the UK has higher vaccination is because they have more vaccines available (they approved 3 vaccines already) so they have more supplies.

 

So everything considered Operation Warp speed actually has done a better job than many other countries, including Canada. I am sure it could be better and faster, but here we are. What I am hoping is that daily vaccination rates go up now after the administration change and that better focus helps to get this done as quickly as possible, because we need to get to herd immunity levels in summer or we are looking at another sucky winter.

[Cigarbutt]

https://www.ft.com/content/2b0dbba3-6fe8-4c2d-8cca-90e87261d436

One mans experience is not the majority’s. This is a bit fear “mongerish” and covertly political.

My uncle a 65 year old brick layer who has had two back surgeries, one knee replacement, a heart stent and Rheumatoid Arthritis for the past 10 years has covid last month. Kicked it in 6 days with no lasting effects (known to him). Lost his taste and smell and had a migraine most of the time. He was a checkbox for many co-morbidities but seemingly wasn’t phased.

I guess the scariest part is there is no way to know how it will affect you personally.

Respectfully submitted for the ‘analysis’ part.

Let’s say one of my uncles chain-smoked all his life and died of very old age.

Does that mean I can believe that people dying of lung cancers are not real?

The FT piece describes a fairly typical story of somebody aged 57 who ends up in the ICU as a result of a Covid-19 infection (significant higher relative risk in 2020-1), needs invasive respiratory support, develops a semi-paralyzed foot, a significant blood clot in major lung blood vessels and some kind of discomfort along the way.

-----

In related news, there’s been some investigative development on the vaccine front, this time coming from Israel, the area where vaccine deployment is the most effective, by far.

https://www.shebaonline.org/pfizer-biontech-vaccine-is-highly-effective/

There’s been questioning around the efficacy of vaccines to reduce actual transmission to others. While impossible to prove beyond all doubts at this point, there is mounting evidence that vaccines likely have a significant effect on transmission. The Sheba study (small sample) shows that most people develop 6 to 20x antibody levels compared to levels reached after ‘natural’ exposure. The antibodies developed after vaccines appear to be very ‘neutralizing’ and the high levels of antibodies suggest that viral loads could be significantly inhibited with a very potential impact on transmission (symptomatic and asymptomatic).

On that front, in the coming months, there will be a very interesting natural experiment in areas where community spread has remained sustainably high. Vaccines will be distributed and inoculated (resulting in vaccine-induced immunity) in populations already far advanced into the natural immunity territory. It’s been observed that people getting their second doses experience a higher rate of side effects (pain at injection site, fever etc). This whole thing is kind of ironic.

 

[mattee2264]

 

JNJ vaccine sounds promising. They are guiding an efficacy rate of at least 70% but possibly a lot higher and far fewer distribution issues and only one shot. Although there won't be a massive amount of doses available until much later in the year.

[ERICOPOLY]

If they instead had "round 1" distributed more broadly (not just frontline workers), it would have used up the supply of vaccines faster.  So many nurses don't want to be vaccinated, or their employers don't want too many staying home with side effects at any given time.  So they dribble out the vaccine.

 

Another idea is to distribute the vaccines broadly and allow healthcare workers, teachers, vulnerable groups, etc to jump the lines.

[RichardGibbons]

Hopefully not another Hydroxychloroquine.  A double blind study with 4000 patients, but presumably not yet published or peer-reviewed.

 

https://montreal.ctvnews.ca/quebec-researchers-say-they-have-found-an-effective-drug-to-fight-covid-19-1.5279310

 

[Cigarbutt]

Hopefully not another Hydroxychloroquine.  A double blind study with 4000 patients, but presumably not yet published or peer-reviewed.

https://montreal.ctvnews.ca/quebec-researchers-say-they-have-found-an-effective-drug-to-fight-covid-19-1.5279310

This is very interesting.

The lead investigator has a pristine reputation. He is a well known researcher for heart disease, developed an interest in inflammation related to heart attacks and has been studying colchicine for a while. He is known to produce solid work. If interested, he found the handling of 'scientific' knowledge unsettling since Covid spread. i think he had some concern that the colchicine study would become wrapped in some kind of controversy. There was a sound basis for the study but the odds of a clinically significant outcome appeared relatively remote. The preliminary results appear promising and the methodology appears very robust. We should know more in a few weeks (full publication, peer review and other similar studies). Given the overall situation, consideration should be given for widespread use. Colchicine is cheap and the main side effect is diarrhea. With HCQ, it was verbal diarrhea.

[Cigarbutt]

For vaccines, the (from warehouse to arm) ramp-up is proving to be somewhat challenging and there are global dips in inoculation rates during holidays and weekends but the mid-term trajectory appears to be quite bullish (for disease eradication).

 

Here's a country to country comparison but you can pair others if you like. The oversubscription ratio (OR,% procured through contracts to popn) works a bit like IPO pro-rata distribution but, with these vaccines, there are factors that influence who gets what and when and some countries have 'bet' on failures, on some still unknown outcomes and on proven-to-be effective vaccines that will be available only later. Some numbers here may not exactly match official numbers because of slight methodology differences. All numbers in millions except percentages.

 

                popn    doses 'delivered'    % per popn    doses 'given'    % per popn    % 'given' to 'delivered'      OR   

USA          328.2          41.4                    12.6                21.1                  6.4                      51.0                  169.0

Canada        37.6          1.12                    3.0                0.80                  2.1                      71.4                  330.1

 

The US is doing relatively better along most parameters. There is some difficulty for the conversion from 'delivered' to 'given'. This is related to many variables and is still a puzzle to some degree. Some respected and relevant players suspect fragmentation within the supply line may play a significant role:

https://www.bloomberg.com/news/articles/2021-01-23/slow-vaccine-campaign-remains-a-puzzle-to-ex-warp-speed-chief?srnd=markets-vp

 

All in all, i understand the (relative) frustration but this feels like the period immediately after Pearl Harbor where many felt uneasy during the phase where there was a huge space between real production and potential production.

-----

Having said that, i've participated in a huge survey (healthcare related) about various expectations and results came out yesterday. For two questions, my answers are completely anomalous. About two thirds of participants think that there is an imminent threat from a completely new virus which i think is tainted by recency bias but what do i know? My main concern is about the status of the underlying host (a bit like Mr. Grantham) and this seems to concern less than 1% of respondents. :-\