Thoughts on Covid-19

Briefly:

In this interview, Jay Bhattacharya summarizes my views on SARS-Cov-2 very concisely.Here are my notes:
- Vaccination is not "sterilizing" but rather "protective". After vaccination you can get infected and spread the virus, but you will probably be completely asymptomatic. Illness post vaccination is usually in people with immune system problems. (12:00)
- Given that, and the many animal hosts for coronavirus, we will never "eliminate" Covid-19. It is now endemic. But it's not to be feared: the vaccine has "defanged" the disease. Nevertheless, public health officials continue to act as if the disease will be eliminated (15:00, 34:00ff)
- Delta is probably more infectious than the wild Wuhan but no more deadly than other variants. (UK data) (6:30) Vaccination "breakthrough" is common but only very rarely consequential. (11:00)
- There is currently no data suggesting a need for a booster (14:30) Protection from vaccines and infection/recovery is almost certainly for your lifetime.
- Natural immunity is 6.7X more effective than vaccination (Israeli study.
- No randomized trial shows that masks actually stop the disease from spreading at all. No RCT shows any efficacy from masks. No RCT shows that N95 masks in hospitals stop 'flu. We had near 90% compliance with masks last winter with no measurable effect. The one study suggested that relative risk reduction with careful use of N95 masks is 14%, 95% CI 0-20%, but that wasn't statistically significant. Public health officials probably mandate masks because they think there is no cost, but that's not true. The biggest cost is the division between the virtuous and the enemy - the opposite of what public health officials should do. (18:00)
- Ventilation is the only effective preventive measure.
- Worldwide IFR is 0.2%. IFR at age 60 is 0.4%, and that halves or doubles with each 7 years younger or older (9:45) Vaccination reduces IFR for a factor of 50-100 - so for age 67, IFR is 0.004% to 0.008%. (47:10)
- Public authorities have done everything possible to generate fear - to treat other people as vectors of infection, bags of germs, rather than fellow human beings. It's not right epidemiologically. Stigmatizing disease is pernicious, a violation of the norms of medicine which is treating and providing comfort to people. (25:00)
- Proof of vaccination is deeply unethical (27:00). It's discriminatory - food workers and delivery people (many poor and minorities) who got sick and are now immune might reasonably decline vaccination.
- Covid-19 vaccination does not generate a positive externality - that is, vaccinated or not you can spread the disease. What public health purpose is served by vaccination? It just divides society into clean/unclean rich/poor. (29:30)
- Florida has done better than California. Evidence doesn't support government interventions. (41:00ff)
- Ivermectin and other cheap drugs might help but there's no large definitive trial - which is a scandal, since NAIAD should be running multiple trials on cheap and potentially useful drugs (50:00)
The news on vaccines is nothing short of miraculous. Note that only seven new vaccines have been developed in the last 25 years (four by Merck!). The fastest a new vaccine has ever been brought to market is 4 years; the average time is 10 to 15 years. Vaccines intended for mass use by the general population have always required years of testing with very large test groups, because the side effect rate must be minuscule. Indeed, no Phase 3 clinical trials of a Covid-19 vaccine is due to end before October 2022 (see "Vaccines" below for links). Nevertheless, several effective and safe Covid-19 vaccines has been rolled out with minimal adverse events. This is an incredible achievement.
Mitigation measures like "social distancing" and mask-wearing have no effect on the virus's progress. See Non-Pharmaceutical Interventions
Masks don't work.
"Virus gonna virus." In no case has a Covide-19 outbreak been "controlled." It burns its way through the population until it runs out of susceptible hosts.
The current best estimate rule of thumb for the Infection Fatality Rate - the percentage of people who die from Covid-19 as a result of infection by Covid-19 - is 0.40% for people age 60. It halves or doubles for each 7 years younger or older than 60. A 32-year-old's risk of dying from Covid-19 following infection is therefore roughly 0.0025% - less than 3 in 10,000. A 74-year-old faces a risk of 1.6%. (The IFR for influenza is roughly 0.10%.) Covid-19 is much less dangerous than influenza for people under age 50, and more dangerous than influenza only for those over 65. The overwhelming majority of people who die from Covid-19 have a serious comorbidity, most often Alzheimer's or obesity. A large proportion of Covid-19 deaths take place in long term care facilities, where annual mortality before Covid-19 was 32%.
Children overwhelmingly have asymptomatic or mild cases, and only rarely pass the disease to adults. The cumulative numbers from the CDC (August 18, 2021) show 614,531 deaths involving Covid-19. 361 of those were in people under 18. (There were 53,193 deaths for that age group from all causes - including accidents, cancer, drowning, homicide, etc.)
Testing is a total fiasco. Even the NY Times reported that as many as 90% of positive results are false. Most infections are asymptomatic. People who get tested do it because they're required to (hospital admissions, employees who face mandatory testing) or because they're stupid. The test has no clinical value outside a hospital: if you're sick, stay home until you're better and do your very best to stay away from elderly and infirm people. If you have trouble breathing call your doctor. You don't need a Covid-19 test to figure that out. But if you have the test and get a positive result, you're in the system, with attention from officialdom, mandatory quarantine, possible fines, and intrusive contact tracing.
The mere notion of contact tracing for this disease is moronic. The virus has been endemic for almost a year. Most infected people are asymptomatic. By the time a contact tracer gets your data, you've shed virus for days and have recovered. And why cooperate with a contact tracer? Just give them the names of your worst enemies.

There's no end of panic porn about Covid-19, and "Team Apocalpyse" (The Atlantic, CNN, New York Times, etc.) eagerly promotes every possible scary trope. For all the following actual observations, those outlets publish hysterical (and sometimes false) reports of the extremely rare counterexamples:

Covid-19 is not a leading factor in overall morbidity and mortality. For one example, in the past eight months in Santa Clara County, there have been 1901 Covid-19 deaths out of roughly 21,000 total deaths from all causes. More than half of those fatalities were in people 80 years of age or older. Nearly three-quarters of deaths were in people 70 and over. Just 5% were in people under 50. There have been 4 deaths in people under 30 in Santa Clara County out of more than 113,000 proven cases. The disease is less dangerous than influenza for non-obese people under 75.
Infection/recovery confers lasting immunity.
Sequelae like viral myocarditis are extremely rare, and no more common in Covid-19 than in influenza.
Kawasaki disease in young children is no more common now than in past years, and no connection with Covid-19 has been shown.
Lockdowns and social distancing and economic disruption have huge negative effects which will be with us for decades. University Ave in Palo Alto has one empty storefront after another. More disturbing, see e.g. Famines related to the Covid-19 pandemic - "12,000 people per day could die from COVID-19 linked hunger"... It is "projected to be among the worst famines in human history." And then there are suicides, and abuse, and morbidity and mortality because people avoid the healthcare system.

Hospital	Beds
Kaiser Redwood City	149
Kaiser South SF	120
Mills Peninsula	301
Sequoia Hospital	208
Seton Medical Center	434
Seton Coastside	121
San Mateo Medical Center	448
TOTAL	1,763

Sources of data in the early days of Covid-19

The best sources of data and analysis are from the Twitter feeds of Youyang Gu, Aaron Ginn, and Alex Berenson. A good summary is here. Youyang's models have proven to be far more accurate than any other source. Aaron's early, excellent analysis of the Covid-19 outbreak, Evidence over Hysteria, was censored by Medium. This got an op-ed in the Wall St Journal . Read the article: the fact that it was censored says as much as the article itself. Alex Berenson worked as a reporter for the New York Times but left to pursue a successful career as a novelist. After becoming interested in Covid-19, he decided to write a book on it: Unreported Truths about Covid-19 and Lockdowns. Amazon censored the first installment until Elon Musk interceded - and it promptly became the #1 best selling book on the site.

EthicalSkeptic and Covid Tracking Project have great analysis and data.