igor67

That's helpful feedback Machu, my opening was pretty unclear. My intent with the statement was that going backwards in the citations while a pain and certainly something that people (myself certainly included) will shortcut, it is important. After all you can't back track every paper. My word choices were muddled in part because I was thinking about it from a pure science perspective, a teacher perspective, and a I have to vote on actual policy perspective. Those are very different audiences and what came out was a not so good mash-up of strategies.

I have fixed lab tables as my seating. The tables are designed to sit 4 students, and by the current state guidance my room need a waiver on space to be built (aka it is smaller than the state would like) I now routinely have to sit 5 students at those tables, so without splitting in half (and even then I'm not sure I can actually do 6ft for 15 students) yeah the distancing is a big issue. Most of my non science colleagues have mobile desks so they should be able to go into the 15-20 student range.

Sorry to clarify, as far as I can tell from the write up in the just published study, they used typical contact tracing methods that were identified in the other studies as well and not a true surveillance based methodology. Specifically this is what they wrote in the CDC study "When a school was alerted to a positive case in a student or staff member, school officials identified persons who had had close contact with the patient through interviews with the patient, parents, and school staff members. Close contact was defined as being within 6 feet for longer than 15 cumulative minutes during a 24-hour period." So unless I am misunderstanding something fundamental they repeated the same types of method that had been called into question.

I have spent a good chunk of the morning reading the study and I think it makes a pretty good case study in why it pays to be able to back track on sources. I was clued in to the subtle issues last week from this publication from the ONS in England https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/948617/s0998-tfc-update-to-4-november-2020-paper-on-children-schools-transmission.pdf The core issue is one of methods, there are a lot of studies looking at the issue but most of them use contact tracing schemes that will systematically undercount infections in younger students as they are less likely to be symptomatic. Boiling it down the ONS study didn't find statistically different transmission rates in younger students compared to older students when they used more intense contact tracing methods. The methods are outside my normal expertise and I got some help from https://twitter.com/dgurdasani1/status/1351092571435655173. Sure enough if you back track the CDC study reference number 5 (https://pubmed.ncbi.nlm.nih.gov/33315116/ ) it is a meta analysis of school studies. And while they conclude younger students are lower risk they clearly state in their discussion the limitation that most of the studies aren't doing a full surveillance type study. Meaning you run into situations where the first person in the household to look sick is counted as the first case, and then they test other people at which point the younger child who was asymptomatic gets detected. The reference further mentions that rather wide array of answers in the literature as reflecting diverse methods and not a consistent approach. I did pick one of the references they did mention as doing a surveillance type study and it was only looking at a total of 234 cases in Norway. In thinking about cases where experts end up being wrong, and a plurality of experts seem to be in the open schools camp this checks a lot of boxes. 1) The idea is popular for other reasons- that clearly fits here people want to reopen schools 2) There is an identifiable method shortcoming 3) Sloppy scholarship looses some of the early questions across multiple citations It is certainly reasonable to look at the data and conclude that younger students are a lower risk, I actually think it is most likely the case even after my critiques but I doubt it is a very big effect. I also have spent enough time in that area over the last year to say that if the kids were wearing masks at the reported rate they may well have been way safer in school than in the community.

There was a trickle last week with the pilot programs in MN, but if the doses show-up as promised starting this Thursday a rather large fraction of teachers in MN will have had their first shot by next week, non teaching staff and daycare workers are in the mix so I don't know how big the pool is, but the promised 15,000 is about 1/4 of all licensed teachers in the state. MN has put together a nice dashboard showing how the various sub distributors are doing. Most of the big hospital groups have been highly efficient at distributing their vaccines, same with mass vaccine cites. The CVS, Walgreens partnership to get into assisted living homes has not which matches something I read in Wisconsin as well. The category of local providers has also not been super efficient which I think is understandable given the logistics on needing to vaccinate in batches that category covers out-state hospitals and clinics.

As seen most directly with a large number of the large stadium type rollout locations around the country indicating they ran out the core issue is better recognized as a tradeoff between prioritization and speed. Emphasizing the prioritization rules being followed inevitably leads to slow downs once you translate that to individuals on the ground. As an example see the post a page or two back where at least some where throwing out doses instead of getting them to others. A very well thought-out alternative approach is described in this post. https://telliamedrevisited.wordpress.com/2021/01/12/an-engineering-perspective-on-accelerating-vaccine-distribution/

Modest concern is an appropriate feeling at the moment. What I have seen for somewhat deeper looks and analysis to date has not shown a decrease in effectiveness for existing vaccine candidates to these newer mutations. Continued high caseloads worldwide though is just asking for trouble on this front. It is basically lottery math, any individual infection at this point looks to have a very low, almost effectively zero chance of being resistant to the vaccine, but we have millions of new cases and drawings happening all the time just waiting for the winner so to speak.

I haven't seen much in the way of other compelling 3rd base options, which should factor into how the move is judged as well. That 2018 WAR number is duplicated might well equal or exceed any of the free agent options this year.

I think more relevant is that it is helpful to look for incompetency in the private sector. Just to pick an example it was just a few years ago that we were all being sold on how Silicon valley was going to disrupt education with there giant online classes. I used to collect examples big and small for argument sake, but I would just suggest spend time looking for yourself and you are highly likely to conclude the problem is people and having to make judgements to run anything. In this case though it is rather unclear if it is a government or private sector problem, as have seen news stories with the opposite punch line with healthcare workers trying to make sure not a single dose goes to waste, and most of the hospitals are not government run.

Prior to break throughs in HIV treatment (which was the last remotely comparable mass research effort) treatments for viruses were pretty much a complete dead-end. That did unlock some progress, but drugs to treats viruses are still rare. Walz currently announcing that phase 1b is beginning on a very limited basis tomorrow with some new pilot sites. The number of doses is highly limited at the moment and being spread around to some people within the 1b subgroup. Paired with continuing lower case numbers in the state that is rather promising. Hopefully lightening the restrictions within the last 2 weeks won't reverse that. By total case numbers there have been about 100K fewer in MN than WI despite roughly equal populations.

There seems to be some small differences state to state. Minnesota has all but wrapped up group 1A, and was moving in to group 1B potentially within the next week. I'm also getting the sense that trying to vaccinate different groups specifically and rapidly leads to modest differences in timing when different categories within those groups may actually get started.

Didn't miss that one

Well we had 3 healthy running backs

The pass to Lazard was right on target, Lazard just misjudged a bit you could see had a little more ability to extend his arms and then it hits him square

Even before you factor in Crosby been less than 100%, going for 2 makes a ton of sense. I don't think many announcers have adjusted to how much the lower probability on extra point kicks alters the strategy there. In other news even ignoring the 2 passes to end the half Rogers seems a half bit off on his accuracy tonight.

Well it was certainly nice to start the 3rd quarter that way. Maybe Lafleur has just been deep faking everyone all season on the 3rd quarters.

Awesome impact there by Donald.

Category 1B is fairly broad with including many types of front line workers and 75+ adults. The CDC presentation here is fairly clear that it was a deliberate choice to balance other societal factors and life savings https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-20/02-COVID-Dooling.pdf It appears that they also did some modeling of different scenarios, but did not include the data. There summary suggests that there weren't big differences, but it is a little disappointing they didn't include the data. Part of the reason it would seem there isn't a huge difference is that infection rates tend to be higher in younger adults so it partially makes up the mortality difference.

I agree that it is certainly debatable, in a positive sense. I would like to think that by now we could have some very sophisticated modeling that could try and make some predictions on how effective vaccinating different groups will be on both the spread and the death toll. Realistically though even with that type of analysis there is still going to be a fair bit of room for values to enter the conversation. I believe the Stanford health system had briefly come up with an algorithm for distributing the vaccine, and ran into a huge out cry because almost none of the vaccines were going to front line doctors and nurses. It's good to recognize that this is a challenging process with many factors and almost certainly room for reasonable people to make different judgments.

I don't know what normal proportion of flu transmission happens in schools compared to other places, but all respiratory virus numbers have been way down and students are loaded with those all the time.

Very helpful I was unaware of the folding difficulties with HIV proteins. I had assumed that part of the appeal of an mRNA vaccine for flu long term was that eventually it would have a much shorter manufacturing time horizon, so they could do a better job matching the yearly vaccine to the dominant strains that year, not that they would be able to pull off a one size fits all.

I do appreciate a good dose of cold water, Machu. Could you elaborate a bit on which characteristics are the biggest hurdles? I'm considering if I want to invest some time researching more for redesigning part of a unit.

Super excited for you. On a different optimistic note based on the success of the mRNA Covid vaccines, there are already plans for 3 different Phase I trials for a new flu vaccine, HIV, and a 3rd rare disease. I have a strong intuition that we have hit one of those rare perfect storm moments where the dramatically increased investment has really spawned a goldmine of new vaccine technologies that will keep having huge benefits for public health for years to come.

Given that we have at least 50 states, and 1 federal government making recommendations some level of inconsistency is pretty much a guarantee, and in at minimum 2 parties with distinct values controlling those decisions in different locations... More relevantly the decisions both on the business and political levels on how to restart are mostly months old. Or where governments could (like MN) do more restrictions they were clearly moving that direction during the holidays so I don't see a philosophical inconsistency. Public health officials aren't really in a position to go back and refight the old battles (unless you believe that strategy was likely to succeed). So the real question does come down to does it make sense to target a single type of event that will involve about 1/3 of the population (based on 2019 travel numbers) moving?

Clarifying. I know Washington would have made it regardless, with 4 divisions now it happens more often than it did in the past, but not horribly often by itself. It is the having 2 substandard teams in the same year with the higher chance of having at least 1 crummy team in that I find objectionable.