Study their behaviors. Observe their territorial boundaries. Leave their habitat as you found it. Report any signs of intelligence.

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Thursday, June 17, 2021

Why Did We Fumble COVID-19 Therapeutics?

A variety of reasons, in roughly descending order of guestimated importance:

  • The early focus was on "flattening the curve" to preserve hospital and ventilator capacity, and so insufficient attention was paid to early-stage therapeutics.
  • Hydroxychloroquine was unsuccessfully tried as a late-stage therapeutic, and this politicized episode made the healthcare establishment afraid of an embarrassing replay.
  • Therapeutics don't appreciably reduce R0 compared to a vaccine. Treatment is super important, but curtailing exponential spread is super-duper-important.
  • Risk-averse government bureaucrats didn't think to waive the rule that Emergency Use Authorization for vaccines is only allowed if no therapeutics are available.
  • Risk-averse medical bureaucrats are indoctrinated to oppose any therapy that hasn't been proven effective, particularly in randomized control trials.
  • The pharmaceutical industry has no profit incentive to re-purpose off-patent drugs for new indications.
  • The Orange Man was promoting therapeutics, and we can't give him a win.
  • It was harder to recruit early-stage trial subjects because 1) they're not in hospital beds and 2) the pandemic ebbed in summer.

Tuesday, June 15, 2021

COVID-19 Heterogeneity

A list of possible factors for why COVID-19 has affected different regions differently, in decreasing order of my guestimated importance. 

Beware the political agenda of anybody selling a monocausal theory.

  • geographic/travel connectivity, incl. travel bans
  • vaccination curve
  • efficacy of vaccine(s) used
  • population age structure
  • lockdown policies
  • population density
  • hemisphere (summer vs. winter)
  • co-morbidities: obesity, heart disease, hypertension, smoking, asthma, diabetes/kidney, sickle cell, cancer
  • mask polices
  • vaccine demographic targeting
  • elderly clustering e.g. nursing homes vs. multi-generational domiciles
  • super-spreader opportunities
  • under-/over-reporting of COVID-19 deaths
  • domicile ventilation
  • air conditioning
  • temperature
  • humidity
  • ultraviolet incidence
  • prior culture of mask use
  • advanced contact tracing
  • cultural acceptance of lockdowns
  • compliance culture (e.g. Italians racing to trains against lockdown deadlines)
  • use of mass transit
  • prior experience with SARS/MERS
  • greeting culture: kiss, handshake, bow
  • nursing home return policy
  • South Asian Neanderthal haplotype (Zeberg, Paabo 2020) makes hospitalization 2X likely
  • chromosome 12 Neanderthal haplotype (vs RNA viruses, 2021) makes hospitalization 22% less likely
  • blood type?
  • vitamin D use?
  • anti-parasite Ivermectin use?
  • anti-malaria hydroxychloroquine use?