poking holes in "swiss cheese"

the “swiss cheese” model of covid protection is a matryoshka doll of nested fallacies and statistical illiteracy wrapped up in a zeno’s paradox. this is being spread by media and public health officials alike as though it were some sort of epidemiological strategy for risk mitigation. it is not. it’s deeply ignorant denial of science and data being used as a form of propaganda. even a cursory glance at its underpinnings demonstrates this.

cliff notes: you have about a 0.9% lifetime chance of dying in a car crash in the US. your risk of getting covid post vaccination and then dying from it is on the order of 0.015% even if we add no other mitigations and assume you have a 100% chance of getting covid without a vaccine. this is 1/78th the risk of death by car crash over a lifetime.

most americans are OK with this car risk. we drive and we speed. almost none would accept a driving ban or a 30 MPH speed limit on highways to drop this risk by half or to push “zero car deaths.” so what is the case for doing 100X that economic and social damage to reduce covid risk or push “zero covid”? the whole argument is rooted in fallacy and fear mongering.

swiss cheese is hallucinatory fear based delusion masquerading as public health.

the question was never “how do we reach zero covid?”

the question was always “would i pull my kid of out school for a year to drop their lifetime chance or dying in a car crash by less than 0.0001?”

examining the cheese:

first off, this strategy starts with the outlandish “zero covid” idea as though such a thing were even possible. it’s not. it is a literal mathematical impossibility. there is still influenza from 1918 kicking around somewhere. this is just ZENO’S PARADOX where you get halfway there and halfway from there and so on but never arrive. if you make bacon in your kitchen today, you can clean it again and again and you can never get all the bacon trace out. ever. if you spent a million dollars and had the room cleaned by the people who build semiconductor fabs, you could not eradicate the last molecule of pork. no one can. nothing can be made 100% safe or 100% eliminated and the price for each subsequent halving rises exponentially while benefit shrinks the same way.

pretty soon, you’re paying a trillion dollars to buy nothing anyone can even detect. it’s a ludicrous standard and there is not a single thing in human life that gets handled that way.

taking a shower does not have a zero risk of death. you’d be safer if you wore a helmet and maybe a harness while you shower. do you? i’m guessing no. why not? because taking a shower is, for most people, very safe. the risk is so low, that even reducing it by 50% is not worth the trouble.

if i could sell you an “anti-meteor hat” that really, provably reduced your chance of being hit by a meteorite by 90%, how much would you pay? would you even be willing to wear it all the time if i gave it to you for free but it was even slightly uncomfortable or unfashionable? i doubt it. why?

because a 90% reduction of a risk already that low is not worth anything.

that’s the key concept here.

let’s now explore how this fits with covid.

this claim has been widely made (including by the US surgeon general)

the argument is that vaccines, despite what was promised, are not enough for you to get your life back. there is no “normal” just a “new normal” of constant distancing and masking and vigilance. they then go on to explicitly invoke 100% as a standard.

but as discussed above, 100% is an impossible outcome and as we approach it asymptotically, the benefit of each additional mitigation drops exponentially. a 50% drop from 10% likelihood is 5%. we might find that relevant. a 50% drop from 1% is only 0.5%. from 0.1%, well, now we’re only dropping 1/20th of 1% and passing any sort of cost/benefit test is going to get A LOT harder.

so let’s look at where we are by setting up some standards. to start, i am not going to accept “getting a mild flu-like illness” as some massive risk. we’ve lived with flu for 1000’s of years and we take little care to avoid it. we do not distance, mask, or lockdown. we stay home when we are sick and we (maybe) wash our hands a bit more during flu season.

the human race has long since expressed its clear risk preference on flu like illness and it seems to be the only reasonable and fair baseline to use.

the 1968-9 flu (hong kong flu) was, in population adjusted terms, worse than covid 19 on deaths. ask your parents/grandparents if they even remember it. they certainly did not cower from it or lock down. that was the year that woodstock took place. during a “pandemic” worse than this one.

so let’s look at covid risk:

the global IFR looks to be about 0.15%. john ionnidas, who has been among the best on this, set the number. you can see discussion HERE.

we can then look at attack rate from covid. what is your chance of getting it? so long as you are not around people who actually have symptoms, it’s vanishingly low even if you share a home with them/sleep in the same bed. it’s 0.7% and that is for prolonged exposure and shared facilities/bathroom/food/etc. you can see discussion of that study HERE.

so, if we take as our risk standard 0.15% X 0.7% from high exposure to asymptomatics, we’re at 0.00105%. (1 in 95,000)

if we take the upper risk bound of 18% spread from symptomatic carriers, it’s 0.027%. (1 in 3,703)

so let’s call this a basic risk window against which to start to consider covid risk.

if you are young, healthy and avoid actually cohabitating with sick people your risk is likely 1/10th to 1/100th the lower bound. so you’re getting into the 1 in a million-one in 10 million range.

for you, even taking a vaccine would need to be almost perfectly safe to outweigh the miniscule benefit it even COULD provide you. far from being an irrational choice, it might well be the clear and obvious personal risk minimizing choice to NOT take an experimental vaccine.

the idea of being forced to vaccinate mitigate a risk far lower than death by bee sting seems outlandish.

if you are obese, diabetic, or posses some other set of risk factors, perhaps this looks very different and the vaccine benefit far outweighs the risks. (ask your trusted medical advisor. i am not looking to give anyone medical advice here.)

but maybe others must live in fear of you as a carrier. that seems to be a popular narrative.

so let’s look at vaccines:

now let’s consider a vaccine that is, say 90% effective at preventing covid infection. (many make higher claims, but let’s be conservative)

this drops the high risk case from living with a symptomatic carrier to 1 in 37,030.

it drops the low risk case from living with an asymptomatic carrier to 1 in 950,000

it drops the risk from passing someone on the street or in the grocery store to something far lower. we’re getting into absolutely negligible territory.

so what is there left for masks to even work on? if i am asymptomatic and shop near you, my chance of spreading disease to you is easily less than 0.7%. that would be for living with you, sharing food, furniture, bathrooms, and possibly a bed. i have no reliable stats on how much lower, but 10-100x is likely the correct magnitude.

this takes us into the truly infinitesimal ranges of 1 in 10 million of so, possibly 1 in 100 million.

the idea that i owe it to you to limit my life to change your outcomes by less than the chance of getting struck by lightning is a preposterous moral inversion even if these mitigations are REALLY effective (and they aren’t.) your base risk is so low that nothing i do can affect it in any manner that humans have ever been shown to care about in any other circumstance even when we pile this all up.

chances of dying from a car crash in the US are 124 in a million per person per year. 14,357 per year need medical attention. this death toll is rising. we keep driving faster.

if we could drop it by 70% by dropping the speed limit on highways to 30 mph and enforcing it utterly, would you vote in favor? would it be worth the social or economic price? because i sure do not see any remotely representative groups with even a modicum of public support stepping up and making a case for it. most people i know want speed limits raised. most people i know exceed current limits almost every time they drive. it looks to me like this is a level of risk american humans find acceptable/desirable.

  • 124 per million per year die via automobile. 14,357 per million need medical care. that’s the roads.

  • covid risk of death if you are vaccinated even if you live with a symptomatic person looks to be on the order of 27 per million.

  • for asymptomatic, it’s 1 per million and unlike driving, this is a one time risk as getting covid a second time is vashishingly rare, cars are a risk every year and thus that risk is cumulative.

over a lifetime of, say, 80 years, that 0.124% nets out to a ~0.9% chance of dying in a car.

let’s then compare that to the risk of 0.15% IFR X 10% (contraction risk based on 90% success rate on a vaccine).

that’s 0.015%. 1/60th the chance you’ll die in a car crash over your lifetime.

even if you got covid twice, it’s 1/30th. and this assumes you had a 100% chance of getting covid if you were unvaxxed. we can compare covid deaths to lifetime risks for this reason. your risk is really just once a lifetime and these mitigations are costs that could last a lifetime if we keep going as we are.

so just what are we playing at here with all this “swiss cheese”? there is flat out nothing for it to work on if someone is vaccinated and this is not even taking in to account the fact that IFR is going to plummet as we learn more and have already learned more about treatment. how much IFR is just the result of terrible early policies to push sick people into nursing homes and the early, aggressive ventilator use that proved so fatal?

this simple TREATMENT with a safe, affordable asthma drug might well lop a whole zero off the IFR (it reduced need to seek urgent care by 80-90% in a controlled study) why would anyone even consider another odious or high cost mitigation vs buying people $55 inhalers? (and yes, masking is both odious and poses real health risks. see HERE.

we’re already WAY below risk levels that humans clearly find acceptable and dropping them a further 80-90% looks trivial. death as a vaccinated individual looks to average about 1 in 6,667 (and that’s being highly conservative). this is roughly in line with “death by sunstroke” and roughly 6X “death by drowning.” for the young and healthy, it’s like more like “death by insect stings” and we have not even yet factored in the extremely high likelihood that vaccination would make a later infection milder and thus drop IFR further still. assuming it cuts it by half, we’re at about the level of “electrocution.” SOURCE

so, put their fear and wild claims aside and think rationally: the correct framing for a vaccinated person of average risk is:

“if the mitigation you recommend is 50% effective, it will reduce my risk by about 1/2 my risk of death from sunstroke or 1/30th my risk of dying in a car crash even if i use extremely adverse assumptions.

would i be willing to pay whatever price this is to get that benefit and is there any moral or utilitarian basis whatsoever to force others to pay large costs to get me these infinitesimal or possibly illusory benefits?”

any honest, rational person must answer those questions before even seeking to DISCUSS whether mitigations work (and the data there is pretty terrible). most, including masks and lockdowns, do nothing that is even measurable.

so let’s stop all this absolutist safety theater. it never made sense and no reasonable health official with an even rudimentary grasp of risk factors and cost benefit, the literal bedrock of public heath decision making, could possibly be pushing a vax then mask and distance policy for any but the very highest risk tranches.

this is not medical policy, it’s political propaganda and these sorts of 100% demands are a dead giveaway. this is the truly big lie to push you over the line into trading all your freedom for the illusion of safety from a bugbear conjured into being for just that purpose.

just say no. the society you save may be your own. you do NOT want to see where this is GOING if you don’t.