The most alarming problem about Long Covid: Chronic Fatigue Syndrome

‘The main problem with Long COVID is its complexity: dozens of symptoms, different causes, different treatments, vaccine protection, Delta variant, age impact, gender impact, evolution over time…

‘This complexity is crippling. We think “Hmmm Long COVID is bad but how bad? I don’t know… Maybe we should avoid it? But how careful should we be? I don’t know. Is it worth keeping masks? Staying indoors? I don’t know...” So how can we simplify things?

‘By looking at the most alarming problem that Long COVID most likely causes: Chronic Fatigue Syndrome. There are other problems, such as unregistered deaths, post-intensive care syndrome, chronic loss of smell... But they’re too much, and I don’t think they change our takeaways, so we will look at them in the premium deep dive this week, along with other things.’

Read here (Uncharted Territories, Sept 13, 2021)

Delta variant: Everything you need to know -- Tomas Pueyo

‘Delta is a deadly variant. It spreads like wildfire and kills efficiently. We need to be careful.

If you’re an individual

‘If you’re vaccinated, you’re mostly safe, especially with mRNA vaccines. Keep your guard up for now, avoid events that might become super-spreaders, but you don’t need to worry much more than that. If you’re not vaccinated though, this is a much more dangerous time than March 2020. The transmission rate is higher than it used to be, and if you catch Delta, you’re much more likely to die—or get Long COVID. You should be extra careful, only hang out with other vaccinated people, and avoid dangerous events.’

If you’re a community leader

‘If you’re in charge of a community, you have two goals:

1. ‘Vaccinate, vaccinate, vaccinate. The lives of your community depend on it. Any vaccine that works is better than none. If people are opting out, try to lure them in. Most are not anti-vaxxers, but rather they’re on the fence, or simply don’t see the benefit worth the cost. So change their calculation. Create lotteries. The Ohio one, among the first, probably didn’t work, but the cost is paltry compared to the cost of deaths and closing the economy this Fall.
2. ‘Keep Delta at bay as much as you can while vaccinations proceed. An elimination strategy will be best. Good border fences and test-trace-isolate programs are your best tools. Super-spreader events should still be avoided. Masks indoors and in crowds should be mandatory. Great ventilation is a must. 

‘However, if you have vaccinated everybody that wants to be vaccinated, and the rest simply doesn’t want to get vaccinated, then the calculation changes drastically. If your location values the freedom of its people to make the wrong decisions (as long as they don’t impact others), then you might consider opening up the economy. Delta will tear through those unvaccinated, but that’s their prerogative. Maybe the reality will hit better then.

‘But it really depends on each society. Opening up without full vaccination would infect some of those vaccinated, about 10% of them would get long COVID7, and about 0.3% of them would die8.

‘So here each society needs to decide. Say 40% don’t want to vaccinate. Is the freedom of 40% to not vaccinate worth the deaths and Long COVID of those vaccinated? Otherwise, are you willing to force people to vaccinate? Are you going to keep the country closed until there’s a booster vaccine? Will you be able to get your fences and test-trace-isolate programs to work?’

If you’re in charge of vaccine policy

‘An R0 of 8 is bad news for herd immunity. It puts its threshold at ~90% of people protected, which is impossible to reach if vaccines are only 65% protective of infection. Booster shots are necessary. Let’s accelerate their testing, approval, release, and deployment.

‘Also, support vaccine mix-and-match. In most countries, today, if you need a boost you are forced to take the same vaccine. But mixing types likely protects you better and is as safe as using the same type.’

If you’re in a developing country

‘We don’t pay enough attention to developing countries. Most of the science and media focuses where the money is, in developed economies. But Delta is very hard in developing countries, especially in dense urban areas where the poor are forced to work but live in close quarters with many others. India, Argentina, Tunisia, South Africa, and Indonesia are very sad examples of this. 

‘Unfortunately, there’s not many special tricks that poor countries can pull. They tend to have a younger population, which helps. The one thing they have going on for them is that they tend to be warmer and more humid, which helps against COVID. Also, thanks to a warmer weather, they can have more events outdoors. This is the one thing they can leverage: have as many of your gatherings outside, while you do everything you can to vaccinate your population, and delay as much as you can the arrival of Delta with strong fences. 

‘Let’s hope vaccine production keeps growing and people the world over can get vaccinated before the fall.’

Read here (Uncharted Waters, Aug 11, 2021)

Covid FAQ Summer 2021, Part 1: Tomas Pueyo

‘You shared the last article about the Delta Variant so much that nearly 400,000 people read it. Thanks for spreading the word on something so important. You also asked so many good questions that I have tried to answer as many as I could in this article. It’s so long that I split it in two pieces. This 1st piece covers these questions:

1. What’s the update on the Delta variant and cases worldwide?
2. Am I safe if I’m vaccinated? What activities can I go to? Why are there still cases in very vaccinated countries?
3. I’m vaxxed. Can I go to an indoor event if I get masked?
4. When will we leave this behind? when we’re all vaccinated?
5. Can vaccines stop the pandemic?
6. Do we know more about vaccine effectiveness?
7. Should vaccines be fractionalized?
8. Should I get a booster shot?
9. Should I mix-and-match?

Read here (Uncharted Territories, Aug 11, 2021)

Note: Part 2 is only premier, paid subscribers

The mental pitfalls of Covid: Tomas Pueyo

‘If a handful of governments had failed, it would be easy to single them out. Instead, the failure was widespread. Most Western governments failed to contain the virus. When so many humans fail, they are not at fault. Politicians are humans. They’re flawed, biased, like you and me. Their failures are understandable.

‘What failed is the system. Systems should be designed to eliminate human failure. Here, they didn’t. Why have western democracies been so bad at incorporating information quickly? Why was decision-making so poor? Why were they so bad at coordinating citizens, which at the end of it is their sole function?

‘Covid is bad, but thankfully its Infection Fatality Rate is not civilization-threatening. Many upcoming challenges will threaten the collapse of our civilizations, from Global Warming to low fertility, inequality or AI. If our governments have been exposed to be incapable of solving even COVID, what will they do about these more important problems?’

Also discussed why politicians made the errors they made, and what that tells us about ourselves and how to prepare for the future: 

1. Not doing a cost-benefit analysis
2. Not accounting for confidence
3. Dogmatism
4. Social proof
5. Availability bias
6. Authority
7. Escalation of commitment & confirmation bias
8. Reinventing the wheel
9. Desensitization (and hedonic adaptation, framing, storytelling, and anchoring)

Read here (Uncharted Territories, May 25, 2021)

The top 25 mistakes of Covid mismanagement: Tomas Pueyo

We need to learn the lessons so that these widespread governmental failures don’t happen again. Here are the top 25 mistakes of COVID management I see so far, from least important to most.

25. Infection parties
24. Immunity passports
23. Not knowing who to trust
22. Underestimating people’s willingness to do the right thing
21. Lying to the public
20. PCR test management
19. Letting states fend for themselves
18. Forgetting that good fences make good neighbors
17. Storytelling against reality
16. Not adapting to lower income areas
15. Missing that the virus would mutate
14. Not understanding exponentials
13. Not realizing the value of time has changed
12. Be unable to make decisions under uncertainty
11. Misunderstanding individual freedom
10. Making privacy sacred
9. Challenge trials
8. Seeing nails everywhere
7. Aerosols, outdoors, masks, and superspreaders
6. Regionalism
5. Applying developed country logic to emerging economies
4. Not understanding that rapid tests were a game changer
3. Vaccine management
2. Failing at test-trace-isolate
1. Not learning fast enough

Read here (Read here (Uncharted Waters, May 13, 2021)

The fail West: They knew. They ignored. The reckoning, One year in. By Tomas Pueyo

‘Soon, over 1.5 million people will have died of Covid in Western countries. 1.5 million futile, needless deaths. 1.5 million wasted lives. Meanwhile, in a block of Asia-Pacific countries with a population over twice as big, they lost 18,000 people. 

‘For today, we’re going to expose the failures, expose the excuses, expose the lies, expose what we knew one year ago that we didn’t learn fast enough, and the true reasons why the West failed.‘

Read here (Uncharted Territories, May 6, 2021)

Variants v Vaccines: The race between the tortoise and the hare -- Tomas Pueyo

‘The B117 variant will probably take over between February and March in most developed countries. That’s without taking into account the Brazilian and South African variants. Emerging countries are in an even worse position: Not only will they have the 3 variants. They will also receive vaccines much later. And in the Southern hemisphere, they’re now enjoying summer. Winter, with more variants and not enough vaccines, might be less forgiving.

‘So keep tight for a few more months. Don’t let your guard down. The end of the tunnel is near. Get a vaccine if you can. If not, wait till the summer. By September, we’ll likely be back to the new normal in developed countries. And in emerging ones, let’s hope more vaccines and a fast rollout avoids a repeat of 2020.’ 

Read here (substack.com, Feb 8, 2021)

Coronavirus: The Swiss Cheese Strategy -- Tomas Pueyo

‘There are the four layers to stop the spread of the virus: Fences, Bubbles, Contrafection, and Test-Trace-Isolate. None of them is perfect. All have holes that let infections pass. But together they form an impenetrable defence.

‘An infection might be able to pass one layer, or even two. But if there are several, the odds that the infection goes through every layer undetected becomes minuscule. Imagine, for example, that a country has a Fence that catches 80% of infections, no Social Bubbles, Reduced Contagiousness that eliminates 95% of infections, and a test-trace-isolate that neutralizes 50% of infections. Together, these layers catch 99.5% of cases. If the transmission rate R is 3 (the number of people infected by a source), it will be reduced to 0.015! Every infected person only infects an additional 0.015 people, killing the epidemic within a few weeks.’

Also...

• How the US and the EU failed to control the virus, and how comparable countries succeeded.
• How you can make sense of all the necessary measures with one simple idea.
• Why the West’s testing and contact tracing is largely useless — and what they can do about it.
• The questions that journalists and the People must ask politicians to keep them accountable.
• How you can stop the virus in your own community, without the need of your government.

Read here (Medium, Nov 9, 2020) 

To beat the coronavirus, build a better fence: Tomas Pueyo

‘No country has been able to control the virus without a fence. Fences are not enough to stop the virus on their own, but they’re a necessary part of the solution. European countries and U.S. states had hoped otherwise. They were deluded. They opened their arms to their neighbours too soon and got infected in the hug.

‘They need to realise that not every country or state is effectively fighting the virus. Why should their citizens sacrifice so much for so long, with lockdowns and business closures, only to waste their efforts when their neighbours visit?

‘And as long as states fail to control their borders, the coronavirus will come back.’

Read here (New York Times, Sept 14, 2020) 

Should we aim for herd immunity like Sweden?

‘One thing is to decide against a Hammer. That’s fine. It happened. We can’t change the past. A very different thing is to know you can Dance to reduce your epidemic dramatically and for quite cheap, but actively decide not to do it. The UK’s government has acknowledged its mistakes and changed course. Pressure is mounting for Sweden to do the same. Tens of thousands of lives are at stake. If the government doesn’t decide to acknowledge its mistakes and correct its course, bodies will keep piling up for nothing.

Summary of the article: ‘Sweden is suffering tremendously in cases and deaths. Yet few people have been infected yet. They are a long way from Herd Immunity. Between 0.5% to 1.5% of infected die from the coronavirus. Left uncontrolled, it can kill between 0.4% and 1% of the entire population. Many more suffer conditions we don’t yet understand. Unfortunately, that death and sickness toll is far from having bought us Herd Immunity anywhere in the world. Only protecting those most at risk sounds great. It’s a fantasy today. Even if Sweden’s economy has remained mostly open, it has still suffered as much as others. From now on, it might start doing worse. Sweden now has regrets. But not enough. It can control the virus without a lockdown if it acknowledges its mistakes and takes the right measures. Other countries, like the US or the Netherlands, are toying with a Herd Immunity strategy. It will only cause more economic loss and death.’

Read here (Medium, June 10, 2020)

Learning how to dance - Part 5: Prevent seeding and spreading

This is Part 5 of ‘Learning how to dance’, a series which goes in depth to understand what countries need to do to Dance, to reopen their economies without new outbreaks.

‘The bad news first: (1) We will likely need to heavily slow down national and international tourism for months, (2) Big events like business fairs or music concerts will need to remain closed for now

‘The good news: (1) We should still be able to travel for one-way or very long trips (2) There are ways we can accelerate the reopening of tourism (3) We can probably reopen schools (4) A clear order is emerging for which businesses should reopen. The most important to keep open are likely banks, grocery, and general stores, and the least important are likely cafés, dessert parlors, and gyms’.

Read here (Medium, May 13, 2020)

Learning how to dance - Part 3: How to do testing and contact tracing. Tomas Pueyo

‘Thankfully, a set of four measures can dramatically reduce the epidemic. They are dirt cheap compared to closing the economy. If many countries are enduring the Hammer today, these measures are the scalpel, carefully extracting the infected rather than hitting everybody at once. These four measures need each other. They don’t work without one another:

• With testing, we find out who is infected
• With isolations, we prevent them from infecting others
• With contact tracing, we figure out the people with whom they’ve been in contact
• With quarantines, we prevent these contacts from infecting others

‘Testing and contact tracing are the intelligence, while isolations and quarantines are the action. We’ll dive into the first two today — testing and contact tracing — and the next two will be covered next.’

Read here (Medium, April 28, 2020)

Learning how to dance - Part 2: The basic dance steps everybody can follow. Tomas Pueyo

‘Any country can follow a series of measures that are very cheap and can dramatically reduce the epidemic: mandate wearing home-made masks, apply physical distancing and hygiene everywhere, and educate the public.

‘It’s time to dive deep into all these possible measures, to understand them really well and decide which ones we should follow. We can split them into 4 blocks:

• Cheap measures that might be enough to suppress the coronavirus, such as masks, physical distancing, testing, contact tracing, quarantines, isolations, and others
• Somewhat expensive measures that might be necessary in some cases, such as travel bans and limits on social gatherings
• Expensive measures that might not always be necessary during the dance, such as blanket school and business closures
• Medical capacity

Read here (Medium, April 23, 2020)

“Hammer and the dance” in Bahasa Malaysia

A UPM medical student translated Tomas Pueyo's The Hammer and The Dance into BM.

Read here (Medium, March 22, 2020)

Learning how to dance - Part 1: A dancing masterclass, or what we can learn from countries around the world. Tomas Pueyo

‘A month ago we sounded the alarm with “Coronavirus: Why You Must Act Now”. After that, we asked countries to buy us time with “Coronavirus: The Hammer and the Dance” and looked in detail at the US situation with “Coronavirus: Out of Many, One. Together”, these articles have been viewed by over 60 million people and translated into over 40 languages.

‘This article will explain when, and how, we will dance. Specifically, we will discover:

• What can we learn from the experiences of countries around the world?
• What measures will we need to implement during the dance, so we can get back to a new normal? At what cost?
• How can we make them a reality?’

Read here (Medium, April 20, 2020)

The hammer and the dance -- What the next 18 months can look like, if leaders buy us time

This second article by Tomas Pueyo, a follow-up to his ‘Coronavirus: Why you must act now’, is summarised as follows: ’Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.’

In this article he deals with: (1) What’s the current situation? (2) What options do we have? (3) What’s the one thing that matters now: Time (4) What does a good coronavirus strategy look like? (4) How should we think about the economic and social impacts?

Read here (Medium, updated March 19, 2020)

Coronavirus: Out of many, one -- What the US federal government and the states should do to fight the coronavirus

‘It makes political and economic sense for the US to suppress the coronavirus. For that, states and the federal government each have their own roles that they need to adjust.

‘The US is now the country with most coronavirus cases in the world. It is likely to keep that title in the history books. Two key reasons are government decentralisation and concerns about the economic impact of aggressive social distancing measures. Here’s what we’re going to cover today, with a lot of data, charts and sources: (a) What’s the situation in the US and its states (b) Why the coronavirus should be a bipartisan issue (c) The economics of controlling the virus (d) Which decisions should be left to the federal government or to states

Read here (Medium, April 2, 2020)

Read here for a list of people who have endorsed or shared his article

Coronavirus: Why you must act now -- Politicians, community leaders and business leaders: What should you do and when?

This article by Tomas Pueyo, which has received over 40 million views, and translated into over 40 languages as at March 19, begins with the following:

‘With everything that’s happening about the Coronavirus, it might be very hard to make a decision of what to do today. Should you wait for more information? Do something today? What?... Here’s what I’m going to cover in this article, with lots of charts, data and models with plenty of sources: (1) How many cases of coronavirus will there be in your area? (2) What will happen when these cases materialise? (3) What should you do? (4) When?’

Read here (Medium, updated March 19, 2020)

List of prominent people who have endorsed or shared his article. Read here