And while I’m on the subject can someone explain to me why no state has enacted a vaccine mandate for its residents? There are states with mandates for healthcare workers; there are states that ban vaccines. To the best of my knowledge no state however Blue mandates vaccination against COVID-19 for its residents.

All 50 states mandate vaccinations of various kinds for school children. Doing so has been upheld by the Supreme Court. Clearly, the states have the authority to enact such mandates. I believe that all 50 states had mandates for smallpox vaccinations.

The federal government on the other hand does not appear to have that authority, at least based on the recent Supreme Court decision.

So, why do no states have COVID-19 vaccine mandates?

I recommend reading Dhruv Khullar’s musings in the New Yorker on COVID-19 statistics. Here’s a sample passage I found telling:

A coronavirus infection isn’t what it once was. Studies suggest that, compared with Delta, Omicron is a third to half as likely to send someone to the hospital; by some estimates, the chance that an older, vaccinated person will die of covid is now lower than the risk posed by the seasonal flu. And yet the variant is exacting a punishing toll—medical, social, economic. (Omicron still presents a major threat to people who are unvaccinated.) The United States is recording, on average, more than eight hundred thousand coronavirus cases a day, three times last winter’s peak. Given the growing use of at-home tests, this official count greatly underestimates the true number of infections. We don’t know how many rapid tests are used each day, or what proportion return positive, rendering unreliable traditional metrics, such as a community’s test-positivity rate, which is used to guide policy on everything from school closures to sporting events.

There are many other numbers we’d like to know. How likely is Omicron to deliver not an irritating cold but the worst flu of your life? How does that risk increase with the number and severity of medical conditions a person has? What are the chances of lingering symptoms following a mild illness? How long does immunity last after a booster shot or an infection? Americans aren’t waiting to find out. Last week, rates of social distancing and self-quarantining rose to their highest levels in nearly a year, and dining, shopping, and social gatherings fell to new lows. Half of Americans believe that it will be at least a year before they return to their pre-pandemic lives, if they ever do; three-quarters feel that they’re as likely, or more so, to contract the virus today—a year after vaccines became available—as they were when the pandemic began.

He concludes on, presumably, a hopeful note:

But this wave, too, shall pass—possibly soon. At the end of it, the vast majority of Americans could have some degree of immunity, resulting from vaccination, infection, or both. In all probability, we’d then approach the endemic phase of the virus, and be left with a complex set of questions about how to live with it. What level of disease are we willing to accept? What is the purpose of further restrictions? What do we owe one another? A clear-eyed view of the numbers will inform the answers. But it’s up to us to paint the targets.

He also draws a distinction between “hospitalized for COVID” and “hospitalized with COVID”.

My question about much of this is how do we know? How do we know how many people have “some degree of immunity”? How will we know? How do we know what proportion of those hospitalized are hospitalized for COVID or hospitalized with COVID?

This hearkens back to an earlier post. The risk of “thinking like physicians” rather than like public health professionals is already an issue.

Presumably, you’ve heard about the hostage situation in a synagogue in Texas. You’ve heard that it is over, the hostages have been freed, and the hostage-taker has been killed. This passage in the Associated Press report on the incident caught my attention:

DeSarno said the hostage taker was specifically focused on an issue not directly connected to the Jewish community and there was no immediate indication that the man had was part of any broader plan, but DeSarno said the agency’s investigation “will have global reach.”

I think that was a foolish statement. The phrase “directly connected” is carrying far too much weight. Any synagogue and any Sabbath service is directly connected to the Jewish community. Failing to recognize that is a failure to take Judaism seriously. I get his point but I think he would have been wiser to steer away from that.

My quick take about the incident is:

1. It was obviously an act of Islamist terrorism.
2. It was equally obviously antisemitic (in its sense of “anti-Jewish”).
3. All indications are that the guy was a lone nutcase.
4. We have enough homegrown nutcases. In fact we have a superabundance of them. We should do what we can to avoid importing more.

I thought I’d express my views on what I think should happen respecting Ukraine.

• I do not think that Russia should invade Ukraine. Ukraine is a sovereign state and a member of the United Nations. Invading Ukraine without UN authorization would violate Russia’s obligations as a signatory of the charter. That, as a veto-wielding Security Council member, Russia will never be criticized by the Security Council for such an invasion is irrelevant.
• I do not think that Ukraine should be admitted to NATO and, indeed, I think that discussions of Ukraine’s joining NATO are needlessly antagonistic towards Russia. Turn the question around. Is defending Ukraine in the case of invasion in the U. S. interest? Obviously not. Or France’s or the United Kingdom’s? Or Germany’s? If you do not think that defending the Ukraine in the event of a Russian invasion is in the U. S. interest, you don’t think that Ukraine should be a member of NATO either. The two matters are equivalent.
• I think the last country admitted to NATO should have been Spain and have thought so all along but that ship has sailed.
• I don’t think we should withdraw any forces presently in former Warsaw Pact countries but I don’t think we should add any, either. I don’t think we should give any of those countries nuclear weapons or install nuclear weapons of our own in them.
• I don’t think there’s anything we can or should do in the event of a Russian invasion of Ukraine. I don’t think that increased economic sanctions on Russia would have much effect but I also think that Germany is not being particularly helpful in its relations with Russia.
• I suspect that Russia will not invade Ukraine but there will be lots of various other forms of coercion and 4GW.
• I think we should stop taking foreign policy advice regarding our Russia policy from Polish and Ukrainian nationals.

In his latest New York Times column David Brooks laments at how badly we’re behaving:

In June a statistic floated across my desk that startled me. In 2020, the number of miles Americans drove fell 13 percent because of the pandemic, but the number of traffic deaths rose 7 percent.

I couldn’t figure it out. Why would Americans be driving so much more recklessly during the pandemic? But then in the first half of 2021, according to the National Highway Traffic Safety Administration, motor vehicle deaths were up 18.4 percent even over 2020. Contributing factors, according to the agency, included driving under the influence, speeding and failure to wear a seatbelt.

Why are so many Americans driving irresponsibly?

While gloomy numbers like these were rattling around in my brain, a Substack article from Matthew Yglesias hit my inbox this week. It was titled, “All Kinds of Bad Behavior Is on the Rise.” Not only is reckless driving on the rise, Yglesias pointed out, but the number of altercations on airplanes has exploded, the murder rate is surging in cities, drug overdoses are increasing, Americans are drinking more, nurses say patients are getting more abusive, and so on and so on.

Yglesias is right.

Mr. Brooks has no explanation for how badly we’re behaving. I’m open to suggestions.

Let me provide a few of the more egregious examples of bad behavior:
Woman kills her child, dumps body
Four guys arguing in shopping mall, start shooting at each other
TikTok challenges encouraging violence (multiple)
Incidents of violence by air passengers (multiple)

I think these people are feral and there are lots and lots of them.

We are, what, almost two years into the COVID-19 pandemic and it’s taken this long for anyone else to come around to the view that I’ve had since March 2020. In this case it’s Aaron E. Carroll and he expresses the situation pretty well in an op-ed at the New York Times:

Caring for an individual and protecting a population require different priorities, practices and ways of thinking. While it may sound counterintuitive, to heal the country and put our Covid-19 response on the right track, we need to think less like doctors.

I can speak to both ways of approaching health problems. As a physician, I was trained first and foremost to think of the individual in front of me. When seeing a patient, I take a long history, consider all relevant personal information and weigh the benefits and harms of any treatment decision I might take. As the chief health officer of Indiana University, I need to make population-wide decisions that take into account the needs of the university as a whole, not any one person.

Physicians tend to be conservative in their practice of medicine. We fear a bad outcome disproportionately and will do almost anything to prevent it. Although doctors often credit the threat of being sued for the practice of defensive medicine, extra tests and procedures are often ordered because making a mistake would be devastating, both to the patient and to our own understanding of ourselves as healers. This mentality also leads to the thinking that every test and treatment must be the best. Physicians cannot tolerate anything less, because we are who will be held to account if anything goes wrong.

But blown to the scale of a whole country, that kind of focus on individuals has often led us in the wrong direction during the pandemic. Much of my frustration at the response to Covid is that too many officials in senior positions at the Food and Drug Administration and the Centers for Disease Control and Prevention seem to be thinking this way — if something isn’t close to perfect or doesn’t maximize the safety of each individual person, it’s not worth it at all. Some of the greatest initial and continuing failures of public health policy have stemmed from this view.

He goes on to provide several specific examples. My own preferred example is the use of testing. Nearly all testing for COVID-19 has been diagnostic testing rather than epidemiological testing. Dr. Carroll’s explanation of that, presumably, is that there has been too much “thinking like doctors” and not nearly enough thinking like people responsible for the public health.

I think that one of the gravest problems of the modern day is that generalists are undervalued while specialists are becoming progressively increasingly specialized. Add to that the tendency to think of technocracy as “putting people like me in charge”, e.g. to a lawyer technocracy means putting lawyers in charge of everything, to a physician it means putting physicians in charge of everything, and to an economist it means putting economists (with the appropriate political views, natch) in charge, and you not only greatly reduce our ability to respond to challenges you set the stage for a major decline in confidence in experts.

And I haven’t even touched on the ethical issues involved. Another post, perhaps.

Here’s something you may not have thought about. We have, literally, dozens of military bases on or near the Mexican border. They include

• Yuma Marine Corps Air Station
• Yuma Proving Ground
• Fort Huachuca
• Fort Bliss
• a half dozen different facilities in San Diego

My back-of-the-envelope calculation suggests that we have as many as 100,000 troops stationed in those bases. And then there’s our facility at Guantanamo Bay. Somehow those facilities are never described as “massing on the Mexican border” or coercing Mexico or Cuba but, of course, they are and that’s not lost on either the people of Mexico or Cuba.

With that prelude let’s turn to Peter Beinart’s New York Times op-ed on “spheres of influence”:

At the heart of the current crisis between Washington and Moscow is this: Vladimir Putin has massed troops on Russia’s border with Ukraine and implied that he may invade unless he receives a guarantee that Ukraine will never join NATO. The Biden administration rejects that demand out of hand. Powerful nations, it insists, cannot demand that their neighbors fall under their “spheres of influence.” As Secretary of State Antony J. Blinken put it last month, “one country does not have the right to dictate the policies of another or to tell that country with whom it may associate; one country does not have the right to exert a sphere of influence. That notion should be relegated to the dustbin of history.”

It’s a noble principle, just not one the United States abides by.

The United States has exercised a sphere of influence in its own hemisphere for almost 200 years, since President James Monroe, in his seventh annual message to Congress, declared that the United States “should consider any attempt” by foreign powers “to extend their system to any portion of this hemisphere as dangerous to our peace and safety.”

Listening to Mr. Blinken, you might think the United States long ago deposited this prerogative over the foreign policies of its southern neighbors in history’s dustbin. It has done no such thing. In 2018, Donald Trump’s secretary of state, Rex Tillerson, called the Monroe Doctrine “as relevant today as it was the day it was written.” The following year, his national security adviser, John Bolton, boasted that “the Monroe Doctrine is alive and well.”

To be sure, the United States doesn’t enforce the Monroe Doctrine in the same way it did in the first half of the 20th century, when it regularly deployed the Marines to Central America and the Caribbean, or during the Cold War, when the C.I.A. helped topple leftist governments. Washington’s methods have changed. It now prefers using economic coercion to punish governments that ally with adversaries and challenge its regional dominion.

Does Russia intend to coerce Ukraine by putting troops on its border? Of course it does. It doesn’t want an actively hostile Ukraine with foreign troops and weaponry pointed at it anymore than we want an actively hostile Mexico or Cuba with Chinese or Russian troops and Chinese or Russian weapons pointed at us.

IMO the cognitive dissonance on this issue in Washington is actually worse than Mr. Beinart leads us to believe. I think far too many U. S. foreign policy experts find it outrageous that Russia should have interests of its own at all. Why, who do they think they are?

Do I think we should remove our troops from Cuba or from the Mexican border? Of course not. But we should maintain a realistic and frank attitude towards them and our interests than presently appears to be the case.

I wonder if Josh Rogin really means what he says in his most recent Washington Post column, expressing his dissatisfaction with the Biden Administration’s handling of North Korea:

Biden has shown little inclination to devote energy to North Korea. The State Department’s special representative is also a full-time ambassador. The White House hasn’t even bothered to nominate anyone for the positions of North Korean human rights envoy or ambassador to South Korea. Even if the vaccine offer does kick-start diplomacy, the Biden team may not want to devote time and effort to another low-reward, high-risk set of negotiations with the Kim regime.

But it must return to the negotiating process, said former nuclear negotiator Joel Wit, who notes that what happens in Pyongyang doesn’t stay in Pyongyang. An arms race is heating up in Northeast Asia, and North Korea is winning, he said.

“It’s trench warfare, and it’s ugly and unglamorous and politically fraught, but the administration has to find a way to sit down with the North Koreans, and maybe the foot in the door is vaccinations,” said Wit, now a distinguished fellow at the Stimson Center.

China uses vaccines to coerce and threaten other countries. The United States should use them to build bridges, starting in North Korea but then on a global scale. Right now, our neglect of North Korea and several other poor countries is harming our health security and our national security, which are intertwined more than ever.

Do you honestly believe that giving COVID-19 vaccines to North Korea will do anything whatever to improve relations with the country? I don’t. Even if the Kim regime were to accept that offer (which I doubt), most North Koreans would not get them or would not know that what they were receiving came from the U. S.

My own view is that although the Biden Administration’s version of “strategic patience” is a bit more truculent than I’d like, ignoring North Korea is exactly the right thing to do. And if there’s one thing we should have learned by now it’s that negotiating with the North Koreans is an exercise in futility. If we are to return to the bargaining table about North Korea it should be with China not with North Korea. As I’ve said before, if you’re worried about your neighbor’s dog, you don’t discuss it with the dog.

It takes Megan McArdle a while to make her point in her most recent Washington Post column about transgender athletes competing in women’s athletics:

If cases like Thomas [ed. Lia Thomas, swimming for UPenn’s women’s team] are few, it’s relatively easy to make inclusion paramount. But with even a small percentage of elite athletes transitioning after puberty, trans women could conceivably dominate many women’s sports to the point of unavoidable controversy, because there are a lot more “pretty good” athletes who’ve gone through male puberty than all-star athletes who’ve gone through female puberty.

Though even then we might ask: Who cares? Most people will never have what it takes to compete at the elite levels of high school, college or professional sports. That’s not an argument for kicking the genetically blessed out of the league so that those of us who are slower and weaker can experience the thrill of victory. One might add that it is particularly not an argument for kicking out people who face as many other disadvantages in their lives as trans athletes do.

But if you like that answer, you should probably ask whether women’s sports should exist at all. After all, we didn’t create separate leagues to reinforce the special feminine identity of female athletes; if anything, women’s athletics was supposed to break down such divisions. The separation is a nod to biology: After puberty, biological women can’t compete with similarly gifted biological men.

For me the issue is one of relative values, i.e. which you think is more important. If you believe that to provide transgender athletes with the respect and consideration that is their due is the higher value, that they may prevail against biological female athletes is irrelevant. If on the other hand you believe, in Ms. McArdle’s words, it is more important “for cisgender women to have a place where at least a few of us can experience the thrill of victory”, then requiring that athletes compete in the teams of their birth genders is completely appropriate.

The critical points are that you cannot satisfy those with different priorities simultaneously and that, consistent with my previous post, the decision will be made politically.