Good news: WHO approved Sinopharm, Georgians (and expats) are signing up for it, the government is planning to expand the vaccination program, and more doses are coming in.
Bad news: Testing is down slightly; despite this, numbers are still up, and they’ll probably go up again next week.
Other: I rant about shortsightedness and extended restrictions; I talk about my vaccine experience; I discuss Sinopharm in terms of health and politics.
5567 cases reported in Tbilisi this week, up from 5195 last week. My model projected 5453 (4253 – 6653).
Nationwide we had 9474, up from 8964. My model projected 9006 (7025 – 10,987).
Nationwide testing declined again from 158886 to 144641 and the positive test rate is up to 6.55%.
Just a reminder that because testing is low, the reported case numbers are also low compared to the actual cases.
Projections and Risk Assessment
My model projects 6591 cases reported next week in Tbilisi (5141 – 8041). The reported numbers at this point depend heavily on testing – right now they’re testing about 20,000 people per day; if they go back to 25,000 or even 30,000 the numbers will jump up by a lot just from that. In fact if we had tested this week at the rate we were testing three weeks ago, we would be looking at something like 7500 case reports in Tbilisi this week rather than 5500. I expect testing numbers to rebound at least a little bit this week given that there isn’t a major religious and public holiday, but who knows what effect the enforced extended not-lockdown “holiday” will have? We’re also going to start seeing the impact of the Easter celebrations and the impact of the “holiday” on actual cases and I don’t know which effect will dominate. I consider next week to be quite uncertain.
Nationwide my model projects 10,324 cases (8,053 – 12,595) reported next week.
Based on the projected worst case, I’d assess risk at 1 in 100 again – as a rule of thumb, you can expect about one person out of one hundred in Tbilisi to be carrying an active infection that they don’t know about. At a gathering of ten people, there’s about a one in ten chance someone is infected. Remember to avoid closed/poorly ventilated spaces, and wear a mask if you’re going to be in any kind of indoor public space.
Aside: A Polemic About Public Health Interventions
Gamkrelidze seems to be saying that the “holiday” isn’t having much of an impact, and the rate of mask wearing is down ever-so-slightly, which are bad signs. If we have a small Easter bump and minimal help from the “holiday” we’re in for a rough time, with restrictions being tightened and/or extended.
Believe me, while I very strongly believe the government needs to coordinate, lead, and enforce public health measures to protect the vulnerable, I am not pro-restriction or pro-lockdown for their own sake or out of some authoritarian impulse. I want my kids to be in school and I want to be able to go out and see my friends. I just wish the government had timed restrictions so that the most severe restrictions came in winter when we would mostly have been stuck inside anyway, so that we could go into the warmer weather period with low infection rates and feeling secure about doing outdoor recreational activities with minimal risk.
Instead, Gamkrelidze is now warning us (same link as above) about the possibility of extending restrictions. Pardon my French, but this half-assed approach isn’t solving anything. We should have ripped off the band-aid already and gotten the painful parts over with so we could all get back to our lives. Instead we’ve been stuck in this limbo of half-restrictions and Orwellian lockdowns disguised as “holidays” and curfews and steadily increasing infection rates for the last three months, and there’s absolutely no prospect for any of it to get better in the next month. This makes me furious because I could see it coming in February when they started lifting restrictions early. There’s no reason for this short-sightedness.
Yes, I know that businesses said they couldn’t survive another month of lockdown. I know that certain individuals seemed to believe the pandemic would magically disappear with no public health interventions at all due to a mysterious force that scientists were incapable of understanding. I know that people thought vaccines would arrive in the country and the pandemic would instantly be over on that very day. But here we are, the pandemic hasn’t disappeared, and we’re heading into tourist season with Tbilisi racking up the highest numbers of 2021 and no end in sight. Did it occur to anyone that this scenario might be worse for business than if we had stayed locked down throughout February?
Not to mention the human cost of allowing a totally avoidable third wave to manifest.
But instead, certain members of the “business community” threw a tantrum and demanded the government give them priority – priority over our children’s education and social well-being; priority over the medium-term health of the tourist sector and by extension the entire economy; priority over people’s lives – and the government lost its spine and collapsed like a flan in a cupboard.
This is a good illustration of why public health interventions should be based on objective benchmarks which are clearly communicated in advance – so they’re less susceptible to pressure from the loudest or most economically-powerful special interest groups. It’s not so much that the benchmarks represent the Infallible Word of Science which must be followed – it’s rather that having a reasonable benchmark is better than letting your public health policy be blown around by the shifting political winds.
Getting Vaccinated in Tbilisi
I was vaccinated with my first dose of Sinopharm on Wednesday. My appointment was at the National Training Center for Family Medicine, which is around the block from Fabrika, near Marjanishvili metro. There was a sign on the door with “COVID-19” in English and “vaccination” in Georgian, which is an interesting linguistic artifact. My wife came with me for moral support as well as help with any translation, which turned out to be necessary because there was a screening questionnaire in Georgian.
When we went in someone greeted us immediately. They asked for my surname, took my temperature with a laser thermometer, and checked me off a printed list. I arrived early and they were able to get me in about six minutes early. The 10-minute spacing for appointments meant there weren’t many people, and the clinic didn’t seem to have much else going on. I was also able to wait outside on the front steps and get some fresh air.
The appointment itself was quite routine. The questionnaire took some extra time due to the translation back-and-forth and the evaluation of my history of allergies. The shot itself was quick and painless.
They had a fairly comfortable waiting area for the observation period. Because I have a history of allergies (but not serious ones) they kept me for 45 minutes. This area also wasn’t very crowded – everyone was able to remain spaced 2 meters apart, and chairs were placed to facilitate/encourage distancing.
I would rate this as one of my more positive experiences with medical care in Georgia – everything was organized, simple, well-designed in terms of safety and hygiene, and user-friendly. And of course the price was right (totally free). I’ve heard from friends that some of the other sites weren’t necessarily as user-friendly as the Chugureti site, so if you don’t speak Georgian it might be helpful to enlist the help of a translator.
In terms of side effects, I had some very mild soreness at the injection site, and some very minor itchiness the next day, both of which are normal and harmless vaccine reactions. I also admit that I suffered anxiety about the chance of anaphylaxis which was wildly out of proportion with my actual chances of getting anaphylaxis, but fortunately I have fairly good coping mechanisms for anxiety, such as distracting myself with video games or taking four-hour-long afternoon naps, so that wasn’t much of an issue.
This gets into the reasons why I chose Sinopharm over my other options (i.e. waiting, or traveling to the US for a Western-approved vaccine), which deserve their own section.
Sinopharm: Science and Geopolitics
First of all I just want to preface this by saying that for most people the risk:reward calculation of any vaccine probably favors getting the vaccine. Just in Georgia, there have been 4281 confirmed covid deaths and one confirmed vaccine death, and medical mismanagement was a confirmed factor in that one death.
Still, it might be worth thinking about how to minimize risk if you have, for example, a choice between several vaccine options, and/or specific risk factors for any of the rare side effects of any of the vaccines.
This paper outlines anaphylaxis risk factors in the various available vaccines, although it seems to be missing Johnson & Johnson. Based on the ingredients, Pfizer and Moderna represent the highest risk, followed by Sputnik and AZ, followed by all the rest. This seems to be borne out by other evidence – in the US, Pfizer’s vaccine produced anaphylaxis in about 11.1 cases per million, although later numbers show Pfizer at a lower rate, of 5 per million, with Moderna at 2.5 per million. In comparison, so far, from what I can find, there have been zero anaphylaxis reactions to Sinopharm, out of at least 65 million doses administered.
Now, this is where the geopolitics comes in. I keep seeing Western news sources express skepticism about China’s data – and it’s true that China is not known for transparency, and the full results of China’s internal Sinopharm studies do not seem to have been released. So let’s crunch some numbers. Suppose Sinopharm has anaphylaxis numbers comparable to Moderna’s (I think they’re much lower, but suppose). At 2.5 per million, with 65 million doses administered, that’s 162.5 cases of anaphylaxis expected. These cases would be distributed across 45 countries. So what are the chances that this actually happened, but not a single one of these cases made news, despite the media looking for them and jumping on every chance they get to sensationalize safety concerns about vaccines, and specifically Chinese vaccines? What are the chances that the WHO spent months studying the evidence for Sinopharm, eventually listing it for emergency use, without noticing a single one of these cases, according to their assessment of evidence for Sinopharm?
I’m not naive. I don’t trust the Chinese Communist Party to have my best interests at heart. But the Chinese vaccination drive is part of a larger soft power strategy. It’s intertwined with their Belt & Road initiative. China wants to reach out to less-developed countries and present itself as a reliable and valuable partner, and a viable alternative for those countries to relying on the Imperialist West for things like lifesaving medicines and development aid. This extends the market for Chinese products and reduces the likelihood that partner countries will take China to task for its human rights violations. They’re trying to build up something like social capital, but on a global scale.
And I have to be honest: it’s working – at least, for me. I feel deeply grateful for China’s vaccine diplomacy, especially at a time when the US is sitting on 10 million AZ doses which it has neither approved nor shipped to countries that need it. The Western narrative about Chinese products is that they’re cheap knockoffs, or unreliable, or somehow of inherently lower quality than Western products. I suspect that rolling out a vaccine that’s safer, cheaper, and easier to distribute than Western competitors, and getting it to markets like Georgia faster, is going to shape the way people view Chinese products in general for a long time.
Knowingly selling a dangerous or defective vaccine to 45 countries and counting would completely destroy those positive perceptions. It would be very much out of line with China’s big-picture approach to geopolitics and its perceived self-interest. With the WHO watching, and the health departments of countries around the world watching, there’s as much scrutiny on this vaccine as there ever is on anything. China couldn’t get away with passing off bad product any more than AstraZeneca could get away with releasing fishy data. And so it is in China’s political and economic interests to get this vaccine rollout right. I trust those incentives about as much as I trust anything.
Back to the science: Sinopharm is made using a “classic” vaccine technology, which for me means there’s no particular reason to think it wouldn’t work or would have unpredictable side effects or was rushed in any way. And nothing against newer vaccines, but there’s something comforting in taking a vaccine which was manufactured in exactly the same way as most of the previous vaccines I’ve taken, like my annual flu shots.
In conclusion: It’s hard for me to say how much I’m biased by motivated reasoning because Sinopharm was the only vaccine available to me at this point (I could have waited, or traveled to the US, but I couldn’t have accessed another vaccine by now). On the other hand I think I probably have to fight some internalized bias against Chinese products because, as I said, there are stereotypes about Chinese products in the West, and I grew up with them. But all things considered, I was glad to be able to get Sinopharm. Based on the information we have it seems to be the safest coronavirus vaccine available, and in terms of efficacy it’s second-tier after the mRNA vaccines but comparable to AZ and better than J&J. It’s incredibly difficult to untangle science from politics but to the extent that I can do this I believe I am justified in saying that Sinopharm was a good choice, and I would recommend it to others.
But let me reiterate that my belief is that almost everyone should get vaccinated as soon as they can with the first vaccine available unless they have specific risk factors for that specific vaccine, because the risks from covid far outweigh the risks from any of the vaccines.
Georgia is looking to open more vaccine centers and appointments next week, according to Gamkrelidze. When slots are available, they show up on this booking portal.
Numbers courtesy of 1tv.ge, stopcov.ge, and ncdc.ge. Stay healthy!